All water pills not equally effective against heart failure

Apr. 1, 2013 ? Loop diuretics, more commonly known as water pills, are the most widely prescribed heart failure medications, but few studies had extensively compared their effectiveness until Yale School of Medicine researchers examined three approved loop diuretics and found that even though one of them might offer more benefit, it is rarely prescribed.

Published in the April 1 early edition of the Journal of the American College of Cardiology, the research compared the potential benefits of using one of three loop diuretics: toresemide, furosemide, and bumetanide.

"Loop diuretics are a cornerstone of heart failure treatment, so it is vital to understand the comparative effectiveness and real-world use of the drugs within this class," said lead author Dr. Behnood Bikdeli, postdoctoral associate in cardiovascular medicine at the Yale Center for Outcomes Research and Evaluation (CORE).

With over 5 million Americans suffering from heart failure, Bikdeli said that improving existing treatment options is key to providing the best care.

The team found that among 274,515 hospitalizations for heart failure during 2009 and 2010 across a large group of U.S. hospitals, 92% received loop diuretics during their hospital stay. Of those, 87% received furosemide as their only loop diuretic, 3% received bumetanide, and only 0.4% received torsemide, while 10% received a combination of these agents.

Although torsemide is slightly more expensive, the few available studies suggest that it lasts longer, is better tolerated, and might be associated with better clinical outcomes compared with the two other available water pills.

"There appears to be potential benefits from using torsemide compared with furosemide, but it is rarely used in practice," said Bikdeli. "Furosemide is the dominantly used loop diuretic in practice; however, if the potential advantages of torsemide over furosemide are proven in subsequent comparative effectiveness studies, this drug might become the preferred treatment of chronic heart failure."

Other authors on the study include Kelly Strait, Kumar Dharmarajan, Chohreh Partovian, Steven Coca, Nancy Kim, Shu-Xia Li, Jeffrey Testani, Usman Khan, and Harlan Krumholz.

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Story Source:

The above story is reprinted from materials provided by Yale University. The original article was written by Karen N. Peart.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. Behnood Bikdeli, Kelly M. Strait, Kumar Dharmarajan, Chohreh Partovian, Steven G. Coca, Nancy Kim, Shu-Xia Li, Jeffrey M. Testani, Usman Khan, Harlan M. Krumholz. Dominance of Furosemide for Loop Diuretic Therapy in Heart Failure. Journal of the American College of Cardiology, 2013; 61 (14): 1549 DOI: 10.1016/j.jacc.2012.12.043

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/XEFp3w63zFg/130401161426.htm

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Indian court rules against drug maker's 'new' patent

NEW DELHI (AP) ? India's Supreme Court on Monday rejected drug maker Novartis AG's attempt to patent an updated version of a cancer drug in a landmark decision that health activists say ensures poor patients around the world will get continued access to cheap versions of lifesaving medicines.

Novartis had argued that it needed a patent to protect its investment in the cancer drug Glivec, while activists said the drug did not merit intellectual property protection in India because it was not a new medicine. In response to the ruling, Novartis said it would not invest in drug research in India.

The court's decision has global significance since India's $26 billion generic drug industry, which supplies much of the cheap medicine used in the developing world, could be stunted if Indian law allowed global drug companies to extend the lifespan of patents by making minor changes to medicines.

Once a drug's patent expires, generic manufacturers can legally produce it. They are able to make drugs at a fraction of the original manufacturer's cost because they don't carry out the expensive research and development.

Pratibha Singh, a lawyer for the Indian generic drug manufacturer Cipla, which makes a version of Glivec for less than a tenth of the original drug's selling price, said the court ruled that a patent could only be given to a new drug, and not to those which are only slightly different from the original.

"Patents will be given only for genuine inventions, and repetitive patents will not be given for minor tweaks to an existing drug," Singh told reporters outside the court.

Novartis called the ruling a "setback for patients," and said patent protection is crucial to fostering investment in research to develop new and better drugs.

