Scientists unlocking genetics of AIDS progression

The studies, conducted at the Health Science Center in collaboration with other institutions, spotlight gene variations in molecules that influence
an individual's susceptibility to AIDS progression. The molecules in which these genetic variations were found play a critical role in the entry of the AIDS virus into cellular portals called "co-receptors."

"One of the most startling aspects of the studies is that they have provided further evidence that the spectrum of gene variants associated with disease acceleration or retardation differs between African-Americans and Caucasians," said study leader Dr. Sunil K. Ahuja, associate professor of medicine.

The study looked for co-receptor gene variants in 2,300 people--half with HIV infection and half without. The scientists found combinations that retarded HIV-1 disease in African-Americans and others that retarded it in Caucasians.

"Such combinations of alleles (gene variants) may have offered selective advantages to ancestral Caucasian and African populations who were exposed to different spectrums of disease-causing agents," Dr. Ahuja said.

Dr. Ahuja likened these combinations to genetic "ZIP codes" that in the future could be used to assess a person's AIDS susceptibility. Treatments could also result.

Of the 1,151 HIV-positive patients evaluated, 54 percent were Caucasian, 37 percent were African-American, 6 percent were Hispanic and 3 percent were of other origin. The 1,199 uninfected individuals represented ethnic groups living in Africa, Asia and Europe. Ninety-four percent of the subjects were male.

During the study, 38 percent of HIV-infected individuals progressed to AIDS and 34 percent died. The researchers compared these outcomes with the genetic analysis.

AIDS incidence in this country is changing. The disease once pre-dominantly affected homosexual Caucasian men but now largely strikes minority groups.

"Non-Hispanic blacks and Hispanics accounted for 47 percent and 20 percent, respectively, of persons diagnosed with AIDS in 1997, the highest proportions thus far in the epidemic," according to a report summary from the U.S. Centers for Disease Control and Prevention.

This trend makes the study of population-specific genetic determinants "compelling," the authors wrote.

The study was conducted in close collaboration with Lt. Col. Matthew Dolan of the Infectious Diseases Service at Wilford Hall Medical Center. Wilford Hall is the referral hospital for all Air Force personnel who develop HIV infection.

Other study collaborators are with the South Texas Veterans Health Care System, Brooke Army Medical Center in San Antonio, the University of Utah, Wake Forest University School of Medicine, the Public Health Research Institute in New York and the Henry M. Jackson Foundation.

The R. J. Kleberg Jr. and H. C. Kleberg Foundation, the U.S. Department of Veterans Affairs, the National Institutes of Health and the National Science Foundation provided grant funding.

The paper was edited by Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

Seeing science

High school students take a look through high-tech microscopes at last year's bioscience career expo, Science '98. This year's event is set for Oct. 28 and will provide students with information about professions in science. For more information, see page 2.

Institutional Strategic Planning Committee
begins reviews

The Institutional Strategic Planning Committee, chaired by Dr. David Shelledy, respiratory care, will be reviewing the currency of the goals and objectives included in the existing comprehensive plan. The 15-member committee also will be looking at internal and external factors affecting the Health Science Center.

The committee is charged with providing a report and recommendations to Dr. John P. Howe, III, president, by Feb. 1. Between September and mid-November, the committee will update an environmental assessment; review and possibly revise objectives for each of the five current goals.

The committee also will discuss strategies and activities; internal performance measures and external benchmark measures to evaluate full or partial achievement of objectives; and the factors responsible for accomplishing stated objectives and for reporting measures at the Annual Campus Review and to external agencies.

Progress on the plan will be provided in future News articles and through broadcast e-mail messages. The committee will solicit input from members of the Health Science Center community and its external constituencies, as well as feedback from these groups when a draft report is available. During the month of October, members of the committee will visit faculty councils and assemblies as well as directors' meetings to provide information about the committee's activities. Copies of a draft report, targeted for December, will be disseminated for comments to the campus community.

