Washington D.C., Makes Improvements On HIV/AIDS Efforts, But More Work To Be Done, Report Finds; District Expands STD Testing Program For Students
The fifth annual report card from the Washington, D.C.,-based Appleseed Center for Law and Justice examining the district"s response to HIV gives the city "high marks for rapid testing, interagency coordination, surveillance and fighting the disease in the D.C. Jail," but finds that the city falls short in other areas, the Washington Examiner reports (Neibauer, 8/5). "The government also received above-average grades for leadership, managing grants to groups that help people with the illness, and monitoring the effectiveness of those programs," the Washington Post reports. However, "While Mayor Fenty and his administration deserve recognition for the continued support of ò€¦ numerous [HIV/AIDS Administration] initiatives, his public appearances and statements about the epidemic have fallen short of his enthusiasm for action inside the government," the report said. The report added that the district could do more to address HIV and recommended that HAA assess whether the improvements they have made are reducing the spread of the virus, according to the Post (Fears, 8/5).
Diagnostics
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What Is Relistor (Methylnaltrexone)? Why Do Opioids Cause Constipation?
Relistor (Methylnaltrexone) is a medication for patients who suffer from constipation caused by opioid drugs. Opioid drugs are used for pain relief. An opioid is a chemical that binds to opioid receptors that exist mainly in the central nervous system and the gut (gastrointestinal tract). When people take opioids they have a lower perception of pain, a lower reaction to pain, as well as a higher pain tolerance - in other words, opioids provide effective pain relief. However, opioids also cause constipation. The distress of constipation will usually add to the suffering that has already been caused by pain. Patients may start to reduce their intake of their opioid because the constipation causes so much discomfort - some may stop altogether. Many patients find themselves in a Catch 22 situation. Articles related to opioid-induced constipation (OIC) All about opioids and opioid-induced constipation What are the causes of opioid-induced constipation (OIC)? What are the symptoms of opioid-induced constipation? What are the treatment options for opioid-induced constipation (OIC)? Facts about palliative care. Glossary of terms related to opioid-induced constipation Before looking at Relistor in more detail, here is some background information on opioids and opiates: What is the difference between an opioid and an opiate? Opiates are derived from the natural ingredients of opium, while Opioids include the entire family of opiates, as well as synthetic and semi-synthetic substances. An opioid is any substance which activates opioid receptors - molecules that exist on the membranes of nerve cells found mainly in the central nervous system and the gut. There are four main types of opioids: *Endogenous opioids - our bodies produce them. Examples include endorphins, enkephalins, dynorphins, and endomorphins. *Opium alkaloids (natural opiates) - such as morphine, codeine and thebaine. *Semi-synthetic opioids - such as diamorphine (heroin), hydromorphone, oxycodone and buprenorphine. *Fully synthetic opioids - such as fentanyl, pethidine, methadone, tramadol and propoxyphene. Doctors tend to use just the word opioid. Examples of strong opioid drugs *Morphine - the main active ingredient is Papaver somniferum(opium poppy). It is commonly used for pain in cancer, myocardial infarction, sickle cell crisis, trauma, kidney stones, severe back pain, palliative care (relieving pain without curing underlying cause). It is also used as an adjunct (addition) to general anesthesia, in epidurial anesthesia, and intrathecal analgesia (painkiller injected into the fluid surrounding the brain and spinal cord). Morphine is also used to treat chronic diarrhea associated with AIDS. *Diamorphine - also known as heroin. It is a semi-synthetic opioid drug synthesized from morphine. Diamorphine is prescribed in the United Kingdom for the treatment of acute pain in myocardial infarction, post-surgical pain, and chronic pain caused by cancer. It is given via subcutaneous, intramuscular, intrathecal or intravenous route. After a shortage in the UK in 2005 many hospitals switched to morphine. After the shortage was over, a significant number of hospitals did not switch back. *Fentanyl - Fentanyl is generally used to treat post-operative, chronic pain, and breakthrough pain (acute pain on top of persistent background pain). Many see Fentanyl as the first choice for use for pain in cancer patients. *Alfentanil - it is an analogue of Fentanyl. It has only 1/10th of the potency of Fentanyl and only lasts for about 1/3 of the time. However, it starts working four times faster than Fentanyl. It is sometimes used for patients who cannot tolerate morphine, diamorphine or oxycodone due to persistent side effects. *Buprenorphine - it is a semi-synthetic opioid. It is used for the treatment of moderate to severe chronic pain. Its transdermal formulations are commonly used for chronic cancer pain, musculoskeletal pain (muscles, tendons and ligaments along with the bones), and neuropathic pain (chronic pain resulting from injury to the nervous system). *Oxycodone - synthesized from opium-derived thebaine, a minor constituent of opium with stimulatory rather than the depressive effects which are found in morphine. It can be an alternative to morphine for cancer pain. It is also used to treat pain in diabetic neuropathy, postherpetic neuralgia, osteoarthritis, ambulatory