HICNet Medical News Digest      Sat, 24 Sep 1994        Volume 07 : 
Issue 47
 
Today's Topics:
 
   Heart Disease in African-American Women
   Program: Strengthening Hospital Nursing Care
   CDC Issues New Report on Arthritis Prevalence
   Deprenyl - A Parkinson's Drug - 1994 Update
   AIDS Daily News Report
 
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Pennsylvania
 
        Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden
 
         Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA
 
              Lawrence Lee Miller, B.S. Biological Sciences, UCI
 
             Dr K C Lun, National University Hospital, Singapore
 
              W. Scott Erdley, MS, RN, SUNY@UB School of Nursing
 
       Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, 
USAF
 
   Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of 
Medicine
 
   Martin I. Herman, M.D., LeBonheur Children's Medical Center, 
Memphis TN
 
    Stephen Cristol, M.D., Dept of Ophthalmology, Emory Univ, Atlanta, 
GA
 
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----------------------------------------------------------------------
 
Date: Sat, 24 Sep 94 16:16:49 MST
From: mednews@stat.com (HICNet Medical News)
To: hicnews
Subject: Heart Disease in African-American Women
Message-ID: <quJ7sc4w165w@stat.com>
 
                   Heart Disease in African-American Women
                          American Heart Association
                                Sept 17, 1994
 
      The fact that women have not been represented in clinical 
studies of
heart disease is well documented.  However, "women" refers not to all 
women
but usually to white women.  That means that the lack of data about
African-American women and heart disease is even more pronounced.
 
      It is well known that African-Americans in general have a higher 
rate
of coronary heart disease than whites, so that places black women in 
double
jeopardy -- first because they are black, and second, because they are
women.  Along with all women, they share the sex-specific risk factors 
of
age, hormonal status, smoking, high levels of LDL, low levels of HDL,
hypertriglyceridemia and psychosocial stress.  As blacks, they are 
more
likely to have more hypertension-related complications -- a higher 
death
rate from stroke; more frequent enlargement of the left lower chamber 
of
the heart, known as left ventricular hypertrophy; and strikingly more
end-stage kidney disease.
 
      Why high blood pressure should manifest itself differently in 
blacks
than whites is almost as poorly understood as the differences between 
men
and women.  Recent news reports from the Ninth International
Interdisciplinary Conference on Hypertension in Blacks held in June 
1994
shed light on a possible physiologic explanation.  Pharmacologist 
Randall
Tackett, Ph.D., and his colleagues have come up with direct evidence 
that
African-Americans may have less flexible blood vessels than whites, 
which
would increase blood pressure.  This may explain why drugs like beta
blockers, which regulate heart rate but do not relax blood vessels, 
are not
very effective antihypertension drugs for African Americans.
 
      Beyond that, the complexity of the issue is revealed in a study 
of
1,719 consecutive black cardiac patients (780 men and 939 women) at an
inner-city public hospital in Chicago.  The research looked at three
categories of patients: those who had cardiac catheterization for 
presumed
coronary heart disease, hospitalization for heart attack or coronary 
bypass
graft surgery (CABG).  The findings show that black women -- even in
comparison to black men, at least in this sample -- fare worse on a 
number
of parameters.  Diabetes was more common in the women patients in all 
three
groups.  High blood pressure was more prevalent except among those in 
the
CABG subgroup.  Women with CHD reported more angina than men, and the
CHD-associated risk of cardiac death was higher for women than men.
 
      For reasons that are unclear, more women than men underwent
catheterization, which is in contrast with the literature on white 
women
cardiac patients.  Also, the numbers of CHD cases confirmed by 
angiogram
were similar between the sexes -- also in sharp contrast to the male
predominance in most studies among whites.  The excess risk of both 
cardiac
and all causes of mortality in women with significant CHD was much 
greater
than among men.  The implication: Once overt CHD becomes clinically
manifest, black women tend to lose their earlier coronary heart
disease-free advantage over black men.
 
Risk Factors
 
Black women share with white women all the same risk factors for heart
disease with the addition of several more:
 
      High blood pressure.  High blood pressure, or hypertension, is 
more
common among blacks than whites.  Moreover, it develops earlier and
complications are more severe.  As a result of poorly controlled high 
blood
pressure, blacks with coronary heart disease frequently have left
ventricular hype trophy, an enlargement of the left lower chamber of 
the
heart, which is an important predictor of mortality.  This condition 
may
affect both the incidence and the outcome of cardiac arrest, causing 
more
frequent ventricular arrhythmias and more precipitous hypotension (low
blood pressure) in response to irregular heart rhythms or ischemic 
events.
Therefore, early diagnosis and treatment of hypertension is key for
averting heart disease among black women.  Although high blood 
pressure
control has improved among African-Americans over the past 30 years,
uncontrolled high blood pressure requiring emergency care is a grave
condition that still occurs most commonly among black patients.
 