In addition to Dr. Shelledy, the committee includes Dr. Martin Adamo, biochemistry; Dr. Theresa Chiang, student services; Dr. James Freeman, surgery; Dr. Birgit Glass, dental dean's office; Dr. Gary Harris, medicine; Dr. Keith Krolick, microbiology; Dr. Mary MacDougall, pediatric dentistry; Dr. Toni Miles, family practice; Jack Park, legal affairs and technology licensing; Wayne Reed, purchasing; Dr. Chuck Rodriguez, university relations; Dr. Kathleen Stevens; family nursing care; Dr. Janet Williams, pediatrics; and A. Jerome York, vice president and chief information officer.

If you have any questions or would like to provide input into the committee's activities, please contact Dr. Shelledy at <Shelledy@uthscsa.edu>or Dr. Greene at <Greened@uthscsa.edu>.

Physical therapy month targets falling dangers

Physical therapists from the Health Science Center, the University Health System and the community are celebrating National Physical Therapy Month by screening the elderly for risk of falling and by teaching them how to avoid falls. Even if a fall does not result in hospitalization, the fear of falling can keep a person from being active. This can lead to weakness and loss of range of movement, and, ironically, an increase in the risk of falls.

Dr. Barbara Boucher, physical therapy, says the free screenings are being provided to educate not only the public, but health providers as well. "It's not enough to tell people to go out and get more exercise," she said. "People who are at risk for falling need an appropriate exercise treatment."

In order to get that treatment, however, individuals must have a prescription from their physicians. "Physical therapists are like a controlled substance, a medication," Dr. Boucher said. "If there were a pill to prevent falling, everyone would want that. Physical therapy is the medical equivalent of that pill."

Falls are caused by a combination of internal and external factors. Internal factors include visual decline, hearing loss, foot pain, reduced sensation (especially in cases of diabetes), use of four or more medications, and a decline in balance and speed of gait, which are related to activity level and blood pressure problems. External factors include poor lighting in the home, throw rugs, slippery floors and clutter.

One goal of the TPTA is to make balance screenings part of routine medical exams. When physicians determine a patient is at risk, the patient could then be referred to a PT for the correct treatment.

At the first screening session, held at McCreless Mall during a health fair sponsored by the University Health System, the therapists assessed 33 individuals, several of whom were referred back to their physicians, Dr. Boucher said.

The next two sessions will be held from 10 a.m. to 2 p.m. on Oct. 16, at Baptist HealthLink at Bitters and West Avenue and from 9 a.m. to 2 p.m on Nov. 4, at Silver Sage Senior Activity Center in Bandera.

Proposition 17 on the ballot in November

Proposition 17, if adopted, would allow the Fund's investment managers to take advantage of broader investment strategies and to increase the proceeds available for programs and facilities at PUF institutions within both The Texas A&M University System and The University of Texas System. The proposition does not change the institutions participating in the PUF. Most important, the proposition, if adopted, would not increase taxes.

The funding made possible by the proposed changes would be used to finance much needed capital improvements or to acquire capital equipment and library books or materials. Improved facilities, equipment and library materials from this source will reduce the potential financial burden on students who might otherwise have to pay for these items.

The need for legislation that led to placement of Proposition 17 on the November ballot was also supported by a report from the Office of the State Auditor, which suggested the proposed changes would allow better financial returns for the PUF. The proposal was passed unanimously by the Legislature.

Important information on Proposition 17

Proposition 17: The Basics

• Would amend the Texas Constitution to make the Permanent University Fund a "total return" fund, which enables the use of modern and more flexible investment strategies.

• Requires that the fund be managed according to the standards of a prudent investor.

• Provides new funds for higher education with no increase in taxes.

• Provides significant additional funding, beginning this year, for academic programs and facilities at Permanent University Fund institutions in The Texas A&M University System and The University of Texas System.

• Provides guidelines on the minimum and maximum amounts to be distributed to the institutions of higher education.

• Protects against the erosion of the PUF caused by inflation.

• Provides a more predictable and stable source of funds to help support higher education institutions.

• Does not change the participating institutions of the PUF.

• Does not decrease funding to institutions of higher education that do not receive direct funds from the PUF.

