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A baby born with HIV remains free after taking Pills

A 3-year-old girl born in Mississippi with HIV acquired from her mother during pregnancy remains free of detectable virus at least 18 months after she stopped taking antiviral pills.

New results on this child, published online by the New England Journal of Medicine, appear to green-light a study in the advanced planning stages in which researchers around the world will try to replicate her successful treatment in other infected newborns.

And it means that the Mississippi girl still can be considered possibly or even probably cured of HIV infection — only the second person in the world with that lucky distinction. The first is Timothy Ray Brown, a 47-year-old American man apparently cured by a bone marrow transplant he received in Berlin a half-dozen years ago.

This new report addresses many of the questions raised earlier this year when disclosure of the Mississippi child’s case was called apossible game-changer in the long search for an HIV cure.

“There was some very healthy skepticism,” Dr. Katherine Luzuriaga, a professor at the University of Massachusetts in Worcester, tells Shots. She’s part of the team that has been exhaustively testing the toddler’s blood and considering every possible explanation for her apparently HIV-free state.

Luzuriaga is confident the latest tests prove that the child was truly infected with HIV at the time of her birth — not merely carrying remnants of free-floating virus or infected blood cells transferred before birth from her mother, as some skeptics wondered.

The UMass researcher says there’s no way the child’s mother could have contributed enough of her own blood plasma to the newborn to account for the high levels of HIV detected in the child’s blood shortly after birth.

Similarly, Luzuriaga says, new calculations show that the mother “would have had to transfer a huge number of [HIV-infected] white blood cells to the baby in order for us to get the [viral] signal that we got early on.”

Clinching the question as far as the researchers are concerned is the infant’s response to anti-HIV drugs that she began receiving shortly after birth. The remarkable earliness of her treatment is a crucial feature that makes this child different from almost any other.

“There’s a very characteristic clearance curve of viruses once we start babies on treatment,” Luzuriaga says. “The decay of viruses we see in this baby is exactly what we saw in early treatment trials from 20 years ago when we initiated anti-retroviral therapy and shut off viral replication. That’s a very different decay curve than you would expect if it were just free virus transferred to the baby.”

It might be helpful to recap the unusual, if not unique, features of the Mississippi case.

Her mother did not receive prenatal care, so she was not identified as HIV-infected before delivery. If she had been, she would have received drugs that are highly effective in preventing mother-to-child transmission of the virus.

While the mother was in labor, she got HIV testing, as is routine for women without prenatal care. When that came up positive, Dr. Hannah Gay, a pediatrician at the University of Mississippi Medical Center in Jackson, was ready to test the newborn for infection and start anti-retroviral medicines within 30 hours of birth.

The treatment quickly cleared the virus from the baby’s blood. Normally such children would stay on antiviral drugs for a lifetime. But in this case the mother – whose life circumstances were reportedly chaotic – stopped giving the child the medication between 15 and 18 months after birth.

Gay and her colleagues caught up to the child when she was 23 months old and were astonished to discover she was apparently still virus-free despite being off treatment. Five rounds of state-of-the-art testing — at UMass, Johns Hopkins, federal research labs and the University of California San Diego — failed to reveal any trace of the virus in her blood.

That led to last spring’s report and widely reported hope that the child had been cured of HIV.

But Dr. Scott Hammer, an HIV researcher at Columbia University in New York, is not quite convinced. “Is the child cured of HIV infection? The best answer at this moment is a definitive ‘maybe,’ ” Hammer writes in a New England Journal editorial that accompanied the report.

The reason is that a couple of tests done when the child was about 2 years old found indications that her system may contain pieces of RNA or DNA from HIV. This hints that some of the nucleic acid building blocks of the virus are hanging around within her blood cells.

There’s no evidence these “proviral” remnants are capable of assembling themselves into whole viruses that can make copies of themselves. But researchers are concerned about that possibility and how it might be headed off.

