Study shows Hispanics, blacks substantially underrepresented in orthopaedic research

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SAN ANTONIO (April 24, 2014) – In San Antonio, orthopaedic surgeons commonly treat Hispanic and black patients for a vast array of orthopaedic diseases and injuries. When these doctors turned to their specialty’s most esteemed journals to learn more about treatments and breakthroughs, they noticed little to no reference to these minority groups.

Boris A. Zelle, M.D., assistant professor of orthopaedic trauma surgery at The University of Texas Health Science Center at San Antonio and an orthopaedic trauma surgeon with UT Medicine San Antonio, decided to investigate this underrepresentation of Hispanic and black patients in orthopaedic research. He called on his longtime friend and collaborator Mohit Bhandari, M.D., Ph.D., an orthopaedic surgeon and renowned researcher who is the research chair of muscoskeletal trauma and surgical outcomes at McMaster University in Canada.

An extensive and critical review of the most pertinent orthopaedic clinical studies over a four-year period recently resulted in Dr. Zelle’s publication, “Lack of Diversity in Orthopaedic Trials Conducted in the United States,” in The Journal of Bone and Joint Surgery, the premier orthopaedic journal.

“As an academic trauma surgeon, it is my responsibility to constantly review the most pertinent literature and to be up to date. When I started practicing in San Antonio three years ago, I began reviewing the literature with the particular focus to learn more about minority patients. I noticed that study after study made no reference to race or ethnicity,” he said.

“This is important to patients because our treatment algorithms are based on information found in the best available literature,” said Dr. Zelle. “As of now, this literature is poorly representing minority patients like our patient population in San Antonio. We know that Hispanic and black patients have different outcomes after treatment of orthopaedic injuries. We know that they have different associated medical problems as well as different perceptions toward their injury and their health care providers. We need to understand all of this so we can better treat these patients.”

With assistance from Jeremy S. Somerson, M.D., an orthopaedic surgery resident; Clayton Vaughan, M.D., a medical school graduate who was a student at the time, and Christopher S. Smith, M.Sc., from McMaster University, Dr. Zelle and Dr. Bhandari reviewed 158 randomized controlled trials from 2008 to 2011 that had been published in 32 different scientific journals.

“We found that minority patients were not appropriately represented in these clinical trials,” Dr. Zelle said. “In these studies, only 4.6 percent of participants were Hispanic and 6.2 percent were African-American. That is 3.5 times less than the actual Hispanic population, and two times less than the actual African-American population in the United States.”

This research determined that orthopaedic literature is failing to represent these minority populations, he said. “The entire body of orthopaedic literature needs to be challenged as the patients enrolled in clinical studies are not representative of the current U.S. population. Centers with diverse patient populations, such as the UT Health Science Center, must be part of future multicenter trials in order to allow for enrollment of minority patients. Inclusion of Hispanic and African-American patients in research must be a clear goal.”

Dr. Zelle said the UT Health Science Center’s solution to this disparity is developing study tools designed for these populations. For example, the development of outcome questionnaires in Spanish can greatly increase the amount of Hispanic patients who participate in such studies, he said.

“By developing these outcome tools and sharing them with other universities, we will be able to increase the number of Hispanics in future clinical trials. We hope to increase the number of minority patients in orthopaedic research studies across the country. Then we will have much better information to use when treating our patients.”

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.

Study comparing type 2 diabetes medications seeks volunteers

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UT Health Science Center, Texas Diabetes Institute among enrolling centers

SAN ANTONIO (April 17, 2014) — The first comprehensive, long-term study comparing different medications for type 2 diabetes is recruiting participants at The University of Texas Health Science Center at San Antonio and the University Health System’s Texas Diabetes Institute.

The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study will compare the long-term benefits and risks of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes.

Ralph DeFronzo, M.D., principal investigator of the UT Health Science Center and Texas Diabetes Institute study site, said GRADE will compare the effects of four glucose-lowering medications — a sulfonylurea called glimepiride; a DPP-4 inhibitor, sitagliptin; a GLP-1 agonist, liraglutide; and a basal insulin, glargine — when each is added to metformin.

