Future medical marvels

by Consultant Paediatrician Dr. A. T. W. Guneratne

Possibilities of several medical marvels coming into the medical world in treating patients with heart, lung, neuro and several other disease are indicated in - 'stem cell research' now undergoing in medical research laboratories in several countries in Asia, China, South Korea and especially Singapore.

Research

Here researchers are trying to use the special ability of stem cells to produce new cells and tissues to repair and re-produce ailing and damaged tissues and organs in the body.

At present damaged or non-functional tissues and organs are replaced by compatible donor tissues and organs e.g. Renal, Liver and Heart implants. In future it may be possible to grow these tissues in the laboratory itself using 'stem cells'.

Rejection prevented

This may prevent the rejection of donor organs by the body in some cases by the recipients. At present rejection of donor organs is one of the biggest problems faced in donor transplants. Stem cell produced tissues are unlikely to pose this problem, thus indicating that the present donor transplantations may become obsolete in the not too distant future.

What are stem cells

When a sperm joins an egg fertilization takes place. The product of this union is the embryo. Stem cells are the cells found in this embryo, which are capable of producing any cell type (pluripotency). In a human there are about 200 such cell types e.g. brain cells, skin cells, red cells, etc.

Adult tissues

Stem cells are also found in adult tissues but in small numbers, E.g. bone marrow, skin, brian, etc. The umbilical cord, which carries nutrients from the mother to the baby also has stem cells.

At present some forms of Leukaemia, Lymphoma sickle cell anaemia, Thalassaemia are being successfully treated using compatible bone marrow transplants using adult stem cells.Thousands of patients who were doomed to die are leading normal lives due to this type of stem cell treatment.

Future possibilities - Pigs

Experimenting with mice and pigs embryo stem cells were made to grow into heart muscle cells and when these were injected to mice and pigs with heart disease, they replaced the dead cells in the heart resulting in the recovery of cardiac function.

Patients

In the future we could expect patients with myocardial infarction and heart failure to be treated with stem cells.

Rats & Patients

Similar results were obtained in rats with spinal cord injuries. It is possible that in the future patients with paralysis following spinal cord injury may be able to walk again.

Diabetes, Arthritis, Alzheimer's & Parkinson's

Research is being done to treat Type I Diabetes and Rheumatoid arthritis patients on similar lines. Also research is being done to treat chronic neuro degenerative diseases like Alzheimer's and Parkinson's diseases using adult brian stem cells.

At present corneal transplants are done using cadavaric transplants which are sometimes rejected by the recipient.

Encouraging results

Stem cell therapy may replace cadavaric corneal transplants in the future.

Encouraging results have been obtained in animal experiments in treating retinal damage using stem cells.

Strict Guidelines

In most countries where this research is done, strict guide lines are laid to prevent the haphazard destruction of embryos. There is a fear that if embryonic stem cell research is allowed to go unchecked there may be embryo producing hospitals, like factories producing goods.

No restriction

There is no restriction of research on adult stem cells. But adult stem cells have so far not shown the potential as embryonic stem cells.

The Promise - New era in medicine

The promise of stem cell treatment is an exciting one and with intensive research in the future a new era in medicine may dawn curing deadly diseases which at present has no treatment and invariably causing death.

Nature's Gift to Mankind

Dr. Subash Chawla

Garlic has been generally referred to as the monarch of herbs. Alfalfa was titled the herbal 'king of kings' by the Arabs. Fenugreek too is a member of the royal family of herbs.

Fenugreek has been widely used in traditional Chinese medicine and traditional Indian medicine - Ayurveda and Siddha. The herb has been duly recognized in the 30 million page electronic encyclopedia of India's traditional medical knowledge being readied this year 2006.

Fenugreek is one of the most versatile herbs that nature has gifted mankind. Used in earlier times by women in Libya and Egypt for weight gain and breast enhancement, it has been used in the fields of cosmetics and confectionary. In India, fenugreek seed was mixed with jaggery and used in the construction industry in ancient times.

It has been used traditionally as a horse and cattle feed - which helped make the animals robust and more productive.

A favourite condiment for spicing up food, it is an all-time favourite in the Jain community in particular, who are traditional vegetarian. The leaves of the plant are used as a spinach and the seeds flavour curries. A few years ago a well funded study was conducted by a herbal research institute in Sri Mahavirji - a revered Jain pilgrimage site in India.

