Bald made beautiful!
By Dr Gurinderjit Singh
Bald men are so obsessed with their condition that they fear the gaze of others and even their own gaze. Many bald men avoid mirrors. The cosmetic effect of baldness is far from negligible. A man always looks more handsome and younger with his hair than without it. Even in ageing, the hair retains its importance. Grey hair has its charm; it shows experience. When it is abundant and thick as well, it is readily compared to the mane of an old lion.

Light on night blindness
By Dr P.S. Sandhu
Night blindness is not uncommon in our vast population. One needs a careful understanding of its causes so that, if treatable, it is treated at the earliest and, if controllable, it is be adequately controlled. Night vision is a function of small cells in the retina called rods, also known as photoreceptors.

From the frontiers of health and fitness
Vitamins may prevent atherosclerosis
By James Gaffney
Researchers at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School are studying antioxidant vitamins to determine if they can help prevent atherosclerosis. Atherosclerosis is the development of fatty plaques on the inner walls of arteries, which can eventually obstruct blood flow. The condition can lead to a heart attack.

Fooling and killing HIV
French researchers using genetic therapy have succeeded in preventing the virus that causes AIDS from attacking a target cell, the American magazine "AIDS" reports in its latest issue.

Bald made beautiful!
By Dr Gurinderjit Singh

Bald men are so obsessed with their condition that they fear the gaze of others and even their own gaze. Many bald men avoid mirrors. The cosmetic effect of baldness is far from negligible. A man always looks more handsome and younger with his hair than without it. Even in ageing, the hair retains its importance. Grey hair has its charm; it shows experience. When it is abundant and thick as well, it is readily compared to the mane of an old lion.

Many patients come to consult the dermatologist simply because the hair is a little sparse. This is manifested sometimes by simple frontal recession or just a decrease in frontal hair density without any change in the anterior frontal line. Contact and discussion with bald men makes one compare male baldness with the absence of breasts in women. Their attitude, motivation and postoperative reactions are similar. A woman without breasts often feels not as "a real woman" and is not very demanding as to the results of a corrective operation. When the implanted prostheses are too firm, she prefers to keep them rather than ask for their removal.

The motivation in a bald man is such that he accepts procedures that are sometimes painful, unpleasant and repetitive and he is not very particular about the quality of the end-result. Such a motivation cannot be entirely explained by the effect produced on the opposite sex. Women are not averse to bald men or at least pretend not to be, but men definitely don't run after flat-chested women.

The first publication concerning the treatment of baldness is an Egyptian manuscript from the eighteenth dynasty (1580BC). The author recommends a mixture composed of equal parts of the fat of the lion, hippopotamus, crocodile, snake and ibex. These magic formulae may remind us of the placental extracts and fresh cells of today. But the fact is that, while the bald have failed to accept their fate and certain current treatments do for some time normalise hair loss, the only visible and durable results are those obtained by surgery. The ratio between the bald and hairy areas is of vital importance and when this ratio exceeds 1:2, baldness is no longer amenable to surgery. But a new development that will eliminate the problem of the donor-recipient area ratios and produce an unlimited supply of donor hair involves "cloning" — not a true cloning technique, but rather cell therapy.

The way this would be done is by removing a small piece of donor skin containing hair and remove the stem cells from the hair follicles, grow them in the culture medium and re-inject them into the same person and grow hair. This method, which can produce millions of hair is being done successfully in mice and rats. The laxity of the scalp is the second essential prognostic factor. The covering power of the hair is the third important prognostic factor and depends on hair density, which in them depends upon hair thickness and the number of hair.

Transplantation: The technique of grafting has developed towards miniaturisation, going as far as micrografts, which have abolished the "doll's hair" aspect, so prejudicial to such treatment. According to the number of the hair contained in each graft, the grafts are termed as micrografts, minigrafts and conventional grafts.

