Tuesday, July 23, 2013

Something nasty in the Hudson River

The risk of catching some nasty germ in the Hudson River just started looking nastier. Disease-causing microbes have long been found swimming there, but now researchers have documented antibiotic-resistant strains in specific spots, from the Tappan Zee Bridge to lower Manhattan. The microbes identified are resistant to ampicillin and tetracycline, drugs commonly used to treat ear infections, pneumonia, salmonella and other ailments. The study is published in the current issue of the Journal of Water and Health.
"If you find antibiotic-resistant bacteria in an ecosystem, it's hard to know where they're coming from," said study co-author Andrew Juhl, a microbiologist at Columbia University's Lamont-Doherty Earth Observatory. "In the Hudson, we have a strong case to make that it's coming from untreated sewage."
On repeated visits to 10 locations on the Hudson, the researchers found microbes resistant to ampicillin 84 percent of the time, and resistant to tetracycline 38 percent of the time. The stretches harboring the most sewage-indicator bacteria also generally contained the most antibiotic-resistant ones. These were led by Flushing Bay, near LaGuardia Airport, followed by Newtown Creek, on the border of Brooklyn and Queens; and sewage outfall pipes near Piermont Pier in Rockland County, N.Y.; West 125th Street in Manhattan; and Yonkers, in Westchester County, N.Y.. The antibiotic-resistant bacteria found include potentially pathogenic strains of the genera Pseudomonas, Acinetobacter, Proteus and Escherichia.
"They could be difficult to treat in people with compromised immune systems," said Dr. Stephen Morse, an infectious disease epidemiologist at Columbia's Mailman School of Public Health, who was not involved in the study. "If I were inclined to swim in the Hudson, quite truthfully I'd look to this paper for the places to stay away from."
Though people routinely catch infections while swimming, only severe illnesses are typically treated with antibiotics. And an antibiotic-resistant infection would be noted only if the illness failed to respond to treatment - a scenario that probably happens, but is not well documented or reported, said Morse. One exception was an outbreak on the Indonesian island of Borneo in 2000 when 32 athletes competing in a swimming event in the Segama River came down withleptospirosis. Transmitted by animal urine, the infection is marked by fever, chills and pink eye.
Previous studies in the Hudson have shown that microbe counts go up after heavy rains, when raw sewage is commonly diverted into the river. Some 27 billion gallons of raw sewage and rainwater are released into the Hudson each year by wastewater treatment plants. Lacking the capacity during heavy rains to simultaneously pump runoff from city streets and sewage from buildings, many sewage-treatment plants are forced to divert both streams into the river, in what is known as a combined-sewer overflow, or CSO. In an ongoing partnership with the environmental group Riverkeeper, scientists at Lamont-Doherty and Queens College at the City University of New York have been tracking water quality in the Hudson and making their results public on Riverkeeper's website. Their work has confirmed that CSOs remain a serious problem, even though the Hudson is generally cleaner than it has been in the past.
The Hudson has gotten so much better," said the study's lead author, Suzanne Young, a former student at Lamont and Queens College, now at the University of South Florida. "If we came up with a sustainable solution, water quality could continue to improve."
This is not the first time that antibiotic-resistant bacteria have been found in a river. A 2002 study in the journal Emerging Infectious Diseases found ampicillin-resistant bacteria in the Hudson, as well as 15 other U.S. rivers, including the Mississippi, Ohio and Colorado. However, this is the first study to firmly link specific microbes to sewage in the Hudson, and to compare results at different locations.
It is not just a matter of swimming safely. Rivers can incubate bacteria, allowing them to transfer their drug-resistant genes to normal bacteria. "If these resistant genes are transferred, they can develop into disease-causing bacteria," said Ronald J. Ash, a microbiologist and professor emeritus at Washburn University, lead author of the 2002 paper.
Bacteria can also play an important role in the environment. As more antibiotic-resistant microbes replace native bacteria, those changes could eventually have an impact on plants and animals. "Microbial communities can affect the health of the entire ecosystem," said Young, who is now studying how Mississippi water snakes respond to infection with antibiotic-resistant pathogens.
Antibiotic resistance has become a public health crisis. About 100,000 people die each year from hospital-acquired infections, most of which are due to antibiotic-resistant pathogens, according to the Infectious Diseases Society of America. Superbugs resistant to methicillin kill about 19,000 people each year, more than HIV/AIDS. The development of resistance has been linked to overuse of antibiotics to treat minor infections in humans, and to industrial feedlots, where low levels of antibiotics are fed to chicken, cattle and pigs to promote growth and prevent infection. The Natural Resources Defense Council estimates that 80 percent of antibiotics in the U.S. are fed to livestock.
There are signs that the tide is turning, at least in the Hudson. In a landmark deal with the state, New York City agreed last year to spend $187 million to replace some parking lots and city streets with porous pavement, and to plant more vegetation on rooftops and other impervious surfaces to reduce runoff. An additional $2.4 billion will be spent on infrastructure to eliminate 1.5 billion gallons of CSOs by 2030. "There's now a timeline for answering the question, 'How much sewage overflow reduction is needed and when?' " said Larry Levine, a senior attorney at the Natural Resources Defense Council, which pushed for the settlement.
Public awareness may also help. In 2012, New York Gov. Andrew Cuomo signed the Sewage Pollution Right to Know Law requiring public notification of sewage spills in New York waters. Not long after the law passed, Westchester County announced a "controlled discharge" at Sleepy Hollow, sparking a debate about whether the National Ironman competition should cancel its swimming leg 15 miles to the south. (The swim went ahead as planned).
"The results from this study are significant because they help us to understand the processes involved in the spread of antibiotic resistant bacteria through the environment, but also because they provide added incentive to reduce sewage pollution into our waterways" said coauthor Gregory O'Mullan, a microbiologist with joint appointments at Lamont and Queens College who oversees the laboratory where the study was done

New mosquito patch in fight against malaria and West Nile virus

A new mosquito-beating patch is being developed in California that, if successfully rolled out in Africa, could help prevent illnesses such as malaria, West Nile virus and dengue fever.
The Kite patch adheres to clothing, much like a sticker, and uses FDA-approved, non-toxic compounds that block a mosquito's ability to track humans for 48 hours.
The sticker was created by a team based in Riverside, CA, after 7 years of research and development by Olfactor Laboratories, Inc. and the University of California, Riverside.
The company behind the patch, ieCrowd, employed designers to make it withstand tough conditions. The product website for the sticker claims it is "perfectly suited for children in Uganda, professional athletes, families on the soccer field, outdoor enthusiasts, and workers in the suburbs of Manila."
Since mosquitos track humans through carbon dioxide release, the company notes that the Kite should work on all types of mosquitos, citing preliminary field trials that show the patch's effectiveness on many different species of mosquitos.
Though the patch should not replace mosquito nets at night in high-risk areas, the patch is being promoted as a replacement for sprays or lotions currently on the market.

Malaria is a global problem

Humans become infected with malaria when a mosquito carrying the parasite transfers it to the bloodstream through a bite in the skin.
Kite patch
The Kite adheres to clothing like a sticker. For up to 48 hours it can block mosquitos' ability to track humans via carbon dioxide.
According to the Centers for Disease Control and Prevention (CDC), around 219 million people had malaria in 2010 and 660,000 of these people died. Africa was hit the hardest, with 91% of all malaria deaths happening on that continent.
In the US, there are around 1,500 cases of malaria each year, most of which involve people who have traveled to Africa and South Asia.
Symptoms of malaria infection includefever, chills and flu-like illness. If left untreated, sufferers of malaria can eventually die from complications.
The direct costs of malaria - those relating to illness, treatment and premature death - are around $12 billion each year, according to the makers of the Kite. The company claims that costs relating to lost economic growth "are many times more."

Prevention is key for mosquito-borne illnesses

While malaria kills a large number of people each year, it is easily preventable. We know where it comes from (mosquitoes) and we know how to avoid these insects (using nets and repellants).
Grey Frandsen, the project lead and chief marketing officer at ieCrowd, is a surviver of malaria himself. He says:
"We want this small patch to change people's lives. We're designing Kite to deliver everyone protection from mosquitoes, no matter where they are in the world.
It will provide a new level of protection for children in Uganda, for young families in South Africa, and hikers in Seattle or Wyoming or Florida seeking a safer, socially-responsible solution.
We built Kite to be simple and affordable - a small colorful sticker that will appeal to children and adults and survive the rigors of extreme climates, play time, or outdoor recreation."
The company recently launched a crowdfunding campaign to help their first roll out of the potentially life-saving product in Uganda. They will continue to test the patch there, where communities have the highest need for a solution.
A recent study showed that malaria-carrying mosquitos are more strongly attracted to the smell of humans, which is why a patch that blocks their ability to find us in the first place could be an effective weapon against malaria.

