CMV virus is way more common than Zika. But expectant mothers don’t know their babies are at risk.

CMV can cause birth defects, but prevention steps are considered “burdensome,” say doctorsMegan Wiedel and her daughter Anna take American Sign Language tutoring sessions at their home in Wheat Ridge, Colorado.

 

“When you talk about it, it seems like it’s really rare,” Wiedel said. “But it’s not. A lot of kids have CMV.”

“That’s the hardest piece for me is that this is a preventable, prevalent, quiet disease.”

But, now, a small community of mothers and medical workers are trying to make CMV awareness a little less quiet.

Cytomegalovirus, or CMV, is the most common nongenetic cause of childhood deafness in the country. Every year, approximately 30,000 babies are born in the United States infected with CMV, and as many as 8,000 of those children suffer lifetime consequences from the disease — which can also include blindness, cognitive delays and microcephaly. As many as 400 infants die every year from CMV, according to the National CMV Foundation.

American Sign Language teacher Lori Fisk, left, works with 19 month old Anna, right, during a tutoring session at Anna's home on January 26, 2017 in Wheat Ridge, Colorado. Anna was born profoundly deaf as a result of an infection from CMV, a common virus that pregnant women are often under-educated about. It is estimated that, in reality, 20,000 to 40,000 babies in America are born with congenital CMV each year but aren't diagnosed because they appear healthy at birth or doctors mistake their symptoms for other diseases. Anna contracted CMV in-utero from her mother Megan not because the family traveled to another country, but because they have a toddler. CMV is spread most often through the saliva and urine of children under the age of 3 in some studies, it is present in 44 to 100% of toddlers at daycare centers, and they will go on to shed it for two years or longer.
Helen H. Richardson, The Denver Post

American Sign Language teacher Lori Fisk, left, works with 19 month old Anna, right, during a tutoring session at Anna’s home on January 26, 2017 in Wheat Ridge.

It is vastly more common than the Zika virus, which prompted alarm last summer for its potential to cause birth defects. But, while Congress invested $1.1 billion in fighting Zika, funding for CMV lags behind, and numerous studies show that as many as 85 percent of expectant mothers have no idea what CMV is. The American College of Obstetricians and Gynecologists does not advise doctors to talk to expectant mothers about CMV — despite the fact that it is an easily spread virus that is present in nearly every elementary school and day care center in the country.

At Children’s Hospital Colorado, physician assistant Shannon Hughes has developed an outpatient clinic for kids dealing with the aftereffects of CMV. The clinic has served about 40 kids in the past two years. Nearly all of the parents she meets had never heard of CMV before finding out that it would forever alter their children’s lives.

“Obviously, that has a big impact on them emotionally that they think they did something wrong and should have prevented it,” she said.

Neonatal nurse practitioner Erin Mestas, who also works at Children’s as well as at Poudre Valley Hospital, is also trying to raise awareness among both mothers and health care workers about CMV.

WHEAT RIDGE, COLORADO - JANUARY 26: Megan Wiedel givers her 19 month old daughter Anna a kiss on the cheek during a tutoring session at home on January 26, 2017 in Wheat Ridge, Colorado. Anna was born profoundly deaf as a result of an infection from CMV, a common virus that pregnant women are often under-educated about. It is estimated that 20,000 to 40,000 babies in America are born with congenital CMV each year but arenÕt diagnosed because they appear healthy at birth or doctors mistake their symptoms for other diseases. Anna contracted CMV in-utero from her mother Megan not because the family traveled to another country, but because they have an older toddler. CMV is spread most often through the saliva and urine of children under the age of 3Ñin some studies, it is present in 44 to 100% of toddlers at daycare centers, and they will go on to shed it for two years or longer. (Photo by Helen H. Richardson/The Denver Post)
Helen H. Richardson, The Denver Post

Megan Wiedel givers her 19 month old daughter Anna a kiss on the cheek  at home on January 26, 2017 in Wheat Ridge.

“There needs to be more education about CMV risk reduction,” Mestas said. “I think childbearing women need to be more educated.”

In some ways, CMV’s ubiquity accounts for its invisibility.

Most adults have been exposed to CMV at some point in their lifetimes, meaning they have antibodies to fight off a new CMV infection. For women with CMV antibodies, then, being exposed to the virus while pregnant is usually no big deal.

But there is no vaccine for CMV, and a small subset of women don’t have the antibodies. If they catch CMV while pregnant, they will likely pass the infection onto their unborn child, who is then at risk of developmental impairments. The earlier in her pregnancy a vulnerable mother catches CMV, the worse the outcome likely is for the child.

