Wednesday, September 14, 2011

Computer Aided Drug Design an Emerging Tool for Research and Drug Development

About Author: 
Jadhav Ramulu 1, P. Goverdhan2
1 Vaagdevi College of Pharmacy, Hanamkonda-Warangal (Affiliated to Kakatiya University), A.P-506002, INDIA
2 Head of the department, pharmacology, Vaagdevi College of Pharmacy, Hanamkonda-Warangal, A.P-506002, INDIA

Abstract
Computer aided drug design(CADD) is an emerging tool for research and drug development process as it reduce the time taken for the process of drug development and expense. Several new technologies have been developed and applied in drug R & D to shorten the research cycle and to reduce the expenses. In computer aided drug design process so many computational tools are used such as over viewing tools, homology modeling, and homology modeling programs, molecular dynamics, molecular docking and QSAR descriptors. This article provides a brief idea on computer aided drug design process and list of software used. 

Introduction
The process of drug discovery is very complex and requires an interdisciplinary effort to design effective and commercially feasible drugs. The objective of drug design is to find a chemical compound that can fit to a specific cavity on a protein target both geometrically and chemically (1).  It is generally recognized that drug discovery and development are very time and resources consuming processes. There is an ever growing effort to apply computational power to the combined chemical and biological space in order to streamline drug discovery, design, development and optimization. In biomedical arena, computer-aided or in silico design is being utilized to expedite and facilitate hit identification, hit-to-lead selection, optimize the absorption, distribution, metabolism, excretion and toxicity profile and avoid safety issues (2).The development of any potential drug begins with years of scientific study to determine the biochemistry behind a disease, for which pharmaceutical intervention is possible. The result is the determination of specific receptors (targets). In the post genomic era, computer-aided drug design (CADD) has considerably extended its range of applications, spanning almost all stages in the drug discovery pipeline, from target identification to lead discovery, from lead optimization to preclinical or clinical trials (3). The rapidly expanding literature on the computational study of drug structure and activity is important both for the insights it provides into our existing drugs and for the ideas it contributes to new drug discovery (4).  To bring a new drug to the market is very costly, with the current price tag approximating US$800 million, according to data reported in a recent study. Therefore, it is not surprising that pharmaceutical companies are seeking ways to optimize costs associated with R&D, with the goal of increasing profit margins. One method that was quickly adopted by industry was the use of combinatorial chemistry and HTS. In HTS, large libraries of compounds are screened against drug targets to identify lead compounds that can modulate a particular outcome. However, setting up a combinatorial chemistry program and HTS is costly and not able to address the specific needs of many biological (drug target) systems.


Additionally, compounds identified in such screenings are not always amenable to further medicinal chemistry development, with poor ADME (absorption, distribution metabolism and elimination) properties. Although these methods have increased the rate at which lead compounds can be identified, there has not been a commensurate increase in the rate of introduction of new chemical entities (NCE) into the world drug market. As an attractive alternative, in silico methods show promise in identifying new lead compounds faster and at a fraction of the cost of combinatorial approaches and HTS. The addition of computer aided drug design technologies to the R&D approaches of a company, could lead to a reduction in the cost of drug design and development by up to 50% (5). 

COMPUTER AIDED DRUG DESIGN PROCESS
Computer aided drug design is the process which facilitate computational methods and resources that are used in design and discovery of new therapeutic solutions .Several new technologies have  been developed and applied in drug R & D to shorten the research cycle and to reduce the expenses. Computer-aided drug design (CADD) is one of such evolutionary technologies (6). CADD technologies including molecular modeling and simulation have become promising in drug discovery. Recently, CADD has even been used in designing highly selective ligands for a certain target that shares very similar structures with many proteins, which is difficult to be done by other methods. One such example is the rational design of selective inhibitors of p90 ribosomal protein S6 kinase (7). In the postgenomic era, owing to the dramatic increase of small molecule and biomacromolecule information, CADD tools have been applied in almost every stage of drug R & D, greatly changing the strategy and pipeline for drug discovery (6). CADD, from its traditional application of lead discovery and optimization, has extended toward two directions: upstream for target identification and validation, and downstream for preclinical study (ADMET prediction).  Target identification and validation is the first key stage in the drug discovery pipeline. However, identification and validation of druggable targets from among thousands of candidate macromolecules is still a challenging task (8). Numerous technologies for addressing the targets have been developed recently. Genomic and proteomic approaches are the major tools for target identification. For example, a proteomic approach for identification of binding proteins for a given small molecule involves comparison of the protein expression profiles for a given cell or tissue in the presence or absence of the given molecule. This method has not been proved very successful in target discovery because it is laborious and time-consuming (9). Therefore, complementary to the experimental methods, a series of computational (insilico) tools have also been developed for target identification. They can be cataloged into sequence-based approach and structure-based approaches. Hence computational approaches to drug design fall into two general categories: those that do not assume information on the structure of the target macromolecule, and the structure-based approaches that do make use of such information (4). Structure based approaches are not yet applicable because the structure of the target macromolecule is unknown; in these cases, quantitative structure-activity relationship (QSAR) techniques provide the best approach to rational drug design. Traditional (two-dimensional) QSAR methods attempt to correlate biological activity with local features of atoms, whole molecular properties (e.g. charge) and substituent effects (e.g. fragment hydrophobicity indices). New developments in traditional QSAR continue to appear in the literature (e.g. the OASIS program) (10). Most interest in this field, however, now focuses on three-dimensional QSAR. Recent examples of molecules to which this approach has been applied include HIV-1 protease (11) and the cholecystokinin-A receptor (12).