 
      Smoking.  In 1990 about 417,000 Americans died of smoking-
related
illnesses.  Among these nearly 20 percent of deaths from 
cardiovascular
disease are attributable to smoking.  Smokers' risk of heart attack is 
more
than twice that of non-smokers, and 23 million women smoke.  Virtually 
the
same percentage of black women smoke as white women -- 23.9 percent 
and 25
percent, respectively.  Women who smoke and young women who might 
consider
smoking should know that cigarette smoking is the biggest risk factor 
for
sudden cardiac death.  Also smokers who have a heart attack are more 
likely
to die and die suddenly (within an hour) than non-smokers.
 
Smokers also affect the health of those around them.  Nine million 
children
under age five live with at least one smoker and are exposed to 
secondhand
smoke almost the whole day.  Each year this "passive smoke" causes up 
to
300,000 cases of respiratory infections such as pneumonia and 
bronchitis in
babies less than 18 months old.  Up to 15,000 of them must be 
hospitalized.
 
      Obesity.  It is well known that obesity is a risk factor for 
heart
disease and that it is more common among African-American women than 
white
women.  Genetics plays a role, as do diet and exercise patterns as 
well as
different cultural standards of attractiveness.  All women gain weight 
with
the passage of years.  But black women are on average heavier to begin
with, gain more weight in general over the years and specifically with 
each
pregnancy.  A five-year heart study of several hundred women between 
the
ages of 18 and 30 at the time of enrollment, found that black women 
with no
children gained 12.8 pounds whereas comparable white women gained less 
than
half -- 6.0 pounds.  Those African-American women who had children 
during
the study period incurred an additional seven-pound excess weight 
whereas
white women put on only an extra four pounds.  Both white and black 
women
who had babies finished the study with larger waists in proportion to 
their
hips -- usually referred to as the apple shape which is associated 
with a
greater risk of both heart disease and diabetes.
 
      Marital Status.  Surprisingly, being divorced or separated is a 
risk
factor for heart disease for black women but not for white.  In one 
study,
being married decreased the risk for African-American women while 
being
separated or divorced doubled the risk.  According to a Census Bureau
report, titled "Marital Status and Living Arrangements," published in 
July
1994, there is a trend toward delaying marriage, which is more 
pronounced
in the black community with 22 percent of black women age 40 to 44 
never
having been married compared with only 7 percent of white women.
 
Some of the possible explanations for the health benefits of marriage 
are
tied to the economic benefits but also to the emotional support of a
spouse, which may help one better adapt to stress.  In addition, the
relationship exercises some control over negative behaviors -- such as
drinking, overeating and smoking -- and facilitates positive
health-promoting behaviors such as getting enough sleep, eating 
regularly
and seeking prompt medical attention when needed.
 
      Cholesterol Levels.  The Framingham minority study found lower 
HDL
cholesterol levels in blacks -- both men and women -- than in whites.  
As
with white women, high total cholesterol levels are a risk factor for 
black
women as well as high LDL levels.
 
 
      Inactivity.  Black women have a much lower rate of physical 
activity
or exercise than do white women.  A sedentary lifestyle puts one at a 
much
higher risk for heart disease.
 
 
      Diabetes.  The rates of both Type I and Type II diabetes are 
higher
among blacks than whites.  In fact, African-Americans are 1.6 times 
more
likely to have diabetes than whites and experience higher rates of at 
least
three of the serious complications of diabetes: blindness, amputation 
and
kidney failure.  Black women are more than twice as likely as white 
women
(8 percent versus 3 percent) to have diabetes.  Moreover, one study 
found
that high blood sugar was more common among the 939 black women in the
sample -- all of whom had coronary heart disease -- than the 780 black 
men.
 
 
      Lack of Access to Health Care.  For a variety of reasons, 
including
lack of access to medical care, black women may be more likely than 
whites
to delay seeking care for potentially serious symptoms of heart 
disease
such as chest pain.  This may mean that coronary heart disease has 
already
developed or is more advanced when black women are diagnosed.  It also
increases the likelihood of having a cardiac-related event such as 
cardiac
arrest occur outside the hospital.
 
 
Cardiac Arrest
 
      Perhaps the ultimate symptom of coronary heart disease is 
cardiac
arrest.  In a study published in The New England Journal of Medicine 
within
the last year, out-of hospital cardiac arrests that occurred in 
Chicago
over a year were tracked.  Almost half of the cardiac arrests occurred 
in
women -- 43 percent.  Researchers found that the black community 
studied
(2,910 people) was at significantly higher risk for cardiac arrest and
subsequent death than the white community (3,207 people).  The 
subsequent
survival rate was 2.6 percent in whites, compared to 0.8 percent in 
blacks.
The quality of EMS services did not explain the lower survival rates 
among
blacks.
 
      In an editorial accompanying the New England Journal study, John 
Z.
Ayanian, M.D., of Harvard Medical School and Brigham and Women's 
Hospital
in Boston, pointed out that the striking differences between blacks 
and
whites may be attributable to social factors.  Higher socioeconomic 
status
is strongly associated with better health, and those socioeconomic- 
factors
transcend race.
 