Surgeon's smart knife detects cancer cells in tumor operations

When surgeons remove tumor tissue they try to leave a "margin" of healthy tissue to ensure all the cancer is removed. Sometimes this means the patient has to remain under general anaesthetic for another 30 minutes or so while tissue samples are sent for analysis to check if the margin is clear. Even then, it is still possible that some cancerous tissue remains, and the patient has to undergo further surgery to remove it.
Now, a new technique based on an "intelligent knife," called the "iKnife," promises to remove the need for lab analysis and the accompanying delay, and it also helps avoid repeat surgeries.
The iKnife sniffs the "smoke" created by the electrosurgical removal of cancerous tissue and tells the surgeon almost immediately if the tissue it has come from is healthy or cancerous.
This first study appears online this week in Science Translational Medicine, in which the iKnife is tested in the operating room.
In tissue samples from 91 patients, researchers at Imperial College London using the iKnife achieved 100% accuracy in diagnosing whether the samples were cancerous or not.
Study author Dr. Zoltan Takats is the inventor of the iKnife. Asked if his new surgical tool would be confined to use in only certain types of cancer, he told Medical News Today:
"It is a generally applicable tool, we believe it will be useful for many different types of cancer surgeries."
On the question of cost-effectiveness, Dr. Takats told us:
"We believe that it will be a cost-saver - due to elimination of intraoperative histology, shorter intervention times and lower rate of re-operations."

iKnife combines electrosurgery with new mass spectrometry techniques

The iKnife is a combination of an established technology called electrosurgery that was invented in the 1920s and a new technology that is still emerging, called rapid evaporative ionization mass spectrometry (REIMS).
In electrosurgery, the surgeon's knife delivers an electric current that heats the target tissue and cuts through it while causing minimum loss of blood.
The heat from the current vaporizes the tissue, which gives off a smoke that is normally sucked away with an extractor.
The mass spectrometer technology behind REIMS almost instantly identifies the chemicals present in human tissue by analyzing the smoke that is released during electrosurgery.
Cells produce thousands of metabolites in various concentrations, depeding on their cell type. So once the REIMS technology is primed with the profiles of healthy and cancerous cells, it can rapidly use these to screen the sample of smoke and inform the surgeon whether it is from a tumor or healthy tissue.
The iKnife being used by a surgeon
The iKnife device "sniffs" smoke created when cancerous tissue is surgically removed, and it then determines whether the tissue is cancerous or healthy. Photo: Imperial College London

iKnife relies on a library of chemical profiles

In the first stage of the study, the researchers created a reference library of chemical profiles consisting of both healthy and cancerous tissue types for the iKnife. They collected samples from surgery patients, taking note of the characteristics of thousands of cancerous and non-cancerous tissues, including brain, lung, breast, stomach, colon and liver tumors.
In the second stage of the study, the team transferred the technology to the operating room and tested it on 91 patients. In all cases, the iKnife correctly identified the tissue type. The results were confirmed with lab tests on the samples after surgery.

Results delivered in under 3 seconds

By comparing the chemical profile of the tissue it is sampling to the reference library, the iKnife can deliver a result in under 3 seconds, say the researchers.
But for this study, the surgeons carrying out the procedures were not allowed to see the nearly instant readings from the iKnife.
The researchers now hope to run a clinical trial that tests whether giving surgeons access to iKnife readings during operations improves outcomes for patients.
Dr. Takats says in a statement:
"These results provide compelling evidence that the iKnife can be applied in a wide range of cancer surgery procedures."
As the technology delivers almost instant results, it allows "surgeons to carry out procedures with a level of accuracy that hasn't been possible before", he adds, noting that they "believe it has the potential to reduce tumor recurrence rates and enable more patients to survive."

Other applications: "Is this beef or horsemeat?"

Although this latest study uses the iKnife to test cancerous tissue, Takats says there is no reason why it couldn't also be used to test for other features, such as whether there is an adequate blood supply, or to identify types of bacteria in the tissue.
Dr. Takats says he has already used the iKnife to distinguish horsemeat from beef.
He first raised the idea of combining electrosurgery with REIMS from real-time identification of tumor tissues in a paper published in 2009.
Funds from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, the European Research Council and the Hungarian National Office for Research and Technology helped finance the study

US life expectancy varies from state to state

Forget about football teams, the new state rivalry is all about life expectancy. A report from the Centers for Disease Control (CDC) breaks down healthy life-expectancy (HLE) by state. Hawaii dominates the list, while Southern states fall short.
The report uses data about mortality, morbidity and health status to estimate the expected number of years lived in good health for people, beginning at age 65. These types of estimates are used around the world to predict future health service needs and to identify trends or inequalities in each country.
Until now, very few studies for the US have broken down healthy life expectancy for each state.

Life expectancy varies by sex and race

For males, HLE estimates at 65 years ranged from a low in Mississippi of 10.1 years, to a high in Hawaii of 15 years. But for females, those numbers were 11.4 years in Mississippi and 17.3 years in Hawaii.
According to the report, healthy years lived beyond age 65 were:
  • Greater for females than for males, and
  • The difference ranged from 0.7 years in Louisiana, to 3.1 years in the Dakotas.
Life expectancy - figure 1 diagram
Healthy life expectancy for males and females in years from age 65, by state, 2007-2009. Source: CDC
In terms of information by race, the study admits that "HLE estimates for Hispanics, Asians, and American Indians/Alaska Natives were not presented because sufficient reliable data were not available at the state level."
The report does, however, analyze the state-by-state numbers for both blacks and whites, and it reveals that HLE was greater for whites than blacks in almost every state, with the exceptions of Nevada and New Mexico. Iowa had the largest difference in HLE between whites and blacks at 7.8 years.

Why the state-by-state difference in life expectancy?

While the CDC says it is not possible to flesh out why some states have a higher or lower HLE, the report does, however, suggest that several factors can influence health status later in life:
  • Safe and healthy living environments
  • Healthy behaviors, such as getting exercise and not smoking
  • Receiving proper clinical preventive services, such as vaccines, screenings and blood pressure checks)
  • Having access to good health care when needed.
  • Life expectancy - figure 2 diagram
    As a general trend, HLE rates from 2007-2009 were lowest in the Southeast, with higher rates dotted in the Southwest, Northeast, Northwest, Florida and Hawaii. Source: CDC
    Knowing which regions are falling behind the health care curve is an important component of improving overall health care in the country. A recent study revealed that the US has fallen behind other wealthy nations on health, which is why understanding these health trends is so vital.

    Prescription drug corruption: GSK admits executives in China broke law

    The UK-based pharmaceutical giant GlaxoSmithKline (GSK) has issued a statement that some of its executive employees have acted "outside of Chinese law." The company gave the announcement after a meeting with Chinese police officers who were investigating accusations of corruption.
    China's Ministry of Public Security has been looking into claims that four executives working for GSK in China have been "using a network of more than 700 travel agencies and other firms to channel bribes to hospitals, doctors and government officials since 2007," according to a report from Hong Kong by CNN Money.
    Abbas Hussain, GSK's president for Europe, Japan, emerging markets and Asia Pacific, said in a company statement:
    "Certain senior executives of GSK China who know our systems well appear to have acted outside of our processes and controls which breaches Chinese law. We have zero tolerance for any behavior of this nature."
    "I want to make it very clear that we share the desire of the Chinese authorities to root out corruption wherever it exists."
    The Chinese police has detained the four Chinese executives from GSK after "accusing the firm of bribing officials and doctors to boost sales and raise drug prices by funneling up to 3 billion yuan ($489 million) to travel agencies," reports Reuters, which says GSK has called the allegations "shameful."
    The Reuters report also cites sources who claim Sir Andrew Witty, GSK's chief executive, will use a quarterly financial results presentation tomorrow, Wednesday, to outline the drug developer's action in response to the alleged bribery, which could include price cuts for drugs sold in China.

    Other pharmaceutical firms hit by China's clampdown

    GSK is not the only drugs company to have been rocked by China's clampdown on the pharmaceutical industry. Another drugs giant, AstraZeneca, has confirmed that a sales representative has been questioned by police in a separate investigation in Shanghai, according to a Bloomberg report.
    Chinese state media has aired claims that travel agencies were used by the GSK employees to set up sometimes non-existent conferences to "allocate money for bribes." State media has implicated Shanghai Linjiang International Travel Agency in the alleged scandal.
    The New York Times says it has documents showing this same travel agency arranged events and conferences with at least six other global pharmaceutical firms in the past 3 years, including Merck, Novartis, Roche and Sanofi. The Times report stresses that the documents "contain no indication of wrongdoing" at these other firms.
    But with China's fast-growing market for pharmaceutical products, its government is widening its investigation into fraud and corruption, and these documents suggest big drugmakers other than GSK could come under the scrutiny of Chinese authorities, the Times report adds.

    Pharmaceutical industry woes in other emerging markets

    Global companies that develop, make and sell innovative medicines have come under fire in other fast-growing markets.
    India's courts, for example, have taken a number of decisions that have opened the way for generic makers of new branded drugs to sell their copies of the originals even before patents have expired.
    Worries about the high cost of branded new drugs in emerging markets have driven such moves to allow the cheaper copies. In India, making generic alternatives of drugs is also big business for the country. The developers of new drugs, meanwhile, argue that driving down drug prices will reduce innovation.