Proposition 17: In a Nutshell

Proposition 17, if adopted, would allow the State's investment managers, with certain safeguards, to have more flexibility to manage the Permanent University Fund (PUF), to take advantage of broader investment strategies and to stabilize funding for academic programs and facilities at The Texas A&M University System and The University of Texas System institutions. Important to most Texans, the proposition will not increase taxes.

Expo '99 introduces students
to the world of careers in science

Bill Rogers, rehab medicine, (second from left) demonstrates a wound imaging device at the Science '98 expo. The device measures wounds to ensure they are healing.

Science '99 "Explore the Connections" will include exhibits from occupational therapy, clinical laboratory sciences, respiratory care and the South Texas Poison Center, among others.

Participating students can get a variety of information on careers and schools, including how to apply to professional schools and matching student personality to a health career field. Presentations at the expo will include a look at the brain and the heart, information on emergency medicine and a visit to the Health Science Center Briscoe Library.

The event will provide high school students with an opportunity to explore health professions and the relationship science has with everyday life.

The Health Science Center is just one of the many components of Science '99. Throughout the week of Oct. 25 through Oct. 30, students will have a chance to visit the Academy of Health Sciences at Fort Sam Houston, the H-E-B Science Treehouse at the Witte Museum and the Scobee Planetarium at San Antonio College.

The Health Science Center expo will begin at 8:30 a.m. with registration and a welcome session. Exhibits for Session I will be open from 9 a.m. to 11:30 a.m. Session II will begin at 12:30 p.m. and run until 3:30 p.m.

The Office of Special Programs is looking for faculty and staff to help at the registration tables and escort students to breakout sessions. Additional exhibitors also are welcome. For more information, to register or to reserve a table, contact the Office of Special Programs at ext. 2654.

Lawler honored for award-winning article

The article, "An Office Approach to the Diagnosis of Chronic Cough," was selected from more than 130 articles published last year in AFP. Dr. Lawler is the 13th recipient of the Kemp Award, which carries a $1,000 honorarium. The award was named for Walter H. Kemp, managing publisher of AFP for 15 years.

Dr. Lawler is a 25-year veteran of the Health Science Center's Department of Family Practice and the recipient of several educational development awards and nominations for the Presidential Excellence in Teaching Award. He has received the Golden Heart Award and the Distinguished Service Award from the Texas affiliate of the American Heart Association (AHA) and the Meritorious Service Award and Gratitude Award from the San Antonio Division of the AHA.

Dr. Lawler's article reviewing the diagnosis and management of chronic cough, originally appeared in the December 1998 edition of AFP. It was selected by the publication's editorial staff based on presentation, scientific substance, originality of thought and relevance to family practice. The American Academy of Family Physicians' Commission on Continuing Medical Education nominates top articles considered for the accolade.

"It is very flattering to receive this award," said Dr. Lawler. "I owe much to the help of colleagues in this institution who reviewed and made suggestions for the article."

Dr. Lawler received his medical degree from The University of Texas Medical Branch in Galveston and went on to a rotating residency internship at Hennepin County General Hospital in Minneapolis. After serving two years as a flight surgeon in the Army, he completed his residency training in family medicine at the University of Rochester Highland Hospital in New York.

Courtesy flu shots offered Oct. 15, 20 or 21

The University Clinic staff is offering its annual free flu shot service to faculty and staff members of the Health Science Center on Oct. 15, 20 and 21 in the auditorium foyer from 9 to 11:30 a.m. and from 1 to 3:30 p.m. Employees are asked to bring a valid Health Science Center identification card.

Individuals who are unable to get a free shot during the on-site sessions may schedule appointments with primary care physicians in their clinics for $10 co-payments.

The link between periodontal disease and the body

"We know already that there is a link between systemic disorders and periodontal disease. If you had leukemia or diabetes, you tended to have more oral problems such as abscesses in diabetic people for example. Now we have learned that the reverse is going on--the mouth is affecting the rest of the body," said Dr. David Cochran, professor and chairman of the Health Science Center's Department of Periodontics.

The connection is particularly evident in cardiovascular disease.

About 36 million Americans have gum disease. The disease often goes untreated because there are few symptoms. Because it rarely causes pain, the disease is allowed to quietly eat away the teeth and gums. Some individuals experience bleeding and an inability to chew, which eventually requires medical attention.