LIGAND BASED DRUG DESIGN
Ligand based approach contributes to the processes of target identification by providing functional information about target candidates and positioning information to biological networks. For those diseases caused by external pathogens such as bacteria and viruses, unique targets might be found in the pathogens by comparing functional genomics from humans with the corresponding genomics from pathogens (13). For example, Dutta et al. used a subtractive genomic method to analyze the completed genome of Helicobacter pylori (H. pylori) and identified a set of genes that are likely to be essential to the pathogen but are absent in humans (14). In theory, it is possible to recognize all the targets in the pathogen in this way; whereas for endogenous diseases, targets could be discovered by analyzing the differences of genomics between normal and abnormal tissues. A good example of this issue is that several novel steroid targets were identified by combinative use of bioinformatics and functional analysis of hormone
response elements (15). Traditionally, the first consideration before embarking on a computer-aided drug design (CADD) project is whether the detailed three-dimensional structure of the drug target is known. This determines whether a ligand-based (QSAR, CoMFA, pharmacophore) or a structure-based approach (docking, de novo ligand design) is undertaken to generate new lead compounds, which are then evaluated in an iterative process (16). This methodology proceeds to the selection of a small number of the best candidates, which are synthesized or purchased and tested for activity at the target. The results are then fed back into the CADD process. The strict separation of ligand- and structure-based CADD methods has numerous drawbacks. Most ligand based strategies propose and evaluate potential lead compounds so as to conserve the three-dimensional arrangement of functional groups on a scaffold believed to be most important in the activity of existing ligands. This precludes the discovery of novel ligands, which undertake different interactions with the target protein. However, docking methods, where a potential new ligand is placed into the binding site of the target and its ‘fit’ evaluated are computationally expensive, especially if induced fit of both ligand and protein are evaluated. Conformational changes, especially large scale changes, in the protein upon ligand binding are often ignored in these studies. Structure-based methods are also limited by the availability of detailed structures of the target, ideally in different conformations, with and without ligands complexed to it. We propose that integration between ligand- and structure-based CADD methodologies which model separate facets of the natural system will allow us to use all available information in a particular drug design project in a quantitative and objective way. Other such combinations of computational tools have been utilized by different groups to augment the capabilities of the individual tools: 3D QSAR and receptor modeling (17), pharmacophores and molecular docking (18), (19), pharmacophores and receptor modeling (20), pharmacophores and pseudo receptor modeling (21) and pharmacophores and 3D QSAR with excluded volumes from crystallographic protein structures (22).
STRUCTURE BASED DRUG DESIGN
Structure guided methods are an integral part of drug development for known 3D structure of potential drug binding sites, which are the active sites. In structure guided drug design, a known 3D structure of a target bound to its natural ligand or a drug is determined either by X-ray crystallography or by NMR to identify its binding site, the so called active site. For a lead discovery, this is the starting point of structure guided drug design for a known target. Once the ligand bound 3D structure is known, a virtual screening of large collections of chemical compounds, such as ZINC, can be performed. Such screening enables the identification of potential new drugs by performing docking experiment of this collection of molecules. To enhance binding and hence to improve binding affinity/specificity, a group of molecules with similar docking scores is generally used for potency determination; this is High-Throughput Screening (HTS). After the determination of biological potency, several properties such as relationships (QSAR, QSPR, between potency and docking scores) including statistical analysis can be performed to ascertain the potential molecule(s) for lead drug discovery. Before optimization, the lead molecules could be examined further to understand the ADME and reactivity. Investigation of reactivity (examination of electrophilic, nucleophilic or radicals attack) and spectra such as UV Visible of large molecules can be performed applying Gaussian, a powerful quantum mechanical procedure. Instead of virtual screening of a collection of small molecules, a virtual screening of a collection of targets against a single potent drug whose target is unknown could be performed. Such screening would help in the identification of a potential target for the potent drug. At the end a target identified by this docking technique must be verified experimentally. To our knowledge, this approach of identification of target for a potent drug has not been applied. This approach of target identification for a potent drug with unknown target offers a unique opportunity for lead discovery (23).  Peptidases are perhaps the largest class of enzyme to be used as targets for structure-based drug design.  Among the most successful applications to date are drugs against HIV protease and human rennin that stop viral replication and regulate blood pressure, respectively (24). The matrix metalloproteases (MMPs) are a family of about a dozen zinc-containing enzymes that cleave structural proteins such as collagens, gelatins and proteoglycans. These enzymes are involved in tissue rearrangement during embryonic development and wound healing, and also in the process of new blood vessel formation (angiogenesis). Experimental studies have shown that MMP inhibitors block the invasive and metastatic activity of tumors, as well as inhibiting angiogenesis. It is believed that MMP inhibitors should also prevent or delay the resorption of cartilage and bone that occurs around arthritic joints. The first-generation MMP inhibitors, however, are rather non-selective inhibitors of all members of the MMP family; thus, there is great interest in exploring more specific inhibitors of, for example, fibroblast collagenase or stromelysin-1. Several recently published structures open up the prospect of designing such compounds by using CADD. Three studies (25) report human fibroblast collagenase structures, one of which contains a bound peptide inhibitor (26) and another autoinhibitory propeptide sequence (27). A structure of the catalytic domain of human neutrophil collagenase is also available (28). Browner et al. (29) have reported the structure of human matrilysin, the smallest known member of the MMP family. Of particular interest for drug design, this study compares structures complexed with three inhibitors, whose binding affinity covers a >100-fold range. The inhibitors are identical except for their zinc-chelating groups, which are hydroxamate (most potent), carboxylate, and sulfodiimine. The above studies provide information that should facilitate the design of novel chemotherapeutics that circumvent mechanisms of resistance to current agents. Finally, among other new structures of potential pharmaceutical interest is the binding domain of the thyroid hormone receptor complexed to its natural ligand, triiodothyronine (30). Niwas et al. (31) have published the fifth in a series of papers on structure-based design of purine nucleoside phosphorylase (PNP) inhibitors; in this instance, they describe the design of 9-deazahypoxanthines. Other PNP inhibitors from the same group are currently in clinical trials as immunosuppressive agents and anticancer agents. Verlinde and Hol (32) have recently reviewed methods used in structure-based drug design. The present discussion illustrates some recent developments with a few examples. Gehlhaar et al. (33) have described a de novo ligand designer that generates structures in an active site. The program, MCDNLG, starts by filling the active site with a close-packed array of carbon atoms. The use of in silico drug design has led to the discovery of indinavir, the HIV protease inhibitor (34), and the identification of haloperidol as a lead compound in a structure-based design study for nonpeptide inhibitors of HIV (35). Structure-based approach that has shown promise in recent years is to use computational methods to find putative binding proteins for a given compound from either genomic or protein databases, and to subsequently use experimental procedures to validate the computational result (36). One such computational approach, which is the reverse of docking a set of ligands into a given target, is to dock a compound with a known biological activity into the binding sites of all the three-dimensional (3D) structures in a given protein database. Protein ‘hits’ identified in this manner can then serve as potential candidates for experimental validation. Accordingly, this approach is referred to as reverse docking (or inverse docking) (37).
COMPUTATIONAL TOOLS USED IN CADD
The software that is available for computer-aided drug design and development originates from different sources. These include commercial companies, academic institutions, open-source software or in-house development. Each of these sources has its pros and cons, and the appropriate choice varies for institutions that use the software. These software packages also differ in terms of cost, functionality and efficacy (38), and automation (39).
VISUALIZATION
To view the optimized ligand or chemical compound and target molecule, over viewing tools are used.  They are Rasmol, VMD, Molscript, Raster 3D. Rasmol is a computer program written for molecular graphics visualization intended and used primarily for the depiction and exploration of biological macromolecule structures.

