When you go to meet your doctor
by Dr J.D. Wig
The practice of medicine has become more patient-centred due in part of increasing respect for patient autonomy and the belief that medical care should be responsive to patient’s preference and needs. It is important to be prepared when you go to meet the doctor. How best to use your time when you go to see a doctor. You need to be patient when the physician is detained by an emergency or in a busy outpatient clinic.

Causes of anxiety disorders
Dr N.N. Wig
Why do we get anxiety symptoms? While the exact cause is still not fully known, it seems to be a combination of many factors like hereditary tendency, early childhood upbringing, the current life situation, etc. In plain terms, to use an analogy, in some people their "brain wiring" is such that they very quickly respond to a threat, real or imaginary. Their nervous system is rapidly aroused in a state of heightened alertness and their body starts preparing to face a threatening situation even when the danger is very mild or not at all.

Molecules behind cystic fibrosis
Washington:  Scientists at Cincinnati Children's Hospital Medical Center have identified a missing piece of the puzzle of how lung damage occurs in cystic fibrosis (CF).

Cells to revolutionise cancer, HIV therapies
Washington: Canadian scientists have found a way to grow a plentiful supply of disease-fighting cells that might one day boost therapy for cancer and HIV.

New device to help asthmatics
LONDON: Asthmatics living in polluted cities could finally get a breath of fresh air through a gadget called Purebreathe developed by a British sports scientist, Alison McConell.Around 5.1 million people in the United Kingdom suffer from asthma and numbers are on the increase.

Fructose may lead to obesity
Washington, March 27
Fructose, the sweetener used in soft drinks, baked goods and juice drinks, might be the key factor for the increase in obesity across the United States, scientists said.

Stem cells do not turn into  heart cells
Washington: There is no evidence to suggest that hematopoietic stem cells, which usually produce blood cells, can turn into heart cells after injection into the heart.

When you go to meet your doctor
by Dr J.D. Wig

The practice of medicine has become more patient-centred due in part of increasing respect for patient autonomy and the belief that medical care should be responsive to patient’s preference and needs. It is important to be prepared when you go to meet the doctor. How best to use your time when you go to see a doctor. You need to be patient when the physician is detained by an emergency or in a busy outpatient clinic.

Always make a note of questions or concern you might have so that you do not miss anything you would like to find out. You may have a problem that is embarrassing or difficult to talk about. Do not hesitate to talk about it. Making a list of all the important questions helps to ensure that none are forgotten. When you get answers, you feel more relaxed and more satisfied. Do not engage your doctor in idle conversation. Emphasize on the most important complaint. This will help your doctor to focus on what matters most to you. You should be careful indeed of what you say.

If you are going for a problem where you might need to remove your clothes, wear loose clothing to make the examination easier.

It is important to give detailed information about the medicines including Ayurvedic medicine and the reasons for taking them any previous operation, and allergy to any drugs.

Both you and your doctor are responsible for your care. By making your best effort to communicate in an orderly and effective manner, you become an active partner in your own health. If you do not understand something, ask the doctor again. Your questions will help the doctor to do a better job. A high quality history will lead to a more focused, directed, effective, quick and the less costly evaluation by laboratory based testing. Patients who ask questions are able to change the focus of the consultation and control the duration and time of information provided.

Patients vary in the amount of information they wish to be given, or consider relevant. The doctor needs to concentrate on the questions that really matter to the patients. Patients many benefit from physician’s efforts to identify patients preferences for participation in decision making and tailor the decision making process to these preferences. Patients may request an indepth information about their proposed treatment, the risk involved and any alternatives.

Patients who are more active participants in their care may have better health outcomes. However, majority prefers a passive role. The patient wants to be aware of the possible risks of the proposed treatment as well as the expected benefits. Patients are giving increasing importance to the communicatin of risk information. However, only the common risks need to be disclosed with the rare more serious complications being disclosed on request. You must realise that a doctor may reasonably withhold information about the risks if it deemed that such a disclosure would be contrary to the patients’ best interests, could cause serious harm to the patient’s health, or could deter you from a therapeutic procedure considered essential. Doctors do not want to frighten you.

Your consent to the procedures is crucial. An Australian court has ruled that consent for treatment must be based on the wishes of the reasonable patient rather than on the decision of a reasonable doctor. Discussing alternatives is an essential element for informed decision making. Information disclosure reassures you and alleviates anxiety. You may wish to avoid regret and self blame for negative consequences associated with a poor decision.

