Genomics plus human intelligence

The power of gene sequencing to solve puzzles when combined with human Read more

'Master key' microRNA has links to both ASD and schizophrenia

Recent studies of complex brain disorders such as schizophrenia and autism spectrum disorder (ASD) have identified a few "master keys," risk genes that sit at the center of a network of genes important for brain function. Researchers at Emory and the Chinese Academy of Sciences have created mice partially lacking one of those master keys, called MIR-137, and have used them to identify an angle on potential treatments for ASD. The results were published this Read more

Shape-shifting RNA regulates viral sensor

OAS senses double-stranded RNA: the form that viral genetic material often takes. Its regulator is also Read more

Emory School of Medicine

Fertility: a new frontier in treating those with HIV

HIV

Not long ago, physicians who treated those with HIV focused only on helping their patients stay well. Today some physicians are also beginning to focus on helping those patients conceive.

“Most of the patients who are now diagnosed with HIV are in their reproductive years, and as many as a third express a desire to have children,” says Emory reproductive endocrinologist Vitaly Kushnir, MD.

This emerging area of treatment has been made possible thanks to the growing effectiveness of a combination of drugs known as Highly Active Antiretroviral Therapy, or HAART, used for years to treat retroviruses, including HIV.

“Now that people with HIV are living longer, fertility and HIV is an emerging area of interest,” says Kushnir. “Several studies have indicated that HIV drugs if given early in the course of the disease can reduce the risk of transmission from an HIV-positive person to an HIV-negative person.”

But researchers and physicians know very little yet about how treatments for HIV, the virus itself, and the comorbidities associated with HIV affect fertility. So, Kushnir and his colleague, Emory pathologist William Lewis, MD, decided it was time to explore existing data on how HIV and its treatment affect fertility, especially in women. Their review paper on the subject appears in the August 2011 issue of Fertility and Sterility.

Because there are safety concerns and legal restrictions on fertility treatments in couples in which one partner is HIV positive and the other is not, treatment options often are limited.

“This is becoming more and more of an issue,” says Kushnir. “It’s probably time for us to have a more open discussion about the access these patients have to fertility treatment. I think the current system probably discourages these patients from pursuing treatments that are a lot safer than trying to get pregnant on their own.”

Posted on by Robin Tricoles in Immunology Leave a comment

Emory experts weigh in on obesity at AACC Annual Meeting

The obesity epidemic took center stage at this year’s American Association of Clinical Chemistry (AACC) Annual Meeting. Several Emory experts took the podium to further explore obesity not only as a public health problem, but also as an issue that is changing the way we diagnose diseases and treat health issues in children.

Jeffrey Koplan, MD, MPH

Jeffrey Koplan, MD, MPH, director of the Emory Global Health Institute, led one of the meeting’s plenary sessions, emphasizing that obesity must be fought with changes in both public policy and personal decision-making. Koplan also noted that strategies to address obesity must be localized to fit each community because eating and exercise habits are often culturally specific.

Rising rates of obesity also are changing the way physicians and researchers define and diagnose certain diseases, including metabolic syndrome, a cluster of risk factors including insulin resistance, high blood pressure, cholesterol abnormalities and an increased risk for clotting. The common thread among patients with metabolic syndrome is that they are often overweight or obese.

Ross Molinaro, PhD

Pathologist Ross Molinaro, PhD, medical director of the Core Laboratory at Emory University Hospital Midtown and co-director of the Emory Clinical Translational Research Laboratory, presented insights into the important role of lab testing in the definition and diagnosis of metabolic syndrome.  In addition to new markers, Molinaro addressed the global prevalence of metabolic syndrome and the evolving criteria for diagnosis.

Miriam Vos, MD, MSPH

Responding to their members’ demand for more information on how obesity affects children, the AACC hosted a full-day symposium on pediatric obesity and related health complications such as diabetes and high blood pressure.  Miriam Vos, MD, MSPH, assistant professor of pediatrics in  Emory School of Medicine and a physician at Children’s Healthcare of Atlanta described non-alcoholic fatty liver disease as an increasingly common complication of childhood obesity that can cause inflammation and scarring of the liver.

