Johns Hopkins Magazine -- September 2000
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Vital Signs

Internet insight improves vision
New measles vaccine could protect babies
Drug too risky for older heart patients?
Making diabetes easier to stomach
Helpful observers
Once again, No. 1

RP patients from around the globe took part in a study via the Internet.
Internet insight improves vision

Conducting a study entirely over the Internet and through e-mail, a Johns Hopkins researcher has found that the vitamin lutein significantly improved vision in volunteers with retinitis pigmentosa (RP).

A progressive eye disease with no known cure, RP affects about one out of 3,000 people. It destroys the rods of the eye, at first causing a loss of peripheral vision, and in most cases slowly leading to total blindness.

An RP patient and homemaker from Ontario named Ingrid Zorge initiated the study. Zorge belonged to an Internet mailing list for RP patients, their families, and clinicians, and had heard through that electronic grapevine that several list members had improved their vision by taking lutein supplements. Found naturally in the retina, lutein protects the rods and cones against the damaging effects of short wavelength light and free radicals. Zorge then contacted another member of the RP list, Hopkins assistant professor of ophthalmology Gislin Dagnelie, and asked if he would design a study on the effects of lutein supplementation in RP. Dagnelie agreed, and Zorge sought and coordinated volunteers from the retinitis pigmentosa mailing list for the ensuing study.

Participants, who came from nations spanning the globe including New Zealand, Turkey, and Singapore, took 40 milligrams of lutein daily for nine weeks, followed by 20 milligrams a day for 17 weeks. Every week, they tested themselves for visual acuity, using standard letter charts that Dagnelie had e-mailed to them. Following the researchers' instructions, the volunteers also made special wall charts, which they used to test their central vision. Volunteers e-mailed test results to the researchers.

Twelve of the 16 volunteers had significant improvements in their vision. On average, their visual acuity improved 21 percent and central vision improved 8 percent. But some participants achieved as much as 80 percent improvement in visual acuity and 21 percent in central vision. Blue-eyed volunteers experienced the greatest improvements.

"This study would never have been done without the Internet," says Dagnelie, who is now planning a more extensive placebo-controlled study similar to the one just conducted. One question he plans to investigate is whether the apparent benefits of lutein are lasting. He and Zorge reported their findings in the March Optometry: Journal of the American Optometric Association.

Lutein is found in green leafy vegetables, yellow and red fruits, and egg yolks. A good serving of vegetables like spinach, kale, broccoli, or collards probably has about 10 milligrams, according to Dagnelie. He advises patients to tell their doctors if they decide to take lutein supplements. -Melissa Hendricks

Afflicted with measles
New measles vaccine could protect babies

Measles is a top killer of children, accounting for more than 7 percent of all childhood deaths. Particularly at risk are babies younger than 9 months, who don't benefit from the standardly used live virus measles vaccine because of their immature immune system, and interference from maternal antibodies acquired in the womb. More than a third of measles-linked deaths occur in children less than 1.

Now, a study by Hopkins biologists suggests that help may come in the form of a vaccine containing DNA. Researchers led by Diane Griffin, chair of Public Health's Department of Molecular Microbiology and Immunology, found that two DNA vaccines protected rhesus monkeys against measles, with no side effects. They reported their results in the July Nature Medicine.

The vaccines contain genes from the DNA of the measles virus. They are designed to be absorbed by a host's cells, leading to the release of proteins that trigger an immune response. There is hope that the DNA vaccines can be administered safely to babies, thereby overcoming their current "window of susceptibility." Another potential benefit: currently, live virus measles vaccines carry the risk of causing a severe form of the disease called atypical measles. The DNA vaccine, say researchers, could circumvent that problem. -MH

Drug too risky for older heart patients?

Thrombolytic drugs are widely used for patients who have had a heart attack. Thrombolytics administered intravenously following a heart attack appeared to sharply reduce a patient's chances of dying during the ensuing month. But now a recent study by Hopkins cardiologists suggests that thrombolytics do not benefit, and may even increase, the risk of death in patients older than 75.