HOMOLOGY MODELING
Molecular modeling (40) is a science of representing molecular structures numerically and simulating their behaviors with the equations of quantum and classical physics. Most drug targets are proteins so it is important to know their 3D structures in detail. It estimated that the human body has five lacks to one million proteins, but the 3D structure is known for only a small fraction of these. Homology modeling is used to predict the 3D structure of proteins (41). Homology modeling is nothing but similarity searching for drug analogs. It starts with promising drug molecule. There are two computational tools for similarity searching and sequence alignment such as BLAST, FASTA and for multiple sequence alignments ClastalW ClastalX.
HOMOLOGY MODELING PROGRAMS
There are two Homology Modeling Programs. They are Swiss Model, Modeller
Swiss Model makes it quick and easy to submit a target sequence and get back an automatically generate a comparative model, provided an empirical structure with >30% sequence identity exist to use as a template. Modeller is used for homology or comparative modeling of protein 3D structure. The user provides an alignment of a sequence to be modeled with known related structures and modeler automatically calculates a model containing all non hydrogen atoms.
MOLECULAR DYNAMICS
Molecular dynamics (42), (43) is a study of movement of molecule. Every molecule has its own frequency of vibration. It can oscillate position one to two through zero, where the molecule has high potential energy at one and two position and least at zero position.
ENERGY MINIMIZATION
It is also called energy optimization or geometry optimization; it is used to compute the equilibrium configuration of molecules and solids. By this technique we can only obtain a final state of system that corresponds to minimum of potential energy. In Energy minimization one can obtain a molecule with least energy state i.e. zero energy state. In this state molecule get equilibrium configuration. Energy minimization tools are GAMESS Ghemical PS13 TINKER Ghemical (44) can be used or PS13 For quantum mechanical calculations. If proteins are used, a program such as PyMol can be used to identify ligand binding pockets, together with the DeepView PDB viewer to investigate the amino acid sequences of the protein. To transfer files between programs, Open Babel might be useful or even required to interconvert the file formats.
DOCKING
In the field of molecular modeling docking is a method which predicts the preferred orientation of one molecule to second, when bound to each other to form a stable complex. Docking represents ligand binding to its receptor or target protein. Docking is used to identify and optimize drug candidates by examine & modeling molecular interactions between ligand and target macromolecules. In the docking multiple ligand conformations and orientations are generated & the most appropriate ones are selected. There are several docking tools are presently available they are ArgusDock DOCK FRED eHITS AutoDock FTDock (45). Scoring methods are used to rank the affinity of ligands to bind to the active site of a receptor (46). In virtual high throughput screening compounds are docked into an active site and then scored to determine which once morelikely to bind tightly to the target macromolecule.
QSAR DESCRIPTORS
A descriptor is a molecular property that QSAR can calculate. QSAR provides a wide variety of descriptors that you can use in determining new QSAR relationships. There is a limited number of datasets and little information regarding the training and validation used by previous researchers. Tetko et al. (47) suggested the use of SMILES or .sdf files on a website to promote the calculation of additional parameters by other drug discovery scientists. The self-organizing molecular field analysis (SoMFA) test set, which represents the steroid set used to construct the first comparative molecular field analysis (CoMFA), can be downloaded from the Richards group’s web site. This information facilitates a more-rapid evaluation of the SoMFA program.
CONCLUTION
The technological progress of CADD brought a paradigm change to both pharmas and research institutions: it was now possible to obtain appropriate hits within several weeks because of the contribution of CADD. Computational technologies have been entering into the functional genomics studies and target identification in particular. After the completion of the human genome and numerous pathogen genomes, efforts are underway to understand the role of gene products in biological pathways and human diseases and to exploit their functions for the sake of discovering new drug targets. Small and cell-permeable chemical ligands are used increasingly in genomic approaches to understand the global functions of genomes and proteomes. This approach is referred to as chemical biology. As such, reverse docking can be referred to as computational chemical biology, which has been proven to be an effective way in finding clues of new targets. On the contrary, the CADD techniques like virtual screening and library design can also be used to design small molecule probes for illuminating the molecular mechanisms underlying biological processes through altering or perturbing the functions of target proteins by inhibiting or activating their normal functions
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Wednesday, September 7, 2011

Invest in your personality

While corporate training is useful for developing technical skills and certain soft skills required at work, the best way to groom your personality is to invest in the self.

In his book The Power to Transform, Chris Majer acknowledges and addresses the thin line between reacting to life and shaping your own life. Through a series of easy-to-do exercises, the author leads you to a transform you. And who is at the centre of the change process? It's you. Anyone who works on personal grooming would know that the person is the central agent in how his/her personality shapes up.

In today's demanding workplace, the individual must take the lead and invest time and effort in his own personality. Not only will this better prepare him better to face stressful times but also to become resilient in any situation. The international workplace works on the principle of survival of the fittest. The term ‘fit' encapsulates both the necessary technical skills and the right personality and attitude. Raja Chidambaram, leadership and change enabler, discusses the key personality traits, "Every person must invest in communication skills and learning about the company's communication style and models enables one to avoid embarrassing situations. The other important personality dimensions are striking a balance between aggression and sensitivity, maintaining confidentiality wherever required and making result-oriented efforts. The boundary between personal and professional life should not get blurred. Respect the other person's after work hours and do not intrude in their personal lives. Time management is also another critical aspect."
Once you have defined the focus of your self-training regime, you must have a clear starting point and self discipline to make the most of it. Nav kishlay, professional trainer, advises, "Start with the most critical personality aspect - decision making. Identify which of the five senses is most active for you? Just like the rainbow has seven colours but you can get new colours on mixing, similarly you can get new results from using your five senses differently. There are various approaches to achieving the final result and personality development is about discovering the approach that works for you. There is, of course, no guarantee of success but one has to be open to risk taking. You must take time off to visualize your goals. Ask yourself questions like where you want to be in the next ten years and then work on your strengths. Don't ask why this is happening to me. One gains nothing from cribbing. While it is important to not repeat your mistakes, you must not negate yourself the possibility of success by being afraid of failure."
Self improvement is a process of discovering your strengths and weaknesses so as to constantly assess your own capabilitie. To work on your personality, use the right resources – reading material, audio books, taking help from guides and mentors or simply by introspecting. Once your journey inwards begins, success in the outside world will already be yours.