“The question is whether those viral nucleic acids have the ability at some point to replicate and allow a rebound of the virus,” Luzuriaga acknowledges. “That’s why it’s important to continue to test the baby over time.” She says that means years.

But for now, the signs from the Mississippi child’s case are encouraging enough to have generated an ambitious global human experiment that Luzuriaga says is in final planning stages.

Women who present in labor without having had prenatal care will be tested for HIV and, if positive, their infants will be intensively treated within a couple of days of birth, as the Mississippi child was. Then they’ll be followed with the most sensitive tests to determine if the virus has been eradicated.

If certain criteria are met, researchers plan to decide whether it would be safe to discontinue HIV treatment deliberately and follow the children closely to see if the virus returns. (If it did, treatment would be restarted.)

If the experiment succeeds, it would be a huge advance in the prevention of childhood HIV and AIDS in many parts of the world. More than 9 out of 10 the world’s 3.4 million HIV-infected childrenlive in sub-Saharan Africa, where many women deliver without having had prenatal care or HIV treatment. Around 900 children are newly infected every day.

Meanwhile, researchers pursuing an HIV cure will convene next month in San Francisco to consider various strategies — for adults as well as children. One other recent glimmer of hope was provided this summer by Boston researchers who reported that two HIV-infected men with lymphoma remain virus-free without treatment for several months after stopping antiviral treatment.

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World’s first tissue-engineered trachea implant – success 5 years later

Five years after the world’s first tissue-engineered trachea implant, researchers are declaring the procedure is still a success, with the patient reporting good quality of life and minimal complications, Medical Xpress reported.

The patient, a then-30-year-old mother of two from Colombia, received the implant in 2008 after her own trachea collapsed due to complications from tuberculosis. The implant was created using cells from the trachea of a human donor combined with cartilage cells derived from the patient’s own stem cells and epithelial cells taken from the patient’s trachea.

Ten days after the groundbreaking procedure, the patient was discharged from the hospital. After four months, the transplant appeared to be successful, and the patient did not require any immunosuppressive drugs.

In a study published in The Lancet, researchers report that five years after the initial transplant, the recipient is still doing well and enjoying a normal life. Testing has also revealed that the patient has good lung function and isn’t demonstrating any immunological complications, according to Medical Xpress.

Although scarring on the graft required a stent to be inserted six months after the procedure, the patient is no longer experiencing any symptoms of this minor complication, researchers reported.

“These results confirm what we – and many patients– hoped at the time of the original operation: that tissue engineered transplants are safe and effective in the long term,” said Paolo Macchiarini from the Karolinska Institutet in Stockholm, Sweden, who operated on the patient.

Macchiarini noted that he and his fellow researchers hope to improve upon the procedure in the future to avoid complications like the minor scarring seen in the patient. They also hope to continue with clinical trials in order to further demonstrate that this type of procedure can be integrated into routine practice.

According to MedPage Today, several other successful trachea implants have been completed since 2008, including one on a 2-year-old South Korean girl born without a windpipe and another on a 36-year-old cancer patient.

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A text message saves life in Sweden

CPR can significantly increase the survival rate for cardiac arrest victims, but finding someone who knows the proper way to do it at a moment’s notice may be difficult.

Now, a new system aims to change that. By using mobile geographic positioning services (GPS), people trained in CPR are alerted via mobile phone and given the location of a suspected cardiac arrest.  It is happening in Sweden, where over 2 million people are trained in the life-saving procedure.

The program is called SMSlifesavers, and it is a unique research project run by Stockholm South General Hospital and Karolinska Institute. The program uses GPS on mobile phones to identify and quickly alert rescuers.

“Lots of people in Sweden, as well as in America I guess, are educated and really skilled in CPR, but the problem is lots of people don’t get to use their skills, and we are trying to figure out a way to contact them… using a text message or SMS, seems like a fairly easy idea,” David Fredman, project manager for SMSlifesavers, who is also a nurse at Stockholm South General Hospital in Sweden told Dr. Manny Alvarez in an interview for FoxNews.com.

