The man with a PLASTIC HEART

19 February 2011 , BBC

      Heart disease threatens the lives of millions , but with only limited hearts available for transplant , medical science has long yearned for a definitive fix to repair or replace this most vital organ.
      Troy Golden , a pastor from Oklahoma , was born with a heart that would one day break. A genetic condition known as Marfan's syndrome has been slowly attacking his body tissue since birth including around his heart and valves.
      At the age of 41 , he had to undergo life-saving surgery , replacing valves and reshaping his heart's walls. But his condition continued to worsen. In January 2010 , he was put on the heart transplant list , but time ran out without a donor.
      "Tray's heart was so bad that a traditional heart pump wouldn't be enough" , explains Troy's cardiologist Dr Doug Horstmanshof. "So , we decided to try something different - completely replacing the heart".

artificial-heart

      In September last year , Troy became one of the few people in the US to have his entire heart replaced with a device called the Total Artificial Heart. It's made of plastic and weighs 160 grams and is a little larger than a biological heart. It is powered by a pneumatic pump that you carry around in a rucksack.
      Awe inspiring moment Dr James Long , Troy's surgeon , recalled the moment the heart was implanted into Troy. "It was admittedly rather awe-inspiring" , he says. And it was ominous to look inside the chest and know that the only thing keeping him alive was the synthetic pump that we had just replaced his heart with".
      Troy has had to get used to the non-stop sound of the pneumatic pump. But he looks and feels remarkably well and is overwhelmed by what has been done for him.
      'It's awesome , "he said" to be out of the hospital and to be able to come back home and to be able to come back to some normal life".
"You can't even just really comprehend taking your heart out , you know , without a heart you're not alive".
      The Total Artificial Heart has done more than buy Troy some time. It has given him his life back and it has given him hope. But this is not a permanent solution.His heart's batteries must be constantly charged , spares must stand at the ready. the risk of infection and clotting add to the constant worry.
      Medical challenge for now Troy must again endure the long long wait for a donor heart , but there are other solution on the horizon. New avenues of research are focusing on efforts to assist , rather than replace the heart.
      Increasingly , in patients suffering from heart failure ,  miniaturised pumps are being used to assist heart function. They are about the size of a cigar and are essentially plugged into the main pumping chamber of the heart to help it along.
      Unlike Troy's artificial heart , they can be left in place indefinitely. But perhaps more remarkable is the fact that these pumps can sometime be removed , once a damaged heart has recovered.
      And it is the potential for hearts to actually recover , after having been damaged , that is being investigated in some or the most exciting research going on today.
      Much interest centres on stem cells because they are the closet natural thing to the body's spare parts and under the right conditions , they have the potential to transform into a huge number of different call types with specialised functions. Because of this , they can take part in the process of renewal - replacing diseased and damaged tissues.
      Preliminary results are highly controversial , but there is a growing body of evidence that suggests we may in the future be able to harness the heart's potential regenerative capacity for future therapies.
      Growing new hearts more radically , Dr Doris Taylor , of the University of Minnesota , has been using stem cells to actually build new hearts in the laboratory.
      She has achieved this with a rat heart by stripping it of its cells , then re-populating the resulting perfectly heart-shaped scaffold with stem cells , which adapt into heart tissue , so that in time the heart begins to beat again.
      "... the thought would be that we would take a heart , probably from a pig .. wash all the cells out and then take your cells and grow enough of them to .. build a heart that matches your body and have it transplanted into you. That's the home run" , says Dr Taylor.
      If the clinical application can be made to work , it is a revolutionary if relatively distant possibility.
      For Troy and the millions of people like him for whom heart failure is a reality , this work is of vital importance.
      There is the very real possibility here that , within our lifetimes , scientists might finally find the cure they're looking for.
      While their search for that magic bullet remedy is far from at an end , each new discovery brings them another step closer.
 

Arthritis : A degenerative condition

by Dr Jayateerth W Kulkarni

      Arthritis is a degenerative condition causing wear of the articulating surface , resulting in pain at rest , pain with movements , restriction of movements and in severe cases , deformity.

