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Vital Signs
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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."
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SEPTEMBER 2000 TABLE OF CONTENTS.
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