Medicine Man

Two studies led by researchers at the Johns Hopkins Bloomberg School of Public Health found that people infected with HIV in Thailand die from the disease significantly sooner than those with HIV living in other parts of the world.

According to the researchers, the shorter survival time measured in the studies suggests that HIV subtype E, which is the most common HIV subtype in Thailand, may be more virulent than other subtypes of the virus. Both studies are published in a special issue of the journal AIDS.

The first study followed 228 men over a 14-year period starting in 1991. All of the men were serving in the Thai military and were HIV-negative when they enrolled in the study. The researchers tested for HIV every six months to determine approximately when they acquired HIV. The men were also diagnosed at a time before combination antiretroviral drug therapy was available.

The researchers compared the group of Thai men to a group of similar HIV-positive men living in North America and Europe who were included in another study. The median time from HIV infection to death for the Thai men was 7.8 years compared to 11 years for HIV-positive men living in North America and Europe. The survival rate for the Thai men was also lower than studies of similar populations living in low- and middle-income countries in sub-Saharan Africa where subtypes A, C, D and G circulate. However, the shorter survival after HIV infection among persons in Africa infected with subtype D was similar to the survival among the Thai men.

"We were surprised to learn that the young military recruits from Thailand appeared to develop AIDS more quickly and have shorter survival after their HIV infection than persons in Africa who were carefully followed," said lead author Ram Rangsin, assistant professor of Community and Military Medicine at Phramongkutklao College of Medicine in Bangkok. Rangsin conducted the research while studying at the Bloomberg School of Public Health. "Fortunately, the men who have survived after their infection are now receiving treatment with effective antiviral drugs and doing very well."

For the second study, researchers followed a small group of male blood donors and their wives from 1992 to 2007. All of the men and women were determined to have acquired HIV fewer than two years prior to enrolling in the study. The median survival rate from infection to death was 7.8 years for the men and 9.6 years for the women. Again, the survival rate was lower than the 11 years reported for HIV-positive men in developed countries.

"The fact that both young military conscripts and blood donors and their wives in Thailand had similarly shortened survival compared to persons in the U.S. and Africa-except those infected with subtype D viruses-suggests that viral subtypes D and E may be more virulent than many other viral subtypes," said Kenrad E. Nelson, MD, a senior author of both studies and professor in the departments of Epidemiology and International Health at the Bloomberg School. "If we could understand better the virulence characteristics of these viruses, we might learn something more about why those with HIV infection progress to AIDS, usually many years after they are infected."

"The natural history of HIV-1 subtype E infection in young men in Thailand with up to 14 years of follow-up" was written by Ram Rangsin, Phunlerd Piyaraj, Thira Sirisanthana, Narongrid Sirisopana, Onsri Short and Kenrad E. Nelson.

http://www.jhsph.edu/

The Endocrine Society strongly urges Congress to protect patient access to DXA (dual X-ray absorptiometry) - the leading diagnostic tool for the early detection and management of osteoporosis.

New legislation introduced by Congresswoman Shelley Berkley (D-NV), HR 4206 "Medicare Fracture Prevention and Osteoporosis Testing Act of 2007," would restore essential funding for this vital healthcare service.

"Congresswoman Berkley should be commended for leading the charge to protect essential patient care for osteoporosis," said Margaret Shupnik, Ph.D., president of The Endocrine Society. "This is vitally important for hundreds of thousands of women, particularly in rural areas, who rely on their personal physicians as their first and only line of defense against this debilitating yet preventable disease."

Looming cuts to Medicare threaten to drastically reduce medical reimbursement for this service. Left unchecked, these cuts would prevent many doctors from providing DXA services in their offices.

A recent survey by the Lewin Group revealed that 90 percent of physicians who currently offer DXA would be unable to afford this service by the year 2010 when the cuts are scheduled to go into full effect. Congresswoman Berkley's legislation would restore Medicare funding for DXA to 2006 levels, before the cuts went into effect.