“All of these medications currently are approved for the treatment of type 2 diabetes, but it yet has not been established which antidiabetic medication provides the best glycemic control in diabetic patients who are suboptimally controlled on metformin,” Dr. DeFronzo said. He is division chief of diabetes in the School of Medicine of the Health Science Center and deputy director of the Texas Diabetes Institute.

Five-thousand patients will be enrolled in up to 50 academic and VA medical centers nationwide, including 150 in San Antonio. Patient outcomes will be followed for up to seven years. Participants will have their diabetes medications managed free of charge throughout the study, including at least four medical visits per year.

At enrollment, participants must be:

• At least 30 years of age with a diagnosis of type 2 diabetes
• Within 10 years of time of diagnosis
• Taking metformin only
• Willing to take a diabetes medication in addition to metformin

To inquire about study eligibility, please call 210-358-7200.

The GRADE Study is sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. It is coordinated by the Biostatistics Center, a research facility of George Washington University.

Anyone interested in learning more about the study can visit www.gradestudy.org.

The GRADE Study (ClinicalTrials.gov number: NCT01794143) is supported under NIH grant U01DK098246.

Type 2 Diabetes in the U.S., Texas and Bexar County

Type 2 diabetes is an epidemic that threatens to become the century’s major public health problem and poses enormous human and economic challenges worldwide. Nearly 26 million Americans are affected by diabetes and 79 million have prediabetes.

Diabetes is a chronic disease that, when left untreated or not properly managed, can result in serious complications, including kidney failure, blindness, limb amputation and death. In 2012, 11.4 percent of Bexar County adults reported being diagnosed with diabetes, a rate similar to the state of Texas. (Source: 2013 Bexar County Community Health Assessment, Page 168)

Bexar County was home to 1,785,787 people in 2012, according to the U.S. Census Bureau, and 11.4 percent of this figure totaled 203,579. Thousands more individuals in the area lived with undiagnosed diabetes.

 

UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center San Antonio. With more than 700 doctors – all School of Medicine faculty – UT Medicine is the largest medical practice in Central and South Texas. Expertise is in more than 100 medical specialties and subspecialties. Primary care doctors and specialists see patients in private practice at UT Medicine’s flagship clinical home, the Medical Arts & Research Center (MARC), located at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and UT Medicine physicians also practice at several local and regional hospitals. Call (210) 450-9000 to schedule an appointment, or visit www.UTMedicine.org for a list of clinics and phone numbers.

Scientists unlock secrets of protein produced by disease-causing fungus

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SAN ANTONIO (April 16, 2014) — A team that includes scientists from the School of Medicine at The University of Texas Health Science Center at San Antonio, Johns Hopkins University and St. Mary’s University reported the structure of a protein that helps a common fungus to infect the body.

The fungal pathogen Candida albicans causes yeast infections, diaper rashes and oral thrush, and is the most common fungal pathogen to infect humans. It can also cause a life-threatening infection of the blood called disseminated candidiasis.

“In this study, we determined the three-dimensional structure of a never-before-seen cell wall protein called SOD5 that the organism uses as a defense against the human immune system,” said P. John Hart, Ph.D., the Ewing Halsell-President’s Council Distinguished Professor of biochemistry at the UT Health Science Center and Research Scientist in the South Texas Veterans Health Care System.

“SOD5 is a copper-only protein that exhibits significant structural differences from copper/zinc superoxide dismutases (SODs),” Dr. Hart said. “Because SOD5 molecules are widespread throughout fungi, including C. albicans, but are not found in humans, the structural differences can be exploited to develop compounds that specifically target SOD5 to treat a number of widespread fungal infections.”

Current conventional antifungal treatments such as fluconazole can be toxic to the liver in certain individuals, he noted.

“SOD5 is an unprecedented, very powerful antioxidant protein that enables C. albicans to ward off free radicals of the host immune response,” said study senior author Valeria Culotta, Ph.D., professor of biochemistry and molecular biology and environmental health sciences at the Johns Hopkins University Bloomberg School of Public Health. Free radicals are highly reactive molecules that can cause oxidative damage.

The finding was published April 7 online ahead of print by the journal Proceedings of the National Academy of Sciences of the United States of America.