Because CMV is most common among kids, pregnant women who already have children or who work in schools or day cares are particularly at risk.

The ways to prevent a CMV infection are familiar to anyone who has ever tried to dodge a cold during flu season. CMV spreads through saliva or urine, so pregnant women should wash their hands frequently — especially after changing diapers — and avoid kissing their toddlers on the mouth or sharing food or drinks with them.

In a bulletin published in 2015, the American College of Obstetricians and Gynecologists — the country’s largest association for women’s health doctors — wrote that these prevention steps “often are considered impractical or burdensome,” which is why the organization does not recommend doctors talk to expectant mothers about CMV.

“At present, such patient instruction remains unproven as a method to reduce the risk of congenital CMV infection,” the bulletin states.

But recent studies have challenged that analysis.

A study in Utah published last year found that women were generally receptive to practicing CMV prevention once they understood the consequences. And a study from 2015 found that women who had never been exposed to CMV before were significantly less likely to contract the virus while practicing the prevention methods than if they didn’t.

Plus, as Wiedel points out, women can be tested before getting pregnant to determine if they are at risk for a first-time CMV infection, and, if they contract the virus while pregnant, there is a drug they can take that may help limit the damage it causes. Children born with CMV can also have better outcomes if started on treatment right away. But all of this means that means doctors would need to be more proactive in talking about and testing for CMV.

“I think part of the ignorance is willful ignorance,” Wiedel said.

Anna is now almost 2 years old and, though she began walking later than most children, she now happily races across the living room floor. Cochlear implants have brought her hearing — she still hears nothing when they are off — and Anna is both learning to talk and how to use sign language.

Those are blessings considering what could have been, Wiedel said. But, while she wouldn’t want to change her daughter, Wiedel said it is frustrating to think that, had she known more while pregnant, she could have saved Anna from some of the struggle.

Wiedel now acts as an informal resource to friends, relatives and neighbors with questions about CMV. It’s a role she enjoys but wishes she didn’t have to inhabit.

“I have to be the educator,” she said. “And it’s exhausting.

PCOS Is a Lifelong Disorder: ‘Be Vigilant’

Article Source: http://www.medscape.com/viewarticle/879174

Among the diseases that most people tend to get confused about is polycystic ovary syndrome (PCOS). PCOS affects between 10% and 15% of all women worldwide.[1,2] In fact, most studies have indicated that the incidence is almost the same worldwide.[2]

What Is PCOS?

PCOS is a disease that affects the endocrine, metabolic, and reproductive systems. It is detrimental to a woman’s quality of life and results in long-term morbidity. We generally consider PCOS to have three components, but you only need two of the three components to make the diagnosis. These components are hyperandrogenism (evidence of excess male hormones like hirsutism or high androgen levels), evidence of irregular ovulation (generally reflected in irregular menstruation), and evidence of polycystic ovaries, most often detected on ultrasound.[2,3]

Who Should Be Screened for PCOS?

We should screen women who present with a complaint of unwanted hair growth—it does not matter whether you actually see it or not—and women who complain of irregular menstrual cycles.

A good history and physical examination are essential. If you think you have a patient with PCOS, it is very critical that you obtain a very thorough medical history and examine the patient carefully. Exclude other disorders such as adrenal hyperplasia, thyroid dysfunction, and hyperprolactinemia.[3] To do so, check 17-hydroxyprogesterone, thyroid-stimulating hormone, and prolactin levels.

If the patient does not have a lot of hirsutism and you are unsure whether she has excess male hormones, obtain total and free testosterone levels.[3] Use a very good laboratory. Mass spectrometry is the best way to determine whether these women have elevated levels of androgens. However, not all women with PCOS have elevated levels of androgens in their blood, and it is not necessary for the diagnosis of PCOS. You can make the diagnosis using the clinical picture and excluding other disorders as mentioned.

What Comes After a Diagnosis of PCOS?

Women with PCOS require long-term care because many of them are at increased risk for diabetes and glucose intolerance—problems that raise their risk for heart disease and other conditions.

The recommendation today is that all women with PCOS should undergo a glucose tolerance test. A 2-hour, 75-g glucose tolerance test should tell you whether the patient is diabetic.[4] It is also okay to check an insulin level during the test, because that will give you an idea about whether the insulin level is high during the glucose tolerance test.