When an emergency call is received by the Swedish equivalent of 911, the location of the victim is determined geographically. If a cardiac arrest is suspected, the emergency operator engages a positioning system that locates mobile phone users in the SMSlifesaver network.  If a volunteer is located near the site of the suspected cardiac arrest, the rescuer is alerted through the mobile phone along with ambulance and emergency services.

“We are using GSM technology,” said Fredman. “This is not based on smartphones, so you can use it on any platform, as long as you have a phone … We don’t need your fancy phones, we need your fancy skills.”

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Over 1000 Human Genomes Sequenced In Record Breaking Project

A multinational team of scientists reports that they have successfully sequenced 1,092 human genomes from individuals across the globe.

Their new study is the first to break the “1,000 genomes barrier.”

The researchers say the feat is a collegial effort to equip biologists and physicians with information that can be used to understand the normal range of human genetic variants so a patient’s diseased genome can be interpreted in a broader context.

“The DNA donors in the study were not known to have any diseases, so the study gives us the genomic background we need for understanding which genetic variations are ‘within the normal range,’” said Aravinda Chakravarti, Ph.D., professor of medicine and pediatrics and a member of the Institute of Genetic Medicine at the Johns Hopkins School of Medicine in a prepared statement. “With this tool, scientists now have a standard with which they can compare the genome of someone with diabetes, for example.”

Chakravarti said this feat will increase opportunities for understanding a patient’s disease and creating targeted, individualized treatment.

The international group of researchers sampled individuals from 14 different populations and sequenced their full genomes. The sample was based on their ancient migratory history and their genetic relationship to the other populations studied.

Within each population, healthy, unrelated donors were randomly chosen for blood draws. The samples were first transformed into cell lines that can be stored and grown indefinitely so that they will always be available for future studies.

The first human genome to be sequenced made clear that as much as 98.5 percent of human genetic material does not encode proteins as previously thought.

Scientists now know the role of some of the non-protein-coding regions, and that there is reason to suspect that at least some of it plays a role in various disease susceptibility and prevalence.

“The 1000 Genomes Project started at the beginning, with the whole genome and with no bias in the search for disease-related variants toward protein-coding genes,” Chakravarti said. “Regulatory sequences and sequences we still don’t understand were also catalogued, so this information widens the areas of the genome we can search when looking for disease-causing variants.”

The genetic variations the researchers found in the populations analyzed were categorized by how frequently they appeared in the individuals tested. The variants seen in more than five percent of the samples were classified as common. Samples below that were considered of low-frequency, or rare.

The 14 populations sampled included groups from Europe, Africa, East Asia and America. Most of the common variants had already been identified in previous studies and their frequencies varies little between ancestry groups.

The researchers found that among rare variants, the healthy people in their study possessed as many as 130 to 400 protein-altering variants, and 10 to 20 variants that destroy the function of the proteins they encode.

In the healthy people, they also found two to five variants that damage protein function, and one or two variants associated with cancer.

Chakravarti said that several factors allow people to survive with so many errors in our genome, including one that genes occur in pairs, but our bodies require one normal copy to work.

Another error is that a “redundant” gene elsewhere in the genome can sometimes compensate for a specific deficiency. Also, some deleterious genes are only turned on in response to certain environmental cues that a particular individual may never encounter.

“We are all walking natural experiments; some of our genes are switched off, some are active, whilst others are overactive,” said Professor Gil McVean of Oxford University, the lead author for the study. “Our research has found that each apparently healthy person carries hundreds of rare variants of genes that have a significant impact on how genes work, and a handful (from two to five) of rare changes that have been identified as contributing to disease in other people.”

The study was designed so that researchers have access to living cells from all the individuals whose genomes have been sequenced. Scientists can now study how differences in the biology of these cells correlate with genetic differences.

