Treatment For Nausea

Treating Syphilis to Reduce Infant Mortality in Africa

Approximately 2.1 million pregnant women worldwide have an active syphilis infection. Without proper treatment, 69% of these pregnancies will result in either stillbirth or early death of the infant. With the discovery of penicillin in 1928, syphilis went from being a highly prevalent sexually transmitted disease to an easily treatable infection. However, in the Third World, syphilis remains a silent scourge, as pregnant women without economic means suffer adverse birth events as a result of this highly treatable disease.

According to the World Health Organization , syphilis is responsible for approximately 500 000 perinatal deaths each year in sub-Saharan Africa. Of the approximately 2 million pregnant women with an active syphilis infection, 1.2 million cases of syphilis are transmitted to unborn babies. The result of prenatal syphilis exposure may be stillbirth, premature birth, low birth weight or congenital malformation.

Syphilis is an infection caused by the bacterium treponema palladum . It is transmitted through sexual intercourse, blood transfusions, mother to fetus, and through direct contact with open, infected lesions. Syphilis has been called “the great impostor” because its symptoms mimic those of other infections. Typically patients present with a solitary lesion called a chancre, which may appear reddened and slightly painful, but will resolve without treatment in approximately four weeks. Left untreated, syphilis progresses to a secondary infection with more widespread symptoms including body rash, fever, malaise,, body aches, nausea and neck stiffness. Treatment of both primary and secondary syphilis infection consists of a single injection of penicillin, injected intramuscularly. In North America, pregnant women are routinely screened for syphilis, so mother to fetus transmission of this infection is relatively uncommon.

In a recent article published in the medical journal The Lancet , European medical researchers did a meta-analysis of studies which examined the role of prenatal care, syphilis testing, and syphilis treatment on women in Africa. It was found that these interventions could reduce the rate of infant mortality by approximately 50%. It is worth noting that syphilis testing and antibiotic treatment of the infection is extremely inexpensive, costing only a few dollars. With a relatively modest investment in testing, treatment and education of pregnant women with respect to syphilis infection, the result would be a major reduction in infant mortality in Africa.

Study Show Better Treatment Options Needed: Chemo-Induced Nausea ...

“Our study, unfortunately, shows that chemotherapy-related nausea remains a big problem,” said Joseph Roscoe, Ph.D., a research associate professor at the James P. Wilmot Cancer Center at the University of Rochester Medical Center. “Many new drugs have emerged in the last 20 years and they are effective at controlling vomiting, but not equally as effective at controlling nausea.” Roscoe presented the data today at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago. The study included 1,021 patients from 15 private-practice oncology groups across the United States, who enrolled in the trial between May 2007 and September 2009. The volunteers were randomly assigned to four different nausea treatment groups, with 944 people providing data that was evaluated at end of the study period. A couple of significant differences emerged in the latest study, however. First, the addition of a potent steroid – dexamethasone – seemed to enhance control of delayed nausea, a condition that occurs in the days after chemotherapy treatment, Roscoe said. This conclusion confirmed previous research and current antiemetic guidelines for physicians. Second, researchers learned that the newer generation of drugs is not much better than the old warhorse medications at controlling nausea, and the older drugs are less costly, Roscoe said. The drug regimen that seemed to control vomiting better than the others involved giving a patient three drugs initially: aprepitant ( Emend ®, Merck & Co), palonosetron ( Aloxi ®, Helsinn Healthcare SA/Eisai Inc) and the steroid, and then following up with aprepitant and dexamethasone (Decadron®, Merck & Co/DexPak®) on the second and third days after receiving chemotherapy. Since 1996 the URMC-based CCOP group has investigated many aspects of nausea and contributed several significant findings to the practice of oncology. Previous studies, for example, showed that when patients expect to get nauseous, they often experience worse nausea than people who do not expect it. The expectation is usually associated with a person’s prior experiences, such as a tendency to get motion sickness, or to become nauseous when pregnant. Other URMC/Wilmot studies have shown that cancer patients who wore acupressure wristbands had much less nausea while receiving radiation treatment, making the bands a safe, low-cost addition to anti-nausea medication.

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