Tips for personality development
Join a community group or a training and development course in your area, where you can meet self motivated individuals and learn from their experiences.
Use the internet to access articles and free reading material on personality development.
Use online tests to find out what defined your personality. Are you an achiever, a romantic, an action oriented person or a thinker? Find out now!
Use online forums where you can follow personal development coaches and trainers. Try the virtual chat route to get all your queries answered.

- - Unnati Narang

Pay, not the first priority anymore?

 Pic: MonkeyBusiness/IndiaPicture

Would you nix a high-paying job offer if it fails to assure career growth opportunities? According to a recent survey, the modern-day job-seeker is doing just that.
India Inc today is a fragment of an ever-changing corporate scenario and as its dynamics evolve, employees and job-seekers find their aspirations and incentives shifting. Mercer's ‘What's Working' survey validates that out of 13 possible reward elements, Indian respondents say that career advancement is their most important reward element. Base pay is the second-most important followed by training opportunities. Aleem Merchant, director, Synapse Marketing Consultancy Pvt Ltd says, "Reward points in today's scenario get far more complicated than the good old days, where you would have a son coming home to his parents with a box of sweets, proclaiming his salary hike, followed by the entire family breaking into a song and dance of how their lives have changed for good. Today's youth demands are more focussed, planned and diverse. A macro point of view for reward schemes seems quite simple and can be generalised, but as you look closer, rewards need to be personalised and customised to suit needs and desires."
For the job-seeker, below are the thirteen top parameters against which they base their decision to work with a certain employer, as per Mercer's ‘What's Working' survey:
Career advancement
Base pay
Training opportunities
Type of work
Working for a respectable organisation
Bonus or other incentives
Retirement savings plan
Flexible work schedule
Good medical insurance coverage
Wellness programmes
Paid time-off
Tuition reimbursement
Longer term leave
So, what is it that makes career advancement the most sought-after reward element? Nishchae Suri, MD, Mercer explains, "In a hyper-growth environment, ‘growth' is the mantra for business success. For an employee, their organisation or manager working with them on a career development plan is imperative to their personal and professional growth. From an organisation's perspective, career advancement is important for retention as also for attracting talented employees to the workplace. It increases employee engagement levels as well."
Brian Almeida, MD, Direxions Global Solutions Pvt Ltd says, "Career advancement is one way in which employees believe that they can stay relevant. It ensures that employees can keep up with the changes. The age at which one becomes obsolete and redundant is decreasing. Hence, rather than chasing basic pay, employees understand the need to be relevant and have a ‘career'."
After career advancement and base pay, the third most sought-after career incentive was training opportunities, thus revealing that India Inc employees don't just aspire to accomplish a good career, but also want to get better at what they do. "Training is very important. We are in a talent market, which is competitive, and for organisations to meet their growing talent needs, they would need to grow talent internally. Also, there is an increasing change in the type of knowledge and skills employees require, so as to perform their job well in today's dynamic business environment.
Consequently, whether the bait for climbing up the corporate ladder is training opportunities, career advancement incentives or basic pay, one cannot refute the fact that India Inc today is more motivated than ever to be on top of their game.

- - Arshie Chevalwala and Lynn Lobo

The corporate rhythm

Today, music is emerging as a new tool to foster employee bonding and team spirit.
 Pic: MonkeyBusiness/IndiaPicture
It is a well-acknowledged fact that music knows no boundaries and influences several facets of our lives. Now, India Inc is unleashing the power of music to bring their employees together. Experts say that using music as a medium to encourage team work is gaining wider acceptance in the corporate world. Melissa Thompson, GM, MusoMagic, a firm that conducts employee training programmes through music, explains the power of music as a bonding tool. "When a group works together to create music - something out of nothing – something that they can be proud of, and that they can showcase with joy and passion - the bond that is shared from such an experience is unique. The moment they hear their song – whether it's their ringtone when the phone rings, or when playing the song and video for family and friends – the memories of the experience had when creating that song are immediately evoked when those first notes are heard," adds Thompson. 
How does this power of music help in employee bonding? "Music, as a medium, holds universal appeal and acceptance. And when it comes to fostering relationships at work, even if the group is diverse, music serves to bridge the gap, thus allowing people to connect in a fundamental manner," says Vijay Sinha, senior vice president, marketing, product development & agency Sales Training, Tata-AIG Life Insurance Company Ltd.
Experts say that, music as a tool, for team-building stands apart from several other team-building initiatives. "It is different in every aspect," says Adam Davis, partner, PwC Australia. "It is about building something as a team, something that we could be proud of and look back on, as well as help us continue to build a strong team. It is not about individuals being best at something, although we could discover some hidden talents within our team," adds Davis. "Music is interactive, inclusive and motivating. The engaging experience of creating a property will live on the minds of employees. Each of them will always have the pride of ownership, for each one would have contributed in some way or the other in making a historic company song," feels Sinha.
Music cuts across hierarchies, positions,  ages and genders. Music excites, energises and makes people happy, all at the same time. "The prime motive of any team-building exercise is to infuse some kind of energy among employees that they have never experienced before. Music does just that. It is the most exciting and powerful medium that infuses a lot of positive energy among people and also relaxes them at the same time and thus, increases their productivity," concludes Uma Subramanian, regional manager in Mumbai, MusoMagic.

