HICNet Medical News Digest Sun, 19 Dec 1993 Volume 06 : Issue 57 Today's Topics: Information Desired on Carpenter's Syndrome Russian Company Desires Contact with Pharmaceutical Companies Internet Informational Resource on Dental Informatics AIDS Daily News Summary +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-6135 Compilation Copyright 1993 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. E-Mail Address: Editor: Internet: david@stat.com FidoNet = 1:114/15 Bitnet = ATW1H@ASUACAD LISTSERV = MEDNEWS@ASUACAD.BITNET (or internet: mednews@asuvm.inre.asu.edu) anonymous ftp = vm1.nodak.edu Notification List = hicn-notify-request@stat.com FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Sun, 19 Dec 93 22:45:56 MST From: mednews (HICNet Medical News) To: hicnews Subject: Information Desired on Carpenter's Syndrome Message-ID: <0uDuec7w165w@stat.com> Address your responses to: sla@access.usask.ca I am writing on behalf of a family with a boy who has Carpenter's Syndrome. This is a relatively rare disability, and they do not know much about it. They are looking for other families with Carpenter's Syndrome children to coorespond with, concerning how to deal with developmental problems and what kinds of conflict they may encounter in future years. This family lives in rural Saskatchewan, Canada. If you would like to coorespond with this family through regular post(sorry,they don't have access to InterNet) or if you know where they can get more information about their son's disability, Please e-mail your reply to the following address (using Subject *Shannon*). ------------------------------ Date: Sun, 19 Dec 93 22:46:36 MST From: mednews (HICNet Medical News) To: hicnews Subject: Russian Company Desires Contact with Pharmaceutical Companies Message-ID: Medico Center ltd 118, Baikalskaya St., Irkutsk City Hospital Tel.:(3952) 23-59-01 Fax.:(3952) 23-15-92 E-mail: root@medico.irkutsk.su To whom it may concern We are looking for connections with different Pharmaceutical companies (Europian preferably) interested in Siberia and Russian Far East region. We would like to make reliable contacts with pharmaceutical companies for purchasing different kinds of drugs. Also we propose representative and distributive service. Thank you in advance and hope for further cooperation. Sincerely yours, Director Mikhail V.Suturin ------------------------------ Date: Sun, 19 Dec 93 22:47:18 MST From: mednews (HICNet Medical News) To: hicnews Subject: Internet Informational Resource on Dental Informatics Message-ID: Announcement and Call for Contributions AN INTERNET INFORMATION RESOURCE ON DENTAL INFORMATICS The Center for Biomedical Informatics of the State University of Campinas, Brasil, has established this year a Laboratory of Dental Informatics, with the aim of doing research and teaching on the subject. One of our activities for 1994 will be the organization of information resources on Dental Informatics, which will be comprised of a public domain software repository and a comprehensive bibliographical survey on the applications of computers to Dentistry, Oral Pathology and related subjects. Both resources will be publicly available via the UNICAMP anonymous FTP resource in the Internet, coordinated by Prof. Renato M.E. Sabbatini (node CCSUN.UNICAMP.BR). Our target date for making this available is March 1st, 1994. Thus, we would appreciate very much if you could send to us any information on books, papers, technical reports, software, etc., which you and/or your group have produced on Dental Informatics. Your contribution will be included in our repository and duly acknowledged. Thank you very much for your cooperation Claudio R. Palombo, BDS Head, Laboratory of Dental Informatics Center for Biomedical Informatics State University of Campinas, Brazil palombo@fem.unicamp.br ------------------------------ Date: Sun, 19 Dec 93 22:47:42 MST From: mednews (HICNet Medical News) To: hicnews Subject: AIDS Daily News Summary Message-ID: <8XDuec10w165w@stat.com> AIDS Daily Summary The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1993, Information, Inc., Bethesda, MD "Health Officials Say Casual AIDS Transmission Rare" Reuters (12/05/93) (McCabe, Alec) New York--Despite two new cases in which American children contracted the AIDS virus through a rarely documented form of transmission, U.S. public health officials say casual AIDS transmission is rare and the risk minimal. In one case, the virus was transmitted through a razor shared by two hemophiliac teenage brothers, according to the Centers for Disease Control. The other case involved a five-year-old, whose infected blood apparently permeated a rash on the skin of a two-year-old who lived at the same foster home, reported researchers at Rutgers University in New Jersey. While the two cases are rare, they