Saturday, September 05, 2009

"Unapproved" use of Relenza saves swine flu victim

This time she may be lucky she was in England. "Unapproved" usage of approved drugs sends Obama's FDA into a hissy fit. Just promoting such acts has recently cost Pfizer a fine of billions

Enterprising doctors saved the life of a young cancer patient infected by swine flu by making unlicensed use of Relenza, an antiviral drug, The Lancet reports today. The 22-year-old patient's immune system had been weakened by Hodgkin's disease and chemotherapy, damaging her defences against the A(H1N1) virus. She was admitted to London's University College Hospital in July suffering from shortness of breath and fluid build-up in both lungs.

Neither Tamiflu, a pill that is the frontline treatment for swine flu, nor broad-spectrum antibiotics had any effect. By the third day, she was placed on an artificial respirator. Doctors administered Relenza, also known by its lab name as Zanamivir, in its licensed form as a nebulised spray. But this remedy also failed and, over the next two weeks, her condition steadily worsened.

With her life in the balance, the doctors gambled on giving her Relenza intravenously, using a batch specially provided by the drug's manufacturers, GlaxoSmithKline. They backed this with a high dose of corticosteroids to tackle lung inflammation.

Her condition improved dramatically and, within 48 hours, she was taken off artificial respiration and transferred out of the hospital's intensive care unit and into a general ward.

The unorthodox treatment had to be approved by the hospital's oversight committee and the patient's next of kin as it is not a recognised strategy for swine flu.

Most of the deaths from swine flu have been related to severe respiratory failure, especially from people with an underlying medical condition. Physicians Michael Kidd and Mervyn Singer believe their patient's lungs were so impaired by the virus that she could not absorb Relenza in its spray form, so they took a final gamble on an intravenous drip.

Further investigation will confirm whether the treatment can find a wider use beyond a single case report, they said.


Infection-fighting proteins could lead to HIV vaccine 'within years'

HIV researchers have made the biggest breakthrough in 15 years, identifying two powerful antibodies that appear to fight all types of the virus - a development that brings new hope of a vaccine. The Australian reports the US team has discovered two infection-fighting proteins in blood taken from an African who was already infected with HIV but did not show any of the symptoms. The scientists found these antibodies apparently neutralised all major groups, or clades, of HIV.

By determining where the antibodies bind to the virus, they know which parts of the virus to target with vaccines. They also identified what genes the donor's body used to build the "broadly neutralising antibodies". The knowledge could lead to gene therapies to treat people already infected with HIV, as well as vaccines to protect people from infection.

Worldwide, 33 million people are infected with HIV, including about 16,600 Australians. The virus is estimated to kill about 2 million people a year, having already claimed 25 million.

The findings were reported overnight in the journal Science by an international consortium led by immunologist Dennis Burton of the Scripps Research Institute in La Jolla, California, and the newly established Ragon Institute in Boston, Massachusetts.

Trial vaccines developed over the past 15 years have proved ineffective or even dangerous. In November 2007, a global vaccine trial involving 3000 people at high risk of HIV infection, including 19 Australians, was halted when scientists discovered that the vaccine appeared to make them more susceptible to HIV infection. The reason remains unclear.

Virologist Damian Purcell, head of Melbourne University's Molecular Virology Laboratory, cautioned that the research was in its early days, but said vaccines and therapies could be on the market in 10 years, at the latest. "This finding demonstrates that, after all the disappointments over the last 15 years, scientists have gone back to basics and we're looking at fundamental questions like what are the best targets in the virus," Professor Purcell said.

Until now, researchers had been unable to find an Achilles heel on the virus that remained the same across clades. Part of the problem is that HIV mutates rapidly in the community and even in an infected person's body. Further, numerous clades circulated in different regions of the world. And because no one is known to have completely eliminated an HIV infection, it's not known which elements of the body's immune response must be triggered to get rid of, or clear, the virus.


Was blind but now she sees

A wonderful story

A MOTHER has told of the joy of seeing her three children again after radical brain surgery restored her sight. Tammy Rowley, 36, thought she would never see their faces again after she suddenly went blind last month. Doctors found the young mum had a huge brain tumour pushing on her optical nerve.

Two days later neurosurgeons at Monash Medical Centre in Melbourne removed the benign tumour, which had been growing unnoticed in Ms Rowley's head for years before it robbed her of her sight. As soon as she awoke from the operation, Ms Rowley said she knew the surgeons had saved her vision. "One leant over me to tell me it was a success and I looked up at him and went 'Oh wow, I can see you. It is so clear'. I was just so happy to be able to see again," she said. "I make sure I go outside every day to have a look, even if it is a horrible day. "I make sure I take the time to sit and watch my children play now because it is amazing what you take for granted until it is taken away."

As well as vision loss due to the pressure on her optical nerve, neurosurgeon Dr Michael Pullar said more than 90 per cent of Ms Rowley's pituitary gland had been destroyed, leading to constant migraines and hormonal issues which could not be reversed by surgery.

Although the tumour was larger than a golf ball, it did not show up on CT scans taken a year earlier when Ms Rowley suffered migraines and fuzzy vision. It was only when a GP delved deeper and ordered an MRI that the extent of the danger was revealed.

Using a camera and instruments passed through Ms Rowley's nostrils, Dr Pullar was able to detach the tumour and suck it out of her brain. "Her vision was at peril and without decompressing the nerves to the eyes she would have lost vision and become blind permanently," Dr Pullar said.


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