Harvard scientists solve mystery about why HIV patients are more susceptible to TB infection
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A team of Harvard scientists has taken an important first step toward the development of new treatments to help people with HIV battle Mycobacterium tuberculosis (TB) infection. In their report, appearing in the July 2009 print issue of the Journal of Leukocyte Biology (http://www.jleukbio.org) they describe how HIV interferes with the cellular and molecular mechanisms used by the lungs to fight TB infection. This information is crucial for researchers developing treatments to help people with HIV prevent or recover from TB infection.
“HIV/TB co-infection is a critical global health problem, especially in developing countries,” said Naimish Patel, M.D., lead researcher on the study and Instructor of Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School. “We hope that these findings will lead to further studies and possible new therapies for treating or preventing tuberculosis in HIV disease.”
Patel and colleagues made their discovery by extracting immune cells called “alveolar macrophages” from the lungs of otherwise healthy, asymptomatic HIV-positive patients as well as from people who did not have HIV. In people who are HIV-positive, the macrophages have a decreased response to the TB bacterium when compared to people who did not have HIV. To learn why, the scientists examined lung specimens from the HIV-positive patients and found increased levels of a molecule called IL-10, which elevated the amount of a protein called “BCL-3” in alveolar macrophages and that reduced their ability to ward off TB infection.
Report: Prostate cancer screening has yet to prove its worth
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The recent release of two large randomized trials suggests that if there is a benefit of screening, it is, at best, small, says a new report in CA: A Cancer Journal for Clinicians. Authored by Otis W. Brawley, M.D. of the American Cancer Society and Donna Ankerst, Ph.D. and Ian M. Thompson, M.D. of the University of Texas Health Science Center at San Antonio, the review says because prostate cancer is virtually ubiquitous in men as they age, it is clear that a goal of “finding more cancers” is not acceptable. Instead, public health principles demand that screening must reduce the risk of death from prostate cancer, reduce the suffering from prostate cancer, or reduce health care costs when compared with a non-screening scenario. The authors suggest prostate cancer screening has yet to reach one of these standards to date.
No major medical group, including the American Cancer Society, currently recommends routine prostate cancer screening for men at average risk. In the United States, prostate cancer will affect one man in six men during his lifetime. Since the mid-1980s, screening with the prostate–specific antigen (PSA) blood test has more than doubled the risk of a prostate cancer diagnosis. The review says a decrease in prostate cancer death rates has been observed since that time, but the relative contribution of PSA testing as opposed to other factors, such as improved treatment, has been uncertain.
The report says a computer modeling study using National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registries estimated that more than one in four cancers detected in whites (29 percent) and nearly half of cancers detected in blacks (44 percent) were overdiagnosed cancers. A similar model using data from Europe estimated a 50 percent overdiagnosis rate.
Retinopathy of prematurity diagnosis time significantly reduced using telemedicine
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To be properly diagnosed, retinopathy of prematurity (ROP), the leading cause of childhood blindness in the United States and worldwide, requires a time intensive process and significant coordination between ophthalmologist and NICU staff. A recent study examining ROP diagnosis speed using indirect ophthalmoscopy versus telemedicine, remote medical consultation, is featured in the July issue of the American Journal of Ophthalmology (http://www.ajo.com), published by Elsevier.
The study was designed to compare the ophthalmologist’s speed of ROP diagnosis using telemedicine versus traditional bedside ophthalmoscopy. The findings reveal that: 1) ROP diagnosis by the ophthalmologist is significantly faster via telemedicine, and 2) there are significant time requirements by ophthalmologists associated with ROP diagnosis at the NICU bedside beyond ophthalmoscopy. In particular, additional time is taken for travel and communication with families and hospital staff.
To counteract these time requirements the implementation of telemedicine for ROP management has the ability to decrease the time commitment for examining ophthalmologists. Previous studies have shown that telemedical ROP diagnosis is highly accurate and reliable compared with ophthalmoscopy, and future work is required to address workflow questions in more detail.
Who goes abroad for fertility treatment and why?
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A substantial number of European patients travel to other countries for fertility treatment, both because they think that they will receive better quality care abroad and in order to undergo procedures that are banned in their home country says a study of the subject launched at the 25th annual conference of the European Society of Human Reproduction and Embryology today (Monday June 29). Study co-ordinator Dr. Françoise Shenfield, from University College Hospital, London, UK, said that this was the first hard evidence of considerable fertility patient migration within Europe. “Until now we have only had anecdotal evidence of this phenomenon”, she said. “We think that our results will be of considerable value to patients, doctors, and policymakers.”
During a one-month period, the ESHRE Task Force analysed data from participating clinics in six European countries: Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland. Clinics were asked to provide questionnaires to patients coming from abroad for treatment. The questionnaires asked about their age, country of residence, reasons for travelling to another country for treatment, which treatment they had received, whether they had received information in their own language, how they had chosen the centre they were attending, and whether they had received reimbursement from their home country’s health system. 1230 forms were completed and returned.