Study collaborators included Drs. Hart and Culotta; Julie Gleason, Ph.D., and Ryan Peterson, Ph.D., also of the Bloomberg School of Public Health; Ahmad Galaleldeen, Ph.D., and Jessica Waninger-Saroni, B.S., of St. Mary’s University in San Antonio; Alexander Taylor, Ph.D., and Stephen Holloway, Ph.D., of the Department of Biochemistry at the UT Health Science Center at San Antonio; Brendan Cormack, Ph.D., of the Johns Hopkins University School of Medicine; and Diane Cabelli, Ph.D., of Brookhaven National Laboratories in Upton, N.Y.

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.

Hepatitis C treatment cures over 90 percent of patients with cirrhosis

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Oral combination proves safe for patients who could not have interferon therapy

SAN ANTONIO (April 15, 2014) — Twelve weeks of an investigational oral therapy cured hepatitis C infection in more than 90 percent of patients with liver cirrhosis and was well tolerated by these patients, according to an international study that included researchers from UT Medicine San Antonio and the Texas Liver Institute. Historically, hepatitis C cure rates in patients with cirrhosis (liver scarring) have been lower than 50 percent and the treatment was not safe for many of these patients.

Hepatitis C virus is the No. 1 driver of cirrhosis, liver transplants and liver cancer in the United States, noted Fred Poordad, M.D., lead author on the study, which was released by The New England Journal of Medicine in conjunction with Dr. Poordad’s presentation of the data Saturday (April 12) at the International Liver Congress in London. UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center at San Antonio, where Dr. Poordad is a clinical professor of medicine. He is vice president of the Texas Liver Institute in San Antonio.

Interferon previously was the only agent to show effectiveness against hepatitis C, but patients often relapsed and the therapy caused multiple side effects. The new regimen is interferon-free and consists of several agents — ABT-450/ritonavir, ombitasvir, dasabuvir and ribavirin. Twelve weeks after the last dose, no hepatitis C virus was detected in the bloodstream of 91.8 percent of patients who took the pills for 12 weeks. Among patients treated for 24 weeks, 95.9 percent were virus-free 12 weeks after the end of therapy.

“These are out-of-the-ballpark response rates, not on the same planet as interferon,” Dr. Poordad said. “The reason this study is so profound is because interferon is not tolerated nor is it safe in many people with cirrhosis. Many of the patients with cirrhosis in this study were not even eligible to be treated with interferon.”

One of those patients was retired San Antonio anesthesiologist Sergio Buentello, M.D. Diagnosed with hepatitis C infection 11 years ago, Dr. Buentello had treatment with side effects and no cure eight years ago. “My viral count came down, but never to zero,” he said.

When Eric Lawitz, M.D., of the Texas Liver Institute told him of the possibility of treatment with the new therapy, Dr. Buentello said he was skeptical. But as for so many others, the therapy worked.

“I feel very lucky to be living in this time, because I was almost resigned to the idea that I could never be cured,” Dr. Buentello said.

The study examined outcomes in 380 patients at 78 sites, including hospitals and centers in Spain, Germany, England, Canada and the U.S. The biopharmaceutical company AbbVie provided support.

Investigators are cataloging patient blood samples for three years after therapy and so far have noticed no long-term, late relapses, Dr. Poordad said.

“Patients with advanced liver disease can now be cured of their hepatitis with a very well-tolerated and short regimen,” he said.

The combination medication regimen is expected to be on the market as early as the end of 2014 or very early 2015.

 

UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center San Antonio. With more than 700 doctors – all School of Medicine faculty – UT Medicine is the largest medical practice in Central and South Texas. Expertise is in more than 100 medical specialties and subspecialties. Primary care doctors and specialists see patients in private practice at UT Medicine’s flagship clinical home, the Medical Arts & Research Center (MARC), located at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and UT Medicine physicians also practice at several local and regional hospitals. Call (210) 450-9000 to schedule an appointment, or visit http://www.UTMedicine.org for a list of clinics and phone numbers.

The Texas Liver Institute’s mission is to set the standard of excellence in care and innovative research in the field of liver disease. The institute is affiliated with The University of Texas Health Science Center at San Antonio. The physicians are professors and teach at University Hospital of the University Health System and are involved with the liver transplantation program of the University Transplant Center, a partnership of the Health Science Center and the University Health System. For more information, visit http://www.txliver.com/.