- - Priya C Nair

The writer can be conatcted at priyac.nair@timesgroup.com

13 traits of a good leader


 Pic: Picture India/IndiaPicture

Generating trust amongst employees is one of the most important qualities that a leader must possess. Trust forms the foundation for effective communication, employee retention, and employee motivation. When trust exists in an organization or in a relationship, almost everything else is easier and more comfortable to achieve. So, can you build trust when it does not exist? How do you maintain and build upon the trust you may currently have in your workplace? Let me put across the 13 behaviors that help in developing and maintaining trust amongst employees.
TALK STRAIGHT: Be clear and concise in your communication. There should be transparency and clarity in what you speak. Be honest and demonstrate integrity.
DEMONSTRATE RESPECT: Genuinely care and respect everyone and make sure you express it correctly. Be nice to employees who don't belong to your team as well. Be kind and empathetic towards your employee's issues and grievances.
CREATE TRANSPARENCY: Be Open and authentic. Don't hide information or have hidden agendas from employees. After all, everyone in your team is working towards a common goal. Always operate on the premise of "what you see is what you get"
RIGHT WRONGS: If there has been an error from your end, apologies quickly. If possible, be ready to provide compensation. Do not cover things up and own up for your mistake. Always demonstrate personal humility. Make sure you always do the right thing and not what is convenient.
SHOW LOYALTY: Most often ignored, but you must always give credit to hard working employees. You must also be the voice of those who cannot speak for themselves. Avoid speaking negatively about your employees behind the backs. Address problems and issues face to face and provide favorable solutions.
DELIVER RESULTS: Make sure you have a track record of results. Accomplish the task you are hired for. Never overpromise and under deliver. Avoid making excuses for not delivering.
GET BETTER: Always make an effort to learn and improve. Do not be over confident about your skills and knowledge. Develop a formal and informal feedback system. Thank people for feedback but make sure you act upon the feedback you receive.
CONFRONT REALITY: Do not have unrealistic goals and expectations. Always meet issues as they are. Address tough situations directly. Always acknowledge what is the unsaid and lead conversation courageously.
CLARIFY EXPECTATIONS: Be clear while disclosing and revealing expectations from employees. Make sure you discuss and validate your expectations from them. If there is a difference of thinking, renegotiate with them. Always make sure that the expectations are clear.
PRACTICE ACCOUNTABILITY: Always hold yourself and others accountable and responsible for their respective tasks. Take responsibility for results, be it good or bad. Communicate with your employees about how they fare in their tasks.
LISTEN FIRST: Don't make any assumptions. Listen to your employees before speaking. Don't just listen with ears but also keep your eyes and heart open. Understand the employee's situation, and then diagnose a solution.
KEEP COMMITMENTS: Make sure you commit carefully. Always state your intent while committing. Make keeping your commitments the symbol of your honour. Don't break an employee's confidence in you.
EXTEND TRUST: The last and the most important point, extend trust abundantly to those who have made an effort to earn your trust. Also extend trust conditionally to those who are in the process of earning your trust. Don't withhold your trust in employees even if it involves risk.
Trust is built and maintained by many small actions over time. So fundamentally, trust is the cornerstone, the foundation, for everything you'd like your organisation to be now and for everything you'd like it to become in the future. Lay this groundwork well.

- - Rajan Kaicker is the executive chairman and managing director of FranklinCovey SouthAsia and RCS SouthAsia.

Wednesday, August 31, 2011

ANCIENT CHINESE GENDER CHART - GIRL OR BOY

THOUGH, FOLLOWING CHART DOES NOT HAVE ANY SCIENTIFIC PROOF, BUT ITS WORKING....................



Monday, August 29, 2011

Prebiotics and its Role in Therapy


About Author: Mr. Rupajit Bhattacharjee, M.Pharm

What are Prebiotics?
Prebiotics are components present in foods, or that can be incorporated into foods, which yield health benefits related to their interactions with the gastrointestinal tract (GIT).
Prebiotics can be defined as “nondigestible food ingredients that beneficially affect the host by selectively stimulating the growth of one or a limited number of bacterial species in the colon, such as Bifidobacteria and Lactobacilli, which have the potential to improve host health.” Prebiotics are, simply speaking, the “food” for beneficial bacteria.


Prebiotics and their Sources
The prebiotics are generally found in foods we eat. It can also be incorporated into foods. The Table 1 shows the components of prebiotics and Table 2 shows the prebiotics incorporated into foods.

Table 1: Components of prebiotics with their sources:

Component
Source
Potential  Benefit
Prebiotics from foods:- Inulin, Fructo-oligosaccharides (FOS), Polydextrose, Arabinogalactan, Polyols—lactulose, lactitol, Xylo-oligosaccharides, Transgalacto-oligosaccharides, etc.
Whole grains, onions, bananas, garlic, honey, leeks, artichokes, fortified foods and beverages, dietary supplements and other food applications
 Improve gastrointestinal health; improve calcium absorption

Table 2:  Prebiotics incorporated into foods:

Food Products
Source
Potential         Benefit
1. Nutren Fibre® [powd]
2. Bioplus prebiotic cap/chewable tab.
3. Sun Fiber (powd)
1.Nestle
2.Kendy Nutraceuticals, USA
3.Taiyo Lucid Pvt. Ltd.(TLPL)/ Japan
1. Diarrhea & constipation, malnutrition, lactose intolerance.
2. Improve GIT function, modulation of gut microflora.
3. Boost immune system

Mechanism of action:  Prebiotics acts by following mechanisms:
1. Increases the amount of lactic acid producing bacteria e.g. Inulin & Oligofructose.
2. Increases the amount of Short Chain Fatty Acids (SCFAs).
3. Activates carbohydrate receptor immune cells.
4. Increase absorption of vitamins and minerals (calcium & magnesium).


Health Benefits of Prebiotics
1. Improve bowel function, 2. Increase stool frequency, 3. Increase stool weight, 4. Increase production of short-chain fatty acids, 5. Promote the growth of the health promoting bacteria Lactobacilli and Bifidobacteria, 6. Restore gut microflora during or after antibiotic therapy, 7. Inulin can reduce insulin concentrations and lowered triglyceride levels.

Indications
1. Therapeutically useful in Irritable Bowel Syndrome (IBS) and colorectal diseases.
2. Prevention of Antibiotic Associated Diarrhea and the treatment of Clostridium difficile Disease.

Contraindications
Prebiotics like Lactulose is contraindicated in those who require low galactose diet.

Potential Adverse Effects of Prebiotics
GI Disturbances:  Constipation/ Abdominal pain/ Flatulence/ Bloating

Conclusion
The primary role of a diet is not only to provide enough nutrients to fulfill metabolic requirements of the body but also to modulate various functions of the body. The prebiotics facilitate the growth of the beneficial gut microflora, which can be suitably harnessed by the food manufacturers and hold considerable promise for health care industry.

