Disfiguring skin disease plagues Afghanistan
Mon, 07 May 2007 13:22:20 GMTBy Robert Birsel
KABUL - The 10-year-old Afghan girl has big eyes, a shy smile and a dark lesion speckled with blood on her right cheek.
The girl has leishmaniasis, a disease caused by a parasite transmitted by a tiny sandfly that can lead to severe scarring, often on the face.
The girl, Sahima, wearing a purple tunic and trousers and pale blue shoes, answers &;no&; softly when asked if the sore hurts.
But her father is worried about the lesion, the size of a big coin.
&;Of course, this doesn't look good,&; the father, Najibullah, said at a leishmaniasis clinic crowded with children with sores in the Afghan capital, Kabul.
Najibullah said he first noticed a mark on his daughter's face two months ago. &;It was a very small dot but it grew and grew. If it grows any more it will cover her whole face.&;
Leishmaniasis isn't a priority for the government and its aid donors, grappling with shocking rates of infant mortality, tuberculosis, malaria and trauma.
The most common form of the disease is not fatal but it causes untold misery. Victims with scarring on their faces are stigmatized: children are excluded at school and girls often won't be able to find husbands.
Long-neglected by the rich world, the disease is attracting a bit more attention in the West, if not more funds.
Some foreign troops in Afghanistan and Iraq have also been bitten by the sandflies and have developed the disease. NATO saw about 150 cases in Afghanistan in 2005 and about 12 last year, a force spokeswoman said.
NATO camps have been fortified to try to stop the sandflies and soldiers are warned to keep sleeves rolled down, to use insect repellant and to watch for bites.
&;DISEASE OF DESTRUCTION&;
But it's Afghanistan's poor who are most vulnerable.
Kabul, battered and neglected for years, has the world's worst outbreak of leishmaniasis, health experts say.
&;It's out of control, absolutely out of control,&; said Reto Steiner, a medic with the German Medical Service which helps run the Kabul clinic.
&;You won't control it until the sanitation has recovered.&;
The deep ulcers caused by the parasites will heal if left untreated, but that invariably involves disfigurement and can take many months. That has given rise to one of the diseases many nicknames: saldana, or one-year sore.
Though present in all Afghan cities, it is in Kabul's crowded neighborhoods that the disease has exploded and spread to hundreds of thousands of people.
&;When we have one case in a family, of course, it's not only one case: it will be all the family and even the neighbors,&; said Health Ministry official Abdullah Fahim.
The sandflies that spread the parasites are carried by animals including dogs and a species of gerbil, as well as people. The insects often breed on waste land and in rubbish.
Although they don't fly well, the insects infest the cracks and crevices in people's homes from where they emerge to bite exposed parts of the body -- noses, chins, cheeks and hands -- as people sleep, from late spring to autumn.
&;It's a disease of destruction,&; said Toby Leslie, a researcher from the London School of Hygiene and Tropical Medicine. &;It will thrive in post-war areas and areas where there's poor sanitation, poor community services.&;
Cutaneous leishmaniasis is not fatal although a less-common form, visceral leishmaniasis, can cause organ failure and death.
&;Leishmaniasis is one of the top neglected diseases, certainly outside Africa, and it just doesn't attract the funding that's needed,&; Leslie said.
TREATMENT, PREVENTION
Doctor Faquir Amin says he's been treating leishmaniasis since the 1960s. Refugees returning from abroad are particularly susceptible as they have no resistance, he said.
&;No one's taking care of it. The people are coming, it's crowded, the people are susceptible and the disease is increasing,&; Amin said at his Kabul clinic. &;It is not a killer disease but mentally people suffer. We have to deal with it.&;
The sores are treated with a course of injections, or cauterized to kill the parasites. Amin's clinic has the only laser cauterizing machine in Afghanistan. Electric cauterizing machines are also effective and much cheaper.
Prevention is also key, experts say.
Bed nets impregnated with insecticide are being distributed to stop malaria and they will also stop sandflies spreading leishmaniasis. But only a few nets are being distributed compared with the number needed.
&;The ministry is battling to get funds and no one's interested. It's impossible to get funds,&; said Health Ministry adviser Kathy Fiekert.
&;This is an issue that needs to be addressed.&;
Embryonic stem cells can repair eyes company says
Mon, 07 May 2007 17:03:18 GMTBy Maggie Fox, Health and Science Editor
WASHINGTON - Stem cells made from human embryos can home in on damaged eyes, hearts and arteries of mice and rats, and appear to start repairs, a U.S. company said on Monday.
Massachusetts-based Advanced Cell Technology said it had devised a straightforward way to make blood vessel precursor cells out of the stem cells and plans to test them in humans.