Micrografts contain one or two pieces of hair each, minigrafts have three to five pieces and conventional grafts are with six to twenty-five. For most hair-transplant patients, combination grafts, including micro and minigrafts, represent the ideal approach. Micrograft transplanting is ideal for the hairline zone because that site may have relatively low hair density but should contain the most natural as well as even distribution of hair. But this is not ideal for the entire scalp because one can't get as good a hair density with micrografts as with combination grafts, unless at the same time mircografts are crowded so close together than the hair survival is affected. The newer techniques make it possible to operate in areas that still have hair without injury — any of the remaining hair. That is why more and more women suffering from androgenetic alopecia are coming forward and getting the benefit of hair transplantation.

Another reason for getting better results with hair transplantation at present is that a very efficient method of harvesting hair has been evolved. Only one or two very fine scars are produced. This is in contrast to the multiple rows of scars that were produced by previous methods, which required leaving behind a lot of hair to cover the scars. The factors that influence how well a graft takes relating the operator are the size of the grafts (the smaller the graft, the greater is its chances of survival) and the manipulation of the grafts (not to crush the follicles and not to let them dry out).

Other factors, which relate to the patient is graft survival are vascularisation of the receptor site and the postoperative management. Microsepsis, which destroys the follicles must always be prevented. Rather than taking antibiotics, patients should undergo frequent and early shampooing (48 hours).

Synthetic hair: Various procedures for the implantation of synthetic hair have been suggested for androgenic or even cicatricial baldness. Whatever the artificial hair chosen and however well tolerated, it is inevitably rejected after a variable short period. Nido Japanese fibres and implantation needles are used. The fibre is made of polyethylene teraphthalate 3 and is 0.09 mm in diameter, with an alpha-type loop at its end to allow retention. The fibre is implanted on the galea after traversing the epidermis, dermis and hypodermis with a special 0.23-mm needle. The implantation of Nido synthetic hair must adhere to very strict criteria with regard to the choice of patients.

On the one hand there should be absence of major seborrhoea, dandruff and pruritus and on the other hand there should be adequate laxity and tenkness of the scalp. The patient should be informed about the absolute necessity for daily care of the scalp with specific lotions and shampoos. This capillary hygiene should make it possible to avoid or attenuate the development of parakeratotic and pruritic states, follicular seborrhoeic deposits, scar pits or extrusion of synthetic hair.

Folliculitis is treated by local and systematic antibiotics similar to those advised for acne. For recurrent folliculitis, the synthetic hair responsible is removed with forceps, grasping it near the site of its emergence. The patient should never wear a compressive head covering such as a hat, a bathing cap, a wig etc, in order to avoid tugging and breakage of the shafts of the synthetic hair and thus the formation of foreign body granulomas.

(To be concluded)

The author is the Head of the Department of Dermatovenereo-logy and Hair Transplantation at the Mohan Dai Oswal Cancer Treatment and Research Foundation, Ludhiana.

Light on night blindness
By Dr P.S. Sandhu

Night blindness is not uncommon in our vast population. One needs a careful understanding of its causes so that, if treatable, it is treated at the earliest and, if controllable, it is be adequately controlled. Night vision is a function of small cells in the retina called rods, also known as photoreceptors.

Broadly speaking, night blindness can be either nutritional — vitamin A deficiency, or a familial degenerative disease known as retinitis pigmentosa. The less common causes are high myopia (nearsightedness) and advanced cases of glaucoma. The opposite of night blindness is day blindness which is caused by the advancing central cataract; people feel better at night in this situation.

Let us understand nutritional vitamin A night blindness. It is still the leading cause of childhood blindness. Approximately, three million children develop vitamin A

deficiency annually and three lakh of them become blind. A combination of strategies is required for the sustainable control and elimination of the vitamin A deficiency. A revised schedule of vitamin A intake is as follows: The first dose of one lakh international units should be given at nine months of age. The second dose of two lakh international units should be administered at 18 months of age. The third dose of two lakh international units should be given at the age of two years.

The second cause of night blindness is retinitis pigmentosa, a degenerative condition, which is inheritedly determined and difficult to treat. This disease usually starts manifesting itself in the second decade of life, between 12-20 years. A good thing here is that patients do not go blind until late in life.