Stephanie Walsh, MD

Stephanie Walsh, MD, assistant professor of pediatrics in Emory School of Medicine and medical director of child wellness at Children’s Healthcare of Atlanta, leads Children’s efforts in preventing and treating childhood obesity in Georgia, which currently has the second highest rate of childhood obesity in the country. Walsh addressed the effect of Children’s wellness initiative, called Strong4Life, on childhood obesity prevention in Georgia.

“From those in the lab, to those in clinic, to those who strategize and implement public health campaigns, we’re all going to need to work together to protect our children’s future,” says Walsh.

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Exercise, changes in diet alter course for pre-diabetics

The D-CLIP Study staff in Chennai, India

A type 2 diabetes intervention program developed by researchers from Emory and the Madras Diabetes Research Foundation (MDRF) in India is showing promising results in improving risk factors, such as lowering weight and decreasing blood pressure and glucose levels.

The ongoing study, called the Diabetes Community Life Improvement Program, (D-CLIP) was designed to test the benefits of a low-cost community program for people at increased risk for type 2 diabetes, most commonly associated with obesity. The curriculum integrates exercise, nutrition education and dietary changes. The study is being conducted in Chennai, India with hopes of expanding the program into other parts of South Asia.

Six-hundred participants with prediabetes were randomly assigned to either a standard of care control treatment or weekly D-CLIP classes for six months, where they learned about making healthy choices in real life situations such as restaurants and grocery stores. They also learned how to incorporate exercise into their daily routines with the goal of completing 150 minutes of physical activity a week.

Of the 200 participants who have completed the course to date, 83 percent have lost between five and 13 pounds. There also was improvement in blood glucose, serum cholesterol and blood pressure levels in participants.

“This initial research is quite encouraging because it shows we can turn the tide of type 2 diabetes onset by promoting simple lifestyle changes through well-structured community programming,” says Venkat Narayan, MD, Hubert Professor in Emory’s Rollins School of Public Health and a professor in Emory School of Medicine. “Attendance at the lifestyle classes is 85 to 90 percent, with lifestyle changes strongly evident. More than anything, we have formed strong partnerships with the local community that will ultimately lead to the implementation of more successful programs like this.”

The study is conducted by the Global Diabetes Research Center, a collaboration between Emory University and MDRF in Chennai, India. The center received its initial support from the Emory Global Health Institute, with funding from BRiDGES (Bringing Research in Diabetes to Global Environments and Systems), an International Diabetes Federation program supported by an educational grant from Eli Lily. Currently, the 17th session of D-CLIP classes is in progress, with the study set to close in early 2013.

Participants in the D-CLIP study learned to incorporate exercise into their lives to stave off type 2 diabetes.

“We have always known that the right diet and exercise can improve health,” says V. Mohan, MD, president of the Madras Diabetes Research Foundation. “But there has been no scientific community-based program to quantify this until now. We hope this is just the beginning of efforts to reduce the incidence of the type 2 diabetes epidemic worldwide.”

Posted on by Kerry Ludlam in Uncategorized 1 Comment

Healthcare Heroes at Emory

Healthcare Heroes award winners Dean Thomas Lawley and Dr. Ursula Kelly

This week’s issue of the Atlanta Business Chronicle spotlights the winners of its annual Healthcare Heroes Awards, recognizing the contributions of top medical professionals in the Atlanta health care community. Emory was well represented again this year among the impressive list of winners and finalists. Winners included:

 

Finalists included:

 

  • Linda Cendales, MD, assistant professor of Surgery at Emory University School of Medicine, nominated in the Healthcare Innovations category for successfully performing the state’s – and one of the nation’s – first hand transplants on a college student from Orlando, Fla. (see Emory article)
  • Katherine L. Heilpern, MD, professor and chair of the department of emergency medicine, nominated in the Physician category for her contributions to emergency and trauma care and for her leadership among 5 hospitals in Metro Atlanta which receive 250,000 patient visits per year.
  • Curtis Lewis, MD, assistant professor of radiology, Emory University School of Medicine, nominated in the Physician category for his management and training of physicians and residents in his role as chief of staff and senior vice president of medical affairs at Grady.

 

 

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Cervical Cancer – Can Be Hard to Detect

MedicalHorizon

The Pap smear – also called Pap test – is part of the standard annual wellness exam for women’s health and used as a first step in detecting cervical cancer.  But according to a recent article published in the International Journal of Cancer,  the Pap test may not provide reliable results for certain types of cancer that are harder to detect.