    Eat breakfast for a healthy heart

    A new study appears to confirm that when you eat is just as important for health as what and how much you eat.
    US researchers asked men to complete questionnaires about what they ate and when they ate it, then tracked their health for 16 years. Those who said they skipped breakfast were found to have a higher risk of heart attack or fatal coronary heart disease.
    Lead author Leah Cahill, of the Harvard School of Public Health (HSPH), and colleagues, write about their findings in a July 23rd issue of the American Heart Association journal Circulation.
    In a statement, Leah Cahill, who is a postdoctoral research fellow in the department of nutrition at HSPH, explains what may lie behind the findings:
    "Skipping breakfast may lead to one or more risk factors, including obesity, high blood pressure, high cholesterol and diabetes, which may in turn lead to a heart attack over time."
    For their study the researchers analyzed food frequency questionnaires completed by 26,902 male health professionals aged between 45 and 82 years and tracked their health for 16 years from 1992 to 2008. The men were free of heart disease and cancer at the start of the study.
    Over the follow-up, 1,572 men experienced non-fatal heart attacks or died of coronary heart disease.
    When they analyzed the data the researchers found men who said they did not have breakfast had a 27% higher risk of heart attack or death from coronary heart disease than men who said they ate breakfast.

    Men who skipped breakfast had other risk factors

    The men who said they skipped breakfast tended to be younger, single, smokers, who worked full time, did not do much exercise and drank more alcohol.
    The researchers also found when they adjusted the results to take out the effect of body mass index, high blood pressure, high cholesterol and diabetes, the links between skipping breakfast and higher risk for heart attack or death from coronary heart disease became much weaker: they were no longer statistically significant.
    They note this suggests "eating habits may affect risk of coronary heart disease through pathways associated with these traditional risk factors."
    They also found no links between how many times a day the men said they ate and risk of coronary heart disease.

    Eating late at night linked to heart disease

    They did find a link, however, between eating late at night and coronary heart disease. Compared with men who said they did not eat late at night, among those who did, there was a 55% higher risk of coronary heart disease.
    But the authors note that, judging by the few men in the study who ate late at night, this was unlikely to be a major public health concern.
    Leah Cahill says the message from the study, which reinforces previous research, is: "Don't skip breakfast." Eating a healthy meal at the start of the day is linked to lower risk of heart attacks.

    Breakfast tips

    Incorporate many types of healthy foods into your breakfast, Leah Cahill advises - as this is "an easy way to ensure your meal provides adequate energy and a healthy balance of nutrients, such as protein, carbohydrates, vitamins and minerals."
    If eating a bowl of cereal, try adding nuts and chopped fruit, or steel-cut oatmeal. This is a "great way to start the day," Leah Cahill adds.
    Senior author Eric Rimm, associate professor of medicine at the Harvard Medical School, says the team has spent decades looking at the effects of quality and composition of diet on health, and now this new study suggests overall dietary habits should also be considered in lowering risk of heart disease.
    At a conference in 2012, UK scientists presented a study that explained why people who skip breakfast tend to find high calorie food more appealing later in the day: their brain circuits may be primed toward seeking it when fasting.

    Friday, May 31, 2013

    HIV Shell Structure Cracked With Help Of Supercomputer

    A new study that features on the cover of Nature this week describes how researchers in the US have for the first time cracked the chemical structure of the capsid or protein shell of the human immunodeficiency virus (HIV). The breakthrough, which likely opens the way to powerful new drugs against the virus that causes AIDS, was made possible with the help of a new "petascale" supercomputer.
    Scientists have been trying for some time to crack the precise chemical structure of HIV's cone-shaped capsid, a protein shell that protects the virus's genetic material. The capsid is thought to be the key to virulence of HIV and has become an attractive target for new antiretroviral drug development.

    As senior author of this new Nature study, Peijun Zhang, an associate professor of structural biology at the University of Pittsburgh School of Medicine, says in a statement:

    "The capsid is critically important for HIV replication, so knowing its structure in detail could lead us to new drugs that can treat or prevent the infection."

    "This approach has the potential to be a powerful alternative to our current HIV therapies, which work by targeting certain enzymes, but drug resistance is an enormous challenge due to the virus' high mutation rate."

    Previous studies have described attempts to chip away at the capsid structure bit by bit. To try and see the atomic-level detail of the shell, made of over 1,300 identical proteins, researchers have used a range of sophisticated lab tools, from nuclear magnetic resonance spectroscopy and X-ray crystallography, to cryo-electron microscopy and cryo-EM tomography.

    But it was only when they added the processing power of the new petascale Blue Waters supercomputer at the National Center for Supercomputing Applications at the University of Illinois, to the already impressive array of tools, that Zhang and colleagues were able to fathom the chemical structure of the entire capsid.

    A petascale computer has a number-crunching rate measured in "petaflops", or petas (quadrillions, 1015) of floating point instructions per second. To put this into context, a petascale computer can perform in one second the same number of instructions as it would take everyone on Earth doing one calculation per second for 1.5 days.

    The simulations that added the missing pieces to the HIV capsid puzzle were conducted during testing of Blue Waters by co- authors Klaus Schulten, a physics professor, and Juan R. Perilla, a post-doc researcher, both at the University of Illinois.

    Commenting on the HIV capsid challenge, Schulten says:

    "This is a big structure, one of the biggest structures ever solved."

    "It was very clear that it would require a huge amount of simulation - the largest simulation ever published - involving 64 million atoms," he adds.

    From previous studies that had found the HIV capsid contains a number of identical proteins, the researchers already knew these proteins are arranged as pentagons and hexagons, and they had a hunch that the pentagons formed the tight round corners of the cone-shaped capsid they could see under an electron microscope.

    But exactly how many of these proteins it takes to make the capsid, or how the pentagons and hexagons fit together, remained a mystery.

    Zhang and the structural biology team at Pittsburgh found that when exposed to high concentrations of salt, the protein building blocks assemble into tubes made only of hexagons.

    From further experiments they found that certain regions of the proteins interact with one another in a way that is "critical for capsid assembly and stability, and for viral infectivity," they note.

    They then managed to get a rough idea of the overall shape of the capsid by taking cryo-electron tomographs of it sliced into sections.

    From these results, and their own simulations of how the hexamers and pentamers might interact, Schulten and Perilla carried out a series of large-scale computer simulations.

    Schulten says that they could only match the 64-million-atom capsid structure to the "diverse" experimental data using a unique approach they developed themselves that they call "molecular dynamic flexible fitting".

    "You basically simulate the physical characteristics and behavior of large biological molecules but you also incorporate the data into the simulation so that the model actually drives itself toward agreement with the data," he explains.

    With these techniques the researchers found that the HIV protein shell comprises 216 hexagons and 12 pentagons arranged in the way the experimental data suggested.

    The proteins in the hexagons and pentagons were identical but the angles through which they attached to each other were different among different regions of the structure.

    Schulten says this is what puzzled them: such a protein would have to be inherently flexible to form such a varied structure.

    By having pentagons as well as hexagons, the capsid can form a closed structure, explain the researchers, describing the property the pentagons bring as "induced acute surface curvature". (A quick look at the structure of fullerenes, or even soccer balls for that matter, and you get an idea of what they are talking about).

    Schulten says that knowing more about the detailed structure of the HIV capsid will help researchers understand how it functions, and this helps drug developers work out how to disrupt those functions.

    He explains how the HIV capsid has to perform two opposing functions. It has to remain intact to protect its genetic material, but it also has to be able to release it in a timely manner once inside the host cell so it can replicate.

    "That has to happen with really good timing - too quick is not good, too slow is not good. And this is a moment when you can throw a wrench into the system," says Schulten.

    "The timing of the opening of the capsid is essential for the degree of virulence of the virus. This is where we could perhaps best interfere with HIV infection," he adds.

    Funds for the study came from the National Institute of General Medical Sciences at the National Institutes of Health and the National Science Foundation, which also funds the Blue Waters supercomputer.

    Earlier this year, scientists in the UK developed a vaccine against foot and mouth disease that uses a synthetic virus capsid to provoke an immune response.

    To determine the structure of that virus shell, and identify mutations that would improve it, they used Diamond Light Source, the UK's national synchrotron facility.

    Potential For Blood Test To Diagnose Alzheimer's In Earliest Stage

    Blood offers promise as a way to detect Alzheimer's disease at its earliest onset, Mayo Clinic researchers say. They envision a test that would detect distinct metabolic signatures in blood plasma that are synonymous with the disease - years before patients begin showing cognitive decline. Their study was recently published online in the journal PLOS ONE.

    Researchers analyzed cerebrospinal fluid and plasma samples from 45 people in the Mayo Clinic Study on Aging and Mayo Clinic Alzheimer's Disease Center (15 with no cognitive decline, 15 with mild cognitive impairment and 15 with Alzheimer's disease). They detected significant changes in the cerebrospinal fluid and plasma in those with cognitive decline and Alzheimer's. Most important, changes in plasma accurately reflected changes in the cerebrospinal fluid, validating blood as a reliable source for the biomarker development.