You may lack the confidence to assets your needs during the consultation and may worry about annoying your doctor or appearing to question his authority. Doctors always give opportunities to voice your concerns. Do not leave the doctors’ clinic feeling that you do not understand your problem and the treatment plan. You may be unable or unwilling to express your desired role. A doctor may be a poor judge of your preferences. Time constraints may hinder the establishment of adequate rapport between you and the doctor.

By making your best effort to communicate in an orderly and effective manner you become an active partner in your own health. Selection and interpretation of sophisticated tests is possible with the information obtained from the history. Doctors ensure that you understand the information provided and also understand your preferences for participating in decision process. Communication from you to doctor, and doctor to you is the key to a successful consultation and informed decision-making and is the best way to achieve the whole management when you are unwell. You must understand the benefits, risks, alternatives and what would happen if nothing is done to alleviate your suffering.

The doctor must be aware that the patient listens and hears what is said. The words give these patients the strength to embark on a successful recovery. Doctor-patient communication needs to be tailored to the needs and preferences of individual patients. After meeting the doctor, you should have the feeling that the doctor cared for, understood, gave you enough time to explore your concerns, and that you were listened to.

The writer is Professor and Head, Department of General Surgery, PGI, Chandigarh.

Causes of anxiety disorders
Dr N.N. Wig

Why do we get anxiety symptoms? While the exact cause is still not fully known, it seems to be a combination of many factors like hereditary tendency, early childhood upbringing, the current life situation, etc. In plain terms, to use an analogy, in some people their "brain wiring" is such that they very quickly respond to a threat, real or imaginary. Their nervous system is rapidly aroused in a state of heightened alertness and their body starts preparing to face a threatening situation even when the danger is very mild or not at all.

For example, it is a common observation that when the examination is near, almost all students get tense. While some take it very lightly, a few of them almost get paralysed by acute anxiety and tension. They lose their sleep, can hardly eat and cannot relax at all. The more they try, the less they are able to concentrate on studies, resulting in a lot of distress for themselves and their parents. So, individual proneness is an important factor in anxiety, disorders. In general anxiety symptoms are more common in women than in men. Daily stress of life is an important contributory factor.

Management & treatment

Most important message for the patient is to understand and to accept that an anxiety disorder, generalised or acute panic, is in no way life-threatening. It does not indicate any serious defect of any bodily organs. Repeated medical investigations are not only wasteful but also add to a patient’s worries. Once a qualified medical doctor has confirmed that the problem is an anxiety disorder, the patient must put a stop to more specialist medical consultations and investigations. Most anxiety disorders are temporary and selflimiting.

To reduce anxiety, a patient must re-organise his or her life to keep more time for relaxation. It can come through better time management at work, and keeping time for relaxation like doing exercise, yoga, meditation, hobbies, etc. Excessive use of alcohol and drugs only adds to the problems.

If the symptoms of anxiety are persisting or very severe and disabling, then help from mental health professionals can be taken. There are a number of psychotherapy methods like behaviour therapy or cognitive therapy which are helpful. Among the medications, most commonly used are the Benzodiazepine group of drugs like Alprazolam and Diazepam. They are temporarily helpful. Their prolonged use make them less effective, and there is always the danger of habit-forming and dependence. Anti-depressant drugs are also often useful in panic episodes. Anti-anxiety or anti-depressant drugs must only be taken as and when advised by a qualified doctor.

The writer is the Emeritus Professor of Psychiatry at the PGI, Chandigarh.

Molecules behind cystic fibrosis

Washington:  Scientists at Cincinnati Children's Hospital Medical Center have identified a missing piece of the puzzle of how lung damage occurs in cystic fibrosis (CF).

CF is a genetic disease affecting approximately 30,000 children and adults in the United States. People with CF have a variety of symptoms, including very salty-tasting skin, persistent coughing, at times with phlegm, wheezing or shortness of breath, an excessive appetite but poor weight gain and greasy, bulky stools.

The median age of survival for a person with CF is in the early 30s. The discovery, published in the current issue of Nature Immunology, provides impetus for the development of novel therapeutics that decreases inflammation in children with CF. The Cincinnati Children's team found a deficiency in the airways of children with CF of a class of molecules called lipoxins, which are key regulators of inflammation.

Christopher Karp, director of Molecular Immunology at Cincinnati Children's and the study's main author said, "When we give analogs of this molecule (lipoxin-like molecules) in mouse models of CF, the molecules do what we'd like them to do — suppress acute inflammation, switch on the chronic inflammatory process and ameliorate disease—suggesting that this class of molecules might have therapeutic potential in CF".Several studies in recent years suggest that the frequent and prolonged airway inflammation in CF lungs leads to the eventual cardio-respiratory failure that is the primary cause of death in people with CF.

