Sildenafil citrate soft tabs

Among Jewish survivors of World War II, those who were potentially exposed to the Holocaust have an increased risk of cancer, likely due to physical and mental stress, an Israeli study has found.

University of Haifa researchers compared cancer rates in more than 300,000 Israeli Jews who were born in Europe and immigrated to Israel either before World War II (non-exposed) or after the war (potentially exposed).

Compared to the non-exposed group, those in the potentially exposed group had a statistically significantly increased risk for cancer, especially breast and colorectal cancer, the researchers found. The younger a person was when they were exposed to the Holocaust, the greater their risk of cancer.

“These observations may have direct impact on the health of World War II Jewish survivors and thus the care required from their caregivers in Israel and elsewhere,” wrote Dr. Lital Keinan-Boker, of the University of Haifa School of Public Health, and colleagues. “These findings warrant further epidemiological studies [such as case-control studies] of past and present risk factors that use individual data.”

The study is published in the Oct. 26 online edition of the Journal of the National Cancer Institute.

The findings add to a growing body of knowledge about the links between cancer risk and severely restricted calorie intake and severe psychosocial and physical suffering, explained the authors of an accompanying editorial.

“Taken together, data from animal and human studies suggest that while [calorie reduction] typically decreases cancer risk, the anticancer effects of [calorie reduction] may be neutralized or overwhelmed in the presence of extreme stressors,” wrote the editorialists, Stephen D. Hursting, of the nutritional sciences department at the University of Texas, Austin and Michele R. Forman, of the epidemiology department at the University of Texas M.D. Anderson Cancer Center in Houston.

“From this unique cohort we can learn lessons about adaptation to extreme hardships in early life, resilience during life, and cancer susceptibility later in life,” they added.

Wearing a cell phone on your hip may reduce bone density in an area of the pelvis commonly used for bone grafts, a new study suggests.

Turkish researchers used dual X-ray absorptiometry to measure bone density at the upper rims of the pelvis (iliac wings) in 150 men who carried their cell phones on their belts. The men carried their phones for an average of 15 hours a day, and had used cell phones for an average of six years.

Bone density was slightly reduced on the side of the pelvis where the men carried their cell phones, the study found. The difference wasn’t statistically significant and didn’t approach bone level density reductions seen in people with osteoporosis. However, the men were relatively young (average age 32), and further bone weakening may occur, said Dr. Tolga Atay and colleagues at Suleyman Demirel University in Isparta.

The study, published in the September issue of the Journal of Craniofacial Surgery, suggests that electromagnetic fields emitted by cell phones may have a harmful effect on bone density.

However, the researchers emphasized that their findings are preliminary and noted that future generations of cell phones may reduce users’ exposure to electromagnetic fields. In the meantime, it “would be better to keep mobile phones as far as possible from our body during our daily lives,” Atay and colleagues concluded.

The iliac wings of the pelvis are widely used for bone grafting, which means any reduction in bone density there may affect reconstructive surgery. In procedures where bone density is important for good outcomes, surgeons may want to consider the possible effects of exposure to electromagnetic fields from cell phones, the researchers suggested.

Crushing the notion that you can be both fat and fit, new research has found that current professional football linemen already have some risk factors for heart disease.

In a study comparing professional football players to minor and major league baseball players, researchers found that football linemen were more likely to have higher fasting blood sugar levels, larger waist circumferences and a greater waist-to-height ratio.

Although the idea that a football player could be at risk for heart disease might seem paradoxical because football players have to be in top physical condition, the lineman position also requires players to bulk up, with many tipping the scales at more than 300 pounds. All that extra weight may put players at risk later in life.

“We’ve identified a subset of players that are exercising like crazy and they’re extremely fit, but the exercise isn’t completely protective,” said one of the study’s authors, Dr. John Helzberg, co-director of the division of gastroenterology at Saint Luke’s Hospital in Kansas City, Mo.

Helzberg was quick to point out that the study was not designed to look at the rates of heart disease or deaths from heart disease later in life but to identify only current risk factors. The hope is that by identifying the risk factors, steps could be taken to tackle the risk factors now, and interventions could be designed to help players when they retire.

Results of the study were scheduled to be presented Oct. 26 at the American College of Gastroenterology’s annual scientific meeting in San Diego.

Previous research has suggested that football players face myriad risks later in life, such as higher rates of chronic pain, depression and even dementia. Helzberg said the idea for the current study came from a news report that suggested that football players were twice as likely to die before the age of 50 as baseball players.

To get an idea of how football players’ health really compared with that of baseball players, Helzberg and his colleagues assessed a range of risk factors in 69 professional football players and 155 baseball players — both minor and major league.

