Protecting young women from cervical cancer may be even easier than experts thought.

A virus called HPV causes almost all cases of cervical cancer. Vaccines can protect girls and women from some of the most threatening types of HPV. However, the vaccines are given in three doses, and in the United States most women don't complete the three-dose regimen
A new study suggests they may not need to.
In the study, reported in the Journal of the National Cancer Institute, researchers looked at thousands of women who received one to three doses of an HPV vaccine. The researchers followed them for about 4 years, taking note of women who had an HPV infection that lasted at least 10 months.
The vaccine seemed to be about as effective whether women had one, two, or three doses. As a result, the researchers point out that one or two doses might offer as much protection as all three. However, more research is needed to show whether the three-dose schedule offers longer protection, and whether these results apply to other HPV vaccines.

HPV Test Spots Cervical Cancer Earlier Than Pap Smear: Study

THURSDAY, Dec. 15 (HealthDay News) - To catch cervical cancer or the lesions that can lead to it, a human papillomavirus (HPV) test is the best option for women over 30, Dutch researchers report.
Using it in conjunction with the more traditional Pap smear resulted in earlier detection of precancerous lesions and prevented more cervical cancers from developing, said study author Dr. Chris Meijer, a professor of pathology at VU University Medical Centre in Amsterdam.
The study is published online Dec. 15 in The Lancet Oncology.
Nearly all cervical cancers are caused by HPV, a virus spread through sexual intercourse. Some HPV strains are more strongly linked with the cancer than others.
The superiority of HPV testing over traditional Paps at finding precancerous cervical lesions is established, Meijer noted. However, his team wanted to see if HPV testing also offered better protection and detection long-term -- in two screenings done over a five-year period.
They found it did.
While five years may sound like a long lag time between screenings, it is not, he said. "The Netherlands already has a screening interval of five years, starting from 30 years of age until 60 years," he said. The program is inexpensive and effective, he added.
In the study, Meijer's team evaluated nearly 45,000 women, aged 29 to 56. Women in one group got a traditional Pap smear and an HPV DNA test. The women in the other group got just the Pap test.
Five years later, all women got both tests.
The researchers looked to see whether HPV tests resulted in fewer high-grade cervical lesions and cervical cancer in the second screening, due to earlier detection and treatment.
In the first screen, the HPV tests found more of the early changes that can precede cervical cancer than the Pap smear alone did.
Five years later, far fewer women in the HPV group had more advanced lesions or cervical cancer than did the Pap-only women.
Four women in the HPV/Pap group were diagnosed with cervical cancer, while 14 in the Pap-only group were.
When they looked at cervical cancer or advanced lesions, 88 in the HPV arm of the study were diagnosed with one or the other compared to 122 in the Pap-alone arm.
The improved protection against advanced lesions, the researchers said, is due to the earlier detection of the precursor lesions. When they were treated, it helped prevent them from progressing.
In an accompanying commentary, scientists from the U.S. National Cancer Institute wrote that the Dutch trial does show the five-year screening interval is safe. But they added that it is unclear if the same results would hold true in a different population with different testing guidelines.
The HPV test can be done using the same specimen collected for the Pap test, Meijer said.
Costs of the tests differ. Meijer said Pap smears are about $38 in the Netherlands, while an HPV test costs about $64. However, the Dutch Minister of Health recently recommended lowering the cost of an HPV test to below that of the traditional Pap.
The new study is "further defining how we can incorporate HPV testing into our screening program," said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital, in New York City.
She noted that she doesn't think the HPV screen will replace the Pap test completely. "It may turn out to be a first-line screen. Stay tuned for more," she said. "Certainly ask your physician if you've had HPV."
In October, three U.S. cancer groups proposed new guidelines for cervical cancer testing, extending intervals between screenings and making other changes. These guidelines, issued by the American Cancer Society and others, call for combination HPV/Pap smear testing for women aged 30 and older.
After three normal Paps, women over 30 can have the test ever two to three years, according to the American Cancer Society.
However, the U.S. Preventive Services Task Force remains cautious about the use of the HPV test, standing by the Pap as the best bet for now.
The Dutch study was funded by Zorg Onderzoek Nederland (the Netherlands Organization for Health Research and Development).
SOURCES: Elizabeth Poynor, M.D., gynecologic oncologist and pelvic surgeon, Lenox Hill Hospital, New York City; Chris Meijer, M.D., professor, pathology, VU University Medical Centre, Amsterdam, the Netherlands; Dec. 15, 2011, The Lancet, online

One Malaria Episode Early In Pregnancy Triples Miscarriage Risk

According to the largest study on the effects of malaria and different anti-malarial drugs in early pregnancy to date, just one episode of malaria in the first trimester is linked to a three-fold greater risk of miscarriage. Researchers also discovered that women treated with anti-malarial drugs did not suffer any serious side effects or increase their likelihood of miscarriage. The study was published Online First in The Lancet Infectious Diseases.