are documentary proof that HIV can be transmitted by vehicles other than sexual contact or needle-sharing, the two primary means of transmission. The infections probably never would have occurred if CDC precautions had been heeded, contend public health officials. Among the recommendations, issued in 1985, are refraining from using the toothbrushes of HIV carriers and avoiding unprotected contact with their wounds. Dr. Lawrence Frankel of Rutgers University said that the cases are a warning to parents to adhere to strict precautions if they have one child who is HIV- positive and another who is negative, although he cautioned against using the findings to segregate infected children. Related Story: New York Times (12/04) P.33; USA Today (12/06) P.10; Chicago Tribune (12/04) P. 20. "Finding May Greatly Improve Potential AIDS Therapy" Reuters (12/02/93) (Riordan, Teresa) Washington--Colleagues at the University of Colorado say they may have discovered a way to improve the effectiveness of one experimental AIDS treatment. Thomas Cech and Bruce Sullenger think they have learned to make an antiviral agent that acts as a guided missile, aiming at the exact location within a cell that harbors an RNA molecule encoding the AIDS virus. The agent reaches its target, splitting it into two and making it harmless. A decade ago, Cech helped make the revolutionary discovery that RNA molecules could perform important functions. Viruses consist of strands of DNA or RNA, which can cause an array of diseases from the common cold to AIDS, by entering normal cells and using them to replicate the virus. Since this finding, scientists have been developing molecules called ribozymes that will slice apart disease-carrying RNA molecules. But promising lab results have not been repeated when the molecules are locked in a cell. Cech and Sullenger, in their new report, suggest that this is because a cell is much like a large house with many locked doors. Unless the ribozyme emits a specific signal that acts as a password to let it enter the room where the AIDS-encoding molecule is living, it will be automatically ushered into another room. Cech and Sullenger are developing a type of gene therapy in which genes that will encode HIV-seeking ribozymes are moved to bone marrow, where blood cells are manufactured. Newly made cells would contain the anti- HIV ribozyme and, ideally, work as a "man-to-man" defense. "AIDS in Children" Washington Post (Health) (12/07/93) P. 9 (Evans, Sandra) Despite two rare cases of HIV transmission between children that surfaced last weekend, public health officials are reassuring parents that youngsters are at virtually no risk of contracting AIDS from contact with infected playmates at day-care centers or schools. This type of transmission is "a chance of one in hundreds of thousands or one in a million," calculates Donald T. Dubin, one of six New Jersey researchers who reported one of the cases. Another, Lawrence D. Frenkel, agrees. "We do not think there is any reason to have increased concern from school contacts in day-care settings ..." he says. "There is no need to panic." Still, health officials are emphasizing the need for institutions to follow recommended safety guidelines, such as wearing disposable rubber gloves when diapering children, treating nosebleeds, or bandaging scraped skin and routinely cleaning soiled surfaces with disinfectants and disposable towels. Early in the AIDS epidemic, there was debate over the treatment of infected children. Attempts by parents and officials to bar these youngsters from schools and day-care facilities were often successful. Health authorities argued that transmission was difficult and risks could be controlled in school settings. The Americans With Disabilities Act of 1990 dictates that AIDS-infected children today cannot be kept out of schools simply because they are infected. "AIDS Therapy" Associated Press (12/04/93) (Recer, Paul) Bethesda, Md.--A panel of experts who advise the National Institutes of Health has approved an experiment using a vaccine made from an altered mouse virus to boost resistance to the AIDS virus in human patients. The Recombinant DNA Advisory Committee, which evaluates experimental human therapy proposals that use manipulated genes, gave the green light to test the vaccine on 20 human subjects. The experiment must now be approved by the directors of NIH and the Food and Drug Administration before it can be conducted. The lead researcher of the project, Dr. Richard Haubrich of the University of California at San Diego, said the vaccine is the first to use HIV genes to trigger action by the body's T lymphocytes, the "killer" cells of the immune system. The experimental vaccine is made from a non-infected mouse virus that has been modified to include two harmless genes from