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Health and Fitness

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*** a monthly newsletter ***          Vol.2, No.4, April 15, 2003

April 2003  HEALTH TOPICS:

SARS (Severe Acute Respiratory Syndrome)

What is SARS? SARS is a new strain of an acute flu that leads to a high fever, a severe cough and an atypical pneumonia where the inflammation of the lung tissue caused by this new type of virus leads to a severe lung infiltration that can be detected with chest X-rays. Cases similar to SARS have been known to the medical profession for several decades under the name of "atypical viral pneumonia".

Most viruses lead to a laryngotracheitis, affecting only the lining of the upper airways like the trachea and the voice box. However, SARS is not like this. It is a new strain of virus that goes right down into the lung tissue and leads to more severe breathing problems from secretions that plug the airsacs (alveoli) of the lungs. However, only about 3% to 4% of patients who get SARS actually die as explained in the links below (see CDC and WHO Internet sites). Here is a brief review explaining the evidence in the medical literature that is known at this time (April 2003). Since March 2003 it is known that SARS likely is transmitted by a small virus belonging into the same family of viruses like measles or mumps (the Paramyxoviridiae family of viruses). This WHO link explains this in more detail. However, Dr. Francis Allan Plummer from the National Microbiology Lab in Winnipeg/Canada has isolated a human metapneumo virus in six out of 8 specimens from high suspicion cases for SARS that were submitted to the Lab. It is at present not clear whether there are only one or perhaps two or three similar viruses that may work in concert in tricking the immune system not to mount an immune response in some susceptible persons whereas in the majority of patients the immune system produces enough antibodies to overcome the disease.

This latest publication from the New England Journal of Medicine , which was released one month early on Apr.10,2003, describes from the SARS working group that there has been a corona virus isolated from 18 SARS patients who died from this disease 10 to 14 days into it and that this is a new strain of virus, which likely originated from a single ill health care worker from the Guangdong Province in China. These researchers used genetic tests (reverse transcription- polymerized chain reaction), electron microscopic tests of cell cultures with throat swabs from infected SARS patients as well as immunological tests with group specific corona virus antibodies to pinpoint the cause of SARS.

The new name for this virus: Urbani SARS-associated coronavirus in honor of Dr. Carolo Urbani, a WHO investigator who died of SARS himself when he investigated the early epidemic in Asia.

There might be inborn (genetic) weaknesses in some patients. The National Institute of Health is developing a vaccine against the corona virus, which is thought to trigger SARS. At the present time the best therapy is isolation in a hospital for those who are very sick with a possible combination treatment with corticosteroids and antiviral antibiotics, which may be 70% effective in halting the disease. The most important point is prevention of further transmission by isolation procedures (quarantine). Hopefully there will be a vaccine available soon, which could possibly be incorporated into the Flu vaccine.

Here is a link to the official CDC site about SARS

This link brings you to the World Health Organization site (WHO) where SARS is discussed.

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

It has been known for some time that flu shots would be beneficial. But it was not known until now whether in larger field studies people who are 65 years or older would benefit significantly and to what degree from yearly influenza vaccinations("flu shots"). The April 3rd, 2003 issue of The New England Journal of Medicine published the answer to this question. Dr. Nichol from the University of Minnesota, Minneapolis, and his collegues have followed 140,055 patients of whom 55.5% were vaccinated against the flu in the 1998/1999 flu season. They also followed 146,328 subjects during the 1999-2000 flu season of whom 59.7% were vaccinated against the flu. Here is a breakdown how they fared when compared to non-immunized controls.

The examiners of this study concluded that high risk patients (asthma patients, patients with diabetes, cancer, elderly patients, arthritic patients and patients with high blood pressure) should have a yearly Flu vaccination. However, in my opinion anybody would benefit from regular Flu vaccinations as this boosts the immune system in general protecting against other infections and colds as well.

Older Americans Need More Knowledge About High Blood Pressure

A telephone survey of 1,503 Americans age 50 or older was published recently by Dr. Brent Egan from the Medical University of South Carolina, Charleston, in the March 24, 2003 issue of the Archives of Internal Medicine. Although 94% had their blood pressure measured at least once in the past year, only 46% knew how much it was. Of all the patients who knew that they had a systolic blood pressure of 140 mm mercury or higher, 30% did not know that this was abnormal and was called "systolic hypertension (high blood pressure)". 20% of patients with established high blood pressure did not take their medication or had on their own reduced the amount of medication they should have taken. In this group only about 1 in 5 complained that the cost of the medication would have been the reason for stopping the blood pressure pills.