Kevin Ault, MD, associate professor of obstetrics and gynecology at Emory University School of Medicine and investigator at the Emory Vaccine Center conducted a post-hoc analysis of the FUTURE I and FUTURE II (Gardasil) vaccine trials.  Based on that analysis Ault, a leading expert and pioneer in the field of human papilloma virus (HPV), says a regular Pap test is not always effective in diagnosing adenocarcinoma, because it starts high up in the cervical canal and may not be sampled by the Pap smear.

“There are a number of reasons the Pap smear could lead to inaccurate results. For example, the pathologist examining the cells could make an error, the gynecologist may not sample the cervix adequately or an infection could obscure the results,” says Ault.

According to Ault, andenocarcinoma is the second most common type of cervical cancer, accounting for about 20 percent of all cervical cancer cases. While the overall incident of cervical cancer is on the decline, Ault reports the proportion of cervical cancers that are andenocarcinoma is rising.

Cervical cancer is the eighth most common type of cancer in American women. More than 12,000 new cases of invasive cervical cancer are diagnosed each year, and more than 4,200 women in the U.S. die from of this disease annually* according to the American Cancer Society.  Scientists believe that pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the sexually transmitted HPV.

“The take-away from this recent paper is the HPV test would be a better test for the harder to detect adenocarcinoma cervical cancer, if not all cervical cancer,” says Ault.

* 2010 data

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Health sciences on the A-List

Parade magazine’s back-to-school survey in the August 22 issue and website included Emory on its A-list of colleges with excellent programs in the health sciences.

“Good health programs combine strong academic preparation with a hands-on approach and offer a wide variety of choice,” said the magazine.

“Emory University, a stand-out in health sciences, has the Centers for Disease Control virtually next door.”

Emory also made the A-list for its pre-med programs:

“At Emory, students interested in the field of medicine have the opportunity to gain first-hand exposure to the daily routine of the physician through their House Staff Assistant program. Students witness all aspects of the job and become integral parts of the medical team, which consists of attending physicians, resident physicians, and medical students.”

The list of outstanding schools was based on the recommendations of 43 top guidance counselors across the country.

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Higher education linked to improved heart disease outcomes in richer countries

A higher level of education is associated with reduced risk of heart disease and stroke for people who live in rich countries, but not for those in low- and middle-income nations, according to the findings of a recent study led by Emory epidemiologist and cardiologist Abhinav Goyal, MD, MHS.

Abhinav Goyal, MD, MHS

The study published in the Sept. 7, 2010, issue of the journal Circulation, a publication of the American Heart Association, is one of the first international studies to compare the link between formal education and heart disease and stroke. It examined data on 61,332 people from 44 countries who had been diagnosed with heart disease, stroke, or peripheral arterial disease, or who had cardiovascular disease risk factors such as smoking or obesity.

Goyal and team found that highly educated men in high-income countries had the lowest level of cardiovascular disease. However, their findings suggest that research conducted in richer nations can’t always be applied to poorer countries.

“We can’t simply take studies that are conducted in high-income countries, particularly as they relate to socioeconomic status and health outcomes, and extrapolate them to low- and middle-income countries,” says Goyal, assistant professor of epidemiology and cardiology at Emory’s Rollins School of Public Health and Emory School of Medicine. “We need dedicated studies in those settings.”

The research team was surprised to find that despite decreased heart disease risk among the higher educated in industrialized nations, nearly half of the highly educated women from high-income countries smoked, compared with 35 percent for those with the least amount of schooling. For men, smoking rates were virtually the same across educational groups in low- and middle-income countries.

“Everyone needs to be educated about the risk of heart disease in particular, and counseled to adopt healthy lifestyles and to quit smoking,” Goyal says.

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A concussion is more than just a headache

 

Ken Mautner, MD

To ensure better management of sports concussions, physicians at Emory Sports Medicine Center have incorporated Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) into their program for high school athletes.

 

Concussions occur in about 10 percent of all athletes in contact sports.

They are caused by sudden and violent rocking of the brain inside the skull from a traumatic blow to the head or upper body.

Symptoms vary in length of time and may include amnesia, disorientation, confusion, fogginess, headache, blurred vision, nausea, fatigue and sometimes loss of consciousness.