Arthritis and its types
      The most common type is osteoarthritis , which is wear and tear associated with ageing.
      It can be accelerated or aggravated or even caused by trauma , excess body weight , obesity , mal-alignment of the joints or congenital joint deformities (dysplasia).
      The other common type of arthritis is called rheumatoid arthritis. In this disease , the immune system of the body reacts against the joints and musculoskeletal tissues. This causes inflammation of joints and leads to wear and tear.
      The other types of inflammatory arthritis are : aukylosing spondylarthropathy , Lyme disease , gouty arthritis , arthritis associated with connective tissue disease , psoriasis , inflammatory bowel disease , etc..

Can arthritis be stopped or reversed ?
      Once wear and tear has been established , arthritis progress relentlessly.
      There is no way to stop or reverse arthritis. Certain factors like weight reduction , activity modification , correcting mal-alignment , control of inflammation by anti-inflammatory or disease modifying anti-rheumatic drugs etc. may control wear and tear , but cannot reverse it.
      Certain nutritional supplements like chondroitin sulphate and glucosamine and other medication like methyl-sulphonul methane , esterified fatty acids and diacerin have been shown to have some beneficial effect on arthritis , but can not completely cure arthritis or reverse the wear and tear process. These are beneficial in early stages of arthritis and need to be taken for 3-12 months. They are not beneficial in advanced arthritis and neither have they any role in inflammatory arhritis.
      currently , tissue culture and genetic engineering are being applied to find a cure for arthritis , but till date , there is no universally successful technique that has effective clinical applicability. Dr Jayateerth W Kulkarni is Senior Consultant Orthopedic Surgeon , Apollo Hospital , Bangalore.

Breast cancer calls outsmart the immune system and thrive

      Scientists have discovered a new way breast cancer cells dodge the immune system and promote tumor growth , providing a fresh treatment target in the fight against the disease. While comparable mechanisms to avoid the immune system have been identified in mice with breast and and other cancers , the study tested human breast tumor calls , putting researchers closer to understanding how the disease progresses in real patients.
      The study , published in the journal Cancer Research , found high levels of the protein Hsp27 (heat shock protein 27) are released from human breast cancer cells and may not only render immune cells unresponsive to the tumor , but increase blood flow to the tumor as well , both of which fuel tumor growth.
      "Our study is very unique because we used human breast cancer cells , which are extremely difficult to get" , said Asit De , lead author and research associate professor in the Department of Surgery at the University of Rochester Medical Center , who worked closely with physicians at the Wilmot Cancer Center. "The way tumor cells operate in mice is not identical to humans , so we need to do more of these types of human studies to confirm or reject cancer-related discoveries in mice".
      Past research reports Hsp27 is present in high levels inside breast tumor cells and is associated with resistance to chemo and radiation therapy. De and his team discovered Hsp27 is also released or pushed out of breast tumor cells , into the area surrounding the tumor , known as the breast tumor microenvironment.

 Transform

      Once outside the cells , Hsp27 may transform circulating white blood cells called monocytes that enter the tumor into cells known as macrophages , which do the opposite of what they are mean to do.
      Usually , macrophages work to wipe out tumor cells , but in this case they help , rather than hurt , tumor cells.
      These particular macrophages may make human T cells - the main immune calls that attack and kill foreign invaders , like tumors - totally indifferent to the tumor and the body,s call to destroy it.
      In addition to suppressing the immune response to the tumor , these macrophages encourage rapid formation of extra blood vessels that can help in supplying blood to the tumor - a process known as angiogenesis - essentially feeding the tumor so it can continue to grow.
      Elevated levels of Hsp27 have been found in the blood of cancer patients with other solid tumors , such as liver and pancreatic cancer tumors , leading study authors to believe the protein may play a role in tumor progression beyond breast cancer.
      "Our finding that Hsp27 aids tumor progression is just the start - we know there are several other molecules that help breast tumor cells suppress the immune system and we hope to identify more of them in future research" , noted De.
     
