Health Headlines - July 25

Clinton Launches HIV/AIDS Initiative

Former President Bill Clinton on Saturday kicked off a program that will almost double the number of children in Kenya receiving HIV treatment by the end of 2005, the Associated Press reported.

About 100,000 children in that country are currently infected with HIV, according to the AP, but only 1,200 actually received treatment for their disease. The Clinton Foundation's Pediatric HIV/AIDS Initiative will target an additional 1,000 children.

After flying to Rwanda late Saturday, Clinton donated a year's supply of anti-retroviral treatment for 2,500 children in that country. The foundation's goal is to have 10,000 HIV-infected children in at least 10 countries on anti-retroviral treatment by the end of the year. The money for the massive effort was raised by Clinton mostly from private donors, the AP said. Rwanda was the last stop on Clinton's tour of six African countries, the aim of which was to shine the spotlight on this continent's AIDS crisis.

Children account for one-sixth of HIV/AIDS deaths each year, but they represent only 5 percent of those treated worldwide, according to the United Nations.

FDA Approves New Treatment for Insomnia

A new treatment for insomnia was approved on Friday, and it bears the distinction of being the first prescription sleeping aid not to be classified as a controlled substance.

The drug, known as Rozerem (ramelteon), works differently than its competitors, the Associated Press reported. It is a chemical cousin of melatonin, a natural hormone that keeps the body's sleeping/waking cycle in balance. Rozerem appears to stimulate melatonin receptors in the brain, Dr. Robert Meyers, of the U.S. Food and Drug Administration, told the AP.

Studies have also shown the drug does not cause dependence, which is why the FDA did not classify it as a controlled substance. However, the medication is metabolized by the liver, so those with liver conditions should not take this drug, Meyer added.

Rozerem should be available in late September, although its maker, Takeda Pharmaceuticals, would not reveal a price. Roughly a third of adults have trouble sleeping, and about 10 percent have trouble functioning during the day, the AP reported.

New Hope for Those With High Blood Pressure

More than two-thirds of the 65 million Americans with high blood pressure require two or more anti-hypertensive drugs to manage their condition. Many of these people also take medicines for high cholesterol and diabetes.

That makes for a heaping mound of pills to swallow every day.

"Anybody can take a few drugs for a few months, but these people have to be on drugs indefinitely," said Dr. John D. Bisognano, an associate professor of medicine and director of cardiac rehabilitation and clinical preventive cardiology at the University of Rochester Medical Center in Rochester, N.Y.

But there is encouraging news on the horizon for people with high blood pressure. Easier-to-take medications and novel drugs and devices promise to improve long-term hypertension management. Basic research continues to sort out the causes of hypertension. And vigorous prevention initiatives aimed at sparing children from this chronic health problem breed hope for future generations of Americans.

Hypertension, often called "the silent killer," usually occurs without symptoms but remains a leading risk factor for stroke, heart attack, heart failure and kidney disease. The only way to find out if you have it is to have a blood pressure reading.

High blood pressure is literally the force exerted as blood pumps into the arteries through the circulatory system and as the arteries resist the flow of blood, says the American Heart Association. Systolic pressure, the "upper" number in a blood pressure test, measures the force when your heart is beating; the "lower" diastolic number reflects the pressure when the heart is resting between beats.

A normal blood pressure for adults is less than 120 mmHg over less than 80 mmHg, and a reading of 140/90 mmHg or higher is considered high, requiring medical intervention.

In 2003, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, a panel convened by the federal government, added a new blood pressure category, called "prehypertension" -- to put people on warning about the potential risk they face. Prehypertension is defined as a pressure of 120-139/80-89 mmHg.

For people with diabetes or kidney disease, the goal is to reduce blood pressure to 130/80 mmHg.

"One of the problems you run into is people who are at the highest risk -- the people with diabetes and kidney disease -- often require lots of medications to get their blood pressure down, because every medication gives you about a 10- to 15-point drop or so," Bisognano said.

"If you're starting at 200 and need to go to 130, that's a lot of medications," he added.

No single medication has proved to be the magic bullet for lowering blood pressure, so doctors typically rely on a number of different pharmaceuticals, including diuretics, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, beta blockers and calcium channel blockers.

Pharmaceutical developers are responding to the need to make it easier for hypertensive patients to comply with medication regimens by developing new combination products. In the future, we will see more fixed-dose combos of antihypertensive medications as well as pills that can treat more than one risk factor at a time, predicts LeadDiscovery, a United Kingdom-based research outfit.

Pfizer Inc. was the first to offer such a two-in-one product. In 2004, the company received approval from the U.S. Food and Drug Administration to begin marketing Caduet, a pill that contains both Norvasc for lowering high blood pressure and Lipitor for treating high cholesterol.

There are a few new agents in the pipeline that hold promise. One novel class of medications, called oral Renin inhibitors, works by targeting an enzyme released by the kidneys that can affect blood pressure. The first of these agents to be introduced on the market is likely to be Aliskiren, a Novartis drug currently in phase III testing. Analysts expect the company to seek regulatory approval in 2006 and are forecasting blockbuster sales topping $1 billion by 2008 and reaching $3.6 billion by 2012, LeadDiscovery reports.