A severe loss of vision is caused by the associated retinal disease of glaucoma for which treatment should be taken. These cases develop cataract early but they tolerate cataract surgery very well.

As the central vision is very good in these cases, cataract surgery without an intraocular lens is beneficial because of the magnifying effect of the spectacles which act as a low-vision aid.

There has been a resurgence recently in the role of vitamin A therapy in delaying the progression of retinitis pigmentosa. The timely diagnosis, regular yearly check-ups and the treatment of the associated eye disease, along with reassurance, constitute the mainstay of the management in this disease.

The blanket statement that retinitis pigmentosa patients would not have children is not desirable without knowing the background of inheritance. Most of these patients have simplex inheritance with no family history. Less than 20 per cent of the patients have the autosomal dominant form of inheritance. So, the chances of transmitting the disease to the offspring in general are very limited. Well-informed and reassured patients can plan their career and lead a useful and reasonably good life.

From the frontiers of health and fitness
Vitamins may prevent atherosclerosis
By James Gaffney

Researchers at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School are studying antioxidant vitamins to determine if they can help prevent atherosclerosis. Atherosclerosis is the development of fatty plaques on the inner walls of arteries, which can eventually obstruct blood flow. The condition can lead to a heart attack.

Vitamins E, C and beta carotene have reduced vascular disease in laboratory animals, said Dr. Stephen H. Schneider, Associate Professor of Medicine at the UMDNJ-Robert Wood Johnson Medical School in New Brunswick, who is heading the study.

The research team, which has received funding for the one-year study from the New Jersey affiliate of the American Heart Association, will test the vitamins on 15 persons with mild elevations of triglycerides and cholesterol, which are fatty substances in the blood.

New vascular procedure cuts costs
A new procedure that reduces the length of hospital stays and the costs associated with repairing aneurysms of the aorta, the body’s largest artery, is being tested by vascular surgeons at The University of Texas Southwestern Medical Center at Dallas. Only 15 medical centres in the nation have been selected to participate in a nationwide study to assess the new procedure, which has been performed on a limited basis around the world. UT Southwestern, the only medical centre in the southwestern United States in which further testing of the minimally invasive surgical procedure will be performed, is recruiting patients to be part of the national study, said Dr. G. Patrick Clagett, chief of vascular surgery at UT Southwestern.

The procedure is designed to correct abdominal surgery aortic aneurysms, which occur most frequently in people over age 50 and give no warning signs of their presence, Clagett said.

An aortic aneurysm is a weakening of the wall of the aorta and could be fatal if it goes undetected and ruptures.

In the new procedure, a cloth graft with metal hooks on the top and bottom is guided via a catheter to the aneurysm site and positioned by a small balloon. When inflated, the balloon forces the graft’s hooks to latch on to areas of normal aorta located on either end of the aneurysms. The tube-like graft replaces the weakened part of the aorta, and blood flow to the lower part of the body is then routed through the graft, Clagett said.

Beta-blocker drug power
Scientists believe they have found a promising new use for beta-blocker drugs as treatment for chronic heart failure, according to a report in the American Heart Association journal, “Circulation”. Since they became available in the 1960s, drugs that block a portion of the adrenergic nervous system have been used primarily to slow heart rate and reduce blood pressure.

Beta-blockers get their name from the beta receptors, proteins on the surface of heart cells that control the uptake of nervous system chemicals that help determine the force of a heartbeat and the frequency of beats. By blocking this uptake, the drugs slow certain metabolic processes and have a “calming” effect, thus easing the heart’s workload and lowering blood pressure.

The research is based on two dozen studies in more than 2,300 patients with chronic heart failure, said Dallas researcher, Dr. Eric J. Eichhorn.

“We’ve found that beta-blockers are not just slowing down the rate of progression of heart failure, but actually reversing some of the damage,” he said. “We’ve never had a drug that did that before.” Previous research by Eichhorn and other investigators established that beta-blockers improve the function of the heart by increasing the efficiency of the left ventricle (the main pumping chamber of the heart) and reducing the size of the ventricle.