"It's traditionally been thought that the basic problem in the CF lung is an inability to clear bacteria, with infection leading secondarily to lung-damaging inflammation. Recent studies suggest it may well be the other way round: abnormally vigorous and prolonged airway inflammation may be a primary problem. Such responses are inefficient at clearing bacteria, may damage the airway in ways that promote colonization with bacteria, and over time lead to airway destruction," said Karp.

Inflammation in the CF airway is acute inflammation dominated by neutrophils, which are white blood cells that serve as a frontline protector against infectious pathogens. "The more we know about the unique cycle of inflammation in CF, the better we are able to develop the appropriate tools to fight it. This study adds to our knowledge about CF and suggests an additional therapeutic direction," said Robert J. Beall, president and CEO of the Cystic Fibrosis Foundation. "If we can reduce the rate at which lung tissue is damaged, we should be able to increase life expectancy and delay, or even eliminate the need for difficult and costly lung transplantation procedures," added Beall. — ANI

Cells to revolutionise cancer, HIV therapies

Washington: Canadian scientists have found a way to grow a plentiful supply of disease-fighting cells that might one day boost therapy for cancer and HIV.

The cells, called T cells, normally patrol the body and swallow up infected or cancerous cells. But chemotherapy or radiotherapy and the HIV virus destroy them, according to a report in Nature.

Now a Canadian team has grown potentially limitless T cells in the laboratory. "We're very excited," says immunologist Juan Carlos Zuniga-Pflucker of the University of Toronto. Researchers have converted mouse and human embryonic stem cells into blood, nerves and muscle. But they did not know how to coax them into making T cells.

Zuniga-Pflucker and his team succeeded by identifying a molecule, called DL1, that is essential in T-cell production. They genetically engineered cells to make DL1, and then grew embryonic stem cells on top of this concoction.

The DL1 stimulated the stem cells to make immature immune cells, the team report said in this week's Nature Immunology1. When implanted into mice lacking an immune system, these in turn made mature T cells, helping the animals fight off a mild viral infection. Zuniga-Pflucker hopes that T-cells grown from human embryonic stem cells might one day be used in cancer and HIV patients whose own supply has been wiped ou — ANI

New device to help asthmatics

LONDON: Asthmatics living in polluted cities could finally get a breath of fresh air through a gadget called Purebreathe developed by a British sports scientist, Alison McConell.Around 5.1 million people in the United Kingdom suffer from asthma and numbers are on the increase.

According to a report in the BBC, McConell produced the device with the help of product designer Johannes Paul from the Royal College of Art.

She says that there are chunks of carbon and lead present in exhaust gases and other environmental pollutants that are harmful for lungs. "Most asthmatics already have a slightly inflamed respiratory system, so breathing in these particles can trigger an exacerbated response, namely an asthma attack," said McConell.

The filter, which has been tested in clinical trials, works like a sieve, using electrostatic fibres to attract and hold particles before they enter the mouth and can trap particles as tiny as bacteria.

McConnell and Paul took the filter, which was created by another company, and married it to a hi-tech design which they claim makes it far superior to the usual pollutant protective masks.

They say that the resistance in standard masks actually makes breathing more difficult, and the material they are made from—neoprene—does not allow the skin to breathe and traps heat and moisture.

On the other hand, Purebreathe is made from low energy recyclable materials, and is designed to be comfortable to wear. — ANI

Fructose may lead to obesity

Washington, March 27
Fructose, the sweetener used in soft drinks, baked goods and juice drinks, might be the key factor for the increase in obesity across the United States, scientists said. Consumption of fructose does not trigger responses in harmones that regulate appetite and energy use and is more likely to be converted into fat, a study conducted by Lousiana-based Pennington Biomedical Research Centre reveals.

“The increased use of high-fructose corn syrup (HFCS) in the US since the mid-1980s mirrors the rapid increase in obesity,” according to the study led by Mr George A. Bray.

“Both clinical and animal studies show that fructose consumption does not make someone feel full, so you want to eat more and drink more,” said Mr Barry M. Popkin, one of the authors of the report which is to be published in the April issue of the American Journal of Clinical Nutrition. — PTI 

Stem cells do not turn into heart cells

Washington: There is no evidence to suggest that hematopoietic stem cells, which usually produce blood cells, can turn into heart cells after injection into the heart.