The Runs for the Roses? The other race to Derby Day

catchyWeek 1, Sept. 3-9, 2017:
One case of hepatitis A

Rui Zhao hunkers behind his twin computer monitors. Most visitors to the epidemiologist’s uncomfortably cramped office talk to his brow and the short black hair on the top of his head. They may glimpse his eyes when he looks up from his screens. On the wall to his left are small stuffed toys of irregular shapes, each a cuddly version of some nasty germ. From this third-floor office at the Louisville Metro Department of Public Health and Wellness, Zhao watches other germs work their way across Louisville. In the 90-degree days of early September, it’s a bit too soon to think about influenza, which will sweep through nursing homes in cold weather, taking lives as it does most every year. More of interest now: the chronic liver diseases hepatitis B and C. In fact, cases of hepatitis B are dancing upward in the metro area. Hepatitis C is already considered an epidemic, although the number of new cases is tiny.

Of hepatitis A, there’s a single case. And there’s no case the following week. It’s meaningless noise in the ebb and flow of the 25 or so infectious diseases surveilled by the state. Each year, one or two people in the city — and, rarely, as many as five — will contract the hepatitis A virus. They travel to a country where it’s common, endemic. They bring it home from mission trips or as a souvenir from an exotic vacation. More frequently, travelers never know they have it. About 30 percent of adults with hepatitis A produce no symptoms.

But for the unlucky, it can be brutal, bringing low-grade fever, headache, weakness and exhaustion, diarrhea, sudden nausea and vomiting, and abdominal pain, especially under the ribs on the right side, where the liver sits. Stools turn pale and urine dark. There may be intense itching. The white of the eye and skin often yellow, another sign that the virus is in the liver. And that’s the end of it, usually. Unlike hepatitis B and C, hepatitis A doesn’t settle in for a lifetime, grinding away at the liver. Uncomfortable? Absolutely. Miserable? Often. Life-threatening? Only in people older than 50 and those with other health problems. And it’s self-resolving, with no cure but time. It’s also highly contagious, most likely to spread while its host feels tip-top, before discomfort sets in. Any virus shed during infection lingers on surfaces for months. It is frequently transmitted by food, and while it succumbs to soap and water, or near-boiling temperatures, gel sanitizers can’t touch it.

Hepatitis B and C, on the other hand, infect via body fluids like blood, semen or vaginal secretions — the same pathways taken by the virus that causes AIDS. Since February 2017, a combined hepatitis A-B vaccine has been offered to visitors at the syringe-exchange sites operated by Metro Health and Wellness. There is no vaccine against the relatively new virus hepatitis C, which was discovered in 1989 and originally called non-A, non-B hepatitis. The syringe-exchange clinic is one sure way for the health department to reach a group of people normally driven into the shadows, a population vulnerable to a variety of diseases.

The importance of such contact is about to increase. The question is, will it be enough? By April, few will think so.


Weeks 2-5, Sept. 10-Oct. 7:
Three new cases of hepatitis A. Total: 4

The Courier Journal is full of the troubles facing the University of Louisville basketball program as October rolls in with 70- and 80-degree days and enough sunshine to convince anyone that summer will stretch on forever. Zhao notes that hepatitis A cases are now double the number seen in a normal year. But whether those four cases are significant isn’t clear. There’s also an unusual surge in false-positive hep A tests. He always sees a few. Every year, three or four people will test positive, yet their illness makes no sense. Usually, these cases of mistaken viral identity involve women 60 and older who have symptoms that would fit any number of diseases, including hepatitis A. It’s essentially a bad joke played by an aging immune system. Immune defenses lose precision with each passing year; our bodies are more prone to interpret any number of ailments as an attack on the liver and ramp up antibody production to fight a phantom infection.

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Dead Horses Have Babies, Clones Compete, Superhorse Has Arrived

How to get a baby horse by any method except sex. I wrote this story for the April issue of Louisville Magazine.

The colt was born this morning. Now shy and spindly, it clomps lightly on supermodel legs, a bit dazed beside the mare that birthed him. Up and down the barn aisle are other mares with newborns or mares fatly pregnant. One Morgan mare, a month overdue, her body swollen and heavy, seems to slosh and sway in her stall.