Ken Mautner, MD, sports medicine physician and assistant professor in the Department of Orthopaedics at Emory University School of Medicine, says that most athletes recover completely from concussions as long as they are not returned back to play too soon.

Repeated concussions are cumulative and may cause critical damage to the brain.  Studies have indicated a possible association with frequent or untreated concussions and development of dementia, depression and, most recently, ALS (Lou Gehrig’s Disease).  Going back to the sport too soon, before the brain recovers, leaves athletes vulnerable to repeat concussions.

Athletes in the ImPACT program take a 20-minuted baseline test on a computer that measures brain processing such as speed, memory, and visual motor skills.

Each individual’s data are stored in a computer file. In the event of injury, the athlete will take the ImPACT test in the days following concussion.  Post-concussion data are then compared to baseline data to help determine the severity and effects of the injury.

Mautner says that data from ImPACT combined with a thorough history and physical exam is the best way to prevent athletes from getting “back in the game” too soon.

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First of its kind neurosurgery boot camp held at Emory

Emory’s Department of Neurosurgery recently hosted a two-day boot camp for first-year neurosurgery residents. The unique event was part of a new national course launched by the Society of Neurological Surgeons (SNS) in Atlanta and five other cities including Boston, Portland and Chicago.

The course focused on fundamental skills, patient safety, professionalism and communications. Day one was structured in a traditional lecture format, while day two placed participants in simulated operating room environments and neurosurgical procedures.

A first-year neurosurgery resident participates in the nation's first series of neurosurgery boot camps.

“This boot camp concept is the first of its kind in medicine providing interns with a strong foundation to learn basic concepts and procedures and helping to ultimately reduce the number of errors among training residents,” says Costas Hadjipanayis, MD, PhD, assistant professor of neurosurgery at Emory School of Medicine and chief of neurosurgery service at Emory University Hospital Midtown.

More than 90 percent of all incoming neurosurgery residents in the United States participated in the training at one of the sites. Emory neurosurgical faculty, fellows, and residents led intensive and interactive exercises oriented to fundamental bedside procedural and operative skills.

The exercises were designed to allow residents to familiarize themselves with the basics in an educational and risk-free environment. Skills relevant to all first-year residents were covered, such as line placement and suturing, as well as specific neurosurgical skills like drilling and performing a craniotomy.

According to Hadjipanayis, one of the Emory organizers and course directors, the group of 37 interns participating in the Atlanta training was the largest number nationwide. They were from universities across the region ranging from Virginia to Puerto Rico.

“This was definitely a great start to a course we will cultivate and enhance from year to year,” says Hadjipanayis. “Our goal is for continuous evaluation and improvement.”

Click here to view a CNN news story filmed at the Emory boot camp by CNN medical correspondent and Emory neurosurgeon, Sanjay Gupta, MD.

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Study: Prescription and OTC drugs leading culprits of kids’ poisonings

A study published online Aug. 4, 2010, by the journal Pediatrics found that prescription and over-the-counter drugs are the leading cause of accidental poisonings among American children.

Each year, more than 71,000 U.S. children ages 18 and younger are seen in emergency rooms for unintentional overdoses of prescription and over-the-counter drugs, according to the study authors.

More than two-thirds of emergency department visits are due to poisoning from prescription and over-the-counter medications — that’s more than double the rate of childhood poisonings caused by household cleaning products, plants and the like, the researchers noted.

Robert Geller, MD, Emory professor of pediatrics and medical director of the Georgia Poison Control Center

“The number of children seen in the emergency room due to overdoses that are unintentional or medication errors is remarkable,” says Robert Geller, MD, professor of pediatrics in the Emory University School of Medicine and medical director of the Georgia Poison Center, who was not a part of the study.

The study team used 2004 and 2005 data from the National Electronic Injury Surveillance System to estimate the number of emergency department visits resulting from unintentional medication overdoses for children aged 18 and younger.

The most common medications accidentally taken by children are acetaminophen, opioids or benzodiazepines, cough and cold medicines, nonsteroidal anti-inflammatory drugs (NSAIDs) and antidepressants, researchers found.

Geller says the study highlights the growing need to improve packaging to cut the number of cases of unintended ingestion.

“If you could make it harder for a kid who came upon a package to get the contents of the package, it would make it more likely they would never need to go to the emergency room,” Geller noted.

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