HIV. The virus would be injected into patients, where it would infect cells near the injection site. This delivers the HIV genes to the cell interior, where they command the cell to manufacture a protein normally found on the surface of HIV. The immune system will sense this process as a foreign invasion and cause the T lymphocyte killer cells to seek out and destroy all cells containing HIV genes. Haubrich expects the experiment to get underway in the spring. "Dermatologists See Rise in Cases of Latex Irritation" Philadelphia Inquirer (10/08/93) P. A8 Doctors attending the annual meeting of the American Academy of Dermatology agree that there has been a sharp increase in the number of allergic reactions to natural rubber latex, the elastic material used to make products such as condoms and surgical gloves. Dr. Ronald R. Brancaccio of the New York University Medical Center reported that, although no comprehensive study has been conducted, he and other physicians have observed widespread cases of allergic reaction ranging in severity from mild irritation to life-threatening shock. Hives and other allergy reactions are being reported "more and more commonly," particularly among medical employees, said Brancaccio. According to one study, he said, 7 percent of surgeons and 5 percent of operating room nurses were allergic to the latex in their surgical gloves. Surgical gloves are instrumental in preventing HIV transmission through exchange of blood and other body fluids, and condoms are critical to curbing the spread of the virus through sexual contact. "Texas Researchers Block HIV Infection in Cell" Reuters (12/06/93) (Gilardi, John) Houston--A drug made from an HIV protein segment that attaches to healthy cells appears to effectively block the virus from expanding in tests on healthy cells outside of the body, according to a study by researchers at the University of Texas M.D. Anderson Cancer Center. The research focused on the part of HIV known as the "V3 loop," which is thought to be key in binding to cell surfaces. The Anderson scientists synthetically reproduced the protein fragment and tested it on cultures of human cells outside the body. Six different protein segments have been developed, which lab tests suggest should block most HIV strains. Researchers are not certain how the drug actually blocks HIV infection in healthy cells, but they speculate that it occupies all of the slots on a cell surface that would otherwise be used by the AIDS virus to penetrate the cell. It also prevents HIV transmission by halting the fusion process between infected and non-infected cells. Researchers say the study may be indicative of an effective AIDS treatment. "Our discovery may lead to a more effective therapy because it blocks HIV from ever entering the cell and prevents it from spreading," explains Dr. Jagan Sastry, an assistant professor at the cancer center, and the head of the study. The full implications of the study, however, will remain unknown until human tests are conducted to test the drug's effect on AIDS. "Natural Protein Is Found to Reignite Cells' Failing Immune Response to HIV" Wall Street Journal (12/10/93) P. B5 (Chase, Marilyn) A natural blood protein is able to restore the declining immune response of cells taken from carriers of the AIDS virus, finds a new laboratory study. Most white blood cells of HIV patients fail to launch a normal immune response when exposed to invaders. But when the protein interleukin-12 (IL-12) was added to cell cultures, the immune system was enhanced, said researchers. In a study of blood taken from 47 HIV-infected subjects, IL-12 was found to improve a number of immune reactions, including significant increases in T- lymphocyte and in the number of killer cells, as well as the release of a flood of other immune-boosting agents like gamma interferon and interleukin 2. The study's findings support an emerging theory about how HIV cripples the immune system, and how this effect might be delayed or reversed. IL-12, believe the researchers, may spark an effective type 1 response, which involves vigorous and effective response by immune cells. "Our findings imply that in HIV infection, a type 1 response can be restored [in the test tube] by IL-12," said Dr. Gene M. Shearer of the Experimental Immunology Branch of the National Cancer Institute, who conducted the study along with colleague Mario Clerici and others at the National Institutes of Health and Lackland Air Force Base in Texas. "Whether we'll be able to bring patients back to [type 1], or simply take people [in the early stage] and hold them there, will require human trials." IL-12 , manufactured by Boston-based biotech firm Genetics Institute Inc., is scheduled to begin human clinical trials in the first half of next year. Related Story: New York Times (12/10) P. A22 "Rare HIV Antibody Response May Help Develop Vaccine--Study" Reuters (12/09/93) (Brothers, Caroline) London--A previously unknown antibody response to the AIDS virus has been discovered, and could be an important step toward developing a vaccine, announced U.S. researchers writing in the medical journal the Lancet. The researchers said they found a handful of patients who had HIV antibodies in their urine, but not in their blood. They believe those patients have developed a rare type of immunity to HIV infection. Dr. Howard Urnovitz, founder of the U.S.