Meantime, even a gadget to keep blood pressure at bay is being tested. In March, doctors at the University of Rochester Medical were the first in the nation to implant the Rheos, a battery-operated generator that activates the body's natural blood pressure regulation systems. Much like a pacemaker regulates heart rhythm, this device stimulates nerves in the carotid arteries to tell the brain to reduce blood pressure. Bisognano is part of the team that is testing the device.

Still, preventing hypertension in the first place is a far better thing than having to rely on medicines or machines, clinicians agree. That is why the National Hypertension Association (NHA) has focused on basic research and education.

NHA researchers have shown, for example, that salt-sensitive rats get high blood pressure when exposed to excess salt. "But the salt resistant ones are not bothered by it at all; their kidneys get rid of it," noted Dr. William M. Manger, NHA chairman and clinical professor of medicine at New York University Medical Center. At least in salt-sensitive rats, it appears that excess salt to the brain causes hypertension, he said. How that will play out in humans is still unknown, but investigators are hopeful.

The NHA also sponsors VITAL (Values Initiative Teaching About Lifestyle), a rapidly expanding school-based initiative to change the lifestyle and behavior of young children. It focuses on nutrition and exercise, a much broader agenda than hypertension alone. But it fills a critical gap, according to Manger, author of the not-yet-released book, Our Greatest Threats Protect Your Children and Yourself, focusing on preventing unhealthy lifestyles.

"I think this VITAL program is the best thing we could do for our nation," he said.

Pay Attention to Bladder Cancer's Warning Signs

People need to pay attention to the early warning signs of bladder cancer and get prompt medical help, says a University of Michigan Health System bladder cancer expert.

"It's very important for patients to pay attention to the symptoms that they may experience. For example, if someone has blood in the urine, they may have a tendency to dismiss that or ignore that. I cannot emphasize enough that it is very important for patients with that symptom to be evaluated by a physician," Dr. Cheryl Lee, director of the bladder cancer program at the U-M Comprehensive Cancer Center and assistant professor of urology at the U-M Medical School, said in a prepared statement.

Along with blood in the urine, other symptoms of bladder cancer include: urgency to urinate; frequent urination in small amounts; back or abdominal pain; painful urination; loss of appetite or weight.

Tests to diagnose bladder cancer include: checking urine samples for cancer cells; X-rays of the kidney and urinary system, including the bladder; and cystoscopy, in which a small flexible tube with a camera on the end is inserted into the bladder.

Bladder cancer strikes men three times more often than women. Treatment for bladder cancer is most successful in the early stages, when the tumor is smaller and on the surface of the bladder.

"If a patient unfortunately has had a delay in diagnosis, or has not responded to some of the signs such as blood in the urine, the tumor has the opportunity to grow, to invade the wall of the bladder and even to extend beyond the bladder, or metastasize, to other organs. In that scenario, we're looking at much more aggressive and radical treatment plans," Lee said.

This year, about 63,000 Americans will develop bladder cancer, which kills about 13,000 people in the United States each year, the university said.

Maggot Treatment Saves Mich. Woman's Foot

Barbara Enser wasn't very comfortable at first with the idea of using maggots to clean the wound on her right foot. But if it meant saving it from amputation, she was willing to give it a try.

The 57-year-old Bay City woman was diagnosed with diabetes 40 years ago and subsequently lost her left leg to the disease. She also suffers from neuropathy, meaning she has no feeling in her foot or leg, and ulcers or wounds can develop from constantly putting pressure on the foot.

"I'm just hoping this works because I think this is the last straw for saving the foot," Enser told The Bay City Times before a recent treatment. "I don't like creepy, crawly things. I won't even kill a creepy, crawly thing."

Enser went through a number of other procedures to stem the infection that is spreading through her foot. She had the wound cleaned with a scalpel and has been on antibiotics.

But after those failed, she turned to Dr. Gerald L. Dowling, head of the podiatry section of the Orthopedics Department at Bay Regional Medical Center. He first treated Enser with maggots on July 6.

For the procedure, the maggots —- about 2 millimeters each in size —- are placed on the wound, then surrounded by an adhesive foam, clear tape, and a gauze bandage.

By July 8, the maggots had swelled to twice their normal size and eaten away part of the infection. When Dowling removed the bandages two days later, Enser's foot was looking better. Healthy, pink skin was replacing the dead tissue, and the swelling was down in her foot and ankle.

The maggots do more than just clean a wound. They also dissolve the infected tissue, kill bacteria and leave an enzyme behind that stimulates healing. They will only eat the infected tissue, leaving healthy tissue alone.

"In general, maggots have the capacity to distinguish viable and dead tissue on a cell-by-cell basis," said Dr. Steven M. Holland, chief of the laboratory of clinical infectious diseases at the National Institute of Allergy and Infectious Diseases.

As much good as the first treatment did, Dowling decided to go with one more treatment. And when the bandages from the second procedure were removed 72 hours later, Dowling deemed the procedure a success.

Once the bandages were taken off, the maggots were removed using tweezers and the area was rinsed with a saline solution. Dowling then cut away leftover dead skin.