“There are variations that jump out from the data as looking ‘a bit bad for you’, for example mutations in regions that regulate genes are likely to be ‘bad news’ — possibly doing something dramatic to how cells behave,” said Dr Richard Durbin from the Wellcome Trust Sanger Institute, co-chair of the 1000 Genomes Project. “Using our data you can now look to see if natural selection has been getting rid of such mutations — giving you a clue as to how harmful these variants might be.”

The team’s work is already being used to screen for cancer genome mutations that might identify therapeutic pathways. It is also being used to interpret the genomes of children with developmental disorders.

“Our research shows that you can take localism much further: for example, even just within the UK, Orkney islanders will have different variations from mainlanders, and will be different again from those from other nearby islands,” McVean added. “In the future we would like to reach the scale of having a grid of individuals giving us a different genome every couple of square kilometers but there is a long way to go before we can make this a reality.”

Sir Mark Walport, Director of the Wellcome Trust remarked that it is remarkable we have gone from completion of the first human genome sequence in 2003, to sequencing more than 1,000 in less than a decade.

“This study is an important contribution to our understanding of human genetic variation in health and disease and the DNA sequences are freely available for analysis and use by researchers,” Walport said.

The next phase of the project will include as many as 3,000 individuals, according to Dr. Fuli Yu, assistant professor in the Baylor College of Medicine Human Genome Sequencing Center.

“The impact of this project will be huge,” said Yu. “Here we have information on nearly 1,100 people, including their rare and common single nucleotide polymorphisms (SNPs) along with insertions and deletions of the genetic material and large structural variations in the DNA itself.”

The researchers reported their findings in the journal Nature.

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Elevated Carcinogen Levels In 87 %Of California Daycare Centers

Nearly nine out of every 10 day care centers analyzed in a new University of California, Berkeley survey contained elevated levels of formaldehyde or other types of contaminants.

The study, which was funded by the California Air Resources Board (CARB) and is the first detailed analysis of environmental contaminants and exposures for California day care centers, looked at 40 child care facilities in Alameda and Monterey counties, UC Berkeley Media Relations official Sarah Yang reported Thursday.

It discovered that 35 of them (87.5%) had chemicals and other pollutants that exceeded state health guidelines, including formaldehyde levels above California’s safe-exposure guidelines of 9 micrograms per cubic meters over an eight hour period.

Formaldehyde is listed as a carcinogen under the state’s Safe Drinking Water and Toxic Enforcement Act of 1986 and is also a known respiratory irritant, Yang said. It is “commonly found in the glues used in pressboard furniture and laminated wood,” as well as “in many paint, clothing and cosmetic products” and in emissions originating from “combustion sources such as wood burning and gas stoves,” she added.

“Children are more vulnerable to the health effects of environmental contaminants, and many small children spend as much as 10 hours per day, five days a week, in child care centers,” Asa Bradman, lead author of the study and the associate director of the UC Berkeley Center for Environmental Research and Children´s Health (CERCH), said. “We wanted to establish the baseline levels of environmental exposures in these early child care settings, and to provide information that could be used for any necessary policy changes.”

The 40 facilities studied by UC Berkeley and the CARB serviced more than 1,700 children in both rural and urban areas, Yang explained. Bradman and colleagues collected dust samples from both the air and the floor while the children were in attendance at the centers, and tested those samples for a variety of chemicals and other substances, including fine particulates that can be inhaled into a person’s lungs.

“These findings show that cleaning and sanitizing products impact air quality in child care settings,” Victoria Leonard, who was not involved in the research but works as a scientist at the UC San Francisco Institute for Health and Aging and the head of an initiative to promote healthier product choices in child care, told Yang. ”Given that many young children have asthma or other respiratory problems, this study offers strong evidence to select safer cleaning products that have less volatile chemicals.”

“In some centers, levels of ultrafine particles increased by up to a thousandfold when cooking appliances were turned on,” Yang explained. “And since formaldehyde can also be emitted from gas stoves, the study authors advised using a range hood and fan when cooking to reduce particle and formaldehyde levels.”

Other substances detected by the investigators included phthalates (found in plastics), flame retardants, pesticides and perfluorinated compounds (found in Teflon and stain resistant carpets), she added.