    The team uses a relatively new technique called metabolomics, which measures the chemical fingerprints of metabolic pathways in the cell - sugars, lipids, nucleotides, amino acids and fatty acids - to detect the changes. Metabolomics assesses what is happening in the body at a given time and at a fine level of detail, giving scientists insight into the cellular processes that underlie a disease. In this case, the metabolomic profiles showed changes in metabolites related to mitochondrial function and energy metabolism, further confirming that altered mitochondrial energetics is at the root of the disease process.

    The researchers hope that identified changes in the metabolic pathways could lead to the panel of biomarkers, which can eventually be used on a larger scale for early diagnosis, monitoring of Alzheimer's progression, and evaluating therapeutic approaches, says co-author Eugenia Trushina, Ph.D., a Mayo Clinic pharmacologist.

    "We want to use these biomarkers to diagnose the Alzheimer's disease before symptoms appear - which can be decades before people start exhibiting memory loss," Dr. Trushina says. "The earlier we can detect the disease, the better treatment options we will be able to offer."

    Anti-Smoking Ads Increase The Chances Of Quitting

    Education through anti-smoking media via television, radio, or billboards, magazines, and newspapers, has greatly increased the chances of current smokers quitting, according to a new report released by the CDC in honor of World No Tobacco Day today.
    The finding was included as part of this week's Morbidity and Mortality Weekly Report (MMWR) and was found to be true in 14 out of 17 countries studied.

    The CDC examined data from 17 countries that took part in the Global Adult Tobacco Survey (GATS). They looked at the relationship between awareness of antismoking messages and intent on smoking cessation.

    Odds ratios were adjusted for demographic characteristics, awareness of tobacco ads, and awareness of warning labels on cigarette packages.

    Results showed that in nine of 17 nations, intent to quit was greatly linked to awareness of antismoking messages in a single media channel compared with no awareness. In 14 nations, intent to quit was notably linked to awareness of messages in multiple channels compared to no awareness.

    Antismoking messages in mass media channels can aid in the reduction of tobacco intake by urging smokers to think about quitting and could be more effective in more than one channel.

    Of the total 265,564 participants, 50,209 of them reported they were current smokers. In all nations, these participants picked up on antismoking information during the last 30 days in all four of the media channels.

    Over half of the subjects noticed antismoking campaigns in at least one of the four media channels in all nations. Additionally, more picked up on antismoking messages from television than any other type of media channel.

    Among participants, 10,439 said they planned to quit. Other significant findings included:
    • In five of 17 nations the participants intending to quit were >30%
    • The number of subjects who noticed a warning label in the last 30 days was high in all nations, ranging from 70.7% in India to 97.9% in Romania
    • Wide variance was seen in the percentage of subjects who noticed any type of pro tobacco marketing in the last 30 days with 0% in three countries (Egypt, Thailand, and Vietnam) and 87.3% in Indonesia.
    Efforts like the CDC's Tips from Former Smokers, tobacco education ad campaigns are necessary to counter the $1 million an hour that is used on pro tobacco marketing in the U.S.

    The Tips campaign has triggered a considerable jump in calls to 1-800-QUIT-NOW begin_of_the_skype_highlighting 1-800-QUIT-NOW FREE end_of_the_skype_highlighting , a quit-line number, as well as visits to the CDC's website. Both provide smokers free help for quitting.

    Mosquitoes With Altered Smell Gene Lose Preference For Humans

    By changing one gene, scientists have bred a mosquito that does not seek out the smell of humans in preference to other animals. The team behind one of the first successful attempts to genetically engineer mosquitoes believes their work not only shows what can be done with the latest genetic techniques, but also helps us better understand the insect's attraction to humans and therefore how to block it.
    Lead researcher Leslie Vosshall, a Howard Hughes Medical Institute (HHMI) investigator at The Rockefeller University in New York, says in a statement:

    "The time has come now to do genetics in these important disease-vector insects. I think our new work is a great example that you can do it."

    "By disrupting a single gene, we can fundamentally confuse the mosquito from its task of seeking humans," she adds.

    Vosshall and colleagues write about their work in a paper published online in Nature on 29 May.

    Their report follows another study published recently in PLOS ONE, where researchers from the London School of Hygiene & Tropical Medicine in the UK describe how malaria-carrying mosquitoes are more strongly attracted to the smell of humans.

    Starting Point Was a Gene in Flies

    After scientists in 2007 announced they had sequenced the complete genome of Aedes aegypti, the mosquito that carries dengue and yellow fever, Vosshall switched her lab's focus from Drosophila flies to mosquitoes and set about trying to alter their genes.

    From working with genetically engineered flies, she and her team already knew of a gene called orco that was important for the fly's sense of smell. So, as Vosshall explains, they started working on this gene in mosquitoes:

    " ... we had some hints that mosquitoes interact with smells in their environment, so it was a good bet that something would interact with orco in mosquitoes."

    Genetic Engineering Tools

    To mutate the orco gene in Aedes aegypti, the team used "zinc-finger nucleases" (ZFNs), powerful tools that can be designed to target and cleave specific sequences of genomic DNA.

    First, they injected ZFNs into mosquito embryos and when these matured, they sought out mutant individuals and used them to generate mutant strains so they could study the behavior of the orco gene in mosquitoes.

    They discovered that brain cells linked to sensing odors were not as active in the genetically engineered mosquitoes. But they also found some other interesting changes.

    Less Preference for Human Odor

    Normally, when presented with a choice between humans and other animals, non-mutant Aedes aegypti mosquitoes fly toward humans, attracted by their smell.

    But when Vosshall and colleagues gave their mutant mosquitoes a choice between human scent and that of guinea pigs, they did not show a preference for humans. This was the case even in the presence of carbon dioxide, which is supposed to enhance the attraction of mosquito to humans.

    It appears that changing a single gene, the orco gene, disrupts the mosquito's ability to seek human prey.

    However, this experiment did not establish precisely how the mutated mosquito lost the preference for human smell.

    For example, did the mutated insect lose its ability detect that the guinea pig smell is not a preferred one, or did it lose the ability to discriminate that the human smell is the one to go for? Or did the altered gene cause both these changes?

    Response to DEET

    In a second part of their study, Vosshall and colleagues found that the mosquitoes with orco mutations were attracted to human skin even when it was protected by the common insect repellant DEET.

    They exposed them to two human arms: one slathered in a solution of 10% DEET, and the other untreated. The insects flew equally to both arms, showing therefore that they could not smell the DEET.

    However, once the mutant mosquitoes landed on the arms, they quickly flew away from the one slathered in DEET solution.

    Two Different Odor-Sensing Mechanisms Identified

    The team concluded that their experiments with DEET on human arms showed the mosquitoes are using two separate mechanisms to sense the DEET.

    "One is what's happening in the air, and the other only comes into action when the mosquito is touching the skin," Vosshall explains.

    There has been talk of a dual mechanism, but this is the first experiment to show it.

    Vosshall's team now wants to explore how the orco protein interacts with the mosquito's smell receptors to shape its sense of smell.

    "We want to know what it is about these mosquitoes that makes them so specialized for humans," she says.

    "And if we can also provide insights into how existing repellants are working, then we can start having some ideas about what a next-generation repellant would look like," she adds.

    In another recently published study, US researchers suggest it may be possible to use a bacterium that stops malaria parasites developing in mosquitoes.

    Thursday, March 14, 2013

    IPhone Microscope Helps Diagnose Intestinal Worms

    smart phones are transforming the way that people communicate throughout the world. Now scientists are using them in an innovative way to help diagnose intestinal worm infections in school children living in rural Tanzania.

    The scientists have developed an inexpensive microscope using a glass lens costing $8 USD, a strip of double-sided tape, and a cheap flashlight - altering an iPhone 4s into a device that can detect intestinal worm infections; parasites that infect two billion people and result in malnutrition.

    Isaac Bogoch, MD, an infectious disease specialist at Toronto General Hospital and the study's lead author explained:

    "There's been a lot of tinkering in the lab with mobile phone microscopes, but this is the first time the technology has been used in the field to diagnose intestinal parasites."

    The scientists' findings were published in the American Journal of Tropical Medicine and Hygiene, and evaluated 199 stool samples of children using their unique device.

    Along with a standard light microscope the researchers examined the samples with the cell phone microscopes and a regular laboratory slide. The kids participating in the trial on Pemba Island, Tanzania, were undergoing different treatments for eliminating intestinal worms.

    Scientists first covered the slide in cellophane, then used the double-sided tape to attach it to the camera, lit it from underneath with the flashlight and finally took a picture.

    The iPhone microscope was found to be not as sensitive as a light microscope, however, the scientists believe that with some changes it will come close. Bogoch commented, "We think cell phone microscopes could soon become a valuable diagnostic tool in poor, remote regions where intestinal worms are a serious health problem, particularly in children."

    Intestinal Worms - A Global Issue

    The cell phone microscope sensitivity was dependent on the type of worm and the strength of the infection.

