Friday, August 19, 2011

HIV Virus May Hide in Brain

FRIDAY, Aug. 27 (HealthDay News) -- The brain can be a convenient hiding place for HIV, the virus that causes AIDS.
That's the finding of Swedish researchers who analyzed samples from about 70 HIV-infected patients who'd been taking anti-HIV drugs. The tests showed that about 10 percent of the patients -- a larger proportion than expected -- had traces of HIV in their spinal fluid but not in their blood.
Another study by the researchers found that 60 percent of 15 HIV-infected patients treated with medication for several years showed signs of inflammation in their spinal fluid, although the levels were lower than they were without treatment.
Anti-HIV drugs can prevent the virus from multiplying, but the virus also infects the brain and can cause damage if the infection isn't treated, according to lead researcher Dr. Arvid Eden, a doctor and researcher at the Institute of Biomedicine at the Sahlgrenska Academy at the University of Gothenburg.
"Antiviral treatment in the brain is complicated by a number of factors, partly because it is surrounded by a protective barrier that affects how well medicines get in," Eden said in a university news release. "This means that the brain can act as a reservoir where treatment of the virus may be less effective."
It is unclear whether small quantities of the virus in spinal fluid represent a risk for future complications, researchers said. Still, the findings indicate that "we need to take into account the effects in the brain when developing new drugs and treatment strategies for HIV infection," Eden added

September is Ovarian Cancer Awareness Month

ovarian cancer: is the fifth most common cancer in women.
It is a cancer that forms in tissues of the ovary.
There are three types: 1) those of the covering of the ovaries or the epithelial; 2) those of the ovaries themselves or germ cell (this type is seen most often in women under 40) and, 3) those of the connective tissue or sex-cord stroma.

Most ovarian cancers are either ovarian epithelial carcinomas (85-90%) or malignant germ cell tumors (5%)

Estimated New U.S. Cases and Deaths from Ovarian Cancer
New cases - 21, 880 Deaths - 13, 850 (World wide cases 230,000)

*Family History of Ovarian Cancer
*Being of Eastern European (Ashkenazi) descent
*Having never given birth (or had difficulty doing so)
*Personal History of Breast, Uterine, Colorectal Cancer

*Personal History of Endometriosis
Modified from NCI

More white women than other ethnicities get this cancer (but Hispanic women come in at a close second) The average age of diagnosis is 63 and although most women get this over the age of 50 (90% of women are over the age of 40), women of any age can be diagnosed. In depth statistics are here


Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include:

• Pressure or pain in the abdomen, pelvis, back, or legs

• A swollen or bloated abdomen

• Nausea, indigestion, gas, constipation, or diarrhea

• Feeling very tired all the time

Less common symptoms include:

• Shortness of breath

• Feeling the need to urinate often

• Unusual vaginal bleeding (heavy periods, or bleeding after menopause)

Based upon the presenting symptoms and since they more often are not due to ovarian cancer, women who get diagnosed are often at advanced stages of their disease.

IN THE NEWS.... Two Gene Mutations Found That Mark Hardest-To-Treat Ovarian Cancer - Sept 9, 2010
Finding published in the journal Science and the New England Journal of Medicine (click here for full article)
The genes are for ovarian clear cell carcinoma (10 - 12% of all ovarian cancers) and is one of the most difficult to treat as well as most lethal. It is linked with endometriosis and is resistant to chemotherapy. Two teams of researchers published on this - one from Hopkins and one from the British Columbia Cancer Agency. Dr. Bert Vogelstein and colleagues at Johns Hopkins University in Baltimore named the two new genes as ARID1A and PPP2R1A. (Science abstract here )