      The route to improvement, according to Ayanian, requires 
substantial
change in three areas: "first, a health care system that ensures 
access to
effective medical care and educates patients to take full advantage of 
it;
second, a commitment by physicians to eliminate racial bias, even in 
subtle
forms, from clinical decision-making and communication with patients; 
and
third, socioeconomic opportunities in American society that are not 
limited
by race."
 
Education
 
      Ongoing education for black women about their risk factors and 
how to
modify them, their recognition of symptoms of heart disease, the value 
of
early diagnosis and the availability of effective diagnostic 
techniques is
crucial to reducing the numbers of deaths and disabilities among
African-American women with heart disease.
 
 
 
------------------------------
 
Date: Sat, 24 Sep 94 16:19:34 MST
From: mednews@stat.com (HICNet Medical News)
To: hicnews
Subject: Program: Strengthening Hospital Nursing Care
Message-ID: <BZJ7sc5w165w@stat.com>
 
THE STRENGTHENING HOSPITAL NURSING PROGRAM
 
1994 NATIONAL MEETINGS
 
ATTN:   Hospital Leaders, Nurse Executives, Medical Staff, Hospital
Trustees and Health Care Providers
 
ALL HEALTH CARE DISCIPLINES ARE INVITED!
 
You are invited to attend one or more National Meetings this fall that
bring together teams from 65 hospitals across the nation participating 
in
Strengthening Hospital Nursing: A Program to Improve Patient Care.  
This
national program, a collaborative initiative funded by The Robert Wood
Johnson Foundation and The Pew Charitable Trusts, focuses on
institutition-wide restructuring to improve patient care.
 
After more than five years of planning and implementation, 18 project 
teams
from 65
hospitals and health care institutions -- including small, rural
institutions and large, urban medical centers, public and private
hospitals, teaching and non-teaching institutions, and hospitals from 
14
states and the District of Columbia -- will share their experiences 
and
findings over the course of these meetings.
 
Four different National Meetings will be held on t he following dates:
 
         October 3-4, 1994               Louisville, Kentucky
         October 16-18, 1994     Arlington, Virginia
         November 3-4, 1994      Portland, Oregon
         November 10-12, 1994    St. Louis, Missouri
 
Registration will be limited to 350 participants at each meeting.  The 
cost
is $75 per person, with discounts for groups of three or more.  To 
request
a brochure, telephone 813/825-1154 or send a  FAX to 813/823-7021.
 
 
--
Les P. Weber, B.S., B.S.E.E.                Adventure is not outside
Weber Engineering Associates, Inc.          a man; it is within.
"Software & System Crafters"                -David Grayson
**
Internet - weber@ic.mankato.mn.us
AppleLink - WEBERENG
Voice - 507-345-1694
 
 
 
------------------------------
 
Date: Sat, 24 Sep 94 16:20:47 MST
From: mednews@stat.com (HICNet Medical News)
To: hicnews
Subject: CDC Issues New Report on Arthritis Prevalence
Message-ID: <c2J7sc6w165w@stat.com>
 
            ARTHRITIS FOUNDATION WARNS OF FUTURE EPIDEMIC:
        CDC ISSUES NEW REPORT ON ARTHRITIS PREVALENCE ATLANTA
 
                 "News from the Arthritis Foundation"
 
     The Arthritis Foundation today warned that arthritis will be the
epidemic of the future unless appropriate actions are taken now to
limit its impact. The warning comes amid new projections released
today by the Centers for Disease Control and Prevention (CDC) that
show the number of people with arthritis shooting upward to more than
59 million Americans in the coming years, a 57 percent increase from
1990 estimates.
       The CDC estimates that 38 million Americans were affected by
arthritis in 1990,15 percent of the population. Today, arthritis
affects nearly 40 million Americans. And projections developed for
the first time show that by the year 2020 the number of people
with arthritis will increase to 59.4 million Americans, fully 18.2
percent of the population or more than one in six people. The
dramatic increase is due in large part to the aging of the baby boom
generation, which is now entering the prime years of arthritis onset.
      "Arthritis already is taking a heavy toll on our nation's
health. The aging baby boomers will make arthritis an even more
pervasive disease extracting a devastating toll in the future unless
we take action now to limit its impact," said Don Riggin, president
of the Arthritis Foundation.
      "This is an alarming report. But by planning for the future,
funding more research to find preventions for arthritis, and taking
the steps we already know can prevent or limit the impact of
arthritis, we can greatly reduce the human suffering and economic
drain caused by arthritis in the future," Riggin said.
Because arthritis prevalence increases rapidly after age 45, the
Arthritis Foundation cautions that the leading edge of the baby
boomers, those born in 1949 or earlier, are already at increased
risk. The Arthritis Foundation suggests people avoid excess weight
gain, or lose excess weight, especially during middle age, to reduce
the risk of developing knee osteoarthritis. Also, taking precautions
to avoid joint injuries or repeated overuse of a joint can lower the
risk for arthritis later in life.
      In addition, the foundation recommends that leading edge baby
boomers begin checking for initial signs of arthritis. These signs
include pain, swelling, and limited movement that lasts for more than
two weeks. Knowing the early warning signs of arthritis and seeking
early treatment can make a difference.
      "Unfortunately, six million Americans say they have arthritis
but have never seen a doctor for help. Yet early treatment is
essential if you hope to avoid future limits on your daily
activities," Riggin said. The CDC report shows that arthritis now
limits major activities, such as working or keeping house, for 6.7
million Americans.
      For people already affected by arthritis, the Arthritis
 