    Mobile Phone Microscope
    Scientists have developed the camera on an iPhone into a microscope that can detect intestinal worm infections.
    Photo Credit: Isaac Bogoch
    For example, the cellphone found 81 percent of infections of giant roundworm (A. lumbricoides) and 54 percent of roundworm infections (T. trichiura ). But, it only detected 14 percent of all hookworm infections; the researchers say that this is due to the much smaller number of eggs present than with the other parasites.

    "It was quite successful at detecting moderate to heavy infections, but not very good at detecting mild infections where there might be only a few eggs in the sample," Bogoch said.

    Worms that infect the intestines, such as roundworms and hookworms - or soil-transmitted helminths - harm nearly two billion people worldwide. In isolated, poor regions of developing nations rates of this disease are particularly high and can result in chronic malnutrition and anemia in kids.

    Bogoch and his team aimed to find an alternative tool by taping a 3 millimeter ball lens to the camera of Bogoch's Apple iPhone 4S - one he already owned. However, the researchers noted that any phone that has a camera with a zoom option could work effectively. Ball lenses are normally used in the telecommunications field in couplings for optical fiber cable. They are inexpensive - generally $8 to $10 USD.

    Instead of an electric light, they used a small flashlight that just needs a single battery for many hours of operation. The entire set-up can be developed for $15 USD, in addition to the cost of the phone, and can be assembled in five minutes.

    Cell Phone Microscope - Several Implications

    The authors believe that the "mobile phone microscope would likely be of clinical use when it is sensitive enough to detect 80 percent of infections," and note that even now there are new developments underway to improve the current cell phone microscopes.

    Bogoch said, "I'm confident that in the near future we will see cell phone microscopes widely used in low-resource settings. They're easy to make, portable, and today, you can find mobile phones with cameras even in some of the most remote regions in the world."

    The cell microscope can be used for treating and diagnosing people with worm infections as well as observing the prevalence of disease amongst the broader population.

    One example could be when administering drug treatment to large populations. Cell phone microscopes could serve as cheap and effective tools to calculate the effectiveness of these mass drug administration campaigns.

    David H. Walker, MD, president of the American Society of Tropical Medicine and Hygiene said:

    "I have nothing but praise for the ingenuity of scientists using all available tools to solve pressing health problems in some of the poorest parts of the world. This study is an illustration of how a modest investment in tropical disease research can help reap enormous health benefits for children."

    Thursday, February 28, 2013

    Vitamin D And Calcium May Not Prevent Fractures

    Vitamin D and calcium supplements do not prevent fractures in adult men or women, according to a report published in the journal Annals of Internal Medicine.
    After discovering that there was not sufficient scientific proof to demonstrate that vitamin D and calcium supplements help protect bones from breaking in men or the majority of postmenopausal women, the U.S. Preventive Services Task Force (Task Force) made their final recommendation.

    Studies on both vitamin D and calcium were reviewed by the Task Force before coming up with their new suggestions.

    A report published last year in BMJ said the risk of fractures later in life is not lowered by a high daily calcium intake. A different report on vitamin D injections showed that they do not reduce the rate of bone fractures suffered by elderly people.

    The new recommendations say that women who are postmenopausal should not take daily vitamin D doses of 400 international units or less or calcium doses of 1,000 milligrams or less.

    However, women should keep taking the supplements if they are told to do so by their doctor because they are vitamin D deficient or have osteoporosis.

    The experts explained:

    These recommendations apply to noninstitutionalized or community-dwelling asymptomatic adults without a history of fractures. This recommendation does not apply to the treatment of persons with osteoporosis or vitamin D deficiency.

    The Task Force suggested that healthy men stay away from the supplements as well. This is because the risk of getting kidney stones is greater than the advantages of taking them.

    However, even though calcium and vitamin D do not prevent fractures, they are both important to the health of bones.

    Seventeen percent of adults in the U.S. take vitamin D and 20% take calcium supplements, even though not of all those people actually need them.

    Extra vitamins are not always necessary when individuals are active and in good health.

    The authors wrote:

    "The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms."

    New Recommendations For Screening And Testing Newborn Children

    New recommendations on testing and screening newborn children for genetic diseases have been published in the latest policy statements of the American Academy of Pediatrics (AAP) and The American College of Medical Genetics and Genomics (ACMG).
    They believe that it is necessary to test all newborn children as it is in the best interest of their health, showing their support for mandatory genetic testing and screening.

    Millions of newborns undergo genetic screening every year.

    However, additional genetic testing after the initial screening is far less common.

    Most additional genetic testing conducted after the newborn period is mainly carried out on children who show signs and symptoms of intellectual disability for diagnostic purposes.

    Beyond the initial screening, the decision to carry out additional testing should rest on the parents, say the experts.

    There were distinct differences between the recommendations for testing for childhood-onset conditions and testing for conditions that appear in adulthood. The experts encouraged testing children who are at risk of childhood-onset conditions, but discouraged testing for diseases or conditions that appear later in adulthood.

    They also noted that when a child shows early symptoms of a disease, it is necessary to make a quick diagnosis and evaluate the best courses of action, guiding the family in making a decision for the best of the child.

    In fact, according to a previous study published in the journal Pediatrics, the majority of parents would accept and embrace predictive genetic testing for their children if offered.

    Even though these two reports discourage testing for adult-onset conditions, some experts believe that results concerning these conditions could help adjust lifestyle risks early on.

    One of the policy authors, Dr. Lainie Friedman Ross, said:

    "There is an important role for counseling before and after genetic screening. The focus should be on education of families, counseling them and helping them make decisions that focus on the child's best interest.

    Clearly, if a child has symptoms, we need a diagnosis to help the family make clinical decisions that are in the child's best interest. This is important even when the disease has no current therapies."

    Sometimes genetic testing can give incorrect results or interpretations; the ACMG suggests that a person who is certified in either Clinical Molecular Genetics (ABMG) or Molecular Genetic Pathology (ABPath/ABMG) should always review test results.

    In addition, they state that pre- and post-test counseling should be provided to patients by an ABMG certified Clinical Geneticist or ABGC/ABMG certified Genetic Counselor.

    In view of the rapid advances made in genetics and genomics, the authors stress that health care providers and pediatricians should always be informed on what the best new practices are.

    Stress Early In Life Can Affect Heart Function Early

    Life stress early on such as that experienced by babies who are sick, appears to have an early impact on heart function, affecting the heart's ability to refill with oxygen-rich blood and relax.
    A group of researchers from Georgia Regents University conducted a study using rat pups, separating them from their mothers for a couple hours everyday. Then, an extra stress was added to raise blood pressure.

    The researchers saw a noteworthy fall in basic heart function. The rates of relaxation and re-filling stayed low in the separation model, however, reductions remained steady by ages two and six months, as the rats progressed to middle age.

    The model as well as the controls had reductions in those functions that generally come naturally with age.

    Surprisingly, the power with which the heart released blood stayed consistent with the added stressor, angiotensin II - a strong constrictor of blood vessels. Echocardiography was used to measure heart function.

    Dr. Catalina Bazacliu, neonatologist at the Medical College of Georgia and Children's Hospital of Georgia at Georgia Regents University, said:

    "We expected the heart's ability to relax and refill to lag behind in our model. We believe these babies may be at increased risk for cardiovascular disease and we are working to understand exactly what puts them at risk."

    The authors are presenting their findings today at the Southern Regional Meetings in New Orleans.

    The findings also show that the blood pressure of rats that are separated from their mothers rises more frequently in response to angiotensin II, their heart rates also increased.

    Generally, a compensatory mechanism pushes the heart rate down a bit when blood pressure increases.

    Previous studies have indicated persistent blood vessel changes in the early stress model, such as elevated contraction and decreased relaxation when similarly stressed.

    Other longitudinal studies in humans have revealed long-term cardiovascular consequences, like babies born during the Dutch famine of World War II, maturing with elevated risks of:
    • cardiovascular disease
    • diabetes
    • obesity
    • other health related issues
    In another related study by Bazacliu, she used a similar animal model showing that babies whose growth was limited in-utero by health issues such as preeclampsia - high blood pressure in mothers during pregnancy - were at an elevated risk for cardiovascular disease as adults.

    These observations were seen whether the babies were born at full term or prematurely. Higher pressure during development decreases blood flow from mother to baby; decreased oxygen and nutrition to the baby is an example of environmental stress.

    Bazacliu points out that although neonatal intensive care units are designed to save and treat premature babies, they can actually cause more stress. The NICU at the Children's Hospital of Georgia works to reduce the negative effects, such as enacting visiting hours, minimizing noise, and other family targeted techniques.

    Bazacliu conclues, "All the procedures we must do, the separation from the mother, the environment, even though the babies need the help, it represents a stress."

    Breast Cancer Rates Increase Among Young Women

    here has been a small increase in the incidence of advanced stage breast cancer among women 25 to 39 years old, according to a recent study in JAMA.

    Breast cancer is the most common form of malignant tumor in women aged 15 to 39 and accounts for nearly 14% of all cancer cases in men and women in that age group. The risk of a woman developing breast cancer before the age of 40 is 1 in 173, according to a 2008 study.

