Healing Connections

An epidemic that began as a faint whisper over 25 years ago in the United States has now become a ROAR heard worldwide. Today, an estimated 1 million people in the U.S. alone are living with HIV or AIDS, with about 40,000 new cases each year. In what one expert called a “grim report,” an analysis by the Centers for Disease Control and Prevention (CDC) of HIV diagnoses trends revealed that during 2001 to 2006, an estimated 214,379 persons in 33 U.S. states were diagnosed with HIV/AIDS, with 97,577, or 46 percent, of those cases being among “men who have sex with men,” or MSM; a term referring to those who often do not identify themselves as strictly homosexual (gay) or bisexual.

However, the most disturbing trend seems to be emerging among young MSMs aged 13 to 24, which had an annual increase of 12.4 percent. Still higher was the increase among young African-American MSMs, who had an annual increase of nearly 15 percent, compared with a 1.9 percent annual increase among African-American MSMs of all ages. In contrast, there was a 1 percent decline in the 25 to 44-year-old group, as well as a 4.4 percent decline for HIV diagnoses attributed to high-risk heterosexual contact, and a 9.5 percent decline in diagnoses due to injection-drug use.

Dr. Richard Wolitski, acting director of the HIV/AIDS prevention at the CDC, said there could be several factors fueling the increases. “Because of the new treatments, some men perceive it to be a less severe disease than it once was,” he said. “These men represent a new generation that has not been personally affected by AIDS in the same way that their older peers were.” Ron Simmons, president of Us Helping Us, an AIDS service organization for gay black men, agrees that the revolution in antiretroviral therapy over the last ten years appears to have lessened the fear of HIV infection. “I can remember going to a funeral every four or five days,” he said. “Now, if you talk to some of these young men, they say, ‘If I do get infected, I will simply take the blue pill or the pink pill, like my friend.”

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A new report published in the open-access journal PLoS Biology examines the effect that light has on humans and animals. Most of us are familiar with how light affects the growth and development of plants (phototropism, for example, describes how plants grow towards light), but researcher Nathalie Hoang and colleagues set out to explore light’s impact on humans and mammals.

Plants have photoreceptor proteins called cryptochromes that take in blue light to help the plant grow and develop seedlings. Cryptochromes are also present in mammals, and the researchers studied those found in flies, mice, and humans. In humans, cryptochromes have been shown to have an effect on regulating the circadian clock (the 24 hour cycle of biochemical, physiological or behavioral processes), but we still do not know much about exactly how these cryptochromes operate.

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Eating a poor diet when pregnant or breastfeeding may cause long-lasting health damage to the child, animal studies suggest.

The offspring of rats fed fatty, processed food had high levels of fat in their bloodstream and around major organs even after adolescence.

The animals had a raised diabetes risk - even if they ate healthily.

The study, by the Royal Veterinary College and London’s Wellcome Trust, features in The Journal of Physiology.

Studies by the same team have already shown that rats whose mothers were fed junk food during pregnancy and breastfeeding were more likely to crave similar snacks themselves.

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Diarrhea and vomiting are not something anyone wants to experience, yet thousands of babies and children experience them annually in the form of the Rotavirus. New Rotavirus vaccines have recently entered the market and are helping to prevent the effects of this dreaded virus. 2006 was the first year Merck’s RotaTeq® vaccination was marketed and has reported great results. The U.S. Centers for Disease Control and Prevention has reported a reduction in cases of the Rotavirus since the entrance of RotaTeq®, noting that the 2007-2008 Rotavirus season started three months later than it has for the past 15 years, and that diagnosed cases were down last year by almost three fourths. The U.S. vaccine experts are recommending adding Rotavirus vaccinations to the routine immunizations list.

Positive Rotavirus results were down 79 percent during the first year of RotaTeq®. The FDA approved GlaxoSmithKline’s product Rotarix in April of this year and now allows for a choice between the two Rotavirus vaccines. The CDC’s Advisory Committee for immunizations is currently formulating recommendations in regards to the use of both Rotavirus vaccines that seem to be equally safe and effective.

RotaTeq® is given in three oral doses and Rotarix® in two oral doses, both over a six-month period. Rotarix® and RotaTeq® have been approved for use in children ages two months to six months. The main difference between the two is in the dosages. Some of the most common side effects of the vaccinations, per the FDA, were fussiness, irritability, nausea, and cold symptoms such as fever, runny nose and cough.

