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Bioterrorism: The inevitable future?

Interview with Donald Henderson.

PPP: The Key to Defence Against Bioterrorsim.

In the present scenario, cancer is found to be one of the distressing diseases that accounts for huge number of deaths all around the world. Till now, several conventional treatments like radiation therapy, chemotherapy and immunotherapy were available but due to certain restrictions like scarcity of specificity, cytotoxicity and multi-drug resistance which were the major issues that pose the hurdle in successful cancer treatment. Owing the presence of toxicity and resistance to immunity with traditional treatment procedures, some effective technology like nanotechnology is being used to efficiently treat the cancer and reduce the chances of risk. In the past, nanotechnology-based immunotherapeutic agents have been employed to treat cancerous cells by separating normal cells from the target site. With this special feature, nanotechnology might be the ray of hope for rapid, cheap and secured technique for the identification and treatment of cancer cells and cancer biomarkers. This technique involves certain nanomaterials like carbon nanotubes, liposomes and polymeric micelles that help in the formulation of cancer drugs that have been found to have a significant pharmacokinetic and pharmacodynamic application in the diagnosis and prophylaxis of cancer. In this review, our prime focus is on the utility of nanoparticles (NPs) in cancer diagnosis and prophylaxis. Apart from this, we also discuss about the challenges that hamper the utility of NPs and also give suitable remedial approaches for the same.

The association between cancer and venous thromboembolism (VTE) has been known for over 150 years. Although the actual prevalence of cancer induced VTE is unclear, due largely to the frequent coexistence of cancer with other risk factors for VTE, including advanced age, immobilisation, surgery and chemotherapy. VTE is a common and life-threatening complication of and the second leading cause of morbidity and mortality amongst patients with cancer. Appropriate prophylactic practice for both surgical and non-surgical patients can significantly reduce this morbidity and mortality amongst patients with cancer.

Specific guidelines for the prevention and treatment of VTE in patients with cancer have been published by a number of expert groups and include the following recommendations:

(1) All hospitalised cancer patients should receive VTE prophylaxis with anticoagulant therapy in the absence of bleeding or other specific contraindications.

(2) Routine prophylaxis of ambulatory cancer patients with anticoagulants is not recommended, with the exception of patients receiving thalidomide or lenolidomide.

(3) Patients undergoing a surgical procedure of greater than 30 minutes anaesthetic time should be considered for preoperative anticoagulant prophylaxis, which continues for seven to ten days post-operatively or, for high risk patients, up to four weeks post-operatively.

(4) Specific prophylaxis to prevent VTE in patients with indwelling venous catheters is not recommended.

(5) Low molecular weight heparins (LMWH) are the preferred agent for both the initial and continuing treatment of cancer patients with established VTE. Recommended treatment duration for VTE is six months, or indefinite if active cancer or other risk factors persist.

(6) The impact of anticoagulants on cancer patient survival requires additional study and cannot be recommended at present.

Immunosuppression associated with the use of chemotherapy for both solid tumours and haematological malignancies has been linked to the reactivation of hepatitis B in those with serological evidence of past or present hepatitis B infection. Reactivations may be unanticipated, unidentified or untreated, and can lead to fulminant liver failure and death. Hepatitis B flares may also interrupt chemotherapeutic regimens, thereby potentially increasing the risk of cancer-related morbidity and mortality.

Chronic hepatitis B is endemic worldwide, and in Australia its prevalence is rising, in part related to changing trends in migration. Clinicians caring for people with malignancy need to be aware of the potential for hepatitis B reactivation as a complication of chemotherapy in susceptible individuals. Thus, individuals at risk for chronic hepatitis B must be screened serologically for the virus before chemotherapy or immunosuppression is contemplated and prophylactic therapy with lamivudine or another nucleos(t)ide analogue, instituted. This chapter reviews hepatitis B prevalence, immunology, virology and the risk of reactivation in patients receiving chemotherapy. Recommendations regarding monitoring and prophylaxis are outlined. Other chronic hepatitis viral infections in the setting of chemotherapy are briefly discussed.