Ranjit Shahani, the vice chairman and managing director of Novartis India, said the ruling "will hinder medical progress for diseases without effective treatment options."

He said the court's decision made India an even less attractive country for major investments by international pharmaceutical companies.

"Novartis will not invest in drug research in India. Not only Novartis, I don't think any global company is planning to research in India," he said.

The Swiss pharmaceutical giant has fought a legal battle in India since 2006 to patent a new version of Glivec, which is mainly used to treat leukemia and is known as Gleevec outside India and Europe. The earlier version of Glivec did not have an Indian patent because its development far predated the country's 2005 patent law. Novartis said Glivec is patented in nearly 40 other countries.

India's patent office rejected the company's patent application, arguing the drug was not a new medicine but an amended version of its earlier product. The patent authority cited a provision in the 2005 patent law aimed at preventing companies from getting fresh patents for making only minor changes to existing medicines ? a practice known as "evergreening."

Novartis appealed, arguing the drug was a more easily absorbed version of Glivec and that it qualified for a patent.

Anand Grover, a lawyer for the Cancer Patients Aid Association, which led the legal fight against Novartis, said the ruling Monday prevented the watering down of India's patent laws.

"This is a very good day for cancer patients. It's the news we have been waiting for for seven long years," he said.

Aid groups, including Medicins Sans Frontieres, have opposed Novartis' case, fearing that a victory for the Swiss drugmaker would limit access to important medicines for millions of poor people around the world.

Glivec, used in treating chronic myeloid leukemia and some other cancers, costs about $2,600 a month. Its generic version was available in India for around $175 per month.

"The difference in price was huge. The generic version makes it affordable to so many more poor people, not just in India, but across the world," said Y.K. Sapru, of the Mumbai-based cancer patients association.

"For cancer sufferers, this ruling will mean the difference between life and death. Because the price at which it was available, and considering it's the only lifesaving drug for chronic myeloid cancer patients, this decision will make a huge difference," Sapru said.

Leena Menghaney of Medicins Sans Frontieres said India would continue to grant patents on new medicines.

"This doesn't mean that no patents will be granted. Patents will continue to be granted by India, but definitely the abusive practice of getting many patents on one drug will be stopped," Menghaney said.

The judgment would ensure that the prices of lifesaving drugs would come down as many more companies would produce generic versions.

"We've seen this happening with HIV medicines, where the cost of HIV treatment has come down from $10,000 to $150 per year. Cancer treatment costs have come down by 97 percent in the case of many cancer drugs," she said.

"This decision is incredibly important. The Supreme Court decision will save a lot of lives in the coming decades," Menghaney said.

___

AP writer Kay Johnson contributed to this story from Mumbai, India.

Source: http://news.yahoo.com/drug-maker-novartis-loses-india-patent-battle-092200333--finance.html

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High-End Hi-Fi: Need or Desire