------------------------------
 
Date: Sat, 24 Sep 94 16:22:00 MST
From: mednews@stat.com (HICNet Medical News)
To: hicnews
Subject: Deprenyl - A Parkinson's Drug - 1994 Update
Message-ID: <D4J7sc7w165w@stat.com>
 
                    Deprenyl - A 1994 Update
             The American Parkinson Disease Association
                      Summer 1994 Newsletter
             Copyright 1994, Reproduced with Permission
 
 
EDITOR'S NOTE: In 1989 APDA published "Deprenyl Update" an
educational supplement authored by A. Lieberman, M.D.,
Chairman of the APDA Medical Advisory Board. At that time
Deprenyl had just been approved by the FDA for use in this
country.
 
A short time ago an article on Selegiline (Eldepryl-Deprenyl)
authored by E. Brunt, M.D., appeared in Parkinson Magazine
highlighting the presentations made at a June 1993 neurologists
meeting in Budapest, the city where Prof. Knoll developed this drug
30 years earlier.
 
APDA is grateful to both Dr. Brunt and to Parkinson Magazine
for sharing this article with our readers.
 
Originally developed as a "psychic energizer" selegiline,
also known as I-deprenyl or Eldepryl, appeared to be an irreversible
inhibitor of the MAO-B enzyme. The MAO-B enzyme constitutes
the main degrading pathway for dopamine, the transmitter which
is deficient in the brain in Parkinson's disease (PD). An
important advantage of selegiline compared with other MAO
inhibitors was its lack of the "cheese effect". This effect is caused
by the uptake of a food constituent, tyramine, which is present
in high concentrations in cheese and Chianti wine, and causes
the sudden, marked elevation of blood pressure in patients
treated with other, previously used MAO inhibitors.
 
In the seventies, Prof. Birkmayer, Prof. Csanda and Dr. Lees
were among the first to apply, in the medical treatment of PD
patients, the concept of slowing down the dopamine degradation
by selegiline. The addition of selegiline to levodopa therapy
appeared to be successful, as patients with motor fluctuations
showed improvement and levodopa dosage could be reduced.
 
In 1985 Birkmayer reported a nine year retrospective study
from which appeared that addition of selegiline to levodopa
therapy in PD patients also lengthened their lifetime. Thus,
selegiline not only improved the response to levodopa, but
also appeared to have a protective action against deterioration
in PD. Support for a possible protective role of selegiline came
from studies on two animal models of PD. In the "MPTP model"
and the "6- hydroxy-dopa model", simultaneous administration of
selegiline appeared to prevent the development of parkinsonism.
The MPTP animal model of PD originates from the discovery
that this substance, methylphenytetrahydropyridine was
responsible for the development of a PD-like disease in
users of a synthetic heroine-like drug in California in the early
eighties. MPTP was found to be oxidized in the brain by the
MAO-B enzyme into MPP+, which could destroy dopamine
producing cells after being taken up into these cells, causing
a PD-like syndrome. In this model, blocking of MAO-B enzyme
prevents death of dopaminergic cells by MPTP.
 
In the 6-hydroxy-dopa model of PD, this substance is injected
into the brain of rodents in the tract formed by the dopamine
nerve cell fibers running from the brainstem to their target in
the basal ganglia. After being taken up into the nerve endings,
6-hydroxy-dopa also causes death of these cells, again producing
a PD-like syndrome. Also in this model, selegiline prevents the
damage, by blocking the uptake of the substance into the nerve
cells.
 
Thus in the second half of the previous decade, both human
and animal studies suggested a possible neuroprotective action
of selegiline in PD.
 
To evaluate the results of previous open studies and to
investigate the supposed neuroprotective effect of selegiline,
several controlled studies have been performed by the groups
of Dr. Langston, the Parkinson Study Group in the United States,
and by the groups of Dr. Myllyla in Finland and Dr. Allain in
France.
 
The largest and most important of these studies was a
multicenter study called "DATATOP" (deprenyl and tocopherol
antioxidant therapy of Parkinson). Over 800 newly diagnosed
PD patients from 40 centers in the US and Canada
were included in this study and randomized to treatment with
selegiline, vitamin E (tocopherol) or placebo. This study showed
a strongly significant delay of the need to add levodopa therapy
in the selegiline treated group. However, the interpretation as to
whether this effect was due to a symptomatic or protective effect
remained controversial. In other words it could not be ascertained
whether the delay was due to improvement of PD symptoms, or to
slowing down of the progression of the disease. Critics argued
that the one-month "wash-out" period following the withdrawal
of selegiline, after which the groups of patients had been
compared, was too short. Indeed, early this year, it was reported
that the difference in favor of the selegiline treated group was no
longer obvious after a prolonged wash-out period of 3 months.
 