    The authors wrote:

    "Young women with breast cancer tend to experience more aggressive disease than older women and have lower survival rates. Given the effect of the disease in young people and a clinical impression that more young women are being diagnosed with advanced disease, we reviewed the national trends in breast cancer incidence in the United States."

    The study involved assessing three U.S. National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registries from 1973-2009, 1992-2009 and 2000-2009. Rebecca H. Johnson, M.D., the leader of the study, and her colleagues obtained information from the registries regarding the incidence of breast cancer, any incidence trends, the survival rate as a function of age, and the extent of the cancer at diagnosis.

    The SEER defines localized breast cancer as cancer only found in the breast, regional cancer as cancer that's spread to adjacent organs such as the chest well, and distant cancer as cancer that's spread from one part of the body to another part not directly related to it (in this case the brain and lungs would be an example).

    Over the past three to four decades, the incidence of distant breast cancer in young women aged 25 to 39 has gone up steadily, from a rate of 1.53 per 100,000 in 1976 to 2.90 per 100,000 in 2009. This difference translates to an annual increase in incidence of 2.07 percent per year.

    The authors added:

    "The trajectory of the incidence trend predicts that an increasing number of young women in the United States will present with metastatic breast cancer in an age group that already has the worst prognosis, no recommended routine screening practice, the least health insurance, and the most potential years of life."

    The increasing incidence of distant cancer was greatest among women aged 25 to 34 and got progressively smaller in women as they got older, by 5-year age intervals. There was no real increase in the incidence of distant breast cancer in women 55 years old or above. The authors added that: "For young women aged 25 to 39 years, the incidence of distant disease increased in all races/ethnicities assessed since at least 1992, when race/ethnicity became available in the SEER database."

    This finding is particularly concerning, considering that young women, between 20 to 34 years of age who develop breast cancer, have the lowest 5-year breast cancer survival rate as a function of age.

    Researchers from the Institut Jules Bordet, in Brussels, Belgium, identified that breast cancer in young women is in itself a biologically unique disease, requiring customized management strategies, and is associated with age related biological processes that are independent from other, more common factors, used in prognosis by oncologists.

    Young women who are diagnosed with breast cancer often find themselves feeling isolated and alone, given that most medical resources for the disease are designed for women over 50. In addition, a study in the Journal of National Cancer Institute revealed that health-related quality of life is a lot lower in young women with breast cancer - it is linked with weight gain, increased psychological distress and early onset of menopause.

    Mosquito Repellent DEET Is Becoming Less Effective

    Mosquitos are now able to ignore the scent of the insect repellent DEET three hours after being exposed to it.
    The finding, published in PLoS One, suggests that even though historically, insects have been strongly repelled by the scent of DEET, other studies by Dr.James Logan reveal that some mosquitoes and flies carry a genetic alteration in their aroma receptors rendering them insensitive to the smell.

    DEET is one of the most successful protectors against mosquito bites that can transmit deadly diseases, such as:
    • West Nile Virus
    • Malaria
    • Dengue fever
    • Encephalitis
    • Yellow fever
    Products that have DEET come in many different forms including liquids, sprays, lotions, wristbands. DEET has been in use by the public since 1957.

    In this latest study, Dr. Logan and his peers from the London School of Hygiene & Tropical Medicine discovered a response in mosquitoes that occurred due to short-term changes (not genetic ones).

    The investigators examined changes in responses to DEET in Aedes aegypti mosquitoes - which are well known for biting during the day and transmit deadly diseases, such as yellow fever and dengue fever.

    They discovered that a slight exposure to DEET was enough to make some mosquitoes less sensitive to the repellent.

    Three hours following exposure, the mosquitoes were put off seeking out attractants like human skin and heat even though they had been previously exposed to DEET.

    The investigators also saw that this ineffectiveness of the odor could be linked to a fall in the sensitivity of smell receptors on the mosquito's antennae after an earlier exposure.

    Dr Logan, medical entomologist and Chief Scientific Officer for the Arthropod Control Product Test Centre, said:

    "We think that the mosquitoes are habituating to the repellent, similar to a phenomenon seen with the human sense of smell also. However, the human olfactory system is very different from a mosquito's so the mechanism involved in this case is likely to be very different.

    Our study shows that the effects of this exposure last up to three hours. We will be doing further research to determine how long the effect lasts. This doesn't mean that we should stop using repellents - on the contrary, DEET is a very good repellent, and is still recommended for use in high risk areas. However, we are keeping a close eye on how mosquitoes can overcome the repellent and ways in which we can combat this."

    In 2008, a new class of bug repellent was found to be effective for three times longer than DEET, which is the quality standard of all repellents.

    Scaling Up HIV Treatments Worth The Price, South Africa

    According to two studies published in this week's Science journal, ramping up HIV antiretroviral treatments in the South African province of KwaZulu-Natal has been worth the extra expense.
    According to the findings of the HTPN 052 (HIV Prevention Trials Network 052) trial, people who are HIV positive have a 96% lower chance of transmitting the virus to their partners if they are receiving ART (antiretroviral) medications.

    Jacob Bor, from Harvard University, Massachusetts, USA, and team followed up on this trial. They reported that the life expectancy of the average KwaZulu-Natal adult is now 11.3 years longer since ART was expanded in this rural region of the country - life expectancy rose from 49.2 years in 2003 to 60.5 years in 2011.

    Scaling up antiretroviral treatments is expensive

    By local standards, these treatments are not cheap. Annual ART costs between $500 and $900 per year for each person. Experts and agencies had disagreed on whether scaling up such treatments could be justified.

    The authors gathered and analyzed data on the changes in adult life expectancies of about 100,000 people from 2000 to 2011. They focused on the difference in life expectancy four years before ARTs were scaled up in the region, and eight years afterwards, and "determined that the survival benefits of antiretroviral treatments exceeded the cost of the treatments 26 times over."

    The longer adult life expectancy in the region was nearly entirely due to changes in HIV-related deaths, they added.

    In a related news release from the Harvard School of Public Health, Bor said:

    "Many people have been worried that the ART scale-up, which is a massive public health intervention, would negatively affect populations who do not suffer from HIV but need care for other diseases. We do not find any evidence to support this worry."

    In an Abstract in Science, the authors concluded "These gains in adult life expectancy signify the social value of ART and have implications for the investment decisions of individuals, governments, and donors."

    One of the limitations in the study, the authors explained, was that access to clean water and electricity occurred at the same time the antiretroviral treatments were being scaled up. Even so, they added, in a worst-case scenario, increasing access to retroviral treatments in southern Africa would save lives and money.

    In another study published in the same journal, Frank Tanser and team discovered that the risk of becoming infected with HIV in sub-Saharan Africa is reduced considerably when ARTs are scaled up.

    They followed up 16,667 people who were not infected with HIV in KwaZulu-Natal for a period of eight years after ARTs were expanded in 2004. They found that HIV-free people had a 38% lower risk of becoming infected when they lived in areas with high ART coverage, compared to areas where coverage was low.

    For years, experts have been saying that if the South African government started ART for HIV-positive residents earlier, the country would save money and many deaths would be prevented.

    Early HIV Antiretroviral Therapy is Cost-Effective

    Researchers from Weill Cornell Medical College and GHESKIO (Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) showed in PLoS Medicine that early treatment for HIV is not only a life-saving move, but also a cost-effective one.

    Before 2009, WHO (World Health Organization) recommended that antiretroviral therapy for HIV-positive patients should only start when their CD4 T cells went below 200 cells per cubic millimeter. Weill Cornell scientists carried out a randomized clinical trial in Haiti which demonstrated that early ART reduced mortality by 75% in HIV-positive adults with a CD4 cell count between 200 and 350 cells/mm3.

    After looking at their findings, WHO changed their recommendation to start ART in HIV-positive patients when their CD4 cell count drops below 350 cells/mm3.

    Infants Who Develop Slowly Catch Up On Growth In Time

    New research reveals that most babies who put on weight at a slow rate during their first 9 months do eventually catch up to normal weight by the time they are teenagers, however, they will remain slightly shorter and lighter than their peers for a long time.

    The findings, which were published by researchers at the University of Bristol in the journal Pediatrics, finally provides conclusive evidence to show that, with careful care, babies who are slow to put on weight during their first 9 months can eventually catch up to within a normal range.

    A total of 11,499 people who were born in the 90s participated in the study. The researchers studied and analyzed their weight gain during their first 9 months as children. 507 of the infants gained weight at a slower than normal rate before the age of eight weeks and were part of the 'early group'. 480 put on weight at a slower than normal rate between the age of eight weeks and 9 months and were part of the 'late group'.

    Children in the early group were able to quickly recover to a normal weight before the age of two, while those in the late group took a bit longer to recover, gradually gaining weight until the age of seven and then experiencing a spurt.

    At the age of 13 those in the late group were found to be an average of 4.4 cm shorter and 5.5 kg lighter than other children, while infants in the early group were an average of 3.25 cm shorter and 2.5 kg lighter.