&;We figured out how to produce literally billions of so-called 'hemangioblasts' -- the mythical cell in the embryo that gives rise to our entire blood and immune system as well as to the blood vessels in our body,&; Dr. Robert Lanza, vice president of research and scientific development at ACT, said in an e-mail.
&;We've also tested these cells in animals for the first time, and it turns out that they have incredible reparative potential.&;
Embryonic stem cells are the ultimate master cell of the body, giving rise to all of the tissues and organs. The use of human embryonic stem cells is controversial because many people oppose destroying the embryo.
The U.S. Congress has passed several bills that would expand federal funding of human embryonic stem cell research but President George W. Bush vetoed one and has said he will veto any more.
However, companies working with private funding, such as the over-the-counter listed ACT, may do as they please.
Working with embryonic stem cells is not easy. For medical uses, researchers would like to partly differentiate them -- start them down the road toward becoming a specific cell or tissue type.
PREVENTING CONTAMINATION
Another roadblock is that many of the current batches, or lines, of stem cells must be grown in a serum culture taken from animal blood. This can contaminate them with viruses.
Writing in the journal Nature Methods, Lanza's team said they found a way to grow and differentiate human embryonic stem cells without using culture.
They directed the stem cells into becoming what they believe are hemangioblasts, the blood vessel precursor cells, although other teams will have to replicate this for it to be accepted.
&;When injected into the bloodstream, they homed to the other side of the body and repaired damaged vasculature within 24 to 48 hours,&; Lanza said.
&;For example, we injected the cells into mice with damaged retinas due to diabetes or other eye injury. The cells (labeled green) migrated to the injured eye, and incorporated and lit-up the entire damaged vasculature. The cells are really smart, and amazingly, knew not to do anything in uninjured eyes.&;
The researchers killed the mice to check the cells' progress, so they do not know the long-term effects.
&;The cells also showed remarkable reparative capacity in animals with heart attacks and ischemic (blocked by a blood clot) limbs. The cells reduce the mortality rate by 50 percent after a massive heart attack,&; Lanza said.
&;If the same thing works in humans (these would be the same human cells we would probably use), you might be able to prevent patients from having legs and other limbs amputated by simply injecting some cells.&;
William Caldwell, chairman and chief executive officer of Advanced Cell Technology, said the company wanted to test the cells in people and had asked the Food and Drug Administration for permission to do so by the end of next year.
&;We also have studies underway indicating that the cells can also considerably accelerate wound healing, repair lung damage, and can even generate unlimited amounts of red blood cells for transfusion,&; Lanza said.
Indian scientists identify troublemaker TB protein
Mon, 07 May 2007 17:02:18 GMTHONG KONG - Researchers in India have identified a protein in the tuberculosis bacteria which weakens the body's immune response to the deadly disease.
By knowing what the TB protein can do, the scientists hope to find another cure for treating the disease. The protein may also be harnessed to stop diseases which are caused by inflammation going out of control, such as hay fever, rheumatoid arthritis and atherosclerosis.
Writing in the latest issue of the journal Nature Immunology, the scientists said the protein, ESAT-6, binds itself to a type of white blood cells and disrupts their ability to fight off harmful viruses and bacteria.
More than a third of the world's population is infected with TB and the infection rate is one every second. However, only one in 10 infected persons will develop symptoms and that usually happens when their immune systems are weak.
Left untreated, TB, or Mycobacterium tuberculosis, kills half its victims.
Lead researcher Joyoti Basu at the Bose Institute in Calcutta said the ESAT-6 protein in TB bacteria latches onto certain receptors called TLR2 on the surface of macrophages -- a type of white blood cell.
When that happens, the macrophages can't function properly.
&;Then the white blood cells would not be able to put up as good a fight,&; she said in a telephone interview.
Macrophages are important &;sentry cells&; in our immune system. They engulf and digest invaders like viruses and bacteria, and stimulate other immune cells to fight the invaders.
Basu's team created mice without TLR2 receptors on their macrophages. The scientists then extracted the macrophages and exposed the cells to TB bacteria.
Botox shot may help children with cerebral palsy
Mon, 07 May 2007 18:22:38 GMTNEW YORK - In children with the movement disorder cerebral palsy affecting one limb, injections of botulinum toxin A, best known by the brand name Botox, appears to enhance the benefits gained from occupational therapy, new research suggests.
In the study, Dr. Remo N. Russo, from Flinders University in Daw Park, South Australia, and colleagues randomly assigned 43 children with hemiplegic cerebral palsy to receive four sessions of occupational therapy alone or in combination with a shot of Botox in the affected limb.
Children treated with Botox showed a significantly better improvement in body structure and activities participation at 3 months compared with controls, they report in the journal Pediatrics.
Self-perception was also enhanced in the Botox group at 3 months.
By 6 months, no differences were seen between the groups in activities participation or self-perception, but the benefit of Botox on body structure was still apparent.