"By the time patients do come in to find out what is the matter with their gums, the disease has advanced considerably," said Dr. Cochran.

Periodontal disease also is being linked to other disorders. Poor oral health in pregnant women has been implicated in the incidence of low birth weight, preterm babies. It seems the inflammatory response in the gums and teeth causes a hyperimmune response in the body, which affects the fetus. In addition, researchers have found that if diabetics are treated for periodontal disease, their glucose levels will be easier to maintain.

"Since the blood vessels of diabetics are already compromised, the disease becomes even more pronounced and the ability to heal suffers," said Dr. Cochran. "It's crucial for diabetics to keep their gums healthy, not only because of their diabetes but because of the threat of heart disease as well."

Beyond researching the mouth-body connection, periodontists are developing techniques and materials to aid in regeneration of bone and tissue following periodontal surgery. One such material, bone morphogenetic protein (BMP) is already in phase 2 and 3 clinical trials in the Dental School. "We have about six human trials going right now," said Dr. Cochran. Another promising new material is emdogain, which is currently being tested under a three-year grant.

"There are not enough hours in the day," he said, "It's really exciting. This is probably the most sought-after periodontal graduate program in the country, and we get a really great selection of students."

Cochran awarded periodontics honor

Now Dr. Cochran serves as a consultant to that committee. In addition, he chairs the Committee on Research, Science and Therapy. The research committee is responsible for reviewing, checking, editing and issuing position papers for the AAP.

Dr. Cochran joined the Health Science Center in 1992 from a faculty position at the Medical College of Virginia after completing his training at the Harvard School of Dental Medicine. He received his DDS degree and a doctorate in biochemistry from the Medical College of Virginia, followed by a master's in oral biology from Harvard. Caring Cleaners Volunteers during last year's Days of Caring event reflect the goodwill Health Science Center employees bring to every job. This year more volunteers are needed for a park construction project. See the Of Note item below for more information.

Caring Cleaners

Applause

• Dr. Tomy Starck, ophthalmology, received an Achievement Award Certificate from the Board of Trustees of the American Academy of Ophthalmology.

• Dr. Victor Sandoval, associate dean for student affairs in the Dental School, was selected to participate in the year-long Community Education Leadership Program, administered by the Intercultural Development Research Association.

• Dr. William A. Watson, South Texas Poison Center, was inducted as a Fellow of the American Academy of Clinical Toxicology at the recent North American Congress of Clinical Toxicology meeting in California.

• The following Health Science Center faculty members have been commended by name in health care surveys returned by patients of the University Health System: Drs. Steven Bailey, David Sherman, Marc David Feldman and Hasi Venkatachalam, medicine; Drs. Animesh Agarwal and Michael Wirth, orthopaedics; and Dr. Nicolas Walsh, rehabilitation medicine.

• Two seniors in the Dental School, Jose Alvarez and Jeff Alvarado, have been chosen to join the yearlong Leadership Program sponsored by the Hispanic Chamber of Commerce.

Of Note

Days of Caring begins Oct. 19

The project is designed to provide the neighborhood with a safe place for recreation. During the week, volunteers will be constructing softball fields, creating a nature trail and constructing a parking lot.

Volunteers should dress appropriately for outdoor labor in work boots, gloves and if possible, long sleeved shirts. Bill Miller Bar-B-Q will provide lunch at a cost of $5 in advance, or volunteers may bring their own lunches. For more information, contact Mary Yanes at ext. 2205, e-mail <yanes@uthscsa.edu>, or Joe Ocampo at ext. 2980.

Burroughs Wellcome Foundation lecture Oct. 27

Dr. Schachman, who was awarded a visiting professorship from the Burroughs Wellcome Foundation, will discuss "Science Policy and Its Impact on Research," an outgrowth of his role as special advisor to the director of the National Institutes of Health and NIH ombudsman in basic sciences.

The lecture will begin at 3:30 p.m., in lecture hall 3.104A, with a wine and cheese reception to follow at 5 p.m. The Burroughs Foundation, Beckman Coulter Inc., and the Health Science Center Department of Biochemistry will sponsor the event, which is open to the public.

