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Sunbeds And UV Classed As Definitely Cancer-Causing
Global health experts have moved use of sunbeds and exposure to ultraviolet radiation (including sun exposure) to the highest risk category for causing cancer: they
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Blogs Comment On Appeals Court Ruling On Virginia Abortion Ban, German Abortion Law, Other Topics
The following summarizes selected women"s health-related blog entries.~ "Another Abortion Case Developing," Lyle Denniston, SCOTUSblog: The decision by the full U.S. Court of Appeals for the 4th Circuit to uphold Virginia"s 2003 law banning what abortion-rights opponents call "partial-birth" abortion -- known medically as intact dilation and extraction -- could send a new abortion-rights case to the U.S. Supreme Court, Denniston writes. He continues that if the case, Richmond Medical Center v. Herring, is appealed to the U.S. Supreme Court, it could be a "sequel" to the court"s 2007 ruling in Gonzales v. Carhart, which upheld a federal ban on the procedure. Denniston notes that the 4th Circuit Court panel twice struck down the Virginia law. A "key factor" in those rulings was that the state law "differs in some significant respects from the federal ban," he writes. Denniston continues that the full appeals court in its opinion said that the Virginia law "is "somewhat different" from the federal ban, but still "provides sufficient clarity as to what conduct is prohibited to enable a doctor of reasonable intelligence to avoid criminal liability under it."" According to Denniston, "The most significant difference between the Virginia ban and the federal ban is that, under the Virginia law, a doctor who intends to perform an abortion that does not violate the law, but the fetus accidentally is delivered intact to a significant degree, and if the mother"s life is not at stake, the doctor has committed a crime" (Denniston, SCOTUSblog, 6/24).~ "More Restrictive Law on Late-Term Abortions Comes to Germany," Anna Wilkowska-Landowska, RH Reality Check: Pregnant German women seeking abortions after the first trimester of pregnancy "will face stringent consultations and will be required to undergo a waiting period of at least three days before a physician can make a final decision allowing the abortion" under a new German law, Wilkowska-Landowska writes. According to a 1995 German law, an abortion performed during the first three months of pregnancy is considered an unlawful act but not a punishable offense if a pregnant woman first visits a counseling center, though the woman is not required to give a reason for seeking the procedure. German law allows abortion after 20 weeks" gestation if there is a risk to the physical or mental health of the pregnant woman. In May, the lower house of the German parliament enacted a law requiring women seeking the procedure after the first trimester to wait at least three days before a physician can make the decision to perform an abortion. Women also must undergo a psychological evaluation. In addition, parliamentarians voted to increase "consultations and support for families with handicapped children considering termination," Wilkowska-Landowska writes. She continues that the medical and psychological consultation requirements are aimed at reducing the number of abortions performed after the first trimester. According to Wilkowska-Landowska, church representatives and lawmakers began discussions on the issue in 2005,when it was reported that the number of abortions performed later in pregnancy were increasing (Wilkowska-Landowska, RH Reality Check, 6/25).~ "Jon Stewart and Mike Huckabee on Abortion," Jim Wallis, Sojourners" "God"s Politics": Wallis writes that he was surprised to see that The Daily Show handled a discussion on abortion between host Jon Stewart and former Republican presidential candidate and former Arkansas Gov. Mike Huckabee with such "nuance and respect" for the topic. According to Wallis, although Stewart and Huckabee "didn"t solve the issue, ... the depth of their dialogue and their respect for the other"s core values and opinions was clear." Wallis writes they "never quite reached common ground, but their dialogue was a great example of the type of civil discourse our country needs to be engaged in." Wallis also includes video clips of the interview (Wallis, "God"s Politics," Sojourners, 6/24).~ "George Tiller: Health Care P
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Analysis Of Edoxaban Phase II Data Provides Insight Into Reduced Bleeding Events Seen In Once-Daily Dosing
A sub-analysis of a Phase IIb multinational study(1) with edoxaban(2) - an investigational oral Factor Xa inhibitor - provides insights into why patients with non-valvular atrial fibrillation (AF) receiving edoxaban once daily (QD) experienced fewer bleeding events than patients given edoxaban twice a day (BID). The analysis finds that bleeding associated with edoxaban is most closely correlated with minimum concentration levels of the drug in the blood, and that these trough levels may best predict bleeding events, rather than total exposure or maximum concentration levels.