SORRY GUYS

HOPE YOU ARE ALL WELL.........EVERYTHING IS JUST FINE...........

LAST TWO WEEKS WAS HECTIC FOR ME.............NO WAY TO POST ANY NEW ARTICLE.................PREPARING PPTS FOR NEW TRAINING PROGRAMME, DESIGNING VISUAL-AID FOR COMING CYCLES & SALE REVIEWS ETC...........

NOW ONWARDS I WILL POST TWICE IN A WEEK............ONE IS ON WEDNESDAY ANOTHER IS ON SATURDAY.......

BUT TODAY I WILL POST ONE ARTICLE

Thursday, August 18, 2011



Cigarette smoking implicated in half of bladder cancers in women

NIH study confirms bladder cancer risk from smoking is higher than previously estimated

Current cigarette smokers have a higher risk of bladder cancer than previously reported, and the risk in women is now comparable to that in men, according to a study by scientists from the National Cancer Institute (NCI), part of the National Institutes of Health. The report was published on Aug. 16, 2011, in the Journal of the American Medical Association.
This latest study uses data from over 450,000 participants in the NIH-AARP Diet and Health Study, a questionnaire-based study that was initiated in 1995, with follow-up through the end of 2006.
While previous studies showed that only 20 to 30 percent of bladder cancer cases in women were caused by smoking, these new data indicate that smoking is responsible for about half of female bladder cancer cases – similar to the proportion found in men in current and previous studies.  The increase in the proportion of smoking-attributable bladder cancer cases among women may be a result of the increased prevalence of smoking by women, so that men and women are about equally likely to smoke, as observed in the current study and in the U.S. population overall, according to surveillance by the CDC. The majority of the earlier studies were conducted at time periods or in geographic regions where smoking was much less common among women. 
The researchers found that the amount of risk brought on by smoking, called excess risk, was higher in this study than in previously reported. “Current smokers in our study had a fourfold excess risk of developing bladder cancer, compared to a threefold excess risk in previous studies. The stronger association between smoking and bladder cancer is possibly due to changes in cigarette composition or smoking habits over the years,” said study author Neal Freedman, Ph.D., in NCI’s Division of Cancer Epidemiology and Genetics (DCEG). “Incidence rates of bladder cancer in the United States have been relatively stable over the past 30 years, despite the fact that smoking rates have decreased overall. The higher risk, as compared to studies reported in the mid-to-late 1990s, may explain why bladder cancer rates haven’t declined.”
Although there have been reductions in the concentrations of tar and nicotine in cigarette smoke, there have been apparent increases in the concentrations of certain carcinogens associated with bladder cancer. A 2009 NCI/DCEG study was the first to suggest a higher risk for smoking-induced bladder cancer than previously reported.  That report, based on data from the New England Bladder Cancer Study, found that the association between cigarette smoking and risk of bladder cancer appeared to be stronger than it was in the mid-1990s. The results of the new study confirm the 2009 report.
In the current study, former smokers were twice as likely to develop bladder cancer as never smokers, and current smokers were four times more likely than those who never smoked. As with many other smoking-related cancers, smoking cessation was associated with reduced bladder cancer risk. Participants who had been smoke-free for at least 10 years had a lower incidence of bladder cancer compared to those who quit for shorter periods of time or who still smoked.
“Our findings provide additional evidence of the importance of preventing smoking initiation and promoting cessation for both men and women,” said senior author Christian Abnet, Ph.D., also from DCEG. “Although the prevalence of cigarette smoking has declined, about 20 percent of the U.S. adult population continues to smoke.”
Even though smoking carries the same risk for men and women, men are still about four times more likely to be diagnosed with bladder cancer.  These results, as well as those from previous studies, suggest that difference in smoking rates explain only part of the higher incidence rates in American men.  The researchers suggest that occupational exposures, as well as physiologic differences, may contribute to the gender disparity.
In 2011, approximately 69,250 people will be diagnosed with bladder cancer in the United States, and 14,990 will die from the disease.
For more information about NCI’s Division of Cancer Epidemiology and Genetics, please visit: http://dceg.cancer.gov.
For more information about smoking cessation, and resources for those who want to quit, please visit: http://smokefree.gov or call 1-800-QUIT-NOW.
NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Reference:
Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, and Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA. Online August 16, 2011.