Here are some more general results regarding this study in table form:

Apart from the remarks on the importance of education in the table above I would like to stress how important it is for patients with high blood pressure to learn how to measure their own blood pressure at home.

The method of how to do this is not as important as the fact that you buy and use some kind of home blood pressure measuring device (either the conventional bood pressure cuff or the more expensive electronic device). You can measure and record your own blood pressure either daily or 3 to 4 times per week and bring this record with you to the doctor's office with your next check-up. With this method you will gradually learn what life style factors bring your blood pressure up and how much medicine you need to take to control the blood pressure at all times. This will prevent major events such as heart attacks and strokes and preserve eye-sight and kidney function.

Here are various useful links regarding related topics.

Link regarding body mass index (BMI) .

Link regarding high blood pressure(hypertension)

Menopause And "Perimenopause" In Women

In the February 19, 2003, issue of The Journal of the American Medical Association there was an extensive review of the topic of menopause and the time before and after menopause, called "perimenopause".

The authors, Dr. Lori A. Bastian, from Duke University, and colleagues critically reviewed 1,246 articles on this topic and identified 16 studies that were accepted as being reliable regarding the review of this topic.

They were interested in finding menopause symptoms, signs and blood tests that would be reliable in terms of assessing whether a woman would be approaching menopause or would be in menopause. The result was that no single test or symptom was reliable, but that a number of tests and symptoms in combination were very helpful.

They measured reliability by "likelihood ratios (LRs)". What this means is that any value above 1.0 is significant, but the higher the number, the more reliable and important is this fact or sign. I summarized the findings in table form below:

The authors concluded that there is no need for blood tests for menopause diagnosis in a woman, if several points of the first 4 findings are positive (top part of the table).

Here is a link regarding menopause.

Edible Vaccines From Lettuce, Tomatoes And Other Plants

Can vaccines be taken by mouth (orally)? Yes, we know this from the polio vaccine.

Can vaccines be produced by plants? This does not sound likely, but this is exactly what researchers have already achieved and what they are working on now. A group of researchers under Dr. Robert Rose from the University of Rochester in New York have been working on a number of vaccines with the help of genetic engineering.

The rationale is simple: in developing countries it can be difficult to keep vaccines refrigerated and to administer them by injection in a sterile manner through doctors and nurses. Also, the cost of production can be a major factor with regard to effectiveness of the vaccine on a population basis, if large parts of the community cannot afford the vaccine. For many vaccines to be effective more than 85% of the population have to be vaccinated. Newer research has shown that the protein envelope of a virus, which has a certain surface antigen associated with it, can be broken down into smaller subunits. According to a review article in The Medical Post ( March 4, 2003, page 29) Dr. Rose and his team have isolated the DNA sequence of the human papillomavirus (HPV) envelope in the early 1990's. They were able to program potatoes to grow the protein subparticles that were immunologically active, but were not infective (no virus activity). In other words after genetic engineering the plant grows a vaccine, which can be safely consumed and the body mounts an immune response to this modified virus protein similar to the polio vaccine, but without a trace of virus.

As potatoes have to be cooked before consumption, some of the effectiveness of the vaccine gets lost. The researchers have since concentrated on other plants like apples, bananas, tomatoes and lettuce, which are eaten in the raw state. The various diseases that are being tested at the present time are: hepatitis B, respiratory syncytial virus (RSV), Norwalk virus, rotavirus and even the measles vaccine.

Dr. Charles Arntzen from the Arizona State University in Tempe, Arizona, has successfully applied the above technology to the production of plant vaccines against the Norwalk virus, the E.coli enterotoxin and hepatitis B in potatoes and tomatoes. He is taking this a step further as he is developing a technique of freeze-drying tomatoes containing the vaccine against the Norwalk virus, which allows the vaccine to be stored for long periods of time. When it is needed, it can be rehydrated and could also be delivered in pill form to vaccinate the population at risk at the time of an epidemic of enteritis the with Norwalk virus.

In summary, the new plant technology of vaccine production allows for much cheaper vaccine manufacturing. It eliminates the problems surrounding sterile injection techniques. The vaccine delivery by mouth allows for a much simpler distribution to a population at risk and can be done by lay persons. Also, a variety of vaccines will be able to be manufactured this way in future. The plant production is similar to the photocopying process where a template (the specific viral protein subparticle) is being copied by the plant. This allows for a number of vaccines against different strains of viruses to be programmed fairly quickly. It is an exciting new technique.

Here is a link to Influenza, which is one of the viral illnesses that can be significantly suppressed by vaccination.

Here is a link that explains the rationale of vaccinations and vaccination schedules.