    Clinicians often face a dilemma when treating infants with slow weight gain as they have to ensure that they are able to increase daily calorie intake without putting the children at risk of obesity later in life.

    There were significant differences in the patterns of recovery between the early group and the late group.

    Professor Alan Emond noted Professor of Community Child Health in the University's School of Social and Community Medicine, noted that the reason why children in the early group might have recovered more quickly is because they had feeding difficulties which were identified within the first eight weeks, resulting in earlier and more effective treatment.

    He said:

    "As Children of the 90s is an observational study, there is limited information available about which infants received nutritional supplements or medical treatments. Those children who showed slow weight gain later in infancy took longer to recover, because of the longer period of slow growth and because their parents were smaller and lighter too."

    He added:

    "Overall, parents can be reassured that well babies showing slow weight gain in the first year do eventually recover to within the normal range, but at 13-years tend to be lighter and smaller than many of their peers."

    It's important to monitor and check a baby's weight progression during their first months of development. However, parents should not overly worry if their baby is well but growing at a slow rate, as they will often catch up with the national average in time.

    The findings suggest that, unless urgently required, doctors shouldn't necessarily increase the calorie intake among infants too quickly as it can severely increase their risk of weight problems later in life.

    Asthma Drug Treats Chronic Hives, Severe Itch

    A commonly used asthma drug, omalizumab, has shown to be effective in treating chronic hives and severe, itchy rash in adolescents and adults.
    The finding came from a new study published in The New England Journal of Medicine after examining the effects of a once-a-month, high-dose injection of omalizumab on 323 subjects at 55 medical centers.

    The participants had previously been taking standard antihistamine therapy, however, it did not put an end to their underlying, allergy-like response, referred to as chronic spontaneous urticaria or chronic idiopathic urticaria.

    Sarbjit (Romi) Saini, M.D., a Johns Hopkins allergist and immunologist, and study co-author, said:

    "Physicians and patients may now have a fast, safe and well-tolerated treatment option to consider before prescribing even more antihistamines, which can be highly sedating."

    The results of the report correspond with the researchers' first presentation at the American Academy of Allergy, Asthma & Immunology's yearly meeting in San Antonio, Texas.

    The majority of the study participants were female and were between 12 and 75 years old. The investigation started in 2009 and lasted until 2011.

    The volunteers were randomly assigned to take one of three dosing regimens of omalizumab, or placebo, and then for fourth months after, they were observed via uniform checkups.

    The investigators and the subjects were both unaware of what particular dose each person was taking throughout the trial.

    Chronic hives and rash affected all participants for at least 6 months, while several had the condition for over 5 years. Hives or a severe itchy rash were still a problem in all of the patients even after taking antihistamines for seven days.

    Saini, an associate professor at the Johns Hopkins University School of Medicine who has studied omalizumab since 2005, explained:

    "Patients suffering with this condition need more and better treatment options because chronic hives and rash are profoundly hard to treat and can be very debilitating."

    The antihistamine XYZAL(R) (Levocetirizine Dihydrochloride) was approved by the U.S. FDA for chronic hives in 2011. However, fewer than 50% of the people who are treated respond to traditional drug therapies with antihistamines, according to Saini.

    Omalizumab is safer than other treatments

    The novel research provides considerable proof that this first injection treatment option is not only effective, but is also safer than other drugs, including corticosteroids and the immunosuppressant cyclosporine, which are associated with possible severe and toxic reactions, such as bone thinning, infection, and high blood pressure.

    The most serious reaction seen with the drug omalizumab was headache. None of the volunteers died or experienced anaphylactic shock, or had to back out of the study because of negative site effects.

    About 3 million people in the United States are affected by chronic idiopathic urticaria, which sometimes involves swelling. Women are two times more likely to suffer from these "socially isolating conditions" than men, Saini said.

    Some patients have a hard time breathing because they develop such bad swelling of their hands, eyes, lips, face, and throat. Some people will not even leave their house during flare-ups, meaning they have to miss work.

    Hives can be treated with a single, uniform dose of the drug

    The American and European researchers injected a 300-milligram dose of the treatment, marketed as Xolair, once a month for 3 months.

    After one week, the initial relief from symptoms occurred. Fifty-three percent of subjects experienced a complete elimination of hives after 3 months, and 44% did not develop hives or itch again afterward.

    The drug was 50% as successful at lower doses (150 milligrams, 75 milligrams and 0 milligrams - placebo) as the next larger dose, or had nearly no impact at all.

    Prior studies had been conducted by Saini on the test doses, which are different from those used in omalizumab therapy for treating asthma. Saini is also the director of Johns Hopkins' medical fellowship training program in allergy and clinical immunology.

    Although dosing for asthma is measured by the person's weight and blood levels of IgE antibodies, which is important to allergic responses, hives can be treated with single, uniform doses of omalizumab.

    How does the treatment actually work?

    Exactly how omalizumab, first approved in 2003 in the U.S. as drug for treating asthma, prevents the allergy-like responses that cause severe hives and itching is still not known, the authors explained.

    However, Saini explained, they are aware that omalizumab binds up free IgE flowing in the body, and reduces the number of IgE receptors on other immune system cells that carry histamine.

    In an allergic response, what normally happens is that allergens, including dust particles and pollen, bind to IgE receptors that are found on these immune system cells.

    A controlled, wave-like release of histamine, a crucial triggering chemical that plays a role in inflammation, results from the process.

    However, since the release of histamine seems to be more spontaneous in the itchy rash of chronic hives, the scientists believe that the histamine-carrying mast cells and basophils are abnormal.

    Saini is now planning to conduct more research on the impact of omalizumab on IgE, and how it plays a role in chronic hives and rash. He hopes "to understand the underlying mechanism of the disease and explain why the drug is effective."

    Written by Sarah Glynn

    View drug information on Xolair.

    Wednesday, February 13, 2013

    New Measles Cases Highest In 18 Years, England

    New cases of measles have reached their highest level in 18 years in the England and Wales, many of them young adults and teenagers who were not immunized after the fraudulent 1998 MMR scare. Health authorities say that many young people and children have had to be taken to hospital.
    According to the HPA (Health Protection Agency), there were 2,016 confirmed cases in England and Wales last year, the highest total for one year since 1994.

    In 2012, there were prolonged outbreaks in Merseyside and Sussex, as well as several minor outbreaks among travelling communities across the country.

    Eighty-seven percent of the 7,392 measles cases reported in the EU (European Union) up to the end of November 2012 came from Romania, Spain, Italy, France and the UK.

    Head of immunization at the HPA, Dr Mary Ramsay, said:

    "Coverage of MMR is now at historically high levels but measles is highly infectious and can spread easily among communities that are poorly vaccinated, and can affect anyone who is susceptible, including toddlers in whom vaccination has been delayed. Older children who were not vaccinated at the routine age, who may now be teenagers, are at particular risk of becoming exposed, while at school for example.

    Measles continues to circulate in several European countries that are popular with holidaymakers. Measles is a highly infectious disease so the only way to prevent outbreaks is to make sure the UK has good uptake of the MMR vaccine, and that when cases are reported, immediate public health action is taken to target unvaccinated individuals in the vicinity as soon as possible."

    Dr. Ramsay explained that many people are not aware that measles can strike people today, can cause severe disease and even death; they see it as a disease of the past. Parents need to make sure that their children are immunized against rubella, mumps and measles with two doses of the MMR vaccine.

    UK health authorities are urging parents whose kids have not been vaccinated to see their GP (general practitioner, primary care physician) to get immunized. Unvaccinated adults should also see their doctor.

    Dr. Ramsay said "If you are unsure whether you or your child has had two doses of the vaccine, speak to your GP who will have a record."

    The following signs and symptoms are common in people with measles:
    • Flu-like symptoms
    • Fever
    • Photophobia (sensitivity to light)
    • Red eyes
    • Gray-white spots in the throat and mouth
    • Within a few days a red-brown spotty rash appears on the skin, which usually starts off behind the ears, makes its way around the head and neck, and then spreads to the legs and the rest of the body.

    USA - 2011 saw highest number of measles cases in 15 years

    In April 2012, the CDC (Centers for Disease Control and Prevention) informed that in 2011 there were more reported cases of measles in the United States than in any of the previous 15 years. Most cases involved foreigners visiting the country or Americans who became infected abroad.

    However, the total, at 222 is dwarfed by the current figures coming out of the European Union. One third of all the measles cases in the USA in 2011 had to be hospitalized - however, there were no deaths from the disease that year.

    The Sexual Revolution May Have Been Launched, Not By 'The Pill' But By Penicillin

    The rise in risky, non-traditional sexual relations that marked the swinging '60s actually began as much as a decade earlier, during the conformist '50s, suggests an analysis recently published by the Archives of Sexual Behavior.

    "It's a common assumption that the sexual revolution began with the permissive attitudes of the 1960s and the development of contraceptives like the birth control pill," notes Emory University economist Andrew Francis, who conducted the analysis. "The evidence, however, strongly indicates that the widespread use of penicillin, leading to a rapid decline in syphilis during the 1950s, is what launched the modern sexual era."