Hundreds of Children Starving in Niger

Nasseiba Ali is the face of hunger in Niger. The 20-month-old girl weighs just 12 pounds, and her eyes are clouded at night, one of the symptoms of her chronic malnourishment, along with sparse, wiry hair, brittle and malformed nails, and a deceptively prominent belly.

Nasseiba may survive because her grandmother was able to get her to a feeding center. But aid groups despair that so many other children -— among the most vulnerable in times of crisis -— are dying because the world was slow to respond.

"I thought we would not make it safely," said Haoua Adamou, Nasseiba's grandmother, speaking in Hausa through an interpreter. Adamou had walked several hours from her village with the baby on her back to the emergency feeding center at Maradi, some 400 miles east of the capital, Niamey. She sat Saturday fanning flies from Nasseiba's face.

The aid agency Oxfam warned last week that about 3.6 million people, about a third of them children, face starvation in this West African nation devastated by locusts and drought. The U.N.'s humanitarian agency estimates some 800,000 children under five are suffering from hunger, including 150,000 faced with severe malnutrition.

The warnings have been coming for months. The United Nations first appealed for assistance in November and got almost no response. Another appeal for $16 million in March got about $1 million. The latest appeal on May 25 for $30 million has received about $10 million.

Donations jumped dramatically in the last week because, U.N. humanitarian chief Jan Egeland said Friday, of increased media attention and TV images of starving children. Egeland estimated thousands of children are dying in Niger.

Nasseiba dozed, at first fitfully, in the intensive care tent of the emergency center erected by Doctors Without Borders in Maradi, where 55 other chronically malnourished children were receiving care. Her mother, who is three months pregnant, and her father stayed behind to work their farm, hoping to coax something from the dry soil come the October harvest.

Nasseiba tried several times to pull out the tiny feeding tube securely taped to her forehead and running down into her nose. She found sleep after several meager mouthfuls of enriched formula and what looked like a long, cold stare, sign of her troubled vision that leaves her blind at night.

Just a few steps from the critically sick, another ward sheltered children who have almost recovered.

Two-year-old Tsclaha has survived the critical 48 hours since her admission, when she weighed just 13.2 pounds. It will take her days to reach her target weight of 16 pounds before being declared fully cured.

Tsclaha, barely able to stand on wobbly legs, happily munched a ready to eat, highly nutritious peanut butter mixture. Tsclaha wore a red bracelet, signaling doctors had decided to admit her. Nearby, 40 women carrying children waited anxiously for them to be weighed and for doctors to decide which ones would get red bracelets, which ones the orange or yellow bracelets that meant that, though considered malnourished, they were well enough to be sent home with supplies of flour and cooking oil.

Outside the MSF center, new tents are being set up to ease up the burden on the already stretched facility, where nurses work round the clock to diagnose the 300 hungry children who come daily from surrounding villages.

A 16-ton shipment of oil, sugar, and nutritional paste arrived in Maradi from France on Thursday and several more shipments were scheduled, the U.N. World Food Program said.

But the need is great and growing in this desert nation of 11.3 million regularly ranked among the world's least developed. When the first appeal was made, only $1 dollar per day and per person would have helped solve the food crisis, the U.N. has said. Now that the situation has worsened and people are weaker, $80 will be needed per person.

"It's the worst I've seen so far," said Hassan Balla, a primary school teacher in Tarna, a village just outside Maradi.

"What is happening is really ugly," he said. "I've seen people eat leaves ... live like animals."

Balla, however, is optimistic.

"The world is generous," he said. `Our friends heard our cries. Do you think they will let us suffer when they are living comfortably?"

Food Fact:
Magic beans.

Beans can help reduce cancer risks -- but you may want to give them a good rinse before cooking. Canned beans have a lot of excess sodium; a little running water will wash it, and that "canned" taste, away. Otherwise, beans, lentils, peas and other legumes are as healthy as tasty food gets. Legumes are full of protease inhibitors, which may protect against several cancers by helping your body repair genetic material, curb out-of-control cell division and inhibit tumors by impairing their enzymes. They're also high in fiber, low in fat, rich in B vitamins (including folate), and contain potassium, magnesium, iron, zinc and trace elements.

Fitness Tip of the day:
Lift weights, lose weight.

Marilyn Monroe knew it, and you should, too: For good health and a great shape, dumbbells are a girl's best friend. Dieters who lift weights and eat well lose more body fat, and feel stronger and more flexible. Lifting weights as you diet makes it easier to shed pounds; increased muscle mass will boost your metabolic rate over time, allowing you to burn calories even at rest. It also gives your muscles a tight, firm appearance.

FAQ of the day:
Why do women need more body fat than men?

It's all about hormones. A woman's body is designed for childbearing and breast-feeding, so her hormones ensure she has a minimum level of body fat. This is why amenorrhea occurs in women who undereat and/or overexercise -- the percentage of body fat drops too low to provide the energy needed to sustain healthy pregnancy and lactation. On the plus side, estrogen helps limit the risk of heart disease by maintaining the average woman's blood-cholesterol profile in a healthier state than a man's.