According to estimates each year, 125 million pregnancies are at risk of malaria. During pregnancy, malaria can cause both severe anemia and parasitic infection in the fetus and increase the risk of low birth-weight, preterm birth, and maternal death.

Until now, scientists know little about the effects of malaria in early pregnancy or the benefits and harms of anti-malarial drugs during the early stages of pregnancy. The treatment of all falciparum malaria is artesunate-based combination therapy (ACT), however, it is not recommend during the first pregnancy trimester as it has been proven toxic in animal studies, potentially causing birth defects or miscarriage.

Leading author Rose McGready from Shoklo Malaria Research Unit in Thailand, explained:

"Both vivax and falciparum malaria contribute significantly to avoidable fetal and infant death. These results suggest that the adverse effects of malaria in the first trimester substantially outweigh any adverse effects of its treatment...[and] emphasizes the importance of early detection of malaria and prompt effective treatment for all pregnant women."

McGready and his team set out to provide more evidence and reviewed records of pregnant women who attended antenatal clinics of the Shoklo Malaria Research Unit on the northwestern border of Thailand between May 1986 and October 2010. They compared outcomes of 16,668 women who no malaria during pregnancy with 945 women who had only a single episode in the first trimester, i.e. at less than 14 weeks into their pregnancy, and discovered that asymptomatic malaria, showing no noticeable symptoms, was linked to almost a three times higher risk of miscarriage compared with those who did not contract malaria, whilst the risk of miscarriage for those with symptomatic malaria tended to be at least four-times more likely. In women with vivax and falciparum malaria the risk of miscarriage was similar.

The researchers discovered that the chances of miscarriage was comparable in women who received chloroquine (26%), quinine (27%), and artesunate (31%) during the first-trimester, with no substantial difference reported between treatments in other birth outcomes, such as still birth or low birth weights. Unlike the findings from animal studies, the researchers detected no additional toxic effects in women treated with artesunate.

The authors comment: "Miscarriage in 24 first-trimester episodes of hyperparasitaemia or severe malaria was high but artesunate did not result in higher rates of miscarriage than did quinine," and conclude saying, that: "These findings have serious implications for malaria treatment and prevention policies, which currently ignore the first trimester...A randomized trial of first-trimester artemisinin-based treatment is now needed to make firm recommendations on the safety of first-trimester malaria treatments with this class of anti-malarial drug."

Meghna Desai and Stephanie Dellicour from the Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya write in an associated comment:

"This study provides a level of reassurance regarding the potential risk associated with artemisinin exposure in early pregnancy, compared with the established risk of malaria. This study, combined with data from ongoing studies done in sub-Saharan Africa, will for the first time allow an informed risk/benefit assessment of disease versus treatment with artemisinin combination treatments in pregnancy."

Docs to spend more time with patients soon

The Medical Council of India (MCI) may soon specify how much time doctors should spend with their patients so that the regimen of medicines being prescribed to them is clear.
A recent World Medicines Situation 2011 report brought out by the World Health Organization (WHO) — as reported by TOI first — had recently said that doctors, on an average, in developing countries spend less than 60 seconds in prescribing medicines and explaining the regimen to their patients.

Consequently, only half of the patients receive any advice on how to take their medicines and about one-third of them don't know how to take drugs immediately on leaving the facility.
Union health minister Ghulam Nabi Azad said on Friday that the government proposes to issue an advisory to the MCI to disseminate appropriate instructions among all registered medical practitioners.
According to WHO, the dispensing process greatly influences how medicines are used. The WHO database shows that the dispensing time is a minute. "In such circumstances it is not surprising that patient adherence to medicines is poor," the report said.
Azad said, "The doctor population ratio is not favourable in our country. Hence, there is tremendous pressure on the doctors serving in public sector hospitals. This may be the major reason for patients getting less than adequate time for consultation."
MCI's own assessment says India has just one doctor for 1,700 people. In comparison, the doctor population ratio globally is 1.5:1,000. MCI has set a target to have 1 doctor for 1,000 people by 2031.
The assessment note, available with TOI, also looked at the situation in other countries. Somalia has one doctor for 10, 000; Pakistan has 1:1,923 and Egypt 1: 1,484.
China's doctor population ratio stands at 1:1,063; South Korea 1:951; Brazil 1:844, Singapore 1:714, Japan 1:606; Thailand 1:500; UK 1:469; the US 1:350 and Germany 1:296.
Kathleen Holloway from WHO's department of essential medicines and pharmaceutical policies said, "Irrational use of medicines is a serious global problem that is wasteful and harmful. In developing countries, in primary care, less than 40% of patients in public sector and 30% of patients in private sector are treated in accordance with standard treatment guidelines."
The report cites, only about 60% countries train their medical students on various aspects of prescribing medicines and only about 50% require any form of continuing medical education.
The basic training for nurses and paramedical staff, who often do a bulk of prescribing, was even less — only about 40% of countries give them any basic training on how to prescribe.
Original article