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3-year-old : hear his father’s voice after implant

Five months have gone by since the operation that allowed 3-year-old Grayson Clamp, born deaf; hear the voice of his father for the first time. While progress has been made, with Grayson spontaneously saying a few words, it appears he still has a lot of catching up to do. Dr. Jon LaPook reports.

For More visit video at: http://www.cbsnews.com/video/watch/?id=50157746n

Painkiller Overdose Deaths Strike New York City’s Middle Class

Drug overdoses are usually thought to afflict mainly the poor and troubled. But it looks like OxyContin and other opioid painkillers are changing the picture.

People in stable, middle-class neighborhoods are also dying from opioid overdoses, a study in New York City finds.

Opioids have become among the most popular drugs of abuse in the past decade, with deaths from overdoses of oxycodone, hydrocodone and codeine eclipsing those from heroin and cocaine combined.

Fatal overdoses from prescription painkillers more than tripled from 1991 to 2007, according to the Centers for Disease Control and Prevention.

To find out what was happening in New York City, researchers at Columbia University’s Mailman School of Public Health mapped the 447 unintentional deaths from opioid painkiller overdoses in its five boroughs from 2000 to 2006. They then compared those deaths to heroin overdoses and accidental deaths from other causes, such as falls and drowning.

The heroin deaths were mostly in low-income neighborhoods where many people struggle with crime, fractured families and untreated mental health problems.

The prescription painkiller deaths were more common in areas where you don’t see much heroin — solid working-class neighborhoods in Staten Island and parts of the Bronx.

“We were very surprised to see these very different patterns for heroin and analgesic,” Magdalena Cerda, an Columbia epidemiologist and lead author of the study, tells Shots.

That may be because people in those neighborhoods are more likely to be prescribed painkillers, Cerda says. “There you see a higher percentage of policemen, firefighters, construction workers,” she says. “They may have a higher percentage of back pain as a result of work-related injuries.”

It’s also easier to get an OxyContin prescription filled at pharmacies or physicians in middle-class neighborhoods, she adds. That’s backed up by earlier studies that found that pharmacies in low-income, minority neighborhoods in the city don’t have enough prescription painkillers to meet legitimate demand.

The findings were published in the American Journal of Public Health.

Cerda and her colleagues are trying to get funding to look more closely at Staten Island and figure out what’s going on there. Are people first prescribed these drugs, and then start using them recreationally? Or do they become addicted while using them as prescribed? “Overdose fatalities are just the tip of the iceberg,” she says.

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Outdoor air pollution: cause of cancer, says UN

The specialized cancer agency of the United Nations World Health Organization (WHO) announced today that outdoor air pollution is a leading environmental cause of cancer deaths.

An evaluation by the International Agency for Research on Cancer (IARC) Monographs Program found there is sufficient evidence that exposure to outdoor air pollution causes lung cancer and increases the risk for bladder cancer.

In a news release, the IARC pointed out that air pollution is already known to increase risks for a wide range of diseases, such as respiratory and heart diseases. Studies indicate that in recent years exposure levels have increased significantly in some parts of the world, particularly in rapidly industrializing countries with large populations.

The most recent data indicate that 223,000 deaths from lung cancer in 2010 resulted from air pollution.

“The air we breathe has become polluted with a mixture of cancer-causing substances,” said Kurt Straif, Head of the IARC Monographs Section. “We now know that outdoor air pollution is not only a major risk to health in general, but also a leading environmental cause of cancer deaths.”

The IARC Monographs Program, dubbed the ‘encyclopedia of carcinogens,’ provides an authoritative source of scientific evidence on cancer-causing substances and exposures. In the past, the Program evaluated many individual chemicals and specific mixtures that occur in outdoor air pollution.

These included diesel engine exhaust, solvents, metals, and dusts. But this is the first time that experts have classified outdoor air pollution as a cause of cancer.