Discovered

      A new way to kill cancer - scientists have discovered a way to kill cancer cells. Hsp27 is a ubiquitous protein that is important in all the body's cells.
      When it remains inside cells at normal levels it acts as a chaperone , protecting cells from stress  , such as exposure to high heat or chemicals.
      Only when the protein is let loose outside cells does it appear to have a detrimental effect on the immune system.
      To carry out the study , De worked closely with clinician in surgical oncology and plastic surgery at the medical Center to obtain and analyze tumor-containing breast tissue samples from breast cancer patients undergoing surgery and normal breast tissue samples from healthy volunteers undergoing breast reduction. He also collected and tested blood samples from untreated breast cancer patients and age-matched healthy women.
      Besides skin cancer , breast cancer in the most commonly diagnose cancer among women in the United States.
       It is also the second leading cause of cancer-related death in American women , behind lung cancer.
      The development of treatment strategies that stop a tumor's ability to silence or circumvent the immune system require a better understanding of tumors' various avoidance mechanisms , such as the one identified by De.
     De plans to continue research on Hsp27 in breast cancer , studying whether blocking Hsp27 slows tumor growth.

Intrmittent drug treatment can curb Malaria

      WHO estimates that about six billion dollars a year are needed to wipe out malaria.
      The intermittent use of preventive antimalarial drugs can be beneficial in curbing the spread of the disease in children , according to the results of a study released Tuesday.
      Trials conducted in Mali and Burkina Faso showed that this type of treatment during the malaria transmission season could reduce infection rates y between 70 and 85 percent.
      The two randomized controlled trials each involved more than 3,000 children who were treated with intermittently with the antimalarial drugs sulphadoxine pyrimethamine and amodiaquine.
      The treatment "provided substantial additional protection against episodes of clinical malaria , severe malaria and all cause hospital admissions" , said the study reported in the public Library of science journal.

 
      The drug treatment "adds the benefit of sleeping under bednets" the report said adding that "that this public health intervention is best delivered by community-based , volunteer village health workers".
      The authors of the Burkina Faso study wrote that the results offer "strong evidence to support the integration of (intermittent preventive treatment for children) into malaria control strategies in areas of seasonal malaria transmission'.
      The authors of the study in Mali arrived at a similar conclusion , saying : "These findings indicate that (the drugs) could make a valuable contribution to malaria control in areas of seasonal malaria transmission alongside other interventions".

      The research was led by Diadier Diallo from the London School of Hygiene & Tropical Medicine ; Amadou Konate from the center National de Recherche et de Formation sur le paludisme in Ouagadougou ; and Alassane Diko from the Malaria Research and Training Center in Mali.
      A third study in Gambia , also noted in the journal , indicated administering the drugs by comminity-based , volunteer village health workers was more effective and less costly than delivery by reproductive and child health teams run by the Ministry of health.
      The disease killed an estimated 781,000 people in 2009 - including about 650,000 children aged under five - but that figure has been reduced from 985,000 in 2000 , the World Health organization said recently.
      International spending in the war on malaria is predicted to peak at 1.8 billion dollars in 2010 , but WHO estimates that about six billion dollars a year is needed to wipe out the disease.

Parkinon's disease

Researchers develop new , working mammalian model to combat genetic causes of Parkinsons

      Evidence is steadily mounting that genetic factors play an important role in many cases of Parkinson's Disease (PD). In a study published February 2 , 2011 , online in the journal of Neuroscience , researchers from the Ecole poly-technique Federale de Lausanne (EPFL) in Switzerland report a new mammalian model for studying a specific gene mutation commonly found in PD sufferers , opening the door to new drugs to fight the malady.