About 75%-85% of women with PCOS have metabolic dysfunction and are at increased risk for diabetes and heart disease.[2] You need to pay attention to their glucose tolerance and their lipid levels. They need to be counseled about weight loss, lifestyle modification, eating better, and treating all of the other risk factors that we know about.

For a patient with PCOS, once you have counseled her about the disease and have done the tests for glucose intolerance, determine what you are going to tell her over the long term. It is your job to make sure that she continues to receive care and understands that this is a lifelong disorder.

PCOS is the single most common endocrine metabolic disorder of humans, affecting up to 15% of women.[1] You should never forget it and should always be vigilant.

Article source: www.lupus.org

Low Public Understanding of Lupus Hinders Progress

Lupus remains a poorly understood and underfunded disease which poses a critical threat to finding a cure. May is Lupus Awareness Month, and the Lupus Foundation of America is urging the public to join the nationwide effort to raise awareness and funds to bring an end to this devastating and cruel disease that impacts millions of families.

Lupus is an autoimmune disease that can impact any organ system. Research shows that nearly two-thirds of the public knows little or nothing about the disease beyond the name. The symptoms of lupus are far-ranging and often mimic those of other diseases, making it challenging to diagnose and treat. People with lupus experience everything from fatigue, skin rashes and hair loss to cardiovascular disease, strokes and kidney failure.

“Lupus is a highly complex disease and increased funding is critical to further research efforts,” Sandra C. Raymond, President and CEO of the Lupus Foundation of America.

“To ensure a better quality of life for those affected and ultimately find a cure for this devastating disease, funding from public and private sources is an absolute necessity.”

Lupus is life changing and life altering. Lupus Awareness Month is a time when people with lupus and their caregivers are able to tell their stories while making an impact. It also provides an opportunity for people to go beyond raising awareness by participating in a variety of fundraising opportunities.

“We’re asking all Americans to take part in the fight against lupus this month by Pumping Up the Purple,” said Raymond. “We will be dedicating all funds from our 24 hour fundraiser, ‘Put on Purple Day’ on May 19, toward building the next generation of lupus researchers through the Gina M. Finzi Memorial Student Summer Fellowship Program.”

For more on how you can get involved and join the fight, visit lupusawarenessmonth.org.

A Rosy Outlook for Pregnancy & Lupus

Article Source: http://www.medscape.com/viewarticle/878764

sle_lupus_research_plasma_autoimmune_pregnancy.jpg

There was a time when women diagnosed with lupus were cautioned against getting pregnant; the combination of lupus and pregnancy was thought to be too dangerous for mother and child. However, research by Jane Salmon, MD, a rheumatologist at the Hospital for Special Surgery (HSS) in New York City, is now helping change this belief. By carefully risk-stratifying patients on the basis of clinical and biological markers, it seems that the vast majority of pregnant patients with lupus can be assured that their pregnancies will be uncomplicated. Medscape recently spoke to Dr Salmon about her work.

Medscape: Tell us a little about how you began studying pregnancy and lupus.

Dr Salmon: Patients with lupus tend to be young women in their reproductive years. Lupus generally presents between age 20 and 40 years, and 90% of the patients are women. Some of the first questions they often ask when they receive their diagnosis are, “Can I have children?” “Will my pregnancy be safe?” and “Will my children have lupus?”

In the 1980s, when I was training in rheumatology, the feeling was that pregnancy in lupus was dangerous. This wasn’t based on strong evidence, but on the rational concept that because lupus tends to be a disease of women, hormones may play a role in disease pathogenesis, and pregnancy is a state with high levels of female hormones (ie, estrogens, progesterone). Thus, it was anticipated that patients with lupus who become pregnant would have severe flares. And in fact, patients who become pregnant when their disease is active and not well-controlled often develop even more severe organ dysfunction. So there was clinical basis for the anxiety among the physicians, but perhaps it was applied too broadly.

Medscape: How has your research helped changed this way of thinking?

Dr Salmon: Patients asked for and deserve data around such an important question. They wanted the evidence that, in fact, this was true. And we wanted to identify the predictors of poor pregnancy outcomes and the mechanisms that caused damage to the placenta and the developing baby.

What is Multiple Myeloma?

From Janssen EMEA

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See link here.

Quest for new antibiotics gets first major funding from global partnership

A major global partnership aimed at fighting superbugs announced Thursday that it is investing up to $48 million in research projects, including potentially the first new classes of antibiotics in decades, to target the deadliest drug-resistant bacteria.

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The investments announced by CARB-X include $24 million in immediate funding for 11 companies. The firms can receive up to $24 million in additional payments over three years if they meet specific milestones.