Many football players, such as quarterbacks and receivers, have heart disease risk profiles similar to those of baseball players. However, the 19 men playing lineman positions — including guards, tackles, centers and defensive ends — had significantly higher fasting blood sugar levels, waist circumferences and waist-to-height ratios, which are all considered risk factors for cardiovascular disease. And, when three such risk factors are combined, it’s considered metabolic syndrome, which often indicates an increased risk for heart disease.

Of the linemen, 26 percent had fasting glucose levels above 100 milligrams per deciliter (mg/dL) compared with 7 percent of the baseball players. That level is considered prediabetic, according to the American Diabetes Association.

Nearly 100 percent of the linemen had a waist circumference greater than 100 centimeters (39.4 inches), which is considered a risk factor for heart disease, whereas only 8 percent of the baseball players had waists that size. Having a waist-to-height ratio greater than 0.5 also increases the risk for cardiovascular disease, and 95 percent of the linemen had a ratio greater than that, compared with 24 percent of the baseball players, according to Helzberg.

“These guys are very big, and yes, they have more muscle, but a lot of the weight is fat, and anyone at a higher weight is at risk of metabolic syndrome,” said Dr. Jonathan Whiteson, co-director of the Joan and Joel Smilow Cardiopulmonary Rehabilitation and Prevention Center at the NYU Langone Medical Center in New York City.

“What happens is that you don’t have to have rip-roaring abnormalities, but when you put these factors together, you create metabolic syndrome,” Whiteson said. “This can put them at risk for premature heart disease, stroke, vascular disease in the legs and sudden death,” he explained.

“The message is clear,” he said. “Being fat is not fit. It’s a medical condition.”

But there are other worries as well, he added. “What’s always a concern of mine is that these people are role models for children, and you see young boys who want to play football bulking up,” Whiteson said. “We should be promoting a better health profile than linebackers.”

Prevention of chronic diseases such as diabetes, obesity and high blood pressure improves the lives of older Americans and also reduces medical costs, study findings show.

Researchers looked at a group of 51- and 52-year-olds from across the nation and projected their future state of health and medical costs if they could avoid developing certain chronic diseases. In a 51-year-old, prevention of obesity would extend life by 0.85 years, preventing high blood pressure would give them an additional 2.05 years, and by avoiding diabetes they would gain 3.17 years. People aged 51 and 52 who quit smoking would gain 3.44 more years of life, the study authors noted in a news release from the American Public Health Association.

Prevention of these conditions also would have lower lifetime medical costs for the individual: Preventing obesity would save $7,168; preventing high blood pressure would save $13,702; and preventing diabetes would save $34,483. However, the lifetime medical costs for a person who quits smoking would be $15,959 higher, the researchers noted in the news release.

“Our data indicate that primary prevention could improve the health and longevity of future cohorts of elderly persons in the United States at a relatively low cost,” the researchers concluded

A diet high in a form of sugar found in sweetened soft drinks and junk food raises blood pressure among men, according to research likely to mean more bad news for beverage companies and restaurant chains.

One of two studies released on Wednesday provided the first evidence that fructose helps raise blood pressure. It also found that the drug allopurinol, used to treat gout, can alleviate the effect by reducing uric acid levels in the body.

The second study, which measured fructose intake in mice, suggested that people who consume junk foods and sweetened soft drinks at night could gain weight faster than those who don’t.

“These results suggest that excessive fructose intake may have a role in the worldwide epidemic of obesity and diabetes,” said Dr. Richard Johnson of the University of Colorado-Denver, who studied the link between blood pressure and men.

The findings provide the latest evidence of ties between sugar-rich diets and health problems that have prompted some experts to call for a tax on sugary soft drinks.

Fructose accounts for about half the sugar molecules in table sugar and in high-fructose corn syrup, the sweetener used in many packaged foods.

Johnson and colleagues at the Mateo Orfila Hospital in Spain studied 74 men given 200 grams of fructose per day on top of their regular diet. That amount is well above a daily intake of 50 grams to 70 grams of fructose consumed by most American adults.

Half the men were also given allopurinol.

After two weeks, the men who received only the fructose registered increases of six millimeters in systolic blood pressure — the top reading — and about three millimeters in diastolic or the bottom reading, the researchers told an American Heart Association meeting in Chicago.

REVERSIBLE EFFECT

Most of their blood pressure readings returned to normal levels after two months.

The men who did not get allopurinol also were twice as likely to develop metabolic syndrome, measured by risk factors such as too much abdominal fat, high blood pressure and poor cholesterol readings.