-based Calypte biomedical research firm, worked with Dr. Gene Shearer and Dr. Mario Clerici of the National Cancer Institute to test some 1,800 people for HIV. They found seven who tested positive only in the urine test. "Our first major conclusion was that you can have antibodies in urine and not in blood--one of the first examples of compartmentalism of immune response," he said. Compartmentalism is thought to occur when the body evolves a localized response to infections specific to each tissue site. "Because they showed this unique immunity, the suggestion was made that perhaps they have a systemic immunity to the virus ... which happens independently of antibody immunity," explained Urnovitz. He speculated that the discovery of cell-mediated immunity to HIV in urine suggests that vaccine development should concentrate on cell-mediated immunity, rather than the development of an antibody. "Oral Contraceptive Use and Infectivity of HIV-Seropositive Women" Journal of the American Medical Association (11/17/93) Vol. 270, No. 19, P. 2298 (Morrison, Charles S. and Schwingl, Pamela J.) Clemetson et al. found a correlation between oral contraceptive (OC) use and detection of HIV DNA in cervical, but not vaginal, secretions. They conclude that their data supports the theory that OC use, as well as cervical ectopy and pregnancy, increases the infectivity of HIV-positive women. While recognizing the importance of the study and its implications, Charles S. Morrison and Pamela J. Schwingl, PhDs, of Family Health International in Research Triangle Park, N.C., offer some adjustments that would improve the results of the study. Clemetson and colleagues found HIV DNA in 33 percent of cervical samples and 17 percent of vaginal samples, then presented odds ratios determined from a multivariate analysis. However, say Morrison and Schwingl, the odds ratio in a cross-sectional sampling design is valid estimate of risk ratio only if the probability of disease is rare--less than .10. Given the cross-sectional sampling of the study and that the incidence of disease is not rare (33 percent), Morrison and Schwingl suggest that the prevalence ratio would be a better measure of the strength of association. They calculate that the estimated strength of the bivariate association between OC use and HIV DNA detection is only a third as strong when the prevalence ratio is used. In addition, the link between OC use and HIV DNA included only eight subjects. Given the significance of the issue, Morrison and Schwingl suggest that a re-analysis be conducted enrolling more OC users and undertaking a prospective study design. "'Natural' Interferon Joins the AIDS Battle" Wall Street Journal (12/14/93) P. B1 Interferon, a substance produced by white blood cells as part of the body's immune defense against disease, once showed promise as an AIDS treatment. Although laboratory and human studies showed that alpha interferon was able to block HIV replication, the substance was problematic in that it caused debilitating flu-like symptoms and had to be administered intravenously, a obstacle to daily use. For years, however, Interferon Sciences in New Jersey has argued that its "natural" interferon manufactured from donated blood is more potent and less toxic than the alpha interferon sold by Schering-Plough and Roche Holding. The company says its Alferon product is a cocktail of 14 alpha interferon subtypes, while the other products are a combination of just two subtypes. It also maintains that one of the subtypes, which is found in its "natural" interferon but not in that of the drug companies, is especially active against the AIDS virus. According to a new report, researchers at the Walter Reed Army Institute claim that the Alferon mixture is, in fact, 100 to 1,000 times more potent than other versions. A test of Alferon in patients also demonstrated fewer side effects than expected. "AIDS Researchers Changing Direction" Philadelphia Inquirer (12/15/93) P. A2 (Collins, Huntly) Unable to find a "magic bullet" to eradicate AIDS, scientists are shifting research focus from antiviral tactics to strategies that draw on the body's own immune system. Various strategies, ranging from gene therapy to the transfer of healthy cells into