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Call them stoic, call them cost-conscious, call them under- or uninsured…but almost 20 percent of the U.S. population either went without or delayed needed medical care at sometime during 2007. That figure is up from 14 percent in 2003, and if you are counting, is an additional 9.5 million Americans who didn’t get the medical care they needed in 2007.

People had numerous reasons why they had postponed or had completely forgone medical care for themselves during the year. Chief among them was out-of-pocket medical costs and deductibles they couldn’t afford to pay, followed by a list that included things like a lack of acceptable clinic hours of operation, difficulty getting to clinics during working hours, problems with doctors being overbooked that resulted in difficulty getting timely appointments, and doctors and hospitals not accepting their insurance plans.

It wasn’t just people without medical insurance that were avoiding medical visits, but both people with and without insurance that were either delaying or forgoing medical care, according to a random national phone survey. The survey was conducted by the Center for Studying Health System Change, a nonpartisan policy group, who called 18,000 people, with a 43 percent response rate.

The study’s lead author, Peter Cunningham, noted that as health care costs increase, a larger share of cost, often in the form of higher deductibles, is being shifted to people and families, requiring them to pay more out of their own pockets. “To the extent that cost increases are passed on to individuals, continued declines in access to care are inevitable,” wrote the co-authors of the study.

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As I begin my independence training, the things I am focusing most on is ADL or adult daily living skills such as cooking, laundry, and house-cleaning. I was given a great deal of advice concerning this particular issue by my local National Federation for the Blind (NFB) chapter. The most prevalent piece of advice was to designate a particular time each day devoted solely to a lesson having to do with ADL skills. Theoretically, it’s a wonderful idea, but practically it is completely impossible.

This is mainly due to the TIME factor. For example, Mom has been cleaning house for so long that it is just second nature to her. She has perfected her technique to the point that she finishes her tasks quickly, making good use of the time she has allotted. However, guiding someone slowly through each step of the process takes a long time. An in-depth ADL lesson could take up the biggest part of the day; time many of us can ill-afford in today’s busy world. I’m sure all the busy parents reading this right now can empathize with my mom.

I was rather stumped for ideas. “How am I ever going to learn all the things I need to know in order to be independent?” I asked Mom.

She thought for awhile and then said that she felt maybe we were going about it all wrong. She said that, despite the advice I had been given, learning is a lengthy process. Just as I didn’t jump up and start walking, but had to learn in steps, first crawling and then pulling up and falling down and learning how to get up again, that is how I would have to learn other things too.

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An international group of scientists found that a new gene called calcium homeostasis modulator 1 (CALHM1), with a previously unknown function, is linked to late-onset Alzheimer’s Disease making this the second discovery of a strong genetic risk factor for the disease.

The study was the work of researchers from the US, France, Italy, UK, and Australia, led by Dr Philippe Marambaud of The Feinstein Institute for Medical Research, Manhasset, New York, and Albert Einstein College of Medicine, Bronx, New York, and is published online in the June 27 issue of the journal Cell.

Alzheimer’s disease is a progressive neurodegenerative disorder characterized by the build up of senile plaques made of amyloid-beta peptides and a massive loss of neurons or brain cells.

The early-onset form of Alzheimer’s is thought to be linked to a few dominant gene mutations, but the vast majority of late-onset cases are believed to stem from complex interactions of genes and environment factors.

The study reports that CALHM1 is active mostly in a calcium channel in part of the brain that is affected early in the development of Alzheimer’s. The researchers discovered that variants of CALHM1 influence levels of calcium, amyloid-beta peptides, and susceptibility to the disease.

This study coincides with the publication of another paper in the 26th June issue of a sister journal Neuron, where scientists report finding an imbalance of calcium in early-onset Alzheimer’s Disease that is linked to a calcium release ion channel.

Marambaud said in a statement that:

“We are very excited about the idea that CALHM1 could be an important target for anti-amyloid therapy in Alzheimer’s disease.”

He said because CALHM1 is restricted to the brain, drugs that target it would most likely have fewer side effects, which is a big question mark with drugs that are currently being trialled because these target enzymes involved in production of amyloid-beta peptides, and these enzymes are also present in other parts of the body.

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Picking up an infection is the public’s main concern about hospital care, a UK-wide BBC poll shows.

Of the 1,040 people quizzed, 40% listed the risk of potentially deadly infections such as MRSA and Clostridium difficile as their top NHS concern.

In a separate finding, 31% said they would consider avoiding NHS surgery for fear of getting an infection.

The government said it had introduced a raft of measures which were already having an impact in reducing infection.