    As penicillin drove down the cost of having risky sex, the population started having more of it, Francis says, comparing the phenomena to the economic law of demand: When the cost of a good falls, people buy more of the good.

    "People don't generally think of sexual behavior in economic terms," he says, "but it's important to do so because sexual behavior, just like other behaviors, responds to incentives."

    Syphilis reached its peak in the United States in 1939, when it killed 20,000 people. "It was the AIDS of the late 1930s and early 1940s," Francis says. "Fear of catching syphilis and dying of it loomed large."

    Penicillin was discovered in 1928, but it was not put into clinical use until 1941. As World War II escalated, and sexually transmitted diseases threatened the troops overseas, penicillin was found to be an effective treatment against syphilis.

    "The military wanted to rid the troops of STDs and all kinds of infections, so that they could keep fighting," Francis says. "That really sped up the development of penicillin as an antibiotic."

    Right after the war, penicillin became a clinical staple for the general population as well. In the United States, syphilis went from a chronic, debilitating and potentially fatal disease to one that could be cured with a single dose of medicine.

    From 1947 to 1957, the syphilis death rate fell by 75 percent and the syphilis incidence rate fell by 95 percent. "That's a huge drop in syphilis. It's essentially a collapse," Francis says.

    In order to test his theory that risky sex increased as the cost of syphilis dropped, Francis analyzed data from the 1930s through the 1970s from state and federal health agencies. Some of the data was only available on paper documents, but the Centers for Disease Control and Prevention (CDC) digitized it at the request of Francis.

    For his study, Francis chose three measures of sexual behavior: The illegitimate birth ratio; the teen birth share; and the incidence of gonorrhea, a highly contagious sexually transmitted disease that tends to spread quickly.

    "As soon as syphilis bottoms out, in the mid- to late-1950s, you start to see dramatic increases in all three measures of risky sexual behavior," Francis says.

    While many factors likely continued to fuel the sexual revolution during the 1960s and 1970s, Francis says the 1950s and the role of penicillin have been largely overlooked. "The 1950s are associated with prudish, more traditional sexual behaviors," he notes. "That may have been true for many adults, but not necessarily for young adults. It's important to recognize how reducing the fear of syphilis affected sexual behaviors."

    A few physicians sounded moralistic warnings during the 1950s about the potential for penicillin to affect behavior. Spanish physician Eduardo Martinez Alonso referenced Romans 6:23, and the notion that God uses diseases to punish people, when he wrote: "The wages of sin are now negligible. One can almost sin with impunity, since the sting of sinning has been removed."

    Such moralistic approaches, equating disease with sin, are counterproductive, Francis says, stressing that interventions need to focus on how individuals may respond to the cost of disease.

    He found that the historical data of the syphilis epidemic parallels the contemporary AIDS epidemic. "Some studies have indicated that the development of highly active antiretroviral therapy for treating HIV may have caused some men who have sex with men to be less concerned about contracting and transmitting HIV, and more likely to engage in risky sexual behaviors," Francis says.

    "Policy makers need to take into consideration behavioral responses to changes in the cost of disease, and implement strategies that are holistic and longsighted," he concludes. "To focus exclusively on the defeat of one disease can set the stage for the onset of another if preemptive measures are not taken."

    Protected Sex Just As Enjoyable As Using No Protection At All

    American men and women consider protected sex with condoms to be just as enjoyable and arousing as using no protection at all, according to a recent study published in The Journal of Sexual Medicine, conducted by researchers from Indiana University School of Public Health.
    The researchers conducted an online questionnaire to assess the characteristics of condom and lubricant use among men and women aged 18 to 59. They were able to gather information detailing the quality of the participants' most recent sexual experience and conclude whether condoms or lubricants have any influence on their quality of sex.

    Results from the 2009 National Survey of Sexual Health and Behavior indicated that men and women consider sex to be just as pleasurable and arousing regardless of whether condoms or lubricants are used, with safe sex using condoms to have the same score of quality as unprotected sex. Men admitted that using condoms or lubricant had made no big difference in their ability to have an erection.

    Women were found to be a lot more unsure than men whether the condoms used in sex were lubricated or not and were also less likely to know what material the condom was made from. This highlights the need for women to become more aware of the different kinds of contraceptions available and understand them more fully in order to practice safe sex.

    Dr Debby Herbenick, lead author of the study, said:

    "This may be because men are more likely than women to purchase condoms and to apply condoms. However, it's important for more women to become familiar with the condoms they use with their partner so that they can make choices that enhance the safety and pleasure of their sexual experiences."

    The country still faces a serious problem tackling sexually transmitted infections, HIV, and unwanted pregnancies, the researchers believe that it's imperative to understand why people buy certain products and avoid others which are related to safer or more pleasurable sex. Understanding more about the nature of current condom use can help health care providers.

    Herbenick concluded:

    "We need to understand how people make choices about the products they use, or avoid using, and how these products contribute to the safety and pleasurable aspects of their sexual experiences. This is particularly important as the products themselves evolve and become more mainstream in American society. We also need to understand what men and women know, or don't know, about the products they use so that we can better target public health education messages to individuals and groups."

    A recent study revealed that one of the leading concerns among health professionals is the improper and misuse of condoms during intercourse. Proper use of contraception is vital in reducing the prevalence of sexually transmitted diseases and HIV.

    Husbands Who Share Housework Have Less Sex

    Husbands who help out with household chores have less sex than men in so-called "traditional" marriages where housework is done exclusively by the wife, researchers from the USA and Spain reported in the journal American Sociological Review.
    In faithful relationships, the wife whose husband is involved in housework obviously has less sex too, the authors added.

    This latest study contradicts most previous ones, which tended to imply that married men generally have more sex in exchange for doing housework. However, those studies did not take into account which chores the husbands did.

    The researchers, all sociologists, said that their study demonstrated that sex is not a bargaining chip in marriage. Rather, it is associated with the kinds of chores each partner completes.

    Married couples reported greater sexual frequency if the women did the cooking, cleaning and shopping and the men did the gardening, electrics and plumbing, car maintenance and paid the bills.

    Co-author Julie Brines, professor of sociology at the University of Washington, said:

    "The results show that gender still organizes quite a bit of everyday life in marriage. In particular, it seems that the gender identities husbands and wives express through the chores they do also help structure sexual behavior."

    Lead author, Sabino Kornrich, warned that men should not assume from these findings that they should not become involved in traditionally female household tasks, such as shopping, cleaning or cooking. "Men who refuse to help around the house could increase conflict in their marriage and lower their wives' marital satisfaction."

    The researchers gathered and examined data from a national survey of approximately 4,500 heterosexual married couples in the USA who took part in the National Survey of Families and Households. The survey, the largest to measure sexual frequency among married couples, included data from 1992 to 1994.

    Brines does not believe that the division of household chores - which in this study did not include child care - and sex have changed much since 1994.

    RIAN archive 114768 Inside the IKEA shopping center
    "Traditional female tasks" include shopping, cleaning, looking after the kids, and cooking
    According to the study, husbands and wives spent an average of 34 hours each week on traditionally female chores. The men's average age was 46, and the women's 44. The couples spent an extra 17 hours each week on "men's work".

    On average, the males were involved in about one-fifth of traditionally female chores, and slightly more than half of male-type work. The researchers found that women tend to be more involved with helping out in traditionally male chores, than men do with female tasks.

    The couples reported having sex approximately five times, on average, during the four weeks before the survey. In marriages where the woman carried out all the traditionally female tasks, the couples had sex 1.6 times as often, compared to couples where the man was involved in all the female chores.

    Brines says she is not surprised that there was more sex among the traditional couples. "If anything surprised us, it was how robust the connection was between a traditional division of housework and sexual frequency." Brines is an expert in family and household dynamics.

    The following possible explanations for their findings were ruled out by the researchers:
    • Male coercive behavior played no role, because women reported similar satisfaction levels in their sex lives in both types of households (traditional or "modern")
    • In two-income households, the difference in sexual frequency was still driven by male behavior regarding traditional female chores. Also, the wife's income had no impact on sexual frequency.
    • The following had no impact on sexual frequency - gender ideology, religion, and happiness in marriage.
    Brines said:

    "Marriage today isn't what it was 30 or 40 years ago, but there are some things that remain important. Sex and housework are still key aspects of sharing a life, and both are related to marital satisfaction and how spouses express their gender identity."

    Recovery from Workload Influenced by Housework and Leisure Activity Balance

    How rapidly and effectively male and female spouses recover from the burdens of work is probably influenced by a balance of housework time and leisure time, a study by experts from the University of Southern California reported in the Journal of Family Psychology.

    Over half of all married couples in the USA are two-income households. The authors wondered whether the winner was the one who had the most help with the housework.

    They found that what seems to be good for the male partner was bad for the female, but what is good for the female does not have enough of an impact on the male.

    In another study involving 17,000 people in 28 countries, researchers from George Mason University found that married men did less housework than live-in boyfriends. The study was published in the Journal of Family Issues.