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Liver Transplantation After Drug Induced Acute Liver Failure Examined By Study

Liver transplantation offers a good chance for survival for patients with drug induced acute liver failure, however, certain pre-transplant factors are associated with worse outcomes. Patients who are on life support, who have elevated serum creatinine, and children whose liver failure was caused by antiepileptic drugs did not fare as well after transplantation. These findings are in the July issue of Liver Transplantation, a journal published by John Wiley & Sons. The article is also available online at Wiley Interscience. Drug induced acute liver failure is very rare, but can be life-threatening. Acetaminophen is the most common cause, accounting for nearly half of cases in adults, but other drugs can also be responsible. For patients who are unlikely to recover spontaneously, liver transplantation is the only treatment. Researchers, led by Ayse L. Mindikoglu, M.D., M.P.H. of the University of Maryland School of Medicine and VA Maryland Health Care System, examined the United Network for Organ Sharing (UNOS) database which contains information about outcomes of nearly all liver transplants performed in the U.S. since 1987. They planned to analyze all of the drugs associated with acute liver failure and subsequent liver transplantation, determine survival rates after transplantation, and develop a model that would predict the risk of death after transplantation for these patients. They included 661 patients - 567 adults and 94 children under age 18 - who were transplanted for drug induced acute liver failure between October 1, 1987, and December 31, 2006. For each case, they collected twenty recipient and six donor demographic and clinical variables from the database. They found that the leading drug groups causing liver failure that required transplantation were acetaminophen (40 percent), antituberculosis drugs (8 percent), antiepileptics (7 percent) and antibiotics (6 percent). For the entire cohort of transplant recipients, median survival time was 14.4 years. One year estimated survival probabilities were 76 percent, 82 percent, 52 percent, 82 percent, and 79 percent for acetaminophen, antituberculosis, antiepileptics, antibiotics and others, respectively. "Among the patients who had acute liver failure due to antiepileptics, one-year survival was only 27 percent in patients less than 18 years old compared to 75 percent in patients 18 years old or older," the authors report. Interestingly, these patients were least likely to be listed as status 1 and spent the most time waiting for an organ. Also, the warm and cold ischemia times were longest for this group of patients. "The relatively low survival probability persisted after controlling for these variables in multivariate analysis," the authors report. The reasons for the decreased survival in this group could not be elucidated based on the available data. Examining the different demographic and clinical factors for each patient and donor, the researchers noted that, "elevated serum creatinine, being on life support, and drug-induced acute liver failure due to antiepileptics (at age less than 18) were found to be independent pretransplant predictors of poor survival." Using the entire study population, the researchers developed a prognostic model which showed strong predictive ability. An accompanying editorial by Paul B. Watkins of the Institute for Drug Safety at the Hamner Institutes of Health Sciences, Research Triangle, NC and Paul H. Hayashi of the University of North Carolina , commends the authors for adding valuable information about acute liver failure caused by drugs. In particular, "the identification of poorer outcome for children with anti-epileptic drug induced acute liver failure is intriguing and points out the need for more focused research on drug induced liver injury in pediatric populations." Drug induced liver injury has wide implications for all of us who take and prescribe medications, they write. And they look forward to future advances in our understanding of the issue, as researchers investigate hypotheses about preventive factors and genetic predisposition. Notes: Article: "Outcome of Liver Transplantation for Drug Induced Acute Liver Failure in the United States. Analysis of the United Network for Organ Sharing Database." Mindikoglu, Ayse L.; Magder, Laurence S.; Regev, Arie. Liver Transplantation; July 2009. Editorial: "Progress in Our Understanding of Severe Drug Induced Liver Injury." Hayashi, Paul H. Watkins, Paul B.; Liver Transplantation; July 2009. Sean Wagner Wiley-Blackwell


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