      "This is a great step forward toward a more comprehensive understanding of how the disease works , and how it can be diagnosed and treated" , explains neuroscientist and EPFL President Patrick Aebischer , lead author of the study.
      PD is a common neurodegenerative disease that greatly reduces quality of life and costs the United States around 23 billion dollars a year.
      Until now , researchers have encountered difficulty in reproducing PD pathology in animals because of an incomplete understanding of the disease.
      Recently , a mutation of the gene coding for LRRK2 , a large enzyme in the brain , has emerged as the most prevalent genetic cause of  PD (genetics are implicated in about 10 percent of all PD cases). When the enzyme is mutated , it becomes hyperactive , causing the death of vulnerable neurons and leading to a reduction in levels of the brain neurotransmistter dopamine. This decrease in dopamine eventually triggers the symptoms characteristic of Parkinsons , such as tremors , instability , impaired movement and later stage dementia.

      Now , with funding from the Micheal J. Fox Foundation for Parkinson's Research , Aebischer and his team in the Neurodegenerative Studies Laboratory at EPFL , have successfully introduced mutant LRRK2 enzyme into one hemisphere of a rat brain , resulting in the same PD manifestation that occur in humans in one side of the rodent,s body.
      To do this , the researchers spent two years producing and optimizing a viral vector to deliver mutated , LRRK2 coding DNA into the rat brain.
      LRRK2 is a large and complicated enzyme and designing a vector capable of transporting its extremely long genetic code was no small feat.

      The new animal model developed by EPFL is sure to benefit future Parkinson's research. The fact that LRRK2 is an enzyme - a cat - alyzing protein involved in chemical reactions - makes it drug accessible and there fore of specific interest to researches looking for neuroprotective strategies or pharmaceutical treatments that halt or slow disease progression by protecting vulnerable neurons. Armed with the LRRK2 model , new pharmaceuticals that inhibit the hyper-activity of the enzyme could one day prevent the destructive chain of events that leads to neurodegeneration and devastation in many with PD.

 

Fever fits

    Common condition in young children

By Nilma Dole

      Parents should be cautious and mindful when their children have fever fits because not all are related to epilepsy. More often than not , we tend to worry about it confusing it with epileptic fits but for any problem , a medical consultation is vital to determine what exactly is the cause. President of the college of paediatricians , Dr.Deepthi Smarage spoke about a particular type of fainting attack called fever fits.
      Q : What are febrile convulsions (fever fits) ?
      A : Febrile convulsions (also called fever fits , fits with fever or febrile seizures) is common condition in children , in the age group of six months to six years. They occur in 3-4%of all children.
           The child loses consciousness briefly and may develop jerky movements coupled with a bout of fever.
           This is not a prolonged fever because it is nothing to worry about but parents should ensure that the child is safe and not in harm's way.
      Q : Do fever fits need prompt treatment if there are repeated fits ?
      A : No. Since it is an age-related condition , it will pass when the child becomes older , after six years.
            Long-term medications have their own side effects because it can be harmful later on in the individual's life. As febrile convulsions are self-limiting , ensure that the child is in a safe environment when such a fit occurs.
      Q : In what way can parents or the guardians help the child when a fit occurs ?
      A : Unwanted manoeuvres during the time of the fit can endanger the child's health and will have dramatic consequences. This can lead to chocking and difficulty in breathing so parents/guardians should be educated on what to do. The important thing is not to panic and bring the child to a position lying down (horizontal) in a foetal position.
            No external substances should be administered by mouth during the time of the fit as it can have a dangerous impact. If the fit doesn't subside after about five minutes , the child should be taken to the doctor immediately.
      Q : Is there a particular drug which the parents/guardian can administer at home ?
      A : Yes , if the fit doesn't resolve spontaneously within five minutes , the parent/guardian can administer a medicine called diazepam which is given through a vial through the rectum.
            The child should be kept under observation and consult the doctor on a fre-quent basis.
      Q : Do febrile convulsions develop into epilepsy later in life ?
      A : This is very rare but if febrile convulsions prolong for more than 20minutes then the chances of developing epilepsy can be more.
            Even though febrile seizures are quite benign , every episode should be fully evaluated by a doctor. A child may have had three febrile seizures from which they recovered quickly and easily , but the fourth episode of convulsions and fever may be a serious illness , not febrile seizures. So it really depends from each child as it can trigger different reactions in children.
      Q : Do children with febrile convulsions need EEG (Electroencephalography) and CT (Computed axial Tomography) scans ?
      A : Not at all. If the diagnosis of febrile convulsions are very clear these investigations are not really necessary.
            Best is to talk to a doctor first before doing any sort of investigations.
      Q : Do febrile convulsions affect the development of the child ?
      A : No. A child will develop normally and achieve their full potential even if they have had febrile convulsions when they were small