The Fattier Your Heart, the Greater Your Heart Disease Risk


Study links buildup of this hidden fat to heart threat, even in people without symptoms
HealthDay news image
The amount of hidden fat that collects around the heart may be a stronger indicator of cardiac disease risk than a bulging waistline or flabby thighs, a new study reports.
Heart fat hidden behind the rib cage -- known as pericardial fat -- appears to promote irregular plaque build-up along coronary artery walls that causes atherosclerosis and can trigger heart attacks, the leading cause of death in the United States, according to the study.
"It turns out there are specific areas around the heart where hidden fat seems to be promoting coronary disease, even in people without symptoms," said senior study author Dr. David Bluemke, director of radiology and imaging sciences at the National Institutes of Health Clinical Care.
"This is chest fat you'd never see by looking at someone," he added.
Pericardial fat is linked to being overweight or obese, according to the study in the Aug. 16 online edition of the journal Radiology.
The findings are from the ongoing Multi-Ethnic Study of Atherosclerosis (MESA), a study of 6,800 participants aged 45 to 84 from six communities around the country who had no heart disease at enrollment. In this study, researchers looked at a smaller slice of the volunteers: 89 women and 94 men with an average age of 61 who, although most were overweight, were representative of the general population.
To look for signs of heart disease, the research team used noninvasive MRI to screen for plaque on the walls of the coronary artery and compared it with CT scans of heart fat volume. The NIH-sponsored study highlighted three main findings:
  • In people with no symptoms of coronary artery disease, the fat volume of the membrane around the heart is closely associated with the heart artery-clogging plaque found on the MRIs.
  • This pericardial fat appears to be more strongly related to coronary artery plaque buildup than is body mass index (a measure of obesity) or waist circumference.
  • Examining coronary artery walls through MRIs and CT heart fat scans may be useful in assessing the risk of heart disease.
High-risk patients with chest pain and known coronary risk factors such as obesity should have a traditional angiogram or advanced diagnostic procedures, said Bluemke. "However, low or intermediate risk patients may eventually benefit from understanding that fat deposits around the heart increase their risk of coronary disease," he said.
And while MRI was used as the "gold standard" for NIH research on fat distribution and the dangers of obesity, the expensive procedure isn't necessary in typical patient screening for cardiac risk, Bluemke added.
Bluemke said CT scans are one of the fastest growing medical procedures in the country and may increasingly be used to evaluate coronary artery disease. Scanning often provides data on calcium in the heart vessel, and can calculate a 'fat score' index for tissues around the heart as a best practice procedure that could save lives, he said.
"Two-thirds of the population is overweight or obese and at risk of coronary artery disease and plaque buildup," said Bluemke, noting that extra fat forms "preferentially" in vulnerable areas of the heart of typical overweight patients. "This research says we should be telling doctors about the amount of fat in a patient's chest that shows up on a CT scan, but cannot be seen from outside the body and was previously ignored."
The U.S. Centers for Disease Control and Prevention has declared obesity a national epidemic and a major contributor to the leading causes of death in the United States, including heart disease. Slightly more than one adult in three is obese, and one child in six is obese, the CDC reports.
Dr. Gregg Fonarow, professor of cardiology at UCLA, agrees that CT scans may eventually help doctors determine who is most vulnerable to cardiovascular disease. However, he cautions patients not to rush out for expensive and unnecessary scans or MRI screenings just to find hidden heart fat that might be temporary or not pose a long-term problem.
"The research is really to generate new knowledge and information, not to be a risk predictor or screening tool for the general population," said Fonarow.
An interesting finding is the volume of fat around the heart being positively related to the plaque burden in asymptomatic men and women, most of whom need to shed a few pounds, Fonarow said: "This shows a new reason why overweight people have a higher rate of cardiovascular risk and gives the public another reason to maintain a healthy and active lifestyle."
SOURCES: David A. Bluemke, M.D., Ph.D., director, radiology and imaging sciences, U.S. National Institutes of Health, Bethesda, Md.; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Aug. 16, 2011, Radiology, online

Weight-Loss Surgery Gains More Practitioners

Study also documents growth in less-invasive techniques, improved survival rates
By Mary Elizabeth Dallas


HealthDay news image
More doctors are performing weight-loss surgery today, and hospitals are touting better survival rates, a new study finds.
Researchers analyzing trends in bariatric surgery said increased use of less-invasive laparoscopic surgical techniques, such as adjustable gastric banding, has led to a greater acceptance of bariatric surgery by morbidly obese patients.
"We've identified a national trend in the use of bariatric surgery that is tied to the rapid expansion of the laparoscopic approach to bariatric surgery and the laparoscopic adjustable gastric banding operation," said Dr. Ninh T. Nguyen, chief surgeon for the division of gastrointestinal surgery at University of California, Irvine Healthcare, and lead author of a study published in the August issue of the Journal of the American College of Surgeons.
Gastric banding involves placing a band around the top of the stomach, effectively reducing the size of the stomach and making patients feel full after eating less.
Like all surgeries, bariatric surgery carries some risks, including serious infections, internal bleeding, blood clots, and death, according to the American Society for Metabolic & Bariatric Surgery (ASMBA).
In addition, a recent Belgian study following gastric banding patients over a 12-year period found that 40 percent had suffered major complications as a result of the surgery, while about half had to have their bands removed.
However, the study authors believe that the benefits of the surgery outweigh the potential risks.
"Many reports we looked at documented the long-term survival and metabolic benefits of bariatric surgery, and these benefits are having an impact on patients' willingness to accept bariatric surgery as an option for the treatment of morbid obesity," Nguyen continued in a journal news release.
For the study, researchers analyzed data on weight-loss surgeries from the Nationwide Inpatient Sample from 2003 to 2008. The proportion of laparoscopic weight-loss procedures jumped from about 20 percent at the start of the study period to more than 90 percent by 2008.
The in-hospital mortality rate related to these procedures fell from 0.21 percent to 0.10 percent during that time, and membership in the American Society for Metabolic and Bariatric Surgery surged 95 percent -- from 931 to 1,819.
Overall, the number of bariatric operations peaked in 2004 with 135,985 procedures performed, the study found. In 2008, just under 125,000 bariatric surgeries were undertaken.
SOURCE: Journal of the American College of Surgeons, news release, Aug. 8, 2011

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Glossary of Dental Terms


  • Amalgam:  Silver/mercury alloy used to fill cavities |More
  • Bleaching: Ccosmetic whitening of teeth using peroxide |More
  • Caries:       Cavities, tooth decay |More
  • Carcinogenic: Cancer-causing Cariogenic decay-causing 
  • Composites: Tooth-colored restorative materials |More
  • Cosmetic dentistry: Aesthetic improvement of the color and shape of teeth performed by a general dentist |More
  • Edentulous:  Eaving lost most or all of the natural teeth 
  •  Endodontist:  Treats oral conditions that arise as a result of disease or injury of the dental pulp of the tooth, such as a root canal
  • General dentist: Primary care provider for patients in all age groups who take responsibility for the diagnosis, treatment, management and overall coordination of services to meet patients' oral health needs |More
  • Geriatric dentist: General dentist who primarily treats senior citizens 
  • Gingivitis: Reversible inflammation of gum tissue not including the bone 
  • Malocclusion: Misalignment of teeth and or jaws 
  • Microair abrasion: A drill-free technique using an instrument resembling a tiny sand blaster that delivers tiny aluminum oxide particles to the surface, where they cut away the decayed area 
  •  Mouthguards: An appliance used to protect teeth from injury |More
  • Occlusal surface: The chewing surface of the tooth 
  • Oral and maxillofacial surgeon: Treats and surgically corrects diseases, injuries, and defects of the mouth and jaws 
  • Oral pathologist: Examines oral tissues for evidence of suspected abnormalities such as cancer. 
  • Orthodontics: A branch of dentistry dealing with irregularities of the teeth and their correction, as by means of braces and retainer |More
  • Orthodontist: Designs and applies corrective and supportive appliances, braces, to realign crooked teeth 
  •  Pediatric dentist: Provides treatment and care for children from birth through adolescence
  • Periodontal disease: Inflammation and irritation of the gums which, if left untreated, can cause the jawbone and teeth to deteriorate and fall out |More
  • Periodontist: Diagnoses and treats diseases of the tissues supporting and surrounding the teeth, especially periodontal disease 
  •  Plaque: Bacterial colonies which have mineralized and attack teeth, causing dental decay 
  • Porcelain veneers: Ultra-thin shells of ceramic material bonded to the front of the tooth |More
  • Prophylaxis: Professional cleaning of the teeth by a dentist or hygienist 
  • Prosthodontist: Constructs artificial appliances designed to restore and maintain oral function by replacing missing teeth and other oral structures such as dentures 
  •  Public health dentist: Concerned with the dental health needs of entire communities, and can design and administer large-scale prevention and dental care programs by compiling and analyzing statistics 
  • Radiosurgery surgery: Technique that uses radio waves to produce a pressureless, bloodless incision; can also be used to heat bleaching agents 
  •  Resin: Plastic material used in bonding, restorative, and replacement procedures 
  • Restorative dentistry: Process of restoring missing, damaged or diseased teeth to normal form and function, performed by general dentists 
  • Sealant: Plastic coating used to protect teeth from decay |More
  • Special patient: Person with a disability who requires particular dental care needs 
  •  Third molars: Wisdom teeth |More
  • TMD: Temporomandibular disorder; problems relating to your temporomandibular joint which include locking of the jaw, frequent headaches, sore jaw muscles, and painful clicking of the jaw |More
  • TMJ: Temporomandibular joint