The mares are all surrogates, the hothouse incubators for champion embryos. While the show-mare mothers continue to prance in the ring, their progeny take up residence in the wombs of genetic strangers who play mother and wet nurse. The privileged champion, like a well-bred Victorian lady, hands off the messy parts without missing a hoofbeat.

A short walk away , in the main veterinary building at Equine Services in Simpsonville, it is fretful filly day. Seaforth’s Bonnie Lass stands in a red metal stall, sensitive to every movement in the room. Her ears point straight up and flick nervously, like receivers snatching at stray signals. She is sedated, but you wouldn’t know it. She could not be more watchful.

Behind her, Scott Bennett pulls on a clear blue plastic glove that goes all the way up to his armpit.

He’ll need it.

Bennett, the veterinarian who owns Equine Services, is about to retrieve an embryo via the back end of the antsy mare. 


Horse Cloning Story COLOR

The Ferocious Insectivore!

93-million-year-old mammal

An insectivore from South America

The charming little guys in the illustration above are the new best clue to what went on in mammalian evolution in the southern continents from 130 million years ago to 60 million years ago. Note what big teeth this insect-eater had. Nobody is sure just what they used those oversized canines for, unless Cretaceous-era insects put up a hell of a fight.

Probably no more than 4- to 6-inches long,  Cronopio dentiacutus  was about the right size to hide from the dinosaurs, the dominant life in the neighborhood. A paper about the discovery of inch-long Cronopio skulls is published in the November 3 edition of Nature. University of Louisville researcher Guillermo W. Rougier, an expert in mammalian evolution, is the lead author.

Rich Cifelli of the University of Oklahoma, who studies early mammals, called the skulls a “Rosetta Stone,” for mammalian evolution in the southern continents.

Ninety-three million years ago, South America was just breaking up from the supercontinent Gondwana, the land mass that included Africa, India, Australia and Antarctica. During Cronopio’s lifetime, Earth was a toasty place, with no polar ice caps. Although the continents were south of where they sit today, and Africa and South America were separated by an ocean no bigger than the Mediterranean Sea, the land was tropical.

The paper’s second author, Sebastian Apesteguia, discovered the Cronopio skulls embedded in rock in 2006. While the Argentine scientists worked to remove the skulls from the surrounding material, Rougier waited to see what emerged. An expert in mammalian evolution, Rougier has conducted field work  in China, Mongolia, Japan, and elsewhere.  When he saw photos of what was emerging in the Argentine laboratory, he was stunned.

“I could not believe those canines! I mean these are really large canines. I asked, ‘Are you sure they’re not falling out?’… I was dying to go down there and I flew away as soon as I could.”

The animals had long, tubular, pointy snouts and the triangular teeth of an insectivore — nothing too surprising there. But the big canines, about one-fifth the length of the head, have no precedent in a skull with this shape, Rougier says. “It’s a model for which we have no living representatives.”

Rougier, who will be 47 on November 4,  came to U of L in 1998 from the American Museum of Natural History in New York City. He grew up in Buenos Aires and dreamed of being a paleontologist since he was 7. Although his primary focus is on mammals, he has researched the origin of turtles, work featured on the cover of Science in 1996. His work on the origin of marsupials was on the cover of Nature in 1998.

Rougier said the skulls are only a single data point in the long history of mammalian evolution.

“We broke a 60 million year hiatus, because we have one mammal, but that is ridiculous,” he says. “I cannot begin to think we have a realistic view of the diversity of mammals.”

In pursuit of that picture, Rougier will return to Argentina early next year.

Fixing Broken Hearts: Louisville Magazine 8.2011

Louisville researchers are using stem cells found in the heart to treat devastating heart failure.  While patients improve after stem cell transplant, no one really knows why. I wrote this story for the August 2011 edition of Louisville Magazine.

No alarm sounds but Dr. Roberto Bolli is awake. Again.

He’d slept fitfully, waking often to fret about the coming day, the thousand things that could go wrong, every possible misstep. Now, at 6 a.m., there was no point staying in bed. By 8, the cardiologist is in the bone marrow transplant laboratory at the James Graham Brown Cancer Center watching the research team prepare precious stem cells. The cells, coddled and multiplied for four months, will now, with a bit of luck, save a life.

Across the street in Jewish Hospital, doctors prepare Mike Jones to receive those cells. Jones, 66, a painting and remodeling contractor, will be awake during the procedure.

It’s good to be awake when you’re making history.

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