Mano Roga or Ayurveda Psychiatry

OCTOBER 10 -   WORLD MENTAL HEALTH DAY

By Ayur. Psychiatrist
  Dr.Saman S.Hettige

      Mental illnesses are increasing day by day. According to the WHO there are 450 million phychiatric patients around the world.
      Mano Roga is classified into twenty two psy-chopathologies. It emphasizes how important the biological predisposition is to amalgamate with the environmental factors to develop psychiatric disease in human beings. This system is still being practiced in its original form at Manasa Hospital Boralesgamuwa (Sri Lanka) , Neelammahara by generations of traditional psychiatrists , which is endemic to them.
      Ayurvedic medicine is a system of traditional medicine native to the Indian sub continent and practiced in other parts of the world as a form of alternative therapy.
      Ayurveda remains an influential system of medicine in South Asia. The earliest literature on Indian medical practice appeared during the Vedic Period in India.Over the following centuries , Ayurvedic practitioners developed a number of medicinal preparations and surgical procedures for the treatment of various ailments and diseases and the first plastic surgery was done by Ayurvedic surgeon Susrutha 3500 ago and the blood circulation was exactly described in earliest ayurveda literature exactly as William Harvey described in 17th century.
      According to Ayurveda , "Nidrava" or sleep factor plays a vital role in one's mental health. One needs to have a sound sleep for at least 7 to 8 hours a day for the well-being of one's mental heath. It is stressed that breaking rest at night and sleeping during the day time are factors detrimental to the well-being of one's mental heath.
      The food we consume has an impact on our Mano dhosa and Kaika dhosa (Mental and physical heath). If consuming harmful food influences the mano Dhosa , it can effect the kaika dhosa and Manasika dhosa as well as in the end cause the malfunction of the brain.


Treatment
      This also indicates that physical conditions also effect the psycological state of and individual and vice versa. In Sankaya dharshanaya this bond is known as "Samavai Sambandathavaya" if broken there will be losses in the bond between the body and mind. Environment plays a vital role in one's mental health. If the individual id frequently exposed to stress induced environment or if a person is addicted to substance such as alcohol , heroin or even betel leaves they are vulnerable to mental illness. hereditary factor is also mentioned in the classical text as Nija Roga.
      In ayurveda the treatments are mainly divided into three. Ukththi Viyapashra (Rational therapy) , Daivap Viyapashra (Spiritual therapy) and Sathvawviyapashra (Phycological theraphy).
      Treatments are conducted according to the severity of the individual's condition.
      If the patients are aggressive , hostile and if the treatment cannot be conducted at home , we admit them to hospital for indoor treatments.For patients who are aggresive and hostile , special treatments such as Nasna (Nasal draining) , Hisagalvum (head packs) , Werechana (Purgatives) and Sheerodara are administered. If their condition is critical , counseling would have no effect. Therefore we are using these special methods to sedate the aggressive patients in the initial stage.
      October 10 is World Mental Heath Day. Boralesgamuwa Neelammahara Manasa Ayurveda Hospital the first ayurvedic mental hospital in Sri Lanka would be conducting a mental health campaign at the hospital the hospital premises today from 10a.m to 4p.m to raise public awareness about mental health issues. We want to make people aware of three conditions.
      Most often patients' guardians fail to recognize these conditions. And bring them to us only after the situation becomes worse. Once the disease becomes Nidangatha or chronic , it is very difficult to handle than during acute phase.