“This may not seem to be a very high number”, said Dr. Shenfield, “but it reflects only one month of events in a limited number of centres in six countries. The total number of treatment cycles per year can be estimated by extrapolating our monthly data to a year and by assuming that the centres represent no more than half of the centres in each of the countries studied. This leads to an estimate of at least 20 000 to 25 000 cross-border treatment cycles per year in these countries. It is, however, difficult to derive a number of patients from these numbers as patients receive more than one cycle to obtain a pregnancy, the mean number depending on the type of treatment.”
New tool finds best heart disease and stroke treatments for patients with diabetes
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Researchers from North Carolina State University and Mayo Clinic have developed a computer model that medical doctors can use to determine the best time to begin using statin therapy in diabetes patients to help prevent heart disease and stroke.
“The research is significant because patients with diabetes are at high risk for cardiovascular disease and statins are the single most commonly used treatment for patients at risk of heart disease and/or stroke,” says Dr. Brian Denton, “and this model can help determine the best course of action for individual patients based on their risk of developing cardiovascular disease.” Denton is an assistant professor in NC State’s Edward P. Fitts Department of Industrial & Systems Engineering and lead author of the study.
Statins are a key component of current cardiovascular medical treatment guidelines, Denton says. They lower cholesterol levels and may significantly reduce the risk of heart attack and stroke, particularly in patients that are considered to be at high risk.
New, less invasive genetic test greatly improves pregnancy rates in older women with poor prognosis
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A new test examining chromosomes in human eggs a few hours after fertilisation can identify those that are capable of forming a healthy baby, a researcher told the 25th annual conference of the European Society of Human Reproduction and Embryology today (Monday 29 June). Dr. Elpida Fragouli, from the Department of Obstetrics and Gynaecology, University of Oxford, UK, and Reprogenetics UK, said that her team’s work had already enabled seven ongoing pregnancies in a group of older women with a history of multiple failed IVF attempts.
“Out of 35 patients who had embryo transfers after the test, we achieved a pregnancy rate of 20%, which is exceptional considering the extremely poor prognosis of the women involved.” she said. “This represents a doubling of the usual pregnancy rate for women who fall into this category, which is otherwise, at best, under 10% and, at worst, zero. To date, we have two live births from this group, and all the other women who became pregnant have maintained their pregnancies. The study is continuing, and we believe that we will achieve more pregnancies with the help of this technology in the future.”
The scientists used the Comparative Genomic Hybridisation (CGH) technique to count the chromosomes in each egg. Unlike conventional screening strategies, using the fluorescent in situ hybridisation (FISH) method, which allows less than half of the chromosomes of an embryonic cell to be examined, CGH enables the evaluation of the entire chromosome complement. CGH was used to examine the fertilised eggs by looking at polar bodies, tiny cells that are a by-product of egg development. The chromosomes of polar bodies provide an indication of whether the corresponding egg is normal or abnormal; if the polar bodies have the wrong number of chromosomes, so does the egg.
New Detector Promises Earlier Detection of Viral Infections
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A Vanderbilt chemist and a biomedical engineer have teamed up to develop a respiratory virus detector that is sensitive enough to detect an infection at an early stage, takes only a few minutes to return a result and is simple enough to be performed in a pediatrician’s office.
Writing in The Analyst – a journal published by the Royal Society of Chemistry – the developers report that their technique, which uses DNA hairpins attached to gold filaments, can detect the presence of respiratory syncytial virus (RSV) – a leading cause of respiratory infections in infants and young children – at substantially lower levels than the standard laboratory assay.
“We hope that our research will help us break out of the catch-22 that is holding back major advances in the treatment of respiratory viruses,” says Associate Professor of Chemistry David Wright, who is working with Professor of Biomedical Engineering Frederick “Rick” Haselton on the new detection method.
Scientists Map Genome for Parasite Causing Widespread Infections
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Scientists at the Southwest Foundation for Biomedical Research (SFBR) in San Antonio have for the first time constructed a genetic map of the parasite that causes schistosomiasis, a chronic intestinal infection that can damage internal organs and, in children, impair growth and cognitive development. Schistosome parasites are flatworms that infect more than 200 million people a year worldwide. Infection results in an estimated 200,000 deaths annually in sub-Saharan Africa alone, while 20 million suffer severe disease, according to the World Health Organization.
“A genetic map is the essential tool needed for finding the genes that are responsible for drug resistance and pathogenesis in this parasite. In the case of drug resistance, identification of underlying mutations is critical for management of this disease” said Timothy Anderson, Ph.D., of SFBR’s department of genetics.
“First, identification of mutations allows us to better understand the mechanism of action of the drugs used, and to redesign drugs to restore treatment efficacy. Second, identification of mutations involved allows us to efficiently monitor the spread of resistance in parasite populations using simple molecular methods.”