As the time needed for the restoration of MAO-B in humans is
now estimated to be about 40 days, the current interpretation of
the DATATOP study is that selegiline does have a symptomatic
effect, and possibly a protective effect.
 
A comparable conclusion on the action of selegiline was drawn
by Dr. Myllyla in Finland from the interim analysis of a recently
concluded study on the effect of selegiline in newly treated
PD patients. Also in this study, the group treated with selegiline
required introduction of levodopa at a later date. In addition, in the
following years patients in the selegiline treated group needed
less levodopa than those in the placebo treated group. In a recent
report on the French selegiline multicenter trial, Dr. Allain also
reported both an improvement of symptoms and a delay in
progression in the selegiline treated group.
 
As mentioned before, selegiline not only is being used in many
countries in the treatment of PD, but also has had a major impact
upon the research on PD and other neurodegenerative diseases.
The exciting story of selegiline includes study on the possible
role of MAO-B enzyme in the pathogenesis of PD and evidence
for protective or even rescue effect of the drug upon endangered
and damaged nerve cells.
 
Investigations on the MAO enzymes have made clear that the
two different types, A and B. have their own distribution both
outside and inside the human brain, - and act upon different
substances. The wide differences found between individuals
on the amounts of MAO-A and MAO-B present in skin and blood
may be important in the study of diseases such as PD.
 
Although preferably metabolized by MAO-B, dopamine is
also degraded by MAO-A and auto-oxidation. In the brain about
60% of MAO is of B type and the amount of MAO-B increases
after age 60.
 
After its production and excretion from the nerve cell to act upon
the receptors of other nerve cells, dopamine is re-uptaken and
subsequently degraded. This degradation takes place mainly
outside the nerve cells, possibly in the nearby support glial cells,
which are known to contain the highest concentration of
MAO-B enzyme.
 
It appears that in the normal process of dopamine degradation
by MAO enzymes, toxic compounds such as hydrogen peroxide
are formed, which may react to form "free radicals". These "free
radicals" are aggressive oxidative substances which can impair
the energy production or damage the membrane of nerve cells,
causing their death. At the Budapest meeting, Profs. Olanow,
Jenner and Youdim presented data suggesting that in dopamine
cells of PD patients the production of the oxidizing substances is
increased, while at the same time the defense mechanisms
against this "oxidative stress' is reduced. As selegiline reduces
the turnover of dopamine by impeding its degradation and
increases one of the defending enzymes, reduction of  "oxidative
stress" may be one way in which it may protect nerve cells.
 
Evidence to support a protective role of selegiline was also
provided by Prof. Knoll. He has found a reduction of age related
changes in the dopamine nerve cells of the substantia nigra
and increased longevity in rats treated with selegiline.
 
Maybe the most exciting findings on the action of selegiline
were discussed at this meeting by Prof. Tatton.
 
Several experiments suggest an action of selegiline which
differs from MAO-inhibition or protection from oxidative free
radicals.
 
The first example is the MPTP-mouse model in which low
dose selegiline given following MPTP administration at a time
when lethal damage to neurons has been completed, triples
the number of surviving nerve cells. At this dosage selegiline
causes less than 50% inhibition of the MAO-B enzyme, so this
cannot explain the rescue. Another example is an experiment
in which one facial nerve is cut in rats of two weeks of age.
At this age the cells of the facial nerve are dependent on
nurturing substances ('trophic" or "growth" factors) from the
muscles with which they are connected. These trophic factors
are transported via the nerve and cutting of the nerve
normally results in death for most of the nerve cells.
Selegiline given to these rats both in high and in low dosage,
more than doubled the number of surviving cells, apparently
providing a substitute for the trophic factors. The suggestion
that selegiline provides a substitute for trophic factors is
also supported by the observation that in cultures of brain
cells, selegiline promotes the growth of these cells and
increases the production of growth factors.
 
These examples suggest that selegiline, used in low dosage,
may have a "rescue" effect, comparable to the effect of trophic
factors. Several of these neurotrophic factors have been identified
and they play an important role both in the growth and in
maintenance of nerve cells, and they have also been shown to
be important in fetal cell transplantation.
 
It can be concluded that selegiline has proven to be a
fascinating drug for its use in the treatment of PD and for its
inspiration of a vast area of research on neurodegeneration.
Actions of selegiline at different dosages include; MAO-B
inhibition, dopamine re-uptake inhibition, reinforcement of
defense against "oxidative stress", and substitution for
trophic factors.
 
A symptomatic and levodopa sparing effect of selegiline
in the treatment of PD patients has become evident, supporting
its use in patients already treated with levodopa. A protective
action in PD patients, by diminishing the rate of progression
of the disease, awaits further clinical proof. Therefore, the
decision to use selegiline as monotherapy in early stage PD
and during its further course is currently based upon the
suggestion of possible benefit rather than evidence. Its
suggested rescue effect and substitution of trophic factors for
nerve cells opens most exciting perspectives.
 
