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Health & Fitness (233)
TAHIRPUR, India (AP) -- At first, Ashok Yadav ignored the patches of pink skin on his arm. But when pale sores erupted on his body and he lost sensation in his fingertips, a doctor issued the devastating diagnosis: Yadav had leprosy.
"What followed was like a nightmare," said Yadav, who has lived in Kasturba Gram, a leper colony outside New Delhi, since his diagnosis 30 years ago. "I lost my job. My parents felt I would spoil my sisters' chances of getting married. My family felt it would be better if I left home."
The stigma of leprosy endures in India, even though the country has made great strides against the disease, which is neither highly contagious nor fatal. Now the number of new annual cases has risen slightly after years of steady decline, and medical experts say the enormous fear surrounding leprosy is hindering efforts to finally eliminate it.
People continue to hide their diagnoses from families and loved ones out of fear they will be ostracized. Employers regularly turn away people who have had the disease, even if they've been treated and cured. Many struggle to get driver's licenses and other routine documents. Even the disease-free children of leprosy patients are shunned.
"We face a thousand indignities every day," said Neelawati Devi, a longtime resident of Kasturba Gram. Some 10,000 people live there, including the children of leprosy patients.
"Our children face taunts and slights when they go to school," said Devi, holding out her hands, the stubs of her fingers wrapped in gauze bandages. "But we want them to get an education and get jobs. Their future should not be ruined."
Public health centers across the country have launched campaigns describing leprosy as the world's "least contagious communicable disease." Health workers are trying to spread the word that leprosy is not hereditary and does not spread through normal contact.
But the deformities that are the hallmark of leprosy contribute to the fear surrounding the disease, a chronic bacterial infection that often lies dormant for years before attacking the body's nerves and slowly causing numbness. Hands and feet eventually claw inward and serious injuries often go unnoticed because no pain is felt. Often fingers and toes are lost due to injuries and sores. Scientists believe it is spread through droplets from coughing or sneezing during prolonged contact with someone infected, but they are still not completely sure.
Also called Hansen's disease, leprosy has been curable since the 1940s thanks to antibiotics, and the worst physical deformities can be avoided if it is caught in time. About 95 percent of people have a natural immunity.
Worldwide, the number of new leprosy patients dropped from around 10 million in 1991 to around 230,000 last year as countries intensified efforts to fight the disease. In India, hospitals and clinics began treating patients with a combination of drugs that effectively kills mycobacterium leprae, the germ that causes leprosy.
In 2005, India declared victory, with health authorities reporting less than one case for every 10,000 people. But pockets of the country continue to have problems with leprosy, including in the central state of Chattisgarh, Maharashtra in western India and Bihar and West Bengal in the east.
According to the health ministry, during 2012-2013 India detected 134,752 new cases of leprosy, slightly more than the 127,295 cases reported a year earlier. India accounts for 58 percent of newly diagnosed leprosy cases in the world, according to the World Health Organization. The disease also remains a problem in Brazil, China, Indonesia and East Timor.
C.M. Agarwal, the health ministry official in charge of the country's leprosy campaign, says the rise in cases is the result of an intensified campaign against leprosy, meaning health workers are reporting cases that otherwise would have gone unnoticed.
But some activists disagree. They say that after India's 2005 declaration, the leprosy program was merged with the country's public health scheme and scarce resources were reassigned for other urgent causes.
They also say the problem might be worse than anyone realizes because of leprosy's long gestation period.
"The incubation period can stretch from five years to 15 before the first signs become detectable. And by then, many others could become infected," said P.K. Gopal of the National Forum of Persons Affected by Leprosy, a nongovernmental organization working with leprosy patients.
The government is stepping up its fight against the disease, assigning additional health workers to 209 districts seen as high endemic areas in 16 states. But that won't end the pain and stigma that leprosy brings to patients and their families.
"Our children shouldn't have the shadow of leprosy hanging over their lives," said G. Venugopal, one of the elders at Kasturba Gram, as he sat outside his home under Delhi's weak winter sun.