By contrast, those given allopurinol and fructose had significantly lower uric acid levels, and virtually no increase in systolic blood pressure or higher risk of metabolic syndrome.

For the second study, researchers in Ohio studied mice given fructose water to drink. Some had unrestricted access, while others received it during the day or at night.

“The first thing we noticed was that the mice on restricted access rushed to their drinking bottles to load up on the sweetened beverage, similar to teenagers who drink too many soft drinks,” said Mariana Morris of Wright State University in Dayton, Ohio.

The mice that drank fructose water during their regular daylight sleeping hours gained more weight and had higher stress hormone levels than the other mice.

“This model may be similar to the human condition of night time bingeing of fructose-laden foods and beverages,” Morris said.

The American Heart Association says women should eat no more than 100 calories of added processed sugar per day, or six teaspoons (25 grams), while most men should keep it to just 150 calories or nine teaspoons (37.5 grams). On average Americans consume 22 teaspoons (90 grams) or 355 calories of added sugar each day.

Marriages can be at risk when one partner is an excessive drinker and/or smoker, but the other isn’t, researchers say.

However, when their drinking and/or smoking habits are similar, both partners remain relatively satisfied with their marriage, according to the study published in a recent edition of the journal Addiction.

Researchers tracked 634 newly married couples for seven years, and at their first, second, fourth and seventh wedding anniversaries, the couples completed questionnaires about their marital satisfaction.

Overall, there were initial declines in marital satisfaction, followed by a leveling off after a few years. At each assessment, a difference in heavy drinking between spouses was more common than a difference in smoking. About 15 percent of the couples reported differences in both smoking and drinking habits, the study authors noted.

The information collected from the couples revealed important clinical information, said study author Gregory G. Homish, an assistant professor of health behavior, and colleagues in the University at Buffalo’s School of Public Health and Health Professions and the university’s Research Institute on Addictions.

“For example, if one partner of a heavy-drinking couple enters treatment for his/her alcohol use, the break-up of the ‘drinking partnership’ could have unintended negative outcomes for the couple,” Homish said in a news release from the university. “Therefore, approaches such as behavior couples therapy that assess and treat both partners could have a more beneficial outcome at both the individual and family level.”

In terms of research, “the current findings suggest that an assessment of substance use should extend beyond quantity and frequency of substance use and also incorporate information about the partner’s behavior,” Homish noted.

“Most studies that investigate the impact of substance use focus solely on individual-level risk factors and do not consider the impact of social network influences such as those that exist from a partner,” Homish stated in the news release.

If you get a nosebleed, don’t panic. Many nosebleeds look worse than they really are, says the American Academy of Family Physicians.

Here’s the academy’s advice on steps to help stop a nosebleed:
Sit down, and tilt your body forward slightly. Keep your head positioned above your heart, but allow the blood to drain from your nose, not down your throat.
Use your thumb and index finger and gently apply pressure near the end of the nose, at the soft part.
Hold your fingers in that position for at least five minutes, then check if the bleeding has stopped.
If the nose is still bleeding, hold it for at least 10 minutes more without releasing.
Place an ice pack or cold compress across your nose.
Leave the nose alone once it stops bleeding, and don’t blow your nose or bend over.

VIAGRA was administered to over 3700 patients (aged 19-87 years) during clinical trials worldwide. Over 550 patients were treated for longer than one year.

In placebo-controlled clinical studies, the discontinuation rate due to adverse events for VIAGRA (2.5%) was not significantly different from placebo (2.3%). The adverse events were generally transient and mild to moderate in nature.

In trials of all designs, adverse events reported by patients receiving VIAGRA were generally similar. In fixed-dose studies, the incidence of some adverse events increased with dose. The nature of the adverse events in flexible-dose studies, which more closely reflect the recommended dosage regimen, was similar to that for fixed-dose studies.

When VIAGRA was taken as recommended (on an as-needed basis) in flexible-dose, placebo-controlled clinical trials, the following adverse events were reported:

TABLE 2. ADVERSE EVENTS REPORTED BY ≥ 2% OF PATIENTS TREATED WITH VIAGRA AND MORE FREQUENT ON DRUG THAN PLACEBO IN PRN FLEXIBLE-DOSE PHASE II/III STUDIES

Other adverse reactions occurred at a rate of > 2%, but equally common on placebo: respiratory tract infection, back pain, flu syndrome, and arthralgia.

In fixed-dose studies, dyspepsia (17%) and abnormal vision (11%) were more common at 100 mg than at lower doses. At doses above the recommended dose range, adverse events were similar to those detailed above but generally were reported more frequently.