The Burroughs Wellcome Foundation is a private, independent foundation established to further the medical sciences by supporting research and educational activities.

Herbs and health seminar explores use and safety

Dr. Beverly Hall will discuss scientific research that supports the use and safety of herbs in health care. Sponsors for the event include the Biomedical Development Corporation, Mission Pharmacal, the San Antonio Express-News, Barbara Wulfe, Sun Harvest, San Antonio Credit Union, and S&C Advertising and Public Relations.

The cost is $20 per person. For more information or to reserve a space, call ext. 5901.

Friends of the P. I. Nixon Medical Historical Library
annual dinner set for Nov. 15

Dr. Kerr will discuss "Historic Advocates for the Public Health of Children." An amateur historian who teaches courses in the history of public health, Dr. Kerr has conducted extensive studies of children in both developed and underdeveloped countries to identify the preventable causes of fetal, infant and childhood death in Texas.

Reservations for the event must be made by Nov. 8 through Special Collections Library Assistant Pat Brown at ext. 2400.

Grant submission deadlines coming

Wayland Baptist University
admission counselor to visit

Hogwood will be in the Employee Development and Training Office on Friday, Oct. 22, from 9 a.m. to 3 p.m. Call the training office at ext. 2326 to schedule your appointment.

The semester begins Nov. 15 and ends Feb. 18. Classes offered include "Health Care Law" on Monday evenings, "Theory & Practice of Supervision" on Tuesday evenings, and "Health Care Delivery Systems" on Thursday evenings. Classes meet from 6:15 to 10:30 p.m.

Making the Rounds

Calendar for Oct. 18 - 24

Thursday, October 21
7:30 a.m.
Thoracic Surgery Resident Teaching Conf. (VA: 4th-floor CT Library A404 )
7:30 a.m.
Obstetrics & Gynecology Grand Rounds "Fetal Cardiac Dysrhythmias," Dr. Melinda McFarland (MED: 309L)
8:00 a.m.
Neurology Grand Rounds "Migraine in Women," Dr. Gretchen Tietjen, Medical College of Ohio (MED: 444B)
10:00 a.m.
TNT "Health Care Education & Training: Enliven Your Lesson Plan," Verolyn Bolander, U. T. Medical Branch, Galveston (call ext. 2700 for information)
Noon
Pulmonary, Thoracic & Oncology Conf. (MED: 309L)
12:30 p.m.
TNT "Comprehensive Care & Management of Diabetes: The Latest in Oral Antidiabetic Agent Therapy," Dr. Janet Blodgett (call ext. 2700 for information)
4:00 p.m.
Surgery Tumor Conference, Dr. Anatolio Cruz (MED: 209L)
4:00 p.m.
Anesthesiology Grand Rounds "The Development Neurobiology of Pain in Neonates," Dr. Lynda Wells (UH: 212)
4:30 p.m.
Citywide Thoracic Grand Rounds Conf. "Case Presentations," Dr. Claudio Guareschi (MED: 309L)

Friday, October 22
7:30 a.m.
Pediatric Grand Rounds "Update on Developmental Screening," Dr. Glen Aylward, Southern Illinois University School of Medicine (MED: 409L)
8:00 a.m.
Rehab Medicine Lecture Series "Intramedullary Sarcoidosis Presenting as Spastic Paraparesis: Case Report: A Review of Research," Drs. Loida Ayala & Douglas Barber (UH: Reeves Rehab Center 3rd-floor classroom)
8:30 a.m.
Cardiovascular Research Conf. "Effect of Carbon Dioxide on Autonomic Cardiovascular Responses to Systemic Hypoxia in Conscious Rats," Dr. Haruhisa Hirakawa (MED: 3.078V)
8:30 a.m.
Continuing Dental Education "Bruised, Broken & Bedeviled Teeth: Managing Traumatic Injuries," Dr. Anthony Diangelis (call ext. 3177 for information)
8:30 a.m.
Continuing Dental Education "OSHA-Required Annual Training: A Form-By-Form Program for the Entire Dental Team," Dr. Robert Cooley (call ext. 3177 for information)