"They often face taunts in school. People are cruel. They will say: `Oh, this is the son of a leper.' Then the children say they don't want to go to school and we have to push them," he said.
Gopal, who has worked with leprosy patients for more than 40 years, said the stigma persists "because it's very difficult to change people's attitude over a short period of time."
"As things are, the fear of leprosy is so great that people refuse to come forward for treatment. This has had an adverse effect on the success of the leprosy program," he said.
Venugopal has been working with non-governmental agencies to lobby the government to expand the disability allowances that some leprosy survivors get. "They pay us a monthly allowance of 1,800 rupees ($29), which is a pittance," he said.
The money does not even pay for the bandages that leprosy patients use every day on their sores, said Uttam Kumar, another resident.
Like many others in Kasturba Gram, Kumar was thrown out of his home because neighbors objected to having a leprosy patient in their midst. Kumar, whose bandaged feet are the only sign of his ailment, spent months on the road before finding a refuge in the warren of one-room tenements in Kasturba Gram.
"Here we are all anonymous yet we are all fellow sufferers," Kumar said. "Everyone has their own sorrows, but our pain is the same."
A second baby born with the AIDS virus may have had her infection put into remission and possibly cured by very early treatment - in this instance, four hours after birth.
Doctors revealed the case Wednesday at an AIDS conference in Boston. The girl was born in suburban Los Angeles last April, a month after researchers announced the first case from Mississippi. That was a medical first that led doctors worldwide to rethink how fast and hard to treat infants born with HIV, and the California doctors followed that example.
In another AIDS-related development, scientists have modified genes in the blood cells of a dozen adults to help them resist HIV. The results give hope that this approach might one day free at least some people from needing medicines to keep HIV under control, a form of cure. That study was published in Thursday's New England Journal of Medicine.
The Mississippi baby is now 3 1/2 and seems HIV-free despite no treatment for about two years. The Los Angeles baby is still getting AIDS medicines, so the status of her infection is not as clear.
A host of sophisticated tests at multiple times suggest the LA baby has completely cleared the virus, said Dr. Deborah Persaud, a Johns Hopkins University physician who led the testing. The baby's signs are different from what doctors see in patients whose infections are merely suppressed by successful treatment, she said.
"We don't know if the baby is in remission ... but it looks like that," said Dr. Yvonne Bryson, an infectious disease specialist at Mattel Children's Hospital UCLA who consulted on the girl's care.
Doctors are cautious about suggesting she has been cured, "but that's obviously our hope," Bryson said.
Most HIV-infected moms in the U.S. get AIDS medicines during pregnancy, which greatly cuts the chances they will pass the virus to their babies. The Mississippi baby's mom received no prenatal care and her HIV was discovered during labor. Doctors started the baby on treatment 30 hours after birth, even before tests could determine whether she was infected.
The LA baby was born at Miller Children's Hospital Long Beach, and "we knew this mother from a previous pregnancy" and that she was not taking her HIV medicines, said Dr. Audra Deveikis, a pediatric infectious disease specialist at the hospital.
The mom was given AIDS drugs during labor to try to prevent transmission of the virus, and Deveikis started the baby on them a few hours after birth. Tests later confirmed she had been infected, but does not appear to be now, nearly a year later.
The baby is continuing treatment, is in foster care "and looking very healthy," Bryson said.
The Mississippi girl was treated until she was 18 months old, when doctors lost contact with her. Ten months later when she returned, they could find no sign of infection even though the mom had stopped giving her AIDS medicines.
Bryson is one of the leaders of a federally funded study just getting underway to see if very early treatment can cure HIV infection. About 60 babies in the U.S. and other countries will get very aggressive treatment that will be discontinued if tests over a long time, possibly two years, suggest no active infection.
"These kids obviously will be followed very, very closely" for signs of the virus, said Persaud, who described the LA case at the Conference on Retroviruses and Opportunistic Infections.
The study in adults was prompted by an AIDS patient who appears cured after getting a cell transplant seven years ago in Berlin from a donor with natural immunity to the virus. Only about 1 percent of people have two copies of the gene that gives this protection, and researchers have been seeking a more practical way to get similar results.