Fighting Tooth Decay With ‘Sugar

Using Xylitol to Prevent and Control Cavities
If there's one thing that all dentists have in common, it's that they regularly see young patients with tooth decay. Roughly 42 percent of children ages 2 to 11 have had decay in their primary teeth, while approximately 32 percent of children ages 9 to 11 have decay in their permanent teeth. Although it's vital for all patients to brush and floss every day, children in particular can improve their oral health by adding xylitol to their daily oral hygiene routine, according to an article published in the July 2010 issue of AGD Impact, the monthly newsmagazine of the Academy of General Dentistry (AGD).
 
"Sugary foods and sticky candies can be difficult for children to resist, but they are a serious source of tooth decay, particularly when they get stuck in the crevices between teeth," says Scott Cayouette, DMD, FAGD, spokesperson for the AGD. "Additionally, many children consume large amounts of soft drinks and sports drinks, which are known to have a high acidic pH and sugar content—a recipe for disaster in terms of tooth decay." These dietary factors—combined with the possibility that children are drinking more unfluoridated tap or bottled water—might explain why the rates of tooth decay are rising.
 
However, Dr. Cayouette notes that xylitol gives dentists another weapon in the battle against tooth decay. "Xylitol provides a simple solution for tooth decay in children," he says. "It's a natural sugar that doesn't cause cavities and can actually help to prevent them."
 
Xylitol is a sugar alcohol found naturally in trees, fruits, and vegetables. It's also found naturally in the human liver, which is why it is safe for humans to consume. Unlike table sugar, which breaks down in the mouth and creates an acidic, cavity-promoting pH, xylitol does not break down and therefore does not create any harmful acids.
 
Xylitol can be found in an array of products—including candies, mints, lemonade mixes, all-purpose sweeteners, and certain brands of chewing gum—which can help patients fight cavities without forcing them to drastically change their daily oral hygiene regimen.
 
Research suggests that patients should consume between six and 10 grams, or three to five servings, of xylitol per day. "It's also important for patients to consume xylitol throughout the day and not all at once," Dr. Cayouette says. "The more often that xylitol interacts with the bacteria in your mouth, the better—that way, it's always fighting cavities."
 
While there is no quick fix for eliminating tooth decay, xylitol may offer a realistic way to counteract the problem, especially among the most vulnerable populations.
 
"Parents may wonder why a dentist would recommend that their young patients consume a sugar-like substance," says Dr. Cayouette, "but with more education, they will realize that xylitol is a natural product that can help to prevent cavities."
 
Although xylitol is safe for humans, it is important to note that there is one population—a furry one—that cannot tolerate the sweetener. An article published in the February 2010 issue of AGD Impact reports that, even in small amounts, xylitol can be deadly to dogs. For this reason, it's important to keep xylitol-containing products out of your canine's reach.
Updated: August 2010

Breast Cancer Drug Raises Risk of Heart Problems in Older Women: Study


Herceptin especially likely to raise the odds in patients with a history of heart disease or diabetes

By Robert Preidt

HealthDay news image

WEDNESDAY, Aug. 10 (HealthDay News) -- The breast cancer drug Herceptin increases the risk of heart problems in elderly patients, especially those with a history of heart disease and/or diabetes, a new study says.
Researchers analyzed the medical records of 45 women, ages 70 to 92, who were treated with Herceptin (trastuzumab) since 2005 and found that 12 (26.7 percent) of them developed heart problems caused by the drug.
That rate is slightly higher than what was noted in earlier clinical trials of younger, healthier women.
In this new study, 33 percent of the women with a history of heart disease developed either asymptomatic or symptomatic heart problems as a result of taking Herceptin, compared with 9.1 percent of women without a history of heart disease.
The researchers also found that about 33 percent of women with diabetes developed heart problems, compared with 6 percent of diabetes-free women.
When the women with heart problems stopped taking Herceptin, all but one recovered fully and five were able to re-start treatment with the drug.
The study appears in the journal Annals of Oncology.
"This is the first study specifically to assess trastuzumab-related cardiac toxicity and the cardiovascular factors that are associated with an increased risk in a selected population of elderly breast cancer patients," study author Dr. Cesar Serrano, who conducted the research while working as a clinical fellow at the Department of Medical Oncology Breast Cancer Centre at the Vall d'Hebron University Hospital in Barcelona, Spain, said in a journal news release.
"Trastuzumab is generally well-tolerated and, although there are some concerns about it causing heart problems, until now few risk factors have been identified among patients in clinical trials, most of whom are usually younger than 70 years and have good general health. Our study has demonstrated a significantly increased incidence of cardiac events among patients aged 70 and over with cardiovascular risk factors such as a history of cardiac disease and diabetes," said Serrano, who is now a postdoctoral research fellow at Brigham and Women's Hospital in Boston.
Serrano said the findings suggest that elderly women with one or more heart risk factors who are being treated with trastuzumab should be referred to a cardiologist. He also recommended closer monitoring of such patients for possible heart problems.