Selegiline has now taken a place in the treatment of PD and
experimental work has opened exciting perspectives. Whether
these promises will become a reality for the patients depends
on clinical results. In the end only these count. Much work
needs to be done, but the hope for a better treatment of this
disease is a good reason for doing it.
 
 
 
------------------------------
 
Date: Sat, 24 Sep 94 16:24:28 MST
From: mednews@stat.com (HICNet Medical News)
To: hicnews
Subject: AIDS Daily News Report
Message-ID: <H8J7sc1w165w@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 1994, Information, Inc., Bethesda, MD
 
      In this issue:
      
*******************************************************************
      "Progenics Pharmaceuticals Awarded NIH Grant for Development
       of Imaging Agent for HIV Infection"
      "Swiss Red Cross Collaborating With HemaSure Inc."
      "$25 Million Committed by U.S. for Alternatives to AIDS Drug
       Therapy"
      "AIDS Vaccine Doubted"
      "Female Condom to Get Disease Trials in City"
      "CDC Says AIDS Case Remains Unsolved"
      "Sites Awarded, Renewed for Community-Based AIDS Trials"
      "Gladstone Institute Researchers Create Multi-Purpose
       Vaccine Capable of Generating Immune Response to HIV"
      "Study Adds to Fears of Blood Recipients"
      "U.S. AIDS Research Switches Focu[Position]
x=961
y=471

[Width]
cx=44
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     u̱         1143.NDX a  l  @o PK   uW;   F      1150.NDXc8PPPP
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     ط8         2137.NDX xP PK   Yb<(   2      2368.NDXc8D20  e` Bz PK   L]         2378.NDXcx"^^1D\ @C$HD, @DT/qD(D20 Јe` "^^^ PK   	#         2582.NDXcXpD020H# PK
     Ib
   
      2584.NDX b  b PK   #!   (      3157.NDXcHe`X "8Rz@P"2  PK   ~8"K^         3185.NDXc ":@" B" D @Ă^ P" 0e` @	DX${ PK   ӗ0   A      PERSONAL.NDXc`jg`````L"
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     u̱                  F 1143.NDXPK    uW;   F               G 1150.NDXPK    vN[                  dG 1369.NDXPK    w4#   (               	H 1928.NDXPK    }jL                  RH 2120.NDXPK    \u+   <               BI 2136.NDXPK 
     ط8                  I 2137.NDXPK    Yb<(   2               I 2368.NDXPK    L]                  J 2378.NDXPK    	#                  J 2582.NDXPK 
     Ib
   
               J 2584.NDXPK    #!   (               J 3157.NDXPK    ~8"K^                  EK 3185.NDXPK    ӗ0   A               K PERSONAL.NDXPK    A|
  p               #L CHANNEL1.PTRPK        WT   1150.NDXc8PPPP
ւ:X}Cc7S7s7bIu3  PK   vN[         1369.NDXch`f``f`x "pu30(pw30$v30, B$&
bIKu30 	2 B$!b)):@d:<
Q A$f`hz >H!(#ABu?><<78$$GhABABABABABABA!B!! $4A#B##A&B&&A)B))A,B,,A.B..A1B11FJA3B33A5B55A7B77A9B99A;B;;A=B==A?B??A@B@@ABBBBADBDDAEBEEAGBGGAHBHHAJBJJALBLLAMBMMANBNNAPBPPAQBQQATBTTAUBUUAWBWWLAYBYYAZBZZA[B[[A]B]]A^B^C^tA`B``AaBaaAcBccAdBdd$AeBeeAgBggAiBiiAkBkkAlBllAmBmmrAnBnnApBppAqBqq	
AsBssAtBtt$
AvBvvAwBwwAyByyFNAzBzzA|B||A}B}}A~B~~HPH!
R