Music is eternity. No matter in whatever form music comes; it is always soothing, relaxing and stress relieving. You will not find a single person on the earth who does not like music. No language, heritage or culture can keep music confined; it transcends all boundaries. Either you are in high spirits or sad, stressed or relaxed, music is the only element that matches your mood. Let it be a live concert or hearing music on a DVD player, music is the only thing that touches your heart.
Back in the day, the vinyl, more commonly known as gramophone, was the only medium for artists to communicate to their audience. Music lovers would gently place the needle of the gramophone on the vinyl record and listen away. Then came the valve amplifiers in which music could be properly played back. It wasn't long ago that technological advancements further changed the way we listen to music. The advent of Mp3 CD and DVD players marked a new era of sound technology and greatly changed the way we listen to music. Since then, listening to music, while on the go, became more and more popular. With car audio systems, bluetooth devices, ipod and the latest smart phones, we have music everywhere and every time with us, if also on the move.
With the passage of time, our crave for music keeps on increasing. No matter, how many portable audio devices we have, a high-end hi-fi audio system or a high-end hi-fi home theater will always have the upper hand. For some a high-end hi-fi is a luxury product, whereas for audiophiliacs, a high-end hi-fi audio system is a must have. You expensive home theater will just not worth the price for which you got it if it doesn't produce powerful foot tapping sound. High-end hi-fi systems revolutionize the way we hear music and the sound quality they produce is of superlative standards.
Everyone loves music. We all started out on a small portable device, but today we crave for digital forms of music. The focus on increasing music quality has grown tremendously over the past few years. Low quality music is just like processed food; tasty or not, has minimal nutrition. High-end hi-fi systems help you discover the magic and power of music. Listening music on a high-end hi-fi stereo system is like changing your diet from processed foods to fresh, organic foods. Discerning music lovers and music enthusiasts all over the world can sacrifice any amount of money for even a small detail of high-end hi-fi equipment to get a premium quality sound. The high-end hi-fi systems that are available in the market these days deliver the best acoustic performance, no matter in whatever living space they are fitted. High-end hi-fi products are not for everyone. These esoteric products are meant only for high-end audio aficionados who love to hear music that agrees to their ears. Only audiophiles can understand and appreciate the sound quality produced by high-end hi-fi systems. They will also agree that such exotic products rightly deserve the price tag they carry.

Source: http://www.artipot.com/articles/1546445/high-end-hi-fi-need-or-desire.htm

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NKorea's parliament meets amid nuclear tension

SEOUL, South Korea (AP) ? After weeks of war-like rhetoric, North Korean leader Kim Jong Un gathered legislators Monday for an annual spring parliamentary session taking place one day after top party officials adopted a statement declaring building nuclear weapons and the economy the nation's top priorities.

The meeting of the Supreme People's Assembly follows near-daily threats from Pyongyang, including vows of nuclear strikes on South Korea and the U.S.

Pyongyang has reacted with anger over routine U.S.-South Korean military drills and a new round of U.N. and U.S. sanctions that followed its Feb. 12 underground nuclear test, the country's third. Analysts see a full-scale North Korean attack as unlikely and say the threats are more likely efforts to provoke softer policies toward Pyongyang from a new government in Seoul, to win diplomatic talks with Washington and to solidify the young North Korean leader's military credentials at home.

On Sunday, Kim and top party officials adopted a declaration calling nuclear weapons the "the nation's life" and an important component of its defense, an asset that wouldn't be traded even for "billions of dollars." Pyongyang cites the U.S. military presence in South Korea as a main reason behind its drive to build missiles and atomic weapons. The U.S. has stationed tens of thousands of troops in South Korea since the Korean War ended in a truce in 1953.

North Korea also has threatened in recent days to shut down a jointly run factory complex in the North ? the last remaining symbol of inter-Korean rapprochement. But officials in Seoul say hundreds of workers traveled as usual across the heavily armed border to the North Korean factory Monday as they have throughout the rising tensions.

"I have no idea about what it will be like when I go to the North Korean side. It seems OK to be here, but we will be living there in a tense situation for a week," Kim Won-soo, a South Korean manager working in Kaesong, said before his departure Monday from Paju, South Korea.

While analysts call North Korea's threats largely brinkmanship, there is some fear that a localized skirmish might escalate. Seoul has vowed to respond harshly should North Korea provoke its military. Naval skirmishes in disputed Yellow Sea waters off the Korean coast have led to bloody battles several times over the years. Attacks blamed on Pyongyang in 2010 killed 50 South Koreans.

South Korea's new president, Park Geun-hye, is pursuing a policy that seeks to re-engage North Korea with dialogue and aid after five years of standoff. But she told her military Monday to set aside political considerations and respond strongly should North Korea attack.

Meanwhile, deputies to North Korea's Supreme People's Assembly gathered in Pyongyang. The SPA schedule Monday was unclear.