Bahrain jails 20 doctors after democracy protests

(Reuters) - Bahrain jailed 20 doctors on Thursday for between five and 15 years on theft and other charges, the state news agency said, in what critics claimed was reprisal for treating protesters during unrest in the Gulf kingdom this year.
A security court also sentenced a man to death for killing a policeman by driving his car over him several times and joining illegal gatherings for "terrorist goals," the BNA news agency said. Another man was handed a life term for his involvement.
The doctors, who denied the charges, were among dozens of medical staff arrested during protests led by the island's Shi'ite majority demanding an end to sectarian discrimination and a greater say in government.
Bahrain's Sunni Muslim rulers quashed the protests in March, with the help of troops from fellow Sunni neighbours Saudi Arabia and the United Arab Emirates. At least 30 people were killed, hundreds wounded and more than 1,000 detained -- mostly Shi'ites -- in the crackdown.
The doctors were charged with stealing medicine, stockpiling weapons and occupying a hospital during the unrest and in addition were jailed for forcibly occupying a hospital, spreading lies and false news, withholding treatment, inciting hatred of Bahrain's rulers and calling for their overthrow.
"We were shocked by the verdicts because we were expecting the doctors would be proved innocent of the crime of occupying the Salmaniya medical complex," defence lawyer Mohsen al-Alawi said, adding the hearing had lasted no more than 10 minutes.
The doctors say the charges against them were invented by the authorities to punish medical staff for treating people who took part in anti-government protests.
"Those doctors who have been found guilty were charged with abusing the hospital for political purposes. Nobody is above the law," a spokesman for the government's Information Affairs Authority (IAA) said.
Ten of the doctors, including senior physician Ali Al-Ekri, were given 15-year terms, two were sentenced to 10 years in prison and the rest to five.
"After today's verdict and those issued yesterday we feel pessimism," Alawi said, adding they would appeal against the decision.
On Wednesday a military court upheld life sentences against Shi'ite opposition leaders for organising protests in a trial described as a "sham" by Amnesty International, which also called the latest proceedings a "travesty of justice."
In Washington, a U.S. State Department spokesman said the United States was "deeply disturbed" by the sentencing of the doctors.
"We continue to urge the Bahraini government to abide by its commitment to transparent judicial proceedings, including a fair trial, access to attorneys and verdicts based on credible evidence," spokesman Mark Toner said in a statement.
The British government voiced concern over the sentences.
"These sentences appear disproportionate to the charges brought," British Foreign Secretary William Hague said on Thursday.
"These are worrying developments that could undermine the Bahraini government's moves towards dialogue and the reform needed for long-term stability in Bahrain."
OPEN FOR DISCUSSION
A senior Bahraini official said the government was still prepared to hold more talks with all opposition parties on political reforms to try to end protests that threaten to hold up the economy and scratch its business-friendly image.
Sheikh Abdul-Aziz bin Mubarak al-Khalifa, a senior adviser at the IAA, also said Bahrain had begun receiving some of the $10 billion in economic aid promised by fellow Gulf Arab nations.
"Everything is open for discussion except regime change. That doesn't mean it has to be discussed today (but) the king said reforms are not going to stop," he said. "Other issues can be brought to the table -- when and how, I'm not sure."
Bahrain says it will expand parliament's powers of monitoring government ministers, recommendations that came from a national dialogue held after the U.S. ally crushed pro-democracy protests earlier this year.
But Shi'ite opposition groups, headed by the Wefaq party, want the elected chamber to have real legislative power as well as a new prime minister. The current incumbent, an uncle of the king, has occupied the post since 1971.
The conflict dragged in regional powers; Bahrain accused the opposition of pursuing a sectarian agenda backed by non-Arab Shi'ite giant Iran, just across Gulf waters. The United States, whose Fifth Fleet is stationed in Manama, says the government should talk to Wefaq. SOURCE