HIV usually infects blood cells through a protein on their surface called CCR5. A California company, Sangamo BioSciences Inc., makes a treatment that can knock out a gene that makes CCR5.
Dr. Carl June at the University of Pennsylvania tested it in 12 HIV patients who had their blood filtered to remove some of their cells. The treated cells were infused back into the patients.
Four weeks later, half of the patients were temporarily taken off AIDS medicines to see the gene therapy's effect. The virus returned in all but one of them; that patient turned out to have one copy of the protective gene.
"We knew that the virus was going to come back in most of the patients," but the hope is that the modified cells eventually will outnumber the rest and give the patient a way to control viral levels without medicines, said Dr. Pablo Tebas, one of the Penn researchers.
The National Institute of Allergy and Infectious Diseases sponsored the work with Sangamo and Penn.
"The ultimate goal is to create an immune system in the body that's been edited genetically so the cells are not capable of being infected with HIV," said director Dr. Anthony Fauci, "but we are a long way from there at this point."
Jay Johnson, 53, who works for Action AIDS, an advocacy and service organization in Philadelphia, had the treatment more than three years ago. Although the virus rebounded when he temporarily went off HIV medicines, tests show his modified blood cells are still multiplying.
"Hopefully one day I'll be able to say I'm HIV negative again," he said.
Surgery to remove the prostate saves lives compared to "watchful waiting" for some men whose cancers were found because they were causing symptoms, long-term results from a Scandinavian study suggest.
However, U.S. men should not assume that immediate treatment is best, doctors warn, because the study was done before PSA testing became common, and a newer study found the opposite.
PSA blood tests are not recommended for screening by leading medical groups but are widely used in the U.S. That has led to a dramatic increase in the number of prostate cancers found at a very early stage.
Whether to treat them is a big question. Most tumors grow too slowly to threaten a man's life and there is no good way to tell which ones will. Treatments can cause impotence, incontinence and other problems.
In Europe, PSA testing is far less common, and most prostate cancers are found when they cause symptoms such as trouble urinating. Symptoms like this suggest a larger or more advanced tumor.
The study involved 695 such men in Sweden, Finland and Iceland, diagnosed between 1989 and 1999. Half were given surgery to remove their prostates and the rest were closely monitored and given surgery only if symptoms or signs of cancer worsened.
Earlier results suggested that the surgery group fared better. That trend strengthened as time went on. By the end of 2012, 200 men in the surgery group and 247 in the group assigned to monitoring had died - 56 percent and 69 percent, respectively.
Immediate surgery most benefitted men younger than 65; it didn't reduce deaths in those over that age.
"This study tells us we should be very careful about treating anyone over the age of 65 ... and anyone who has low-grade disease," said Dr. Otis Brawley, chief medical officer of the American Cancer Society.
In the U.S., fewer men are getting treatment right away, and "that's a good trend and we need to continue that," he said.
The U.S. government, the Swedish Cancer Society, the Karolinska Institute, and two foundations paid for the study. Results appear in this week's New England Journal of Medicine.
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP
Exciting research suggests that a shot every one to three months may someday give an alternative to the daily pills that some people take now to cut their risk of getting HIV.
The experimental drug has only been tested for prevention in monkeys, but it completely protected them from infection in two studies reported at an AIDS conference on Tuesday.
"This is the most exciting innovation in the field of HIV prevention that I've heard recently," said Dr. Robert Grant, an AIDS expert at the Gladstone Institutes, a foundation affiliated with the University of California, San Francisco.
"Both groups are showing 100 percent protection" with the drug, Grant said of the two groups of researchers. "If it works and proves to be safe, it would allow for HIV to be prevented with periodic injections, perhaps every three months."
Until a vaccine is developed, condoms are the best way to prevent infection with the AIDS virus and many other sexually spread diseases. But not everyone uses them, or does so all the time, so public health officials have pursued other prevention options.
A drug used to treat people with HIV - Gilead Science's Truvada - also is used to help prevent infection in people who don't have the virus. A big study in gay men a few years ago found it could cut this risk by up to 90 percent, depending on how faithfully people take the daily pills.