Under late leader Kim Jong Il, North Korea had typically held a parliamentary meeting once a year. But Kim Jong Un held an unusual second session last September in a sign that he is trying to run the country differently from his father, who died in late 2011.

Parliament sessions, which usually are held to approve personnel changes and budget and fiscal plans, are scrutinized by the outside world for signs of key changes in policy and leadership.

At a session last April, Kim was made first chairman of the powerful National Defense Commission, the body's top post.

On Sunday, Kim presided over a separate plenary meeting of the Central Committee of the ruling Workers' Party, which set a "new strategic line" calling for building both a stronger economy and nuclear arsenal.

North Korea's nuclear weapons are a "treasure of a reunified country" not to be traded for "billions of dollars," according to a statement issued by state media after the meeting. North Korea's "nuclear armed forces represent the nation's life, which can never be abandoned as long as the imperialists and nuclear threats exist on earth."

Sunday marked the first time for Kim to preside over the committee meeting, a top decision-making body tasked with organizing and guiding the party's major projects. The last plenary session was held in 2010, according to Seoul's Unification Ministry, and before that in 1993.

The plenary statement also called for strengthening the moribund economy, which Kim has put an emphasis on in his public statements since taking power. The U.N. says two-thirds of the country's 24 million people face regular food shortages.

The North also named former Prime Minister Pak Pong Ju as a member of the party central committee's powerful Political Bureau, a sign that he could again play a key role in the North's economic policymaking process. Pak reportedly was sacked as premier in 2007 after proposing a wage system seen as too similar to U.S.-style capitalism.

Pak is reform-minded and his promotion sets him up for further advancement and "for him to take the lead in the North's economic policies," said Cheong Seong-jang at South Korea's Sejong Institute.

___

Follow Foster Klug at www.twitter.com/APKlug.

Source: http://news.yahoo.com/nkoreas-parliament-meets-amid-nuclear-tension-045319187.html

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Report: Saudi Arabia may try to end anonymity for Twitter users

Reuters ? ? ? 2 hrs.

Saudi Arabia may try to end anonymity for Twitter users in the country by limiting access to the site to people who register their identification documents, the Arab News daily reported on Saturday.

Last week, local media reported the government had asked telecom companies to look at ways they could monitor, or block, free internet phone services such as Skype.

Twitter is highly popular with Saudis and has stirred broad debate on subjects ranging from religion to politics in a country where such public discussion had been considered at best unseemly and sometimes illegal.

Early this month, the security spokesman for Saudi Arabia's Interior Ministry described social networking, particularly Twitter, as a tool used by militants to stir social unrest.

The country's Grand Mufti, Saudi Arabia's top cleric, last week described users of the microblogging site as "clowns" wasting time with frivolous and even harmful discussions, local newspapers reported.

"A source at (the regulator) described the move as a natural result of the successful implementation of (its) decision to add a user's identification numbers while topping up mobile phone credit," Arab News reported.

That would not necessarily make a user's identity visible to other users of the site, but it would mean the Saudi government could monitor the tweets of individual Saudis.

The English-language daily and sister paper to the Saudi-owned pan-Arab Asharq al-Awsat newspaper did not explain how the authorities might be able to restrict ability to post on Twitter. Both newspapers belong to a publishing group owned by the ruling family and run by a son of Crown Prince Salman.

Internet service providers are legally obliged to block websites showing content deemed pornographic.

One of the big investors in Twitter is Saudi Arabian billionaire Prince Alwaleed bin Talal, a nephew of King Abdullah who also holds significant stakes in Citi Group, News Corp and Apple through his Kingdom Holding Company.

The country's telecom regulator, Communications and Information Technology Commission (CITC) did not immediately responded to requests for comment on the report. Last week it did not comment on the report it was seeking to restrict Skype use.

A spokeswoman for Kingdom Holding said Prince Alwaleed was not available to comment.