&;This study adds to previous studies investigating the effects of injection of botulinum toxin in the upper limb of children with cerebral palsy, but is unique given the findings related to improvement in self-worth,&; the authors note.
SOURCE: Pediatrics, May 2007.
Syphilis rise in gay bisexual men causes worry
Fri, 04 May 2007 17:17:09 GMTBy Will Dunham
WASHINGTON - Syphilis has risen sharply among gay and bisexual men in the United States this decade, driving up the country's rate for the disease and placing these men at higher risk for AIDS, federal health officials say.
Since dropping to the lowest level on record in 2000, the U.S. rate of syphilis, a sexually transmitted bacterial disease, has risen steadily, Centers for Disease Control and Prevention officials said on Friday.
The rate rose five years in a row through 2005, the most recent year for which the CDC had figures.
Gay and bisexual men accounted for 7 percent of syphilis cases in 2000 but more than 60 percent in 2005, CDC experts estimated.
&;The most devastating consequence of this increase in syphilis cases would be an increase in the rates of HIV infection,&; said Dr. Khalil Ghanem of Johns Hopkins University School of Medicine in Baltimore.
&;Syphilis and HIV have a close, deadly symbiotic relationship.&;
CDC epidemiologist Dr. James Heffelfinger said syphilis, like many other sexually transmitted diseases, raises the likelihood of infection by or transmission of the human immunodeficiency virus, which causes AIDS.
Syphilis raises these risks by an estimated two to five times, he said.
Condom use can greatly reduce the risk of getting syphilis, which is readily curable with antibiotics in its early stages but capable of causing severe medical problems and even death if left untreated.
&;We are seeing that syphilis is on the rise among a very specific subset of gay men: those who are having a great deal of sex with multiple sex partners,&; said Joel Ginsberg, executive director of the Gay and Lesbian Medical Association in San Francisco.
Many are HIV-infected or test positive for HIV for the first time when they learn they have syphilis, he said.
'WHY BOTHER?'
&;Among these men, there seems to be decreased condom use, perhaps related to an attitude of 'I already have HIV, so why bother?' or because HIV is seen as a chronic disease that can be managed well with medications,&; Ginsberg said.
Tremendous progress was made against syphilis in the 1990s. In 1999, the CDC announced an initiative to fully eliminate it from the United States.
After reaching 50,000 cases and a rate of 20.3 cases per 100,000 people in 1990 -- the highest since 1949 -- public health efforts helped drive down the rate to 2.1 per 100,000 people in 2000.
But the rate rose to 3 per 100,000 in 2005, with 8,724 cases, the CDC said.
&;We're concerned that we're seeing this upturn among men who have sex with men because it could foreshadow bigger increases,&; CDC epidemiologist Dr. Hillard Weinstock said.
Ghanem of Johns Hopkins faulted the gay and bisexual community, public health leaders and the medical establishment for failing to get across a message of prevention, citing &;safe-sex fatigue&; after the advent of powerful AIDS drugs in the 1990s.
&;Once these wonder drugs came along, patients no longer saw HIV as a death sentence, and clinicians unfortunately became more lackadaisical about conveying prevention messages,&; Ghanem said.
Use of a smokable form of the illegal drug methamphetamine known as &;crystal meth&; also is associated with unsafe sexual practices linked to syphilis, Ghanem said.
The syphilis rate among men is nearly six times higher than for women. The vast majority of male cases is among gays and bisexuals.
Drug may aid muscle function in leadexposed kids
Mon, 07 May 2007 18:24:52 GMTBy David Douglas
NEW YORK - A common therapy used to remove dangerously high levels of lead from the body may also improve muscle functions involved in balance and movement in children exposed to high levels of lead early in life.
Dr. Amit Bhattacharya and colleagues at the University of Cincinnati found in a study of 161 lead-exposed children that those treated with the &;lead-scrubbing&; drug succimer showed a 19 percent improvement in their ability to perform moving tasks -- such as crossing an obstacle or walking -- than those who did not receive treatment.
Succimer therapy improved static balance.
These results, along with that of earlier research, &;suggests that such therapy may result in reduced injuries,&; Bhattacharya told Reuters Health.
&;Lead exposure is a very serious issue,&; the professor of environmental health and lead author of the study added in a statement, &;and it's important to identify early signs of neuromotor exposure effects -- such as impaired postural balance or locomotion -- before permanent damage occurs.&;
&;Our research may help develop control strategies for minimizing exposure to lead at an earlier stage,&; Bhattacharya said.
It's estimated that more than 434,000 U.S. children between the ages of 1 and 5 have elevated blood lead levels. Lead is known to be associated with decreased intellectual capabilities and balance disorders among infants, children and teens.
SOURCE: Neurotoxicology May 2007.