infected patients, were presented yesterday at a meeting of 1,200 AIDS researchers. So far, the new approaches- -some of which have been tested in labs and on animals--are highly experimental. The interest in immune-based research has been heightened during a period in which the three licensed anti-HIV drugs have demonstrated only limited effectiveness. AZT, ddI, and ddC delay the progression of HIV infection, but are unable to conquer it. The virus eventually becomes resistant to the drug and destroys the body's white blood cells, which fight infection. "It's clear with antiviral drugs, we are having an impact on the disease, but not the major impact we would like," concurred Dr. Joseph A. Kovacs, an investigator at the National Institutes of Health. Even if a new drug is developed that would effectively fight HIV itself, scientists believe that immune-based therapies would still be necessary to restore immune function in patients who may have lost many of their CD4 cells during the course of infection. "4 People Infected With H.I.V. in Doctor's Office in Australia" New York Times (12/16/93) P. B14 (Altman, Lawrence K.) In what is believed to be the first instance of patient-to-patient transmission of HIV in a health-care setting, the AIDS virus has been passed from one patient to four others at an Australian surgeon's office, Australian health officials reported. According to an investigation, the unidentified doctor, who has not become infected, failed to sterilize all of his equipment after performing surgeries to remove skin lesions on five patients on the same day in November 1989. The source of the infection was a homosexual man, who has since died of AIDS, officials at the New South Wales Health Department disclosed. The virus was transmitted to four women who, they say, had no known risk factors for infection. Australian health officials believe the surgeon operated on the gay man first, but have no proof because appointment records were not kept. Officials say there is compelling evidence, though, that the transmission did indeed occur in the doctor's office. "The possibility that five people with HIV, four of them women, two in their 80's, would by chance all attend a doctor on a particular day in 1989 is five in a trillion," declared one Australian health official. "In other words, impossible." Dr. Harold Jaffe of the Centers for Disease Control and Prevention said that the transmission was "almost certainly a breach in infection control." Health officials say the surgeon discarded most items after use, but failed to sterilize all of the equipment. He has not changed his infection control precautions since 1989. Related Story: USA Today (12/16) P. 1D "AIDS--Blood" Associated Press (12/16/93) Washington--French researchers report that passive immunotherapy-- swapping blood plasma rich in antibodies between AIDS patients--appears to significantly slow progression of the disease. Those giving blood did not appear to suffer, and those receiving it seemed to benefit. The approach dramatically reduced the number of new AIDS symptoms in patients who had already developed advanced disease, the researchers said. However promising, the approach does have one major obstacle: the limited blood supply. The availability of blood plasma from AIDS donors "is the main limiting factor" of the approach, confirms Dr. Jean-Jacques Lefrere, a co-author of the study. Regular donations from 150 people were needed to conduct the study of 86 patients. In the study, doctors removed blood plasma from people with AIDS and gave it to study participants. Half received antibody-rich plasma, while the other half received plasma from uninfected donors. Doctors tracked the number of new AIDS symptoms that surfaced over the course of the study, finding 18 new symptoms in 16 patients in the AIDS-antibody group and 50 new symptoms in 27 patients in the comparison group. Overall, those in the comparison group were three times more likely than antibody patients to develop new AIDS symptoms. "AIDS Vaccine Could Embolden HIV Viruses" Reuters (12/14/93) San Francisco--Some experimental vaccines designed to prevent and combat the AIDS virus may, in fact, make it easier for certain viruses to infect a person, say researchers. Vaccines under current development focus on the outside envelope coat of HIV, to which an immunized person responds by producing immune system antibodies that bond to HIV and deactivate it. Studies at the University of California at San Francisco suggests that some of these antibodies, instead of deactivating immunodeficiency viruses, either neutralize them, enhance them, or have no effect whatsoever. This can occur because of the ability of HIV to mutate--or undergo genetic changes-- which result in the creation of new strains, some of which resist the