The new research tested something that could make this type of prevention much more practical - a long-acting experimental drug made by GlaxoSmithKline PLC. The studies tested it in macaques exposed to a human-monkey version of HIV.
Researchers at the Centers for Disease Control and Prevention gave six monkeys shots of the drug every four weeks; six others got dummy shots. All were exposed to the virus twice a week for 11 weeks.
The monkeys who got the fake treatment were readily infected "but the animals that received the long-acting drug remained protected," said study leader Gerardo Garcia-Lerma of the CDC.
The results mirror what was seen in the CDC's early research in monkeys on Truvada, the pill that's available for HIV prevention now.
In the second study, Chasity Andrews and others at the Aaron Diamond AIDS Research Center at Rockefeller University in New York gave eight monkeys two shots of the drug, four weeks apart, and dummy shots to eight others. The animals were exposed to the virus weekly for eight weeks. Again, all animals given the fake treatment were quickly infected and those on the drug were all protected.
To see how long a single shot would last, they did a second study. The single shot protected 12 monkeys for about 10 weeks on average.
The dose used in a single shot corresponded to what people would get from a shot every three months, researchers said.
"This is really promising," said Dr. Judith Currier, an infectious disease specialist at the University of California, Los Angeles. The research "supports moving this forward" into human testing, she said.
Currier is on the program committee for the meeting in Boston where the studies were presented - the Conference on Retroviruses and Opportunistic Infections. The New York study also was published online by the journal Science.
Grant said the long-acting drug is chemically similar to certain AIDS medicines sold now that are "extremely safe, well tolerated and extremely potent." A mid-stage trial testing the long-acting shots in people as a treatment, not a prevention, is already underway, he said.
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP
CHICAGO (AP) -- At age 80, retired Chicago physician and educator Dan Winship is getting a bittersweet last chance to teach about medicine - only this time he's the subject. In the early stages of Alzheimer's disease, Winship is giving a young medical student a close-up look at a devastating illness affecting millions of patients worldwide.
The two are part of a "buddy" program pairing doctors-to-be with dementia patients, pioneered at Northwestern University and adopted at a handful of other medical schools.
Besides offering students a unique perspective on a disease they're likely to encounter during their careers, the programs give patients a sense of purpose and a chance to stay socially engaged before their illness eventually robs their minds.
Winship and his "buddy," first-year medical student Jared Worthington, are building a friendship - dining together, visiting museums, chatting about Winship's medical career and Worthington's plans for his own.
The programs help erase the stigma of Alzheimer's and are laudable for introducing students to medical opportunities related to aging and dementia, said Beth Kallmyer, an Alzheimer's Association vice president who oversees outreach services.
More than 5 million Americans have Alzheimer's or some other form of dementia, a number that could triple by 2050, the group estimates.
Data presented at an Alzheimer's Association conference last year showed the programs are increasing medical students' knowledge of the disease beyond what they learn in the classroom.
About 75 percent of Northwestern students who participate become doctors in fields that deal with Alzheimer's patients, said program director Darby Morhardt.
For everyone, the diagnosis is a cruel blow. For Winship, it was nothing less.
"You can't remember anything," Winship said, sometimes faltering to find the right words. "You lose your ability ... to keep your wits about you."
Alzheimer's "wreaks havoc," he said. But Winship has grown to see it as a chance to meld his loves of medicine and teaching.
His career included stints as medical school dean at Chicago-based Loyola University; professorships at Rush Medical College and the University of Illinois in Chicago, and as an associate dean at the University of Missouri's medical school. He retired in 2010 from the American Medical Association.
Early last year, he got the dreaded diagnosis. Jean Schmidt Winship, 53, his wife of 10 years, says at first she thought his occasional forgetfulness and difficulty learning new computer programs were just signs of aging. But his symptoms gradually worsened.
Jean Winship scrambled to learn more about their options after the diagnosis and found the buddy program online.