Optimal osteoporosis care requires the coming together of many different elements-accurate test results, direct medical intervention by endocrinologists and family practitioners, and personal attention to lifestyle and preventative care strategies. "Patients are best served when their doctors can have first-hand access to DXA test results and can consult with their patients directly to determine the most effective treatment and prevention options," said Shupnik.

DXA is the recognized standard for testing for hip, spine, and vertebral fracture risk. It is the most widely used and most regarded bone density measurement technology.

Currently, only about 20 percent of eligible Medicare patients have had their bone density measured, demonstrating the fundamental need to ensure easy access to testing. Without an increase in prevention, the number of fractures due to osteoporosis is projected to increase by 50 percent by 2025. This increase in fractures equates to an annual healthcare cost of over $22 billion, which will likely increase costs to Medicare and Medicaid.

The U.S. Preventive Services Task Force Recommendations on Osteoporosis urge routine osteoporosis screening for all women age 65 and older to identify those at risk for fracture and that routine screening begin for women age 60 at increased risk for fractures.

By supporting this legislation, Congresswoman Berkley and the 41 co-signers to H.R. 4206 recognize the essential role DXA plays in the health and wellbeing of women and men.

"The Endocrine Society and its partners in the medical community strongly endorse the efforts of Congresswoman Berkley and her colleagues to restore funding for this vital medical procedure," said Shupnik. "Osteoporosis is a crippling disease; patients shouldn't face crippling obstacles when seeking treatment."

http://www.endo-society.org

Recovering alcoholics whose chosen strategy is to abstain from drinking are least likely to relapse, according to a new study of a nationally representative sample of adults.

However, although abstinence is the most reliable form of recovery to help middle-age and older adults avoid alcohol abuse and dependence problems, the study found that sustained recovery might be more elusive for young people, regardless of whether they avoid all alcohol or simply restrict their consumption.

"The biggest surprise was how little abstinence did to improve the prospects for younger alcoholics remaining in remission. To my knowledge, no one has looked at this age differential before," said lead study author Deborah Dawson, Ph.D. She is a substance abuse researcher with the National Institute on Alcohol Abuse and Alcoholism.

The study appears in the December edition of Alcoholism: Clinical and Experimental Research . The article examines results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Dawson's team analyzed the recovery status of more than 1,700 adults who were in some form of recovery at the beginning of the study, but who had been dependent on alcohol in the past.

Researchers grouped the participants into three categories: 1) abstainers, people who said they did not imbibe alcohol; 2) low-risk drinkers, people who drink at levels lower than those thought to increase the risk for relapse; and 3) asymptomatic risk drinkers, people who do not have any symptoms of alcohol abuse or alcohol dependence, but who drink more than the recommended guidelines for low-risk drinking.

The team interviewed study participants in 2001 and 2002, and again in 2004 and 2005.

The alcoholics who were abstainers at the beginning of the study were most likely to still be in recovery - and symptom free - at the second wave of the survey. Fifty-one percent of the asymptomatic risk drinkers had experienced the recurrence of alcohol dependence symptoms, compared with 27.2 percent of low-risk drinkers and 7.3 percent of abstainers.

"The most commonly reported symptoms of dependence in this study were repeatedly trying to stop or cut down on drinking, drinking more or for longer than intended and problems with sleeping, nausea or restlessness when the effects of alcohol were wearing off," Dawson said. "The most commonly reported abuse symptom was driving after drinking too much."

Abstaining worked best for alcoholics older than 25, the study found. The benefits of abstinent recovery were not as strong for younger individuals. "Youthful abstainers are still at high risk," Dawson said.

It is not clear why abstinence does not work as well for young drinkers, but the authors said the high risk for relapse among people age 18 to 24 begs for more study and signals a significant treatment and prevention challenge for the legal system and college campuses.

Health researcher Lee Ann Kaskutas says it is too soon to discount the benefits of abstinence for young alcoholics.