body's immune response, said Jay Levy, head of the research team. The studies show that genetically different strains of HIV responded differently to a single species of antibody, suggesting that it is possible for a vaccine to stimulate production of antibodies that neutralize one strain while making it easier for other strains to cause infection. "Study Says Drugs May Inhibit Replication of AIDS Virus" Reuters (12/14/93) Boston--Researchers at the Dana-Farber Cancer Institute reported their discovery of a new combination of drugs that could potentially inhibit HIV replication. The test-tube study, say the researchers, revives hopes for the anti-AIDS drugs called tat inhibitors. This class of drug attacks HIV by targeting a protein produced by the tat gene, necessary for the reproduction of HIV. The new compound was made of Hoffman-LaRoche's Ro24-7429 and pentoxifylline, which is manufactured by several companies. The drugs were tested in human T lymphocytes into which the tat gene was inserted. "In this experimental system, the drugs proved 100 times more effective at inhibiting tat expression than either drug did by itself," said the researchers. The team also expressed hopes that the compound could achieve antiviral effects without excessive toxicity, a factor that plagued previous studies. The next step, say the researchers, is to test the compound in infected human T cells. "If the drugs prevent the virus from making copies of itself, they could become candidates for testing in AIDS patients," they speculated. "Drug-Resistant Strains of H.I.V. Linked to Tripling of AIDS Deaths" New York Times (12/17/93) P. A28 (Altman, Lawrence K.) A study of 170 strains of the AIDS virus showed that 15 percent of the strains were highly drug-resistant, and that patients infected with these strains were three times more likely to die in a given period than those with other strains. Scientists were aware of the presence of HIV strains that demonstrated resistance to AZT--the disease's main treatment--but had no proof of clinical ramifications. "Now we know it is clinically important," said Dr. Clyde S. Crumpacker of Beth Israel Hospital in Boston, head of the research team that made the discovery. He added that the team viewed resistant strains as an indicator not of death, but rather of disease progression. When AZT-resistant strains are detected in an AIDS patient, doctors could possibly replace AZT with another drug, or simply add another drug to the treatment regimen. Researchers now hope to develop a test for this purpose that can be used in everyday medical practice. A "pressing problem" is the need to develop a quicker and easier version of the existing test that can be done by commercial laboratories, so that physicians can use it in their care of HIV-infected patients, said Crumpacker. "CDC: AIDS Guidelines Won't Be Changed" United Press International (12/16/93) Atlanta--Despite two recent, separate accounts of a child and an adolescent who transmitted the AIDS virus to other members of their households, the Centers for Disease Control and Prevention has announced that it will not make any revisions to its 1985 guidelines concerning school attendance, foster care, or day care. Transmissions in such settings and in homes are "extremely rare," and can be avoided by precautions to prevent exposure to blood, the federal agency said. "In 17 studies involving over 1,100 persons who lived in the same households with HIV-infected persons, none became infected," reassured health officials. "Gilead Sciences' GS 393 Associated With Evidence of Antiviral Activity; Initial Phase I/II Results Presented at First National Conference on Human Retroviruses and Related Infections" HealthWire (12/15/93) Preliminary findings from the Phase I/II clinical trials of an HIV therapy indicate that administration of the drug is linked to decreased p24 antigens and increased CD4 counts. The purpose of the studies of GS 393, or PMEA, is to determine evidence of dose-limiting toxicity, antiviral activity, and pharmacokinetics of the drug. Among the 28 HIV-positive patients enrolled in the study, the GS 393 was generally well-tolerated, although some dose-limiting side effects were observed. In response to these results, Gilead Science--the manufacturer of GS 393--will pursue additional studies, including different routes of administration, lower doses, and compatibility with AZT. The preliminary results of the trials were presented at the University of Washington during the First National Conference on Human Retroviruses and Related Infections. ------------------------------ End of HICNet Medical News Digest V06 Issue #57 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-6135 Bitnet : ATW1H@ASUACAD ******************************************************************************