The following events occurred in < 2% of patients in controlled clinical trials; a causal relationship to VIAGRA is uncertain. Reported events include those with a plausible relation to drug use; omitted are minor events and reports too imprecise to be meaningful:

Body as a whole: face edema, photosensitivity reaction, shock, asthenia, pain, chills, accidental fall, abdominal pain, allergic reaction, chest pain, accidental injury.

Drawing on the power of DNA sequencing, National Institutes of Health researchers have identified a new group of genetic mutations involved in the deadliest form of skin cancer, melanoma. This discovery is particularly encouraging because some of the mutations, which were found in nearly one-fifth of melanoma cases, reside in a gene already targeted by a drug approved for certain types of breast cancer.

In the United States and many other nations, melanoma is becoming increasingly more common. A major cause of melanoma is thought to be sun exposure; the ultraviolet radiation in sunlight can damage DNA and lead to cancer-causing genetic changes within skin cells.

In work published in the September issue of Nature Genetics, a team led by Yardena Samuels, Ph.D., of the National Human Genome Research Institute (NHGRI) sequenced the protein tyrosine kinase (PTK) gene family in tumor and blood samples from people with metastatic melanoma. The samples were collected by the study’s coauthor Steven Rosenberg, M.D., Ph.D., a leading expert on melanoma and chief of surgery at the National Cancer Institute (NCI).

The PTK family includes many genes that, when mutated, promote various types of cancer. However, relatively little had been known about roles played by PTK genes in human melanoma. The NIH study was among the first to use large-scale DNA sequencing to systematically analyze all 86 members of the PTK gene family in melanoma samples.

The team’s initial survey, which involved samples from 29 melanoma patients, identified mutations in functionally important regions of 19 PTK genes, only three of which had been previously implicated in melanoma. The researchers then conducted more detailed analyses of those 19 genes in samples from a total of 79 melanoma patients.

One of the newly implicated genes stood out from the rest. Researchers detected mutations in the ERBB4 gene (also known as HER4) in 19 percent of patients’ tumors, making it by far the most frequently mutated PTK gene in melanoma. In addition, researchers found that many ERBB4 mutations were located in functionally important areas similar to those seen in other PTK oncogenes involved in lung cancer, brain cancer and gastric cancer.

Next, the researchers moved on to laboratory studies of melanoma cells with ERBB4 mutations. They found that these melanoma cells were dependent on the presence of mutant ERBB4 for their growth. What’s more, the melanoma cells grew much more slowly when they were exposed to a chemotherapeutic drug known to inhibit ERBB4. The drug, called lapatinib (Tykerb), was approved by the Food and Drug Administration in 2007 for combination use in breast cancer patients already taking the drug capecitabine (Xeloda).

Encouraged by their study results, the researchers are planning a clinical trial using lapatinib in patients with metastatic melanoma harboring ERBB4 mutations. The clinical trial will be conducted under the direction of Dr. Rosenberg at the NIH Clinical Center. “This collaborative study represents an ideal example of how sophisticated genetic analyses can be translated to the benefit of cancer patients,” said Dr. Rosenberg.

“We have found what appears to be an Achilles’ heel of a sizable share of melanomas,” said Dr. Samuels, who is an investigator in the Cancer Genetics Branch of the NHGRI’s Division of Intramural Research. “Though additional work is needed to gain a more complete understanding of these genetic mutations and their roles in cancer biology, our findings open the door to pursuing specific therapies that may prove useful for the treatment of melanoma with ERBB4 mutations.”

In addition to ERBB4, the researchers identified two additional PTK genes, FLT1 and PTK2B, with a relatively high rate of mutations in melanoma. Each of these genes was mutated in about 10 percent of the tumor samples studied.

NHGRI Scientific Director Eric D. Green, M.D., Ph.D., pointed out how such research is helping to lay the groundwork for the era of personalized medicine. “We envision a day when each cancer patient will have therapies tailored to the specific genetic profile of his or her tumor. Ultimately, this should lead to more effective and less toxic approaches to cancer care,” said Dr. Green, who directs the NIH Intramural Sequencing Center, which generated the DNA sequence data for the melanoma study.

In addition to NIH scientists, the team included a researcher from the Johns Hopkins Kimmel Cancer Center in Baltimore.

In May 2009, Dr. Samuel’s group reported in Nature Genetics another large-scale DNA sequencing study of a different group of genes involved in melanoma, the matrix metalloproteinase (MMP) gene family. This earlier study found that one gene, MMP-8, thought to spur cancerous growth actually served to inhibit it. Those findings are now helping to shape melanoma treatment strategies aimed at MMP genes.

VIAGRA (sildenafil citrate) is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to the nominally indicated amount of sildenafil as follows:

Recommended Storage: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature].