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| HEALTH TRIBUNE | Wednesday,
December 4, 2002,
Chandigarh, India |
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Advantages of new generation cell therapy Need
for an advanced forensic medicine centre Fighting old age with good nutrition AYURVEDA & YOU INFO
CAPSULE
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Advantages of new generation cell therapy CELL therapy has emerged as a strategy for the treatment of many human diseases. The aim of cell therapy is to supplement, replace, repair or enhance the biological function of absent, inadequate or damaged tissue and organs. This can be achieved by the transplantation of specific cells in sufficient number and quality, for them to survive long enough to restore the needed function. In fact, cellular transfusion therapies began with mature blood cells, first with whole blood transfusion and then evolving to the use of specific cells such as red blood cells, platelets, etc. The second phase of cellular therapies was bone marrow cell transplantation for providing haemopoietic stem cells, which are the parent cells having the capacity for self-renewal and differentiation and are able to supply all blood cells throughout the life of a person. Besides bone marrow, these haemopoietic stem cells (progenitor cells) also circulate in the blood at extremely small numbers but can be mobilised in adequate quantities for therapeutic use following the administration of proliferating agents known as growth factors. Also blood from umbilical cord vessels and placenta following delivery has been found to be a rich source of haemopoietic stem cells which can be collected and stored in appropriate conditions for future use. The diseases being treated with such haemopoietic stem cells include various types of leukaemias, lymphomas, multiple myeloma, aplastic anaemia, thalassaemia, immunodeficiency diseases, inherited metabolic disorders, autoimmune disorders and also various cancers or solid tumours. It is clear now that haemopoietic stem cell transplantation has become the treatment of choice as more than 45,000 transplants of these cells from bone marrow, circulating blood or cord blood are being performed annually worldwide. Continuous developments in this field has dramatically reduced the complications of this procedure, resulting in an excellent quality of life in long-term survivors. However, conventional haemopoietic stem cell transplantation (stem cells from a donor) involves the use of maximally tolerated pre-transplant chemotherapy and /or radiotherapy conditioning regimens (myeloablative) to eradicate the underlying disease. The grafted stem cells then proliferate into normal bone marrow cells and serve to rescue the patient from marrow suppression induced by the pre-transplant treatment. Many of the undesirable consequences of stem cell transplantation are caused directly or indirectly by the intensive conditioning regimen administered during the pre-transplant period. This toxicity has limited the use of haemopoietic stem cell transplantation to younger and more medically fit patients, giving almost negligible choice to the elderly patients. An important advancement in this direction is the introduction of non-myeloablative conditioning or reduced intensity conditioning by immuno-suppression without chemo or radiotherapy or the so-called “mini transplant” approach to prevent stem cell graft rejection. This is possible because the donor lymphocytes, which have powerful cell-reducive potential, get transplanted along with the stem cells and can eradicate the residual haemopoietic cells of the recipient as well as occasionally the tumour cells in the recipient. Clinical studies now suggest that high-dose myeloablative chemotherapy, given as conditioning regimen before the stem cell transplant, could be safely replaced with non-myeloablative conditioning. With this approach, stem cell transplant can be offered even to elderly patients, with no upper age limit and also to patients with poor performance status that normally would not be considered eligible candidates for bone marrow transplantation. For young patients, bone marrow
transplantation can be offered with no risk of impairment of growth and development, sterility and multiple endocrine deficiencies, currently unavoidable with conventional myeloablative procedures. Several other simplification strategies discussed recently in the World Congress of Haemotology and Blood Transfusion held in August, 2002, at Seoul, South Korea, has resulted in cost lowering and the availability of this procedure to a larger number of patients even as an out-patient procedure. These developments are highly relevant specially for developing countries like India. Thus, haemopoietic stem cell transplantation has raised new expectations and opportunities. Further improvements for the efficacy and safety of the procedures need to be developed as obtaining full benefits of stem cell transplantation is a highly promising new area for a large number of incurable diseases. The writer is a Professor of
Haematology at the PGI.
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Need
for an advanced forensic medicine centre DURING
the last 50 years tremendous advancement has been made in the various branches of medicine and surgery. Even in India our specialists are not lagging behind. Cardiac angiography and angioplasty and bypass operations, which a few years back were being performed only in the western countries, are being successfully undertaken by Indian physicians routinely. Tumours of the brain are being removed successfully. In the fields of renal transplant, joint replacement, prostate surgery, laparoscopy, open heart surgery, progress in India, both in the private and public sectors, has been phenomenal. Having worked in Mayo Hospital, Lahore, medical colleges of Amritsar and Rohtak and as a professor of Anatomy and Forensic Medicine in PGI, I can say with confidence that the subject of forensic medicine has, by and large, remained neglected. We still follow the routine of pre-Partition days. Every assistant surgeon is an autopsy or police surgeon even though he has had no practical training in the subject. His bible is Modi’s Medical Jurisprudence written way back in 1920. Although some books written by Indians have appeared in the market, usually they are a plagiarised version of Modi’s. The reasons for the neglect of this branch of medicine are many. To enumerate a few: Our mortuaries particularly in district and tehsil headquarters are old-fashioned. Many of them were constructed more than 50 years back. Some of them do not even have an electric light or water supply. There is no arrangement for storing cadavers which rapidly undergo decomposition in the mortuary, obliterating vital information. Proper instruments, dresses and chemicals are not available. Doctors hesitate to handle decomposing bodies. They depend on class IV employees. The doctor has to write the postmortem report there and then in his own hand. How can he conduct an autopsy and write the report at the same time? If the public wants a proper postmortem examination, the required facilities have got to be provided which include proper instruments, autopsy dresses, chemicals, trained laboratory assistants, a stenographer or a dictophone, an X-ray apparatus and a photographer. The number of postmortems to be conducted in a day can hardly be coped with the existing autopsy surgeons. As a rule, an autopsy surgeon cannot conduct more than a couple of proper postmortems in a day. The same doctor has to appear in the court, sometimes at a long distance from his place of posting. He has to travel by overloaded buses or in his private
vehicles. The High Court had ordered, long time back, that the evidence of the doctors should be taken on a priority basis, but the rule is mostly ignored. Although coming from the PGI, sometimes, I had to wait for long hours before my evidence was recorded. The autopsy surgeon in a district is treated by the court as an ordinary witness. He has to stand in the witness box for hours and bear the onslaught of defence lawyers. The defence lawyer treats him as if he was an accused. I, therefore, do not blame doctors for not coming forward to become autopsy surgeons. Every PCMS/HCMS doctor is considered an autopsy surgeon. People should know that for conducting a medico-legal postmortem, the autopsy surgeon must be properly trained. The public had to consider seriously if there is miscarriage of justice when an autopsy in murder cases is performed by an MBBS doctor. Why should doctors take to this speciality when they can do private practice while in service and after retirement undertake further private practice. Autopsy surgeons can neither practice nor can they undertake it after retirement. They are paid niggardly. A friend of ours, Prof Mirchandani, is the Medical Examiner (Autopsy Surgeon) for the City of Philadelphia and is also a professor of forensic medicine in one of the medical colleges there. He is a highly qualified person. Once I asked him why he had taken to become a medical examiner and why he did not become a physician or surgeon. He told me that his salary was double the salary being paid to the Professor of Surgery or Medicine and was provided with all facilities when appearing in a court. In western countries postmortems are usually accepted by courts without the autopsy surgeon appearing in person. When we have specialists in almost all branches of medicine in district hospitals, why should we not have them in the subject of forensic medicine? It is high time we created a department of forensic medicine headed by a properly qualified police autopsy surgeon/medical examiner. The old routine of conducting medico-legal postmortems should be improved. The PGI can give the lead in this regard. An advanced medico-legal centre of forensic medicine for training specialists in the subject should be established. The writer, an Emeritus Professor, retired as Professor, Anatomy and Forensic Medicine, PGI, Chandigarh.
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Fighting old age with good nutrition LONDON: Many of us hope that our advancing years will enrich our lives with a wealth of experience and a degree of wisdom. However, this romantic notion of ageing can be somewhat tempered by a bleaker reality - increased susceptibility to all manner of undesirable conditions, and a greater chance of us shuffling off this mortal coil. Stories of cigarette-toting centenarians and 40-year-old men who drop dead on squash courts, do tend to give the impression that our health and longevity are pretty much in the lap of the gods. However, experimental work over the last couple of decades has shown that the ageing process is intimately related to what we eat, and has suggested some promising dietary approaches to adding both years to our life and life to our years. Scientific studies suggest that at the heart of the ageing process are destructive molecules called free radicals. By-products of the reactions that generate energy in the body, free radicals can damage the body’s cells, and have been implicated in all the diseases associated with ageing including heart disease, cancer, arthritis, dementia and cataract formation. Free radicals are believed to be a major driving force in the processes that speed ageing and hasten our demise. Because the bulk of free radicals in the body are produced when we burn food to make energy, it has been suggested that the more we eat, the more internal damage and ageing effects we can expect to endure. Animal studies show that restricting calories slows the decline in bodily signs of ageing over time and delays the onset of diseases such as cancer, diabetes and cataract formation. While cutting back on food has been found to extend the life spans of a wide variety of animals including mammals, human studies in this area would obviously be impractical. But all the evidence points to the notion that one way to combat the ageing process might be, quite simply, to eat less. I have to say, I find the idea of going short on food dubious. My experience is that hunger is a common springboard into the consumption of unwholesome foods. However, I’ve also noticed that individuals who start to eat more nutritious foods, generally end up eating less too. By concentrating on the quality of their diet in the first instance, issues of quantity often take care of themselves. Eating a healthy diet seems to give the body all the nourishment it needs without overburdening it with unnecessary calories. Perhaps the most nutritious foods of all are vegetables such as broccoli, spinach, Brussels sprouts, cauliflower, cabbage and asparagus.
The Gurardian
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AYURVEDA & YOU Dr R. Vatsyayan AYURVEDIC texts mention four types of lubricants to be used for therapeutic purposes. These are ghee, oil and the fats derived from animal muscle and the bone marrow. Endowed with the properties to absorb the effects of all herbs and food articles and still not losing its basic qualities, ghee is considered as the best among all these lubricants. Called ghritam and sarpi in Sanskrit, ghee has not only been a part of the Vedic rituals but has also adored the Indian kitchen since ages. Apart from the ghee prepared from the cow and buffalo milk, ayurveda has also described other mammalians, including goat, camel and mare, whose milk and ghee can be used for medication purposes. Sushruta, while elucidating the common qualities of all types of ghee, has written that it is sweet in taste and is “saumya” or cooling and mild in potency. It subdues the deranged vata and pitta. Ghee slightly increases the slimy secretions of the body and also acts as a refurbishing mediator to the body systems. Other authors have described ghee as appetising and promoter of memory, intelligence, complexion, glow and amiability of features. Ayurvedic texts have singled out cow ghee to be the augmenter of seven types of tissues in the body such as assimilatory liquids, blood, flesh, fat, bone, marrow and the reproductive tissues. It has been described as a vitalising and rejuvenating agent and best among all unctuous substances. Ghee is also laxative in nature and proves to be of curative value in a number of diseases such as epilepsy, insanity, chemical poisoning, headache, including migraine, and diseases involving all external orifices of the body. Ghee as a medicine has been used both externally and internally. Actually classic ayurvedic literature, while telling many types of medicines to treat diseases, devotes special attention to “ghrit chikitsa” — treatment with various preparations of ghee. It is also used as a first step of treatment (oleation) in a advanced ayurvedic therapy called panchkarma. In emaciated patients its massage is considered to be highly effective as it nourishes the body at the tissue level and also improves blood circulation. Patients suffering from migraine, chronic sinusitis or allergic respiratory problems respond well if they regularly instill a few drops of lukewarm ghee into their nostrils for a period of 10 to 15 days. There is considerable divergence between ayurvedic and modern viewpoints on the effect of ghee on human body. While after the intake of ghee during panchkarma procedure, patients report fall in the triglyceride level, still in the mind of the general public a lot of confusion and fear prevail about the safe consumption of ghee. Though ayurveda emphasises moderation in taking all food items whether it is ghee or something else, to conclusively explore good and bad effects of ghee on various systems of the body, a joint study by experts of both systems is needed. The writer is a senior ayurvedic consultant based in Ludhiana.
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INFO
CAPSULE LONDON: A new study has revealed that coma may be caused by damage to a particular part of the brain that wakes people up every morning. A great deal is known about the parts of the brain that determines the slumber, but what happens when the brain wants us to wake up is a little more of a mystery. Dr Bidi Evans from King's College Hospital in London has suggested that there is a definite physical "switching on" process in the brain which allows humans to emerge from sleep. According to her, the damage to sleep mechanisms might have a significant role to play in patients who are comatose. Since this process involves many different parts of the brain, damage to any or all of them may rob one of this vital ability. This would mean that the patient might lie comatose because the brain is simply unable to wake itself up. ANI Dozing off while driving
LONDON : A new research in the European Respiratory Journal has revealed that five million drivers across Europe are at extra risk of falling asleep at the wheel because they suffer from a sleep disorder which makes them drowsy during the day. The study by an international team of doctors has found that many people with sleep apnoea do not realise they have the condition and are not receiving the treatment they need. As a result, many continue to drive even though they are up to six times more likely to be involved in a road traffic accident, reports BBC. Sleep apnoea causes sufferers to stop breathing five times each hour while they are asleep. People with the condition can also experience frequent attacks of sleepiness during the day, as well as excessive fatigue and a lack of concentration.
ANI
Benign breast tumours
WASHINGTON: A new American study has revealed that Cryoablation, a treatment that uses extreme cold, provides an alternative to surgery for fibroadenomas, the most common form of benign breast tumour. The study, published in the American Journal of Surgery, said that the procedure can be performed in a doctor's office. Under ultrasound guidance, a small needle is placed into the center of the tumour, where the freezing tip delivers extreme cold to the tumour and destroys it. The patient is given a local anesthetic for the cryoablation treatment and can go back to her normal activities immediately after the procedure.
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