A}B}}A|B||AzBzzAyByyAxBxx
AuBuu	UAtBttArBrrAqBqqAoBooAnBnnAlBllAkBkkAiBiiAhBhhAfBffAdBddAcBcc AbBbbAaBaaA_B__WA]B]]A\B\\CCAZBZZAYBYYAWBWWAVBVVASBSSARBRRAPBPPAOBOOAMBMMAKBKKAJBJJAIBIIXAGBGGAFBFFCAAEBEEACBCCABBBBA@B@@A?B??A=B==A<B<<A:B::A8B88HA7B77A5B55A2B22A0B00A.B..A+B++A)B))HA&B&&A$B$$A"B"C"A?ABABABABsABABABABAB$A
B
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A	B		
ABABABu>?<<87$$?CABABABABABA!B!!A$B$$$A&B&&A(B((A*B**A,B,,A.B..A0B00A1B11A3B33A5B55A6B66A8B88A9B99A;B;;A<B<<A>B>>A?B??A@B@@AABAAADBDDAEBEEFZAGBGGAHBHHAJBJJALBLLANBNNAOBOOAQBQQARBRRASBSSAUBUUAVBVV$AXBXXAYBYCYAZBZZA\B\\A]B]]	 $
A_B__AaBaCa
AcBccAdBddAfBffAgBgg$AiBiiAjBjjAmBmmAnBnn $ApBppAqBqqAsBsCsAtBttAuBuuAvBvCvAxBxCxAyByyAzBzzA{B{{A|B||A}B}}A~B~~HEH\VA|B||AzBzzAxBxxAvBvvAtBttArBrrApBppAoBooAmBmmAlBllAjBjjAhBhhAgBgCgAfBffAdBddAcBccAbBbbAaBaasA_B_C_A]B]]A\B\\ $AZBZZAXBXXAWBWWAUBUUATBTTASBSSARBRRAPBPPAOBOOAMBMMALBLLAJBJJAIBICIAGBGG
AEBEEADBDCDABBBBA@B@@
	A>B>>A=B==A;B;C;A9B99HA7B7C7A6B66A4B44A3B3C3HA1B1C1A0B00 A.B..A,B,,A+B++A)B))$A(B((A&B&&A%B%%A#B##A"B""C$A B  ABABABABABABABABu?><<78$$YCABA	B		ABABABA B   $4ABABABA
B
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ABABABCABABCABABCA B  A"B""A$B$$A&B&&A(B((A*B**A+B+C+A-B--A/B//A0B00A2B22A3B33A5B55A6B66A8B88A9B99A:B::A<B<<A=B==F`A?B??A@B@@dAABAAACBCCADBDDAFBFFFbAGBGG$AIBIIAJBJJALBLLAMBMMAOBOOAPBPPAQBQQASBSSATBTTuAVBVVAXBXXAZBZZA[B[[ $A]B]]A^B^^AaBaaAbBbbAdBddAeBeeAgBggAiBiiAkBkkAlBllAnBnnApBpCpAqBqqHAsBssAuBuuAvBvv	AxBxxHAyByyA{B{{A|B||A~B~~
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      "Female-to-Female Sexual Contact and HIV Transmission"
      "Yokohama Conference Overview"
      "Transmission of Zidovudine-Resistant HIV During a Bloody Fight"
      "Kaposi's Sarcoma--Major Overview Published"
      "Publicizing AIDS Data Early and Often"
      "Cocaine and HIV Prevalence in an Alcohol Treatment Center"
      "Human Growth Hormone Reverses Wasting in Clinical Trial"
      "Infectious Diseases in Competitive Sports"
      "Regulating Syringe Exchange Programs: A Cautionary Note"
      "HIV, TB Present Deadly Combination"
      "Directly Observed Therapy for Tuberculosis in New York City"
      "Shifting AIDS Research Back to Basics"
      Correction from AIDS Daily Summary, 09/09/94:
      "Blacks Far More Likely Than Whites to Have AIDS, Agency Says"
      
*******************************************************************
 
 
               "Progenics Pharmaceuticals Awarded NIH Grant for
                Development of Imaging Agent for HIV Infection"
                             PRNewswire (08/30/94)
 
      The National Institutes of Health has awarded Progenics
Pharmaceuticals Inc. an $80,000 grant under Phase I of its Small
Business Innovation Research Program.  The funding goes toward
the development of ProScan-A, an imaging agent designed for the
detection of the HIV in its asymptomatic period.  It can also
help doctors determine how well treatments and vaccines are
working in HIV-infected patients.  Progenics has signed a
clinical trial agreement with Memorial Sloan-Kettering Cancer
Center for a Phase I clinical trial on ProScan-A.
 
 
            "Swiss Red Cross Collaborating With HemaSure Inc."
                         PRNewswire (08/30/94)
 
      HemaSure Inc. announced on Tuesday that it is teaming up with 
ZLB
Central Laboratory, Blood Transfusion Service of the Swiss Red
Cross, to develop the Leukovir Filter, which is designed to
remove methylene blue from virally inactivated plasma.  The
methylene blue can then be transfused into patients to inactivate
viruses which can contaminate plasma.  This application of
methylene blue was developed by the Blood Transfusion Service of
the German Red Cross.  Eugene J. Zurlo, President and Chief
Executive Officer of HemaSure, said the collaboration will be
"beneficial to the organizations involved, and most importantly,
to the patients who will benefit from safer plasma."  Currently
there is no FDA approved viral inactivation process for plasma in
the United States.
 
 
                  "$25 Million Committed by U.S. for
                   Alternatives to AIDS Drug Therapy"
                   Washington Post (09/02/94) P. A19
 
      The federal government has promised $25 million for the
investigation of alternatives to drug therapy for the treatment
of AIDS, to be split among the New England Medical Center, the
University of Pennsylvania, the University of Michigan, the Fred
Hutchinson Cancer Research Center in Seattle, Stanford
University, and the University of California at San Diego.
National Institutes of Health officials said on Friday that more
money is expected to be approved for the studies next year.
Director of the National Institute of Allergy and Infectious
Diseases, Anthony S. Fauci, said, "This effort is crucial because
currently available anti-HIV drugs only partially and temporarily
suppress replication of the virus, and their use is hampered by
toxicity and drug resistance."
 