"Everyone in the buddy program is very committed to understanding that people at this stage of any kind of dementia still need to live and enjoy life," she said. Alzheimer's "is not Dan, it's just a disease that he has. And so, that was huge for us ... realizing we have a lot of living to do here."
In the program, first-year students are matched for a school year with patients, based mostly on common interests.
Winship is an open, engaging man with twinkly dark eyes and a groomed salt-and-pepper beard. He was the first choice for many students who joined the program last fall, said Morhardt, the program founder and director. She had a hunch, though, that he and Jared Worthington would click.
Worthington, 25, from Ontario, Canada, is perhaps more reserved than his Texas-born mentor, but with obvious earnestness and empathy for what Winship is going through. Worthington's grandmother is in the later stages of Alzheimer's.
He said he hopes being a "buddy" will "inform how I interact with patients and hopefully treat them with more compassion and understanding."
"It's something scary and difficult but just because you have Alzheimer's doesn't mean that ... your life is over," Worthington said. "You can still contribute and give back and participate meaningfully."
During a recent visit to Chicago's Shedd Aquarium, he and Winship shared banter watching dolphins leaping in an indoor pool, and curiosity over the anatomy of colorful specimens in an ethereal jelly fish exhibit.
"I'm so fond of Jared because we talk together, we talk the same language. He is a very good student, he's learning and learning, learning and that means everything to me," Winship said.
Winship said he hopes the program will train a new generation of doctors to find new treatments "so we can do away with that stinking disease. "
For him, though, just hanging out with Jared "is the best part of all."
Follow AP Medical Writer Lindsey Tanner atHTTP://WWW.TWITTER.COM/LINDSEYTANNER
CHICAGO (AP) -- Most people who abuse addictive prescription painkillers get them for free from friends or relatives, while drug dealers are a relatively uncommon source for those at highest risk for deadly overdoses, a government study found.
People who abuse the most frequently often doctor-shop; more than 1 in 4 who used these drugs almost daily said they had been prescribed by one or more physicians. Almost as many said they got them for free from friends or relatives; only 15 percent of the most frequent abusers said they bought the drugs from dealers or other strangers.
Those abusers "are probably using at much greater volumes and simply asking a friend for a pill now and then is not going to be sufficient," said Dr. Leonard Paulozzi, a researcher at the federal Centers for Disease Control and Prevention.
According to the study, two-thirds of abusers said they used the drugs infrequently and well over half of these users said they got them free from friends or relatives.
Paulozzi and CDC colleagues analyzed four years of nationwide health surveys on nonmedical use of pain relievers including oxycodone and hydrocodone. These include the brand-name pills OxyContin and Vicodin, in a family of drugs called opioids - chemically similar to opium.
The study was published online Monday in JAMA Internal Medicine.
Paulozzi said overall prevalence of nonmedical use of prescription opioid painkillers has held steady in recent years, at about 12 million, or 1 in 20 people aged 12 and older.
But previous CDC data show overdose deaths involving these drugs more than tripled from 1999 to 2010, with more than 16,000 deaths that year. By contrast, overdose deaths that involved heroin and cocaine totaled less than 8,000, and deaths that involved often-abused prescription drugs that include anti-anxiety medication totaled about 6,500.
A separate study in the same journal presents Tennessee - among states hardest hit by prescription drug abuse - as a snapshot of the problem. From 2007 through 2011, one-third of Tennessee's population filled an opioid prescription each year, the study found. Nearly 8 percent had used more than four prescribers and these abusers were more than six times more likely to have fatal overdoses than the least frequent users.
The larger nationwide study included data from annual government health surveys for 2008-2011 that included questions about use of these powerful painkillers.
"Nonmedical use was defined as use without a prescription or use with a prescription for the feeling or experience caused by the drug," the researchers said.
Paulozzi said the data don't indicate whether friends and relatives who offered free drugs shared their own prescriptions or had obtained the medication in some other way.
Public health messages have urged patients with legitimate prescriptions for addictive painkillers not to share the drugs and to turn in any leftovers to designated drop-off sites.
The new data suggest a need to strengthen messages to doctors to be on the watch for signs of prescription misuse, Paulozzi said.