"It may be that these very young drinkers just haven't lived long enough - or had time to experience the cycle of failure and success - to allow abstinence to work," said Kaskutas, director of training at the Alcohol Research Group in Berkeley, Calif.

Alcoholism: Clinical and Experimental Research : Contact Mary Newcomb at (317) 375-0819 or mnewcomb-acer@earthlink.net or visit http://www.alcoholism-cer.com

Dawson DA, Goldstein RB, Grant BF. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcoholism: Clinical and Experimental Research 31(12), 2007.

http://www.hbns.org

Scientists at the University of Liverpool have been awarded £5 million to investigate how cells respond to stimuli such as stress and UV radiation.

Biologists at Liverpool will investigate the role of the NF-kappaB signalling system to determine how cells decide when to die. NFkB governs responses within cells to stimuli such as stress and the immune system, but when this system goes wrong it is thought that it can lead to cancer, inflammatory problems and septic shock.

Professor Mike White, from the University's School of Biological Sciences, said: "Systems Biology involves the analysis of how biological processes work at all levels. This goes from the interactions between individual biological molecules, to the physiology and behaviour of animals and plants. With this grant we can develop models to understand more clearly how cells communicate with each other."

The project - in collaboration with the Universities of Manchester and Warwick - is a multidisciplinary collaboration involving scientists in Biological and Biomedical Sciences, veterinary scientists and mathematicians.

A second team from the School of Biological Sciences, headed by Dr Anthony Hall has been awarded a further £1 million as part of a £5 million project led by scientists at the University of Edinburgh to develop a model of how plants cope with temperature changes. The research could help to develop higher-yield crops that are better able to survive in harsh conditions, thus allowing scientists to develop plants capable of withstanding the possible effects of global warming.

http://www.liv.ac.uk

There is a close relationship between infection outbreaks on teeth and the presence of alopecia areata or localized alopecia, a type of hair loss which has an unknown origin.

Alopecia areata starts with bald patches on the scalp, and sometimes elsewhere on the body. The disease occurs in males and females of all ages, and experts believe that it affects 1 out 1000 people.

Research by professors José Antonio Gil Montoya and Antonio Cutando Soriano, of the University of Granada, advises going to the dentist when patients notice localized hair loss, in order to receive a careful examination of their oral health.

"Alopecia areata is a dermatitis which presents the following signs: The typical pattern is for one or more round bald patches to appear on the scalp, in the beard, or in the eyebrows, or to undergo a loss of eyelashes. Alopecia areata is thought to be an auto-immune disease", stated the researchers. Hair re-grows in most patients after several months. However, in a quarter of all patients the condition recurs once or more. According to professors at the UGR, the affected hair follicles are not totally destroyed. Therefore, hair can grow back, although patients who have already suffered from alopecia areata may have recurrences.

Frequently, patients with alopecia areata have hairs with the shape of an exclamation mark on the border of the bald patch. Hairs become weak and fall out easily. Several studies suggest that alopecia areata has unpredictable development: sometimes hair grows back within a few weeks, but in some cases the disease progresses and can cause further hair loss on scalp and body.

Until the research at the UGR, which establishes for the first time a relationship between alopecia areata and dental disease, the origin of this kind of hair loss was not well known. Hair-follicle tissue inflames without cicatrisation. In alopecia areata, the affected hair follicles are mistakenly attacked by the immune system. Some of the factors that cause alopecia are: genetics, family history of alopecia, non-specific immune reactions, specific auto-immune reactions of certain organs and emotional stress.

"We have found that bald patches caused by tooth infection are not always in the same place. They normally appear on a line projected from the dental infection and can thus can be located on the face at the level of the maxillary teeth, above a line through the lip-angle to the scalp, beard, or even to the eyebrow. Nevertheless, they can also be located far from infection outbreak." Explained Gil Montoya and Cutando Soriano.

http://www.ugr.es/