laparoscopic tubal ligation surgery, unilateral total knee arthroplasty, and abdominal gynaecological surgery. *Hydromorphone - also known as dihydromorphinone and dimorphone. It is a derivative of morphine. It is used to relieve moderate to severe pain, and is well known for treating painful, dry cough. In many cases it is preferred over morphine because of its superior solubility, rapid onset (starts working faster), milder side-effects, and lower dependence risk. It is much stronger than morphine as a painkiller. *Methadone - it is used as an analgesic (painkiller), and antitussive (cough suppressant). It is also used as a maintenance anti-addictive medication for patients on opioids. It is commonly used in the treatment of chronic pain because it is cheap and lasts a long time. However, blood concentrations of methadone fluctuate significantly between dosing - unlike oxycodone, it is not technologically engineered for sustained release. Examples of weak opioid drugs *Codeine (methylmorphine) - it is used for the treatment of pain, coughs, and diarrhea. Codeine is a very popular medication for people with back pain. It is the most widely used opiate, and perhaps the most commonly used overall. It is said to have between 8% to 12% of the strength of morphine. However, people"s individual metabolisms may alter its potency, as can some medications. *Tramadol - this a synthetic opioid with a chemical structure that is quite different from those of opiates. It is commonly used to treat moderate to moderately severe pain and most types of neuralgia (pain along the course of a nerve), including trigeminal neuralgia (inflammation of the trigeminal nerve, causing intense lightning pain in the lips, eye, nose, scalp, forehead, gums, cheek and chin). Some believe it could be effective for some types of depression and anxiety treatments. It is also used off-label for diabetic neuropathy, postherpetic neuralgia (long term pain linked to shingles), fibromyalgia, restless leg syndrome, opiate withdrawal management, migraine, OCD (obsessive-compulsive disorder), and premature ejaculation. In veterinary medicine it is used for post-operative, injury-related, and chronic cancer pain. Some types of weak opioids are OTC (over-the-counter, no prescription required) medications. A short history of Relistor In 1978, Dr. Leon Goldberg, a pharmacist at the University of Chicago, was presented with a challenge by one of his colleagues. A patient whose prostate cancer had metastasized to his bones would not take morphine for pain, because it would cause unbearable constipation. The colleague"s challenge was a simple one - Was there anything that could be done to help the patient? i.e. create a medication to treat the constipation without undermining the painkilling effects of the opioid. This would mean an opioid that would target only the sub-types of receptors associated with pain relief but without the side effects - one of which was severe constipation. Up to then, with the exception of in-vitro models, there had not been much success in finding one. Dr. Goldberg noticed that medications that acted on the opioid receptors of the digestive system, such as loperamide, and did not cross into the brain were already available. Could they find an analogous opioid receptor antagonist (a similar opioid that blocked the action of the receptor)? In simple terms - could they find a drug that relieved constipation without entering the brain which would neutralize morphine"s painkilling effects? Thousands of opioid-like molecules had been made by the pharmaceutical industry in its attempts at trying to find better painkilling medications. Many of the molecules that had been shelved had no pain-relieving properties. (*an antagonist blocks against or stops an action. As opposed to an agonist which stimulates an action) Goldberg and team screened many compounds. This led to the examination of molecules that were assumed to be antagonists but did not cross the brain barrier (did not get into the brain). Borhringer Ingleheim, a German pharmaceutical company, had synthesized N-methyl-naltrexone (MNTX) and it seemed to be a promising compound. In 1979 MNTX passed initial screening in which mice were given opioids as well as charcoal meals to track their passage through the gastrointestinal tract, and tested for their analgesia (inability to sense pain without losing consciousness). A study carried out by Russell and team in 1982 on dogs reported that constipation caused by opioids could be prevented without affecting pain relief in this model ("Antagonism of gut, but not central effects of morphine with quaternary narcotic antagonists." European Journal of Pharmacology 78: 255-261). Further tests demonstrated how the MNTX could stop constipation, as well as the cough reflex. MNTX was later found to have potential for the treatment of nausea caused by opioids. Unfortunately, Dr. Goldberg died before he could see where his research would eventually lead to. The Department of Anesthesiology and Critical Care at the University of Chicago continued researching into methylnaltrexone throughout the 1990s. In 2005, two pharmaceutical companies - Wyeth and Progenics - signed an exclusive, global agreement to jointly develop and commercialize methylnaltrexone for the treatment of opioid-induced side effects, including: *Constipation *Post-operative ileus - a proportion of the intestines becomes paralyzed typically after abdominal surgery; food and drink cannot be pushed forward in that part of the intestine. RelistorPages: [1] 2
Skipjimroo commented:
My god... Please, for the love of all that is holy, master the art of the paragraph and then repost this mess.
That is all.
22.02.2010