Amongst the findings it was noted that both the fenugreek leaves and seeds were very effective in treating a wide spectrum of skin conditions and for conditioning hair and the seeds were an effective agent inter-alia, for treating throat infections and constipation.

The great jain saint - the lake
Acharya Sri Tulsiji - a life
Dedicated to service, preksha
Meditation, natural and
Alternate therapies

Recent research findings

For millennia, the herb has been credited with properties that can effectively overcome and cure over forty medical conditions, some of which are life-threatening - including cancer, hypertension and diabetes.

Whilst there was no present-day scientific validation of claims made to overcome these serious medical conditions, some startling facts have emerged from recent research findings elaborated by Dr. Ray Sahelian and others in the medical profession. Studies on rodents and rabbits have proved beyond doubt that fenugreek has anti-ulcer, anti-tumor and immune stimulating properties and acts as a cholesterol lowering agent and antioxidant as well.

One of the most valuable findings in recent medical research has been that fenugreek is useful for blood glucose control and in the treatment of Type II diabetes in particular.

Some years ago the famous health writer Steven B. Karch M.D. stated that "Claims about treating diabetes (with fenugreek) appear to have a basis in fact." There appeared to be a degree of uncertainty about the hypoglycaemic action of the herb.

In the studies conducted very recently at the Jaipur Diabetes and Research Centre it was found that regular intake of fenugreek seeds improved blood sugar control, decreased serum triglycerides and increased HDL (good) cholesterol.

Another study in India concluded that "adjunct use of fenugreek seeds improves glycemic control and decreases insulin resistance in mild Type II diabetic patients.

Experiments at Bangabandhu Sheikh Mujib Medical University confirmed, after experiments on rats, that fenugreek decreased the fasting blood glucose levels considerably in the rodents under study.

An alternate and complimentary therapy in the present day context

Modern lifestyle, dietary habits, stress factors and lack of physical activity are some of the factors that have contributed to a worldwide epidemic in diabetes. It is well known that Type I diabetes normally develops in children and juveniles.

Type II diabetes, also called adult onset diabetes, developed in young or older adults.

However due to some of the factors stated above an alarming flood of teenagers are developing Type II diabetes.

At this point of time since there is no cure for the disease, its control is vital and fenugreek has the ability to help in that direction. It is inexpensive and has few side effect, if any. If one considers this complimentary or alternate therapy it is best to consult a qualified practitioner of alternate medicine.

Death certificate and wrongful life in genetic diagnosis

Faiz Marikar, PhD

Accurate and early diagnosis of a disease state, such as a genetic disease, or in a more complicated situation cancer, means life saving, because proper medical interventions can be applied in a timely manner before it is too late to treat the disease.

Clinical molecular genetics, has only recently become recognizable as a diagnostic discipline on its own right is gradually becoming distinct from its academic and research based origins.

The value of life is one of the most difficult things to quantify under law. In a wrongful life case, the claim essentially is that the person would never have been born if it were not for someone's negligence. What is the value of not having been born at all as opposed to an impaired life?

Wrongful life is not a recognized claim in Sri Lanka. It is asserted by a child who alleges that he or she should never have been born in Sri Lanka. In most jurisdictions, recovery by a child with a genetic defect as a result of negligence, has been uniformly denied on the dual grounds, that a legal remedy contradicts the fundamental belief that human life has value, and measuring damages by comparison of an impaired life, with nonexistence is impossible.

Even as the accuracy of genetic testing improved and becomes more common, failures can still occur.

Given the complexity

Given the complexity and evolving scientific and technological nature of the testing, the source of a misdiagnosis will often be extremely difficult to identify. This can be demonstrated with an example; Duchenne muscular Dystrophy (DMD) is a recent case where several entities were sued for the wrongful life of a child born with a rare genetic defect.

DMD eventually affects all voluntary muscles, and the heart and breathing muscles. Survival is rare beyond the early 30s. Diagnostic procedure involves either the analysis of a certain point on the DNA strand using Polymerase Chain Reaction (PCR), or of chromosomes by way of fluorescent in situ hybridization (FISH), to identify genetic defects.

If the outcome is the misdiagnosis was a result of a technological failure but rather by human error (sample mixup) or DNA contamination by one or more of the defendants.

DNA contamination

DNA contamination could have occurred by negligence or non-negligence because experts agreed that the contamination risk could not be eliminated even with the best protocols and patient will be received a wrong death certificate.