"There are people who misuse the social networking and try to send false information and false evaluation of the situation in the kingdom and the way the policemen in the kingdom are dealing with these situations," said Major General Mansour Turki, the security spokesman, at a news conference on Mar 8.

At a separate interview with Reuters this month, Turki argued that a small number of supporters of al Qaeda and activists from Saudi Arabia's Shi'ite minority used social media to stir wider sympathy for their goals and social unrest.

However, he also argued against banning the site.

Two weeks ago one of Saudi Arabia's most prominent clerics, Salman al-Awdah, who has 2.4 million followers on the site, used Twitter to attack the government's security policy as too harsh and call for better services. He warned it might otherwise face "the spark of violence".

Two leading Saudi human rights activists were sentenced to long prison terms this month for a variety of offences including "internet crimes" because they had used Twitter and other sites to attack the government.

Some top princes in the monarchy now use Twitter themselves and Crown Prince Salman, King Abdullah's designated heir and also Defence Minister, recently opened an official account.

(Reporting By Angus McDowall; Editing by Andrew Heavens)

Copyright 2013 Thomson Reuters.

Source: http://feeds.nbcnews.com/c/35002/f/653377/s/2a29c693/l/0L0Snbcnews0N0Ctechnology0Ctechnolog0Creport0Esaudi0Earabia0Emay0Etry0Eend0Eanonymity0Etwitter0Eusers0E1C9144293/story01.htm

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Obama Family Attends Easter Service at St. John's (ABC News)

Share With Friends: | | Politics - Top Stories News, RSS and RSS Feed via Feedzilla.

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Rubio: Reports of immigration deal 'premature'

FILE - In this March 12, 2013 file photo, Sen. Marco Rubio, R-Fla. is seen on Capitol Hill in Washington. The Republican Party?s search for a way back to presidential success in 2016 is drawing a striking array of personalities and policy options. It?s shaping up as a wide-open self-reassessment by the GOP. Some factions are trying to tug the party left or right. Others argue over pragmatism versus defiance. (AP Photo/Susan Walsh, File)

FILE - In this March 12, 2013 file photo, Sen. Marco Rubio, R-Fla. is seen on Capitol Hill in Washington. The Republican Party?s search for a way back to presidential success in 2016 is drawing a striking array of personalities and policy options. It?s shaping up as a wide-open self-reassessment by the GOP. Some factions are trying to tug the party left or right. Others argue over pragmatism versus defiance. (AP Photo/Susan Walsh, File)

Sen. Chuck Schumer, D-N.Y., makes a point as he is joined by Sen. John McCain, R-Ariz., Sen. Jeff Flake, R-Ariz., and Sen. Michael Bennett, D-CO, during a news conference after their tour of the Mexico border with the United States on Wednesday, March 27, 2013, in Nogales, Ariz. A group of influential U.S. senators shaping and negotiating details of an immigration reform package vowed Wednesday to make the legislation public when Congress reconvenes next month. (AP Photo/Ross D. Franklin)

WASHINGTON (AP) ? Even with one of the largest hurdles to an immigration overhaul overcome, optimistic lawmakers on Sunday cautioned they had not finished work on a bill that would provide a path to citizenship for 11 million illegal immigrants.

The AFL-CIO and the pro-business U.S. Chamber of Commerce reached a deal late Friday that would allow tens of thousands of low-skill workers into the country to fill jobs in construction, restaurants and hotels. Yet despite the unusual agreement between the two powerful lobbying groups, lawmakers from both parties conceded that the negotiations were not finished.

"With the agreement between business and labor, every major policy issue has been resolved," said Sen. Chuck Schumer, the New York Democrat who brokered the labor-business deal.

But it hasn't taken the form of a bill and the eight senators searching for a compromise haven't met about the potential breakthrough.

"We haven't signed off," said Sen. Lindsey Graham, R-S.C.

"There are a few details yet. But conceptually, we have an agreement between business and labor, between ourselves that has to be drafted," he added.