David Thiemann, an assistant professor of medicine, reviewed the medical records of 7,864 Medicare patients who had been admitted to hospitals nationwide for an acute heart attack. He and his colleagues compared the death rates in the month following hospital discharge for patients age 65 to 75 against those age 76 to 86.

Among the younger patients, 6.8 percent of those treated with thrombolytics died, compared to 9.8 percent of those who were not treated. However, among the older patients, 18 percent of those treated with thrombolytic drugs died, compared to 15.4 percent of those who did not receive the drugs. The researchers reported their findings in the May 16 Circulation.

Thrombolytics restore blood flow in arteries blocked by a blood clot, the cause of most heart attacks; their downside is that they carry a risk of stroke, hemorrhage, and cardiac rupture. Elderly patients may be more susceptible to these side effects of the drugs. However, adds Thiemann, "we don't know why there's a mortality differential."

Researchers should now conduct further studies of treatment for elderly heart attack patients, who comprise almost one-third of those who suffer a heart attack, says Thiemann. -MH

Making diabetes easier to stomach

For some 75 percent of long-term sufferers of diabetes, a digestive condition known as gastroparesis causes regular discomfort--bloating, pain, even vomiting and dehydration--and can also interfere with insulin therapy by wreaking havoc on blood sugar levels.

Now Hopkins researchers have identified a lack of nitric oxide (NO) in key tissues--the same problem experienced in impotence. By combining insulin and Viagra--the much-heralded impotence treatment drug--the Hopkins team has reversed gastroparesis in diabetic mice. They report their findings in the July 31 Journal of Clinical Investigation.

"The study not only suggests a different approach to relieve gastroparesis, but it also offers ways for diabetics to keep their insulin and blood sugar levels on an even keel," says neuroscientist and study leader Christopher Ferris. With gastroparesis, a person's stomach fails to empty fully; food that remains in the digestive tract "can dramatically alter blood sugar levels," he says.

"Yet being able to predict those levels is critical for diabetics on insulin. We think this work is useful, in part, because it could result in a way to keep digestion--and diabetes therapy--on track."

While insulin alone can help reverse gastroparesis, it does not work as quickly nor relieve uncomfortable symptoms as effectively as Viagra does, the researchers say.

The team is now considering controlled trials of Viagra in diabetic patients. -SD

Helpful observers

Seniors living alone are prone to having psychiatric problems go undiagnosed. So why not enlist the help of those who see them regularly--janitors, building managers, and others? That was the thinking of a team of Hopkins researchers, who created a low-cost program that combines the observations of housing staff with the involvement of a psychiatric nurse. The result was a significant increase in the mental health and stability of seniors.

In the program, a psychiatric nurse trains housing staff to recognize changes in behavior that can signal a psychiatric problem--mood disorders, schizophrenia, dementia, for instance. They become "case finders" who weekly refer at-risk residents to the nurse, who then follows up with a mini-medical exam and a short series of mental diagnostic tests. The nurse confers with a team psychiatrist about the best treatment approach, and arranges in-home or off-site care.

In a study of 945 senior residents of six public housing sites in Baltimore, residents in three test sites scored 17 percent higher in a test of general mental health, and 32 percent lower on a test measuring depression, than did their counterparts in sites without the program. "This new program, based on quickly recognizing mental problems and improving access to care, shows large populations can be helped affordably," says Hopkins psychiatrist Peter Rabins, who directed the study.

The team reported its findings in the June 6 Journal of the American Medical Association.

Once again, No. 1

For the 10th time in as many years, Johns Hopkins Hospital has been ranked tops in the nation in U.S. News & World Report's annual ranking of American hospitals.

In the ranking of 173 qualifying hospitals across the nation, Hopkins earned exceptional ratings in 16 of 17 specialties. Four of those Hopkins specialties grabbed first-place honors: ear/nose/throat, gynecology, urology, and eye care.

"At a time when any hospital can buy ads that toot its own horn and make all kinds of claims to fame," said Edward D. Miller, CEO/dean of Hopkins Medicine, and Ronald R. Peterson, hospital president, "the independent rankings and analysis developed by U.S. News carry real value to the public, to insurers, and to all of us who organize and deliver care."