There were also other factors that could have caused the outcome that were not the result of anyone's negligence. One possibility was the PCR procedure's inherent technological error rate, 3-5% of which the plaintiff had been informed.

Over one-third of the world's population now has the Tuberculosis (TB), which is diagnosed by finding Mycobacterium tuberculosis bacteria in a clinical specimen taking from the patient.

Result may be living or dead

A sample taken from the sputum can undergo PCR test. Positive result may be living or dead Mycobacterium tuberculosis, so a definite diagnosis of tuberculosis can only be made by culturing Mycobacterium tuberculosis organisms from a specimen taken from the patient (most often sputum, but may also include pus, biopsied tissue, etc). Second possibility was the PCR procedure's error rate is 100% of which the dead micro organisms had been confirmed.

Notwithstanding the philosophically questionable claim for wrongful life, particularly in the context of genetic testing, the continued use of this claim may have wide ranging legal and economic impacts statewide.

Given the rapid expansion of genetic testing such as DMD/TB, this claim may encourage more litigation and discourage advancement based on the unavailability or unaffordability of insurance.

Question Box

Reader Mrs. M. Ghouse from Kollonnawa writes to Dr. Atukorale

Friday's Health page is very helpful for the poor patients. You are very kind helping all the patients' questions. Thanks a lot doctor. Please be kind enough to answering questions.

I had very earlier blood pressure, cholesterol, and gastritis. I am very careful with my diet and I stopped all my medicine.

Now I am only taking 1 Amdepin 5 mg 1 in the morning. But whenever I check my blood pressure it's always normal. My question is, do I have to take this Amdepin daily, even if I don't have pressure? my report

Age - 71 years
Blood pressure 140/90
F. Glucose 83.0
Total cholesterol 217.2
Triglycerides 79.1
H.D.L. Cholesterol 51.2
LDL 152.0
V.L.D.L. 14.0
Cholesterol/HDL 4.2

Doctor, shall I stop the amdepin tablets please doctor, let me know, whether to take full cream milk. yogurt, curd, etc.
as I am taking only non fat milk and food. I am very careful in my foods, shall I eat everything? Thanking you doctor.

Dr. D.P. Atukorale's reply to Mrs. M. Ghouse

(a) Hypercholesterolaemia

As your LDL (bad) cholesterol is elevated (over 90 mg/dl) and as the rates of total cholesterol: HDL cholesterol is slightly high, it is advisable for you to get on the low cholesterol, low fat diet. You should avoid full cream milk and buffalo curd (which has more cholesterol than curd prepared using cows' milk).

You should use a low fat milk powder. Use of coconut oil and coconut milk in moderation is allowed as coconut does not elevated LDL cholesterol and does not decrease the level of HDL cholesterol (unlike vegetable oils which have been proved to decrease the level of HDL cholesterol).

You may use polyunsaturated vegetable oils (for frying) in moderation but vegetable oils should never be used for repeated frying as dangerous free radicals, aldehydes and transfects are formed during repeated frying with vegetable oils.

It is advisable for you to consume avocado and nuts such as cashew nuts and peanuts in moderation as these are full of heart healthy monounsaturated fats (which raise the level of HDL cholesterol) and polyunsaturated fatty acids which are known to decrease the level of LDL cholesterol.

It is dangerous to consume too much of vegetable oils as the serum HDL level comes down and serum triglyceride level goes up.

If you are overweight it is advisable for you to get on to a low calorie diet.

Hypertension

It is advisable for you to continue with Ambodipine prescribed by your physician for hypertension because, in spite of the present hypotensive therapy your diastolic B.P. is still on the high side.

Ambodipine is one of the best drugs physicians prescribe for mild hypertension and in your case to date there are no side-effects.

Avoid items such as cheese and dry fish which are full of salt.

Take a low salt diet and take regular exercise (such as brisk walking) for about 45 minutes a day. If you are obese please see a dietician and get on to a low calorie diet.

In view of your age it is advisable for you to have a light dinner as majority of strokes and heart attacks occur between 9 p.m. and 9 a.m.

I am very happy that you are controlling your gastritis with the correct diet without the use of antacids, avoid dietary items such as tomato and chillie sauce and so called "devilled" preparations such as devilled chicken and devilled fish and too much of pepper are best avoided.