Yet just before lawmakers began appearing on Sunday shows, Sen. Marco Rubio warned he was not ready to lend his name ? and political clout ? to such a deal without hashing out the details.

"Reports that the bipartisan group of eight senators have agreed on a legislative proposal are premature," said Rubio, a Florida Republican who is among the lawmakers working on legislation.

Rubio, a Cuban-American who is weighing a presidential bid in 2016, is a leading figure inside his party. Lawmakers will be closely watching any deal for his approval and his skepticism about the process did little to encourage optimism.

Rubio, who is the group's emissary to conservatives, called the agreement "a starting point" but said 92 senators from 43 states haven't yet been involved in the process.

The detente between the nation's leading labor federation and the powerful business lobbying group still needs senators' approval, including a nod from Sen. John McCain, the Arizona Republican whose previous efforts came up short.

"I think we're on track. . But as Sen. Rubio correctly says, we have said we will not come to final agreement till we look at all of the legislative language and he's correctly pointing out that that language hasn't been fully drafted," Schumer said.

Sen. Jeff Flake, R-Ariz., also noted the significance of the truce between labor and business but added that this wasn't yet complete.

"That doesn't mean we've crossed every 'i' or dotted every 't,' or vice versa," said Flake, who is among the eight lawmakers working on the deal.

Schumer negotiated the deal between AFL-CIO president Richard Trumka and Chamber of Commerce head Tom Donohue during a late-Friday phone call. Under the compromise, the government would create a new "W'' visa for low-skill workers who would earn wages paid to Americans or the prevailing wages for the industry they're working in, whichever is higher. The Labor Department would determine prevailing wage based on customary rates in specific localities, so that it would vary from city to city.

The proposed measure would secure the border, crack down on employers, improve legal immigration and create a 13-year pathway to citizenship for the millions of illegal immigrants already here.

It's a major second-term priority of President Barack Obama's and would usher in the most dramatic changes to the faltering U.S. immigration system in more than two decades.

"This is a legacy item for him. There is no doubt in my mind that he wants to pass comprehensive immigration reform," said David Axelrod, a longtime political confidant of Obama.

During the last week, an immigration deal seemed doomed. But the breakthrough late Friday restarted the talks.

Ultimately the new "W'' visa program would be capped at 200,000 workers a year, but the number of visas would fluctuate, depending on unemployment rates, job openings, employer demand and data collected by a new federal bureau being pushed by labor groups as an objective monitor of the market, according to an official involved with the talks who also spoke on condition of anonymity ahead of a formal announcement.

A "safety valve" would allow employers to exceed the cap, the official said, if they could show need and pay premium wages, but any additional workers brought in would be subtracted from the next year's cap.

The workers could move from employer to employer and would be able to petition for permanent residency and ultimately seek U.S. citizenship. Neither is possible for temporary workers now.

"As to the 11 million (illegal immigrants), they'll have a pathway to citizenship, but it will be earned, it will be long, and it will be hard, and I think it is fair," Graham said.

The new program would fill needs employers say they have that are not currently met by U.S. immigration programs. Most industries don't have a good way to hire a steady supply of foreign workers because there's one temporary visa program for low-wage nonagricultural workers but it's capped at 66,000 visas per year and is only supposed to be used for seasonal or temporary jobs.

Separately, the new immigration bill also is expected to offer many more visas for high-tech workers, new visas for agriculture workers, and provisions allowing some agriculture workers already in the U.S. a speedier path to citizenship than that provided to other illegal immigrants, in an effort to create a stable agricultural workforce.

Schumer, Flake and Axelrod appeared on NBC's "Meet the Press." Graham was interviewed on CNN's "State of the Union."

___

Associated Press writer Erica Werner contributed to this report.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/89ae8247abe8493fae24405546e9a1aa/Article_2013-03-31-Immigration-3rd%20Ld-Writethru/id-2ef0066c90314f6f89dc5c854a0b9d9c

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