SABCS audit shows local symposium’s global impact

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SAN ANTONIO (April 9, 2014) – The audit just came in, and the San Antonio Breast Cancer Symposium is a resounding success for San Antonio — and for breast cancer treatment worldwide.

In December 2013, more than 7,400 breast cancer oncologists, nurses, researchers and advocates attended the SABCS, sponsored by the Cancer Therapy & Research Center at the UT Health Science Center, the American Association for Cancer Research and Baylor College of Medicine. That does not include exhibitors, sponsors, staff and members of the media, who bumped the attendance up to 7,625.

That’s more than $9 million in economic impact for the San Antonio downtown area alone, using the San Antonio Convention and Visitors Bureau economic impact formula.

Another way to calculate the conference’s impact over the past 36 years is to look at the experts from across the world who travel to San Antonio to share and learn the latest information on breast cancer.

“We have a global reach and, having done this since 1977, we have had a longstanding global impact on the care of patients with breast cancer,” said Ismail Jatoi, M.D., Ph.D., chief of surgical oncology at the Health Science Center.

They come from every continent but Antarctica, and from countries as small as Equatorial Guinea. The questions of diagnosis, access to drugs and how clinical drug trials are run in different countries are important global health issues addressed at SABCS. And in 2014, SABCS will host a developing country forum focusing on those questions faced by oncologists and health care workers treating breast cancer in the developing world.

“The SABCS is the largest breast cancer meeting in the world, and the most important gathering of key opinion leaders in breast cancer research,” Dr. Jatoi said.

 

The Cancer Therapy & Research Center (CTRC) at The University of Texas Health Science Center at San Antonio is one of the elite academic cancer centers in the country to be named a National Cancer Institute (NCI) Designated Cancer Center, and is one of only four in Texas. A leader in developing new drugs to treat cancer, the CTRC Institute for Drug Development (IDD) conducts one of the largest oncology Phase I clinical drug programs in the world, and participates in development of cancer drugs approved by the U.S. Food & Drug Administration. For more information, visit www.ctrc.net.

7th annual Community Service Learning Conference tackles health literacy

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WHAT:

Barry Weiss, M.D., FAAFP, creator of “the Newest Vital Sign,” which uses a nutritional label from an ice cream container to rapidly and accurately measure patients’ health literacy, gives the keynote address at the 7th annual Community Service Learning (CSL) Conference.

The theme of this year’s conference is “A Prescription for Plain Language: Health Literacy.” It is organized by the Center for Medical Humanities & Ethics at The University of Texas Health Science Center at San Antonio.

Other speakers will cover a range of topics, including using interpreters to communicate effectively with patients and how health literacy can affect medication management.

WHEN:

Thursday, April 3, 2014, from 9 a.m. to 5 p.m.
• 9:15 to 10:30 a.m.: Keynote by Dr. Barry Weiss.
• The full conference agenda is here.

WHERE:

Hurd Auditorium, School of Nursing, UT Health Science Center, 7703 Floyd Curl Drive, San Antonio

WHO:

Dr. Barry Weiss is a tenured professor of family and community medicine at the University of Arizona College of Medicine. His research centers on healthy literacy and patient-physician communication.

“The Newest Vital Sign,” developed by Dr. Weiss and colleagues, has been shown to accurately measure patients’ healthy literacy in about three minutes by asking a half-dozen questions about an ice cream nutritional label.

Dr. Weiss authored the American Medical Association’s health literacy manual for clinicians. He is widely published on health literacy and has served as a consultant on the topic to the Institute of Medicine, among many others.

NOTES:

Health Science Center students will present their own CSL projects from throughout the year at a noon panel presentation and a poster session/reception at 5 p.m. in the Texas Star Café, a short walk from the Hurd Auditorium. The conference has reached its attendance capacity, but members of the news media are welcome.

Efforts like those highlighted at the conference have earned the Health Science Center a place on the U.S. President’s Higher Education Community Service Honor Roll since 2009.

 

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving National Institutes of Health funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 29,000 graduates. The $765 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.