 
                       "AIDS Vaccine Doubted"
                 Washington Post (09/02/94) P. A10
 
      A study conducted by Sally M. Blower and Angela R. McLean of
Oxford University and published in Friday's Science magazine
showed it to be nearly impossible for a vaccine alone to conquer
AIDS.  Using the gay community in San Francisco as a model,
Blower and McLean found that the number of HIV cases in that
community could double every two to seven years.  They further
concluded that a vaccine might even contribute to the disease by
creating a false sense of security and preventing changes in
dangerous behavior.  Several HIV vaccines are currently in
development but none have been approved for widespread testing in
the United States.  Related Story: Philadelphia Inquirer (09/02)
P. A17
 
 
             "Female Condom to Get Disease Trials in City"
                 Philadelphia Inquirer (09/02/94) P. A1
                    (Belluck, Pam;  Collins, Huntly)
 
      On Tuesday a health department committee approved two tests on
the female condom, to start in the fall, involving patients at
the department's sexually transmitted disease clinic.  The first
study, funded by the condom's manufacturer, Female Health Co.,
would attempt to ascertain whether the female condom would
protect women from sexually transmitted diseases.  The second
study, funded by the federal Centers for Disease Control and
Protection, would try to determine what sort of contraceptive
women will use if given a choice.  The female condom gained FDA
approval as a contraceptive last year and clinical trials have
found it to be as effective in preventing pregnancy as the
diaphragm, the sponge, and the cervical cap.
 
 
                 "CDC Says AIDS Case Remains Unsolved"
                 United Press International (09/01/94)
 
      Dr. Harold Jaffe, director of the U.S. Center for Disease 
Control
and Prevention's division on HIV/AIDS, says the agency has no
direct evidence of criminal intent concerning the dental practice
of Florida Dr. David Acer.  Officials linked six cases of HIV
infection to Acer in 1990.  According to investigators,
transmission of the virus could have occurred in one of three
ways.  Dr. Acer could have accidentally cut himself and exposed
patients to his blood, he could have used unsterilized equipment
and unsterile procedures, or he could have intentionally
transmitted the virus.  A behavioral scientist has stated that
results of a three-year study into the case show the late
dentist's personality matches the profiles of 36 serial killers
studied by the FBI.
 
 
          "Sites Awarded, Renewed for Community-Based AIDS Trials"
                          PR Newswire (09/01/94)
      The National Institute of Allergy and Infectious Diseases 
(NIAID)
has awarded funding to four new sites and 12 incumbent sites to
study promising HIV therapies as part of the community-based
clinical trials network.  The first-year funding for the 16
five-year awards is approximately $12 million.  Anthony S. Fauci,
M.D., director of NIAID, says the awards "strengthen our
capability and commitment to offer HIV-infected patients clinical
trials of HIV therapies in community settings such as private
practices and clinics as well as in health centers."  The awards
stem from the recompetition of NIAID's Terry Beim Community
Programs for Clinical Research on AIDS.
 
 
         "Gladstone Institute Researchers Create Multi-Purpose
          Vaccine Capable of Generating Immune Response to HIV"
                      Business Wire (09/01/94)
 
      Researchers from UC San Francisco have inserted two HIV genes
into the poliovirus vaccine to create a new vaccine capable of
generating in an immune response in animals to HIV.  The
decades-old Sabin polio vaccine was used as a vehicle to deliver
key proteins to specific targets in the body, where they could
generate an immune response to guard against infection.  The
proteins packed into the poliovirus included two important HIV
proteins, Nef and Gag, a protein from influenza type A virus, and
the highly toxic cholera toxin.
 
 
              "Study Adds to Fears of Blood Recipients"
               Toronto Globe and Mail (08/31/94) P. A3
                          (Picard, Andre)
 
      The Laboratory Centre for Disease Control in Canada estimates
that 940 to 1,440 people may have been infected with HIV through
transfusions between 1978 to 1985--two to three times the number
of people originally thought to be infected.  In addition, as
many as 245 people may still be "unaware of their HIV-positive
status."  Although public officials in almost every province have
urged transfusion recipients to be tested for the virus,
hospitals have resisted demands that they locate each person who
received blood because of the cost of such research and the poor
condition of records.  Scientists say that the risk of being
infected by bad blood was nearly 25 times higher in 1985 than in
1978.  They also estimate that the risk of HIV to surgery
patients receiving between 30 and 50 units of blood had risen to
9.4 out of every 1,000 by the time mandatory blood screening for
the virus was started in 1985.  Public officials are concerned
that those who didn't realize they were affected could have
spread the disease through sexual encounters.  The Canadian Red
Cross Society reports that the risk of receiving contaminated
blood during surgery in Canada today is estimated at one in
250,000.
 
 
        "U.S. AIDS Research Switches Focus to Boost Immune System"
                   Washington Times (09/07/94) P. A6
  