The projects represent a broad range of approaches. Three companies are working on new classes of antibiotics, a significant development because the last class that made it to market was in 1984. Four companies are developing nontraditional therapeutics to boost the human immune response and disable pathogens’ ability to grow. Yet another company is pursuing a diagnostic imaging tool to identify the type of bacteria causing a lung infection within 60 seconds.

All the projects are in early stages of research, when risk of failure is high, officials said. CARB-X, which stands for Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, was launched in July to stimulate such critical early-stage work. Its goal is to jump-start drug development with money and access to expertise, supporting companies with promising antibiotic candidates so they can attract enough private or public investment to advance development and eventually win regulatory approval.

 

Funding comes from the Biomedical Advanced Research and Development Authority, or BARDA, part of the Department of Health and Human Services, and the Wellcome Trust, a London-based global biomedical research charity. CARB-X aims to invest $450 million over five years with the goal of speeding up preclinical discovery and development of at least 20 antibacterial products and moving at least two of them into human trials. The partnership, which also includes academic, industry and other nongovernmental organizations, was created as part of the U.S. and British governments’ calls for global efforts to tackle antibiotic resistance.

The projects announced Thursday were selected out of 168 applications that flooded in within the first four days that proposals were accepted.  “These projects hold exciting potential in the fight against the deadliest antibiotic-resistant bacteria,” said Kevin Outterson, executive director of CARB-X and a law professor at Boston University, where the partnership is headquartered.

Everything about developing new antibiotics is difficult, he said. On the science side, that means finding a drug that only kills the bad bacteria, leaving good bacteria and the rest of human cells untouched. The economics for antibiotics also turn market incentives “upside down” because, unlike most new products that companies rush to sell, the best antibiotics need to kept on the shelf — to be used for  “last-ditch cases,” he said.

And because resistance will always develop, antibiotics are “the only drug class where we have to start all over every time we succeed,” Outterson said.

But interest has been strong. Additional funds are likely to be awarded later this year, and another 200 applications have already been received for the next cycle.

All the potential medicines under development in this first phase target Gram-negative bacteria, among the most dangerous types of superbugs because they are increasingly resistant to most available antibiotics. They include CRE, or carbapenem-resistant Enterobacteriaceae, which U.S. health officials have dubbed “nightmare bacteria.”

These pathogens, which cause pneumonia, bloodstream infections, and wound or surgical site infections, have been identified by the Centers for Disease Control and Prevention and the World Health Organization as the greatest threat to human health. They have built-in defenses that include a double membrane barrier and a mechanism that expels drugs, such as antibiotics, from the cell.

 

Drug-resistant infections kill an estimated 700,000 people a year globally. The more antibiotics are used, the less effective they become as bacteria develop resistance to them. Scientists, doctors and other public health officials have increasingly warned that if antibiotic resistance continued at its current rate, routine infections eventually would be life-threatening ones. Common modern surgeries, such as knee replacements, could again become precarious.

Last month, the World Health Organization announced its first list of drug-resistant “priority pathogens” to guide and promote research and development of new drugs. Of the 40 antibiotics in clinical development in the United States, fewer than half have the potential to treat the pathogens identified by the WHO, said Allan Coukell, senior director of health programs at the Pew Charitable Trust’s antibiotic-resistance project.

Experts said they are excited by the research CARB-X is funding.

“It’s hitting the right targets for potential drug development,” said Kathy Talkington, director of Pew’s antibiotic-resistance project. “It’s covering a diverse portfolio of products. It addresses the need for novelty.”

Eight companies are based in the United States and three in the United Kingdom. The projects also will receive business and drug development support from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, and other partners.

Companies that are developing potentially new classes of antibiotics include San Diego-based Forge Therapeutics, which was awarded $4 million over 15 months to spur development of a small molecule product to target an enzyme found only in Gram-negative bacteria and essential for its growth.

Visterra Inc. of Cambridge, Mass., was awarded $3 million over 12 months to develop an antibody with a potent antimicrobial compound engineered to kill all strains of the deadly Pseudomonas bacteria, including multidrug-resistant strains, the company said.

And Proteus IRC, based in Edinburgh, Scotland, is receiving $640,000 over 21 months to develop its technology to rapidly visualize bacteria in the deepest part of the human lungs.

Read article here.

Fresh optimism has been injected in HIV/AIDS research

Kudos to Gilead Sciences, Inc.!!

A Durban based scientist has been awarded over two and a half million dollars to fund HIV/AIDS research.