Dr. David Huntsman from the British Columbia Cancer Agency published his groups study in New England Journal of Medicine and found that ARID1A was mutated not only in ovarian clear-cell carcinoma but also in a second type of ovarian tumor linked with endometriosis. He found that "Overall, 46 percent of patients with ovarian clear-cell carcinoma and 30 percent of those with endometrioid carcinoma had ... mutations in ARID1A," It was not found in other ovarian tumor types. The ARID1A gene is also a suspect in some cases of lung and breast cancer, Huntsman's team said.
These findings may identify new 'on-off switches' for these tumors, as well as mechanisms of action that aide in developing new medications to treat it.
MECHANISM OF ACTION - The ARID1A gene is involved in a process called chromatin remodeling, which helps squeeze DNA into cells and control when and how it gets "read" to perform a biological function. Mutations in it allow DNA to improperly 'read' and activated, per the Hopkins team.
"Taken together, these data suggest that ARID1A is a classic tumor-suppressor gene," Huntsman's team wrote. These genes, when not mutated, aid in blocking tumor formation -similar to other genes such as BRCA1 and p53.
Currently, since most women are diagnosed with widely spread disease, most (70%) die within five years.
SOURCES: Science, September 8, 2010 and


*HERE NCI Site with information, clinical trials and more

*What You Need To Know About™ (Epithelial) Ovarian Cancer NCI created resource on ovarian cancer

*If you have a hysterectomy, should you get ovaries out to prevent disease? Controversy discussed at CNN report

* Here's a CDC Podcast on Gynecologic Cancers

New England Journal of Medicine, September 8, 2010.


Thursday, August 18, 2011

Sex and Gender Medicine - A Lens for Evaluating Sociocultural Determinants of Disease

It used to be good enough to be smart - good in science; good at figuring things out. When you only have penicillin or sulfa, then just making the right diagnosis was pretty impressive. But times of have changed - we have PET scans and PCRs; we have minimally invasive surgery and a vast (if not overwhelming array) of medications and interventions at our disposal.

So today our gold standard has migrated past being smart and finding the disease 'in' a patient - now we are expected to influence health outcomes.

When acute injury and infections were a major cause of death (and we had limited tools) we had challenges. Now, most diseases are chronic and the ability to influence runs over a longer timeframe. Diabetes, Obesity, Hypertension, Heart Disease, Cancer - not 'quick in- quick out' challenges and certainly not the easiest to impact on outcomes. Yet, it is do-able.

We just need to get all of the data - scrutinize the biomedical, be clinically and scientifically curious and obtain data about the person in her world. One of the ways we can impact health disparities (and therefore move care closer to excellent for all) is to see the whole picture. The whole person.

In understanding the whole person, we need their story - who lives with them? who helps them? who do they help? what do they think or fear is going on? how do they define a good outcome?
Just today, a short essay on the social history was published in NEJM

Complicated Lives — Taking the Social History  R. Srivastava  N Engl J Med 365:587, August 18, 2011.   I highly recommend that   you read it, as it is written by an Oncologist and gives an interesting perspective on what we need to know to care for patients.  Now worries, it's a quick read!

McGinnis, J.M. 2002;21:78-93
Sociocultural determinants of health issues need to be lenses that we use to evaluate our patients. 
Dr Schroeder from UCSF delivered the Shattuck lecture about this. (We Can Do Better - Improving the Health of American People. Schroeder SA. New England Journal of Medicine. 357(12):1221-8, 2007 Sep 20. ) Access HERE courtesy of Pubmed and NEJM.

As physicians, we need to zoom in and zoom out on the pathophysiology and the life of our patients in order to best understand what is going on and how we can best help them lead healthier lives.

For a review on our discussion about sex and gender health disparities, check out this blog entry - click on Sex and Gender Resources as well as check out our other blog entries.

Culture, Gender, Health
Our second blog is Culture Gender Health and it reviews some of the definitions we discussed. It is available on the left side of the blog

Our third blog is a patient health blog Philadelphia Ujima and is a useful place to find plain language (aka health literacy and culturally appropriate) health education info and resources.

You are invited to suggest topics or even contribute - no advanced computing skills needed!

This blog was created to help your educational experience - let us know what you think!!

Monday, August 8, 2011

The Female Pattern of Heart Disease

Welcome back! Some day, heart disease will not be the biggest killer of people in the U.S. And someday, despite higher risks in men - similar or fewer (rather than more) women will die of heart related deaths.
For this year, I'm trying something a bit different - but I will rely on your feedback to continue with it.
There exists a different way to show material called Prezi. I'm using this as a resource session / lecture review reinforcer to help you 'at a glance' review our time together.

So, here is the link
Check it out and let me know if it is useful - these are pretty labor intensive so I need to know if  they are value added or not.