Despite the concerns raised by the survey, 82% of respondents said they were proud of the health service, with half claiming it was still the envy of the world.

The most widely-cited concern after infections was the wait people face for treatment.

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One of the most comprehensive studies on the minimum drinking age shows that laws aimed at preventing consumption of alcohol by those under 21 have significantly reduced drinking-related fatal car crashes.

Specifically, the study published in the July 2008 issue of the journal Accident Analysis and Prevention found that laws making it illegal to possess or purchase alcohol by anyone under the age of 21 had led to an eleven percent drop in alcohol-related traffic deaths among youth; secondly, they found that states with strong laws against fake IDs reported seven percent fewer alcohol-related fatalities among drivers under the age of 21.

The study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.

The study, led by James C. Fell, M.S., of the Pacific Institute for Research and Evaluation (PIRE), accounted for a variety of factors, such as improved safety features in cars, better roadways and tougher adult drunk driving laws, that are supposed to have contributed to a reduction in fatalities involving underage drivers who have consumed alcohol. Fell’s research controlled for more variables than any other previous study on the topic, accounting for regional and economic differences, improvements in roadways and vehicles, and changes that lowered the illegal blood alcohol content for driving to .08. Yet, according to Fell, the eleven percent drop in youth fatalities is a “conservative” figure.

Fell notes that his research is more sophisticated and comprehensive than previous studies that have looked at the drinking age. “There has been evidence since the 1980s that an increase in the drinking age to 21 was having an impact on traffic deaths,” Fell said. “But this is the first time we’ve been able to tease out the real effect, free of the variables that had been used to question the validity of the evidence.”

In addition to providing comprehensive evidence of the life-saving impact of minimum drinking age laws, the authors of the new study found that tougher sanctions against fake identification cards may represent the second-best legislative tool that states have in combating drunk driving deaths among young people.

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UroToday.com - Dr. Evans presented a lecture on targeted therapies. Most drugs have a mechanistic “target”, such as the enzymes 5-α reductase in the treatment of BPH or 5-phosphodiesterase in the treatment of erectile dysfunction. However, in the current presentation, “targeted therapy” is defined as molecular targeting.

Historically, the selection of systemic therapies for most cancer patients has been largely empiric. However, recent advances in cancer molecular biology suggest that defining biomarkers predictive of response and survival are achievable goals. The Human Genome Project, the International HapMap and progress in high-throughput assays have made genetic testing and individualized therapy a tangible reality. Using pharmacogenomic approaches to cancer therapeutics, one translational approach is to exploit the underlying molecular profile of the tumor (DNA, RNA, protein) or the host (patient genomic DNA) to improve treatment outcomes. To do this researchers must take into account both inter-individual differences (between individual patients) and population-related differences (ethnic/racial differences).

While patients may carry the same diagnosis and clinical features, they possibly harbor different molecular profiles. Among patients carrying the same disease diagnosis, a subset that exhibit toxicity or non-response to standard therapy may have molecular attributes that identify them for alternate therapy. The concept of prognostic biomarkers is well established, but predictive biomarkers that confirm a molecular target or reflect the impact of a therapeutic intervention are newer. For example, while HER2 status delineates poor prognosis in breast cancer, it has positive predictive value for benefit from trastuzumab. On the other hand, the epidermal growth factor receptor inhibitor gefitinib was not initially appreciated to have selectivity for lung cancer patients with mutated EGF receptor (and gene copy number by FISH) and because of this 4,000 patients in 4 major clinical trials were not optimally selected to benefit.

Urologists perhaps became most aware of targeted therapy with the introduction of tyrosine kinase inhibitors for renal cell carcinoma. They resulted from the discovery that most patients with conventional cell renal cancer demonstrated mutation or silencing of the VHL gene, with subsequent delineation of pathways modified by pVHL. Sorafenib and sunitinib are “multikinase” inhibitors that target several kinases to include KIT, FLT3, PDGF and VEGF receptors. But in other histologic types of kidney cancer, different molecular alterations will drive therapy; mutations in the MET proto-oncogene in hereditary papillary renal carcinoma or mutations in the fumarate hydratase gene in hereditary leiomyomatosis renal cell carcinoma for examples. As such, receptors or pathways related to these specific alterations provide different targets. In bladder and prostate cancer numerous potential targets exist, based upon oncogenes, survival genes, gene products and suppressor gene mutations. In addition to testing as monotherapy, many targeted drugs are under investigation as combination therapy, such as the targeted endothelin-1 receptor A inhibitor atrasentan and docetaxel.

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