Ovarian tissue transplant may restore fertility
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Even after highly concentrated cancer treatment of the ovaries, long-term ovarian function and fertility can be restored by repeated ovarian transplant with tissue taken from the patient before treatment, researchers in Korea and the US report in the current issue Fertility and Sterility.
In frozen ovarian tissue, a lack of oxygen after ovarian grafting causes a substantial loss of follicles, shortening the life span of the tissue, so repeated transplantation may be required, Dr. S. Samuel Kim at the University of Kansas, Kansas City, and his co-investigators note.
Until now, the authors note, no successful pregnancies after transplantation have been reported.
Declines in US breast cancer rates not uniform
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Between 2001 and 2004, new cases of breast cancer declined more than 8 percent in the United States. However, new research suggests that the decline was significantly less pronounced among poor women and among women living in rural areas.
“We looked closely at the previously reported decline in breast cancer observed in 2002-2003 using one of the largest databases available and found that the decline was faster in urban and affluent areas than rural or poorer areas,” Dr. Christina Clarke, from the Northern California Cancer Center in Fremont told Reuters Health.
In their study, reported online in the journal BMC Medicine, Clarke’s team looked at trends in the occurrence of breast cancer in US women by urban and rural status as well as poverty status for the period of 1997 to 2004.
Canadian court rules treatment can be forced
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Manitoba social workers were right to force a Jehovah’s Witness teenager to get a blood transfusion even though she said she felt it was like being raped, the Supreme Court of Canada ruled on Friday.
It was already clear under Canadian court decisions that babies and young children could be forced to get transfusions when authorities deemed this was needed but this case revolved around whether “mature minors” could make up their own mind.
The girl, known as A.C., was almost 15—the law stipulates 16 as the age when independent decisions are allowed—and argued that she knew what she was doing when she said she wanted to follow her religion and not take the blood.
Gastric bypass provides long-term diabetes control
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In more than half of obese patients with type 2 diabetes, their metabolic condition resolves after gastric bypass and they remain free from diabetes up to 16 years later, according to study findings presented last week at the 26th Annual Meeting of the American Society for Metabolic and Bariatric Surgery in Dallas.
In a study of 177 patients with diabetes who underwent gastric bypass for obesity, also referred to as bariatric surgery, between 1993 and 2003, the severity of diabetes before surgery was a key predictor of whether diabetes resolved in the long term. Moreover, long-term diabetes resolution correlated with the maintenance of weight loss.
“The most significant finding is that long-term resolution of diabetes seems to be linked to how severe the diabetes was at the time of surgery,” senior author Dr. James W. Maher, from Virginia Commonwealth University, Richmond, told Reuters Health. “Patients with diet-controlled diabetes had a 75 percent likelihood of being diabetes-free at long-term followup, while the figure was 65 percent diabetes-free in patients who were originally controlled with oral medications and only 28 percent of insulin-dependent diabetics had long-term resolution.”
Farrah Fawcett, 1970s sex symbol, dies aged 62
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Actress Farrah Fawcett, the “Charlie’s Angels” television star whose big smile and feathered blond mane made her one of the reigning sex symbols of the 1970s, died on Thursday after a long battle with cancer. She was 62.
Fawcett, first vaulted to stardom by an alluring poster of her in a red swimsuit, was diagnosed with anal cancer in late 2006. It spread to her liver in 2007, proving resistant to numerous medical treatments in Germany and California.
“After a long and brave battle with cancer, our beloved Farrah has passed away,” Fawcett’s long time companion, actor Ryan O’Neal, said in a statement.
China shuts sex health websites to ordinary users
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Ordinary web users in China will be banned from surfing sex-related medical and research websites from next month, amid an Internet crackdown on pornographic online content, according to new regulations.
Medical information service providers must install software to ensure only professionals can access sites that carry information and research about sex, the regulations on the website of the Ministry of Health (http://www.moh.gov.cn) said.
“It is prohibited to spread pornographic content in the name of sex-related scientific research,” the regulations said.
Study shows 1 in 25 deaths worldwide attributable to alcohol
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Research from Canada’s own Centre for Addiction and Mental Health (CAMH) featured in this week’s edition of the Lancet shows that worldwide, 1 in 25 deaths are directly attributable to alcohol consumption. This rise since 2000 is mainly due to increases in the number of women drinking.
CAMH’s Dr Jürgen Rehm and his colleagues found that alcohol-attributable disorders are among the most disabling disease categories within the global burden of disease, especially for men. And in contrast to other traditional risk factors for disease, the burden attributable to alcohol lies more with younger people than with the older population.
Dr. Rehm still takes an optimistic ‘glass half full’ response to this large and increasing alcohol-attributable burden. “Today, we know more than ever about which strategies can effectively and cost-effectively control alcohol-related harms,” Dr. Rehm said today. “Provided that our public policy makers act on these practical strategies expeditiously, we could see an enormous impact in reducing damage.”