“Our task was to evaluate the air everyone breathes rather than focus on specific air pollutants,” said Dana Loomis, Deputy Head of the Monographs Section. “The results from the reviewed studies point in the same direction: the risk of developing lung cancer is significantly increased in people exposed to air pollution.”

The main sources of outdoor air pollution are transportation, stationary power generation, industrial and agricultural emissions, and residential heating and cooking. Some air pollutants have natural sources, as well.

“Classifying outdoor air pollution as carcinogenic to humans is an important step,” stressed IARC Director Christopher Wild. “There are effective ways to reduce air pollution and, given the scale of the exposure affecting people worldwide, this report should send a strong signal to the international community to take action without further delay.”

Source: http://www.un.org

Baby born with heart outside body celebrates first birthday

Audrina Cardenas was born one year ago Tuesday with her heart outside her body. The very next day, she endured a six-hour surgery at Texas Children’s Hospital in which a team of surgeons actually put it back inside her!

Audrina was born with a rare condition called Ectopia Cordis. Only 8 in one million babies are born with that condition and 90 percent of them are either stillborn or die within the first three days of life, according to Texas Children’s Hospital.

Audrina was able to celebrate her birthday free of medications, but is still on oxygen. Her development is improving every day and she’s now crawling and even trying to walk.

She will still require another surgery in the next few months to construct a chest wall to protect her heart and repair cardiac defects associated with her condition.

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Tiny, wireless pacemaker launched in Europe

Developed by US start-up Nanostim, the device is designed to be implanted intravenously directly in the heart.

It is less than 10% of the size of a conventional pacemaker and uses a built-in battery.

Experts said it was an “exciting development” but at a very early stage.

The pacemaker has yet to receive full US Food and Drug Administration (FDA) approval.

Conventional pacemakers require a patient to be cut open and a pocket created in the body to house the pacemaker and associated wires.

Such wires are regarded as the component of pacemakers most likely to fail. The pocket created for the pacemaker is also liable to infection.

By contrast the Nanostim pacemaker is delivered via a catheter inserted through the femoral vein near the groin.

It has a built-in battery, smaller than an AAA battery, that lasts between nine and 13 years. Eliminating the need for wires lowers the risk of infection or malfunction and means that patients are not restricted in the amount of activity they do, the firm behind the device claims.

The procedure to fit the pacemaker typically lasts around half an hour. The device is designed to be easily retrievable so that the battery can be replaced.

Because the device is delivered intravenously, it also means patients will have no scarring.

One doctor, involved in its trials, described it as “the future of pacemaking”.

“For the past 40 years the therapeutic promise of leadless pacing has been discussed, but until now, no-one has been able to overcome the technical challenges,” said Dr Johannes Sperzel of the Kerchhoff Klinik in Bad Nauheim, Germany.

“This revolutionary technology offers patients a safe, minimally-invasive option for pacemaker delivery that eliminates leads and surgical pockets,” he added.

Better understanding

But others were more cautious.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “This is a potentially exciting development but it’s early days.

“Before this leadless pacemaker becomes widely available, we need a better understanding of how long it will last, as well as how easy it is to replace if necessary. As our knowledge of this new pacemaker widens, so too will the expertise needed to fit this potentially exciting device.”

The company behind the device has recently been bought by global medical device firm St Jude.

It has had several wire-based pacemakers recalled in recent years.

Other device makers are also planning to go wireless. The Wireless Cardiac Stimulation system has been developed by US start-up EBR Systems and UK-based tech firm Cambridge Consultants and uses a tiny wireless electrode no bigger than a grain of rice powered by an ultrasonic pulse generator, inserted lower down in the chest.

In 2011 the device was implanted in 100 patients in hospitals across Europe.

Cardiac pacemakers are used to treat slow heart rates. The devices monitor the heart and provide electrical stimulation when the heart beats too slowly.

The first pacemaker was fitted in 1958. Currently more than four million people around the world have some sort of cardiac rhythm device with an additional 700,000 people getting one each year.

Source: http://www.techinvestornews.com