Sensory loss not part of ageing
The physical senses of taste, smell, hearing, touch and vision actually start to decline at around age 30, but the loss is so minimal that most people should be able to function normally throughout their lives, said Dr. James Mold, family medicine specialist at the University of Oklahoma Health Sciences Center in Oklahoma City.

“It’s only when other factors enter in to compound these losses that problems arise,” he said. “For the most part, if people recognised they were going to live a long time and took care of their bodies — avoiding unnecessary injuries, maintaining good nutrition and exercising, they wouldn’t need to worry about sensory losses, because they aren’t significant.”

Most damage to senses is caused by environmental factors, Mold said, much of which becomes apparent as people enter their 70s.

— Chicagoland Senior News

Let healthy food and exercise come first
Obesity: drug can wait
By Mike Collett-White

The anti-obesity drug sibutramine may help patients sustain weight loss over longer periods than at first thought, but doubts remain over possible side-effects, research results published in the Lancet have shown.Tests found that 77 per cent of 605 patients taking daily doses of sibutramine in conjunction with a dietary programme lost more than 5 per cent of their weight in the first six months. They went on to the second, 18-month phase of the trial.

After voluntary or forced withdrawals, 261 individuals completed the treatment, 204 of them on sibutramine and the remaining 57 taking identical placebo tablets.

"Of the 204 sibutramine-treated individuals who completed the trial, 43 per cent maintained 80 per cent or more of their original weight loss compared with 16 per cent of the 57 individuals in the placebo group", the study concluded.

But its authors cautioned that some in the sibutramine group encountered rising blood pressure and pulse rates.

"The benefits of weight loss associated with sibutramine could be moderated by an increased risk of raised blood pressure", they said.

A growing problem
Sibutramine is sold by Knoll Pharmaceuticals under the name Meridia. Germany's BASF AG <BASF.DE> announced it was selling its Knoll drug unit to Abbott Laboratories <ABT.N> this month.

BASF was named in the Lancet as one of the sponsors of the research. The drug is one of a growing number of treatments on the market for obesity, a condition becoming more and more commonplace in the West.

The International Obesity Task Force in London said obesity rates had nearly tripled in Britain since 1980 to 17 per cent in men and 21 per cent in women from six and eight per cent respectively two decades ago.

Prof Philip James, one of the authors of the report in the Lancet, said there was nothing better than healthy eating and exercise to reduce weight, but added that drugs can help.

"The trouble is that when people put on weight it is not only difficult to permanently change their dietary and exercise habits, but as we get older we do progressively less exercise and have to increasingly control our intake", he told Reuters.

More than half of adult Britons and 61 per cent of adult Americans are obese or overweight.

The conditions are calculated using a body mass index, which is the weight in kilograms divided by the height in metres squared. A person who is five feet nine inches (1.75 metres) tall and weighs 170 lb (76 kg) has a BMI of 25 and is overweight. At 203 lb (92) kg) that person is clinically obese with a BMI of 30.
— Reuters

Fooling and killing HIV

French researchers using genetic therapy have succeeded in preventing the virus that causes AIDS from attacking a target cell, the American magazine "AIDS" reports in its latest issue.

Working with mice genetically modified to enable them to accept injections of human cells, the researchers first injected the mice with genes aimed at preventing the HIV from attaching itself to cells.

One week later, the mice were injected with the HIV itself.

"When the virus that causes AIDS encounters a human cell, it is attracted by precise receptors, the CD4, to which they attach themselves in order to penetrate the cells", explained Dr Kamel Sanhadji, Head of the Laboratory for Immune Deficiencies at the Edouard-Herriot Hospital in the city of Lyon.

"We wanted to limit this process by providing these receptors to the virus, but in a soluble form", Sanhadji said.

Thus fooled, the HIV ultimately dies because it is unable to take control of the cell, he said.

Sanhadji noted that after three weeks, no HIV could be detected in the blood of the mice, even with the most sophisticated means of detection, such as genetic amplification — DPA