Friday, February 28, 2014

Preventable Disabilities & Abnormalities

More than 100 million human beings suffer from physical and mental disabilities globally. These are generally caused by malnutrition and also known as nutritional disabilities. If we take the matter seriously; these are preventable disabilities. Malnutrition is a major cause of growth retardation, blindness due to vitamin-A deficiency and rickets due to vitamin-D deficiency. High fluorine content in drinking water may lead to fluorosis.

Over exposure to fluoride in drinking water or otherwise would erode the enamel of teeth; a condition called dental fluorosis. Children below the age of 10 years should not be allowed to use fluoride containing tooth pastes. Dental fluorosis is characterized by coloring and pitting of teeth. Over ingestion of fluoride in drinking water may lead to severe skeletal abnormalities also. Quality of drinking water should be assured by Public Health & Sanitation Departments of the area worldwide.

Deficiency of iodine in drinking water or food would lead to metabolic disorders and mental retardation in children as well as adults. In our body, iodine is processed by thyroid gland (an endocrine gland) present in the front of our neck. The colloidal substance present in the thyroid gland is a store house of iodine. The cells of the thyroid gland secrete an internal secretion called thyroglobulin; that breaks down to thyroxine hormone before being released into blood stream. Thyroxine is a tetra-iodo-compound (also called T4 hormone) that controls general metabolism of our body. Another thyroid hormone isolated from thyroid gland as well as present in blood/plasma is triiodothyroxine (also called T3 hormone). Under secretion of thyroid hormones in children produces cretinism. A cretin child grows up mentally retarded dwarf unless treated by thyroid extract. Goitre (enlargement of thyroid) and cretinism can be prevented with iodized salt or water.

Contamination of orange-red pulses (certain legumes of genus Lathyrus or kesari dal) may cause lathyrism (neuromuscular weakness). Seeds of Lathyrus cicera and Lathyrus clymentum are known to contain a toxin, causing neurolathyrism. Osteolathyrism is caused by a different toxin called beta-aminopropionitrile (present in sweet peas); that affects linking of collagen fibrils with bones and muscles. By careful sorting of legume seeds used as pulses Lathyrism can be prevented.

Protein calorie malnutrition (PCM) is another preventable abnormality/disability. Protein calorie malnutrition (PCM) leads to poor physical and mental endowment. Long term feature of PCM is mental retardation. Through the community education and awareness about nutritional value of food stuffs these nutritional disabilities can be prevented. Rickets is most common amongst malnourished children. Rickets is caused by deficiency of vitamin-D. Deficiency of vitamin-D leads to softening of bones and skeletal abnormalities in children. Children should be exposed to the sunlight as it leads to formation of vitamin-D from the pro-vitamin-D in our body. Butter, egg yoke and some species of fish are rich source of vitamin-D. So, intake of these and exposure to sunlight would be helpful for preventing rickets in our children.

Friday, February 21, 2014

Obesity: Cause, Consequences and Implications

There are many causes and health implications of obesity. Many people are in illusion about the quantitative parameters of obesity. The obesity can be defined in terms of Weight/Height (W/H) ratio or index: where weight is in kilograms (kg) and height is in meters (m). This index should be 25 to 30 normally. If your weight is 47 kg and your height is 1.60 m (160 cm); your W/H index will be 29.375. An ideal weight of an individual with reference to sex, age, height and body build has already been documented somewhere else. The cause of obesity may be genetic, metabolic, physiological, lifestyle or pathological (as in cases of hypothyroidism). Take your weight on the same scale daily for a week. If you are overweight or your W/H index is considerably more than 30, then plan to loose your weight through dieting and exercise. Never starve yourself. You can eat as desired from the unrestricted food items' list but remain within limits on restricted food items' list and keep away from prohibited food items' list:

Unrestricted Food Items' List
Unrestricted food items for the obese are fresh fruits, fresh vegetables, chicken, fish, poached eggs, boiled eggs (do not eat yellows), tea, coffee, skimmed milk and products made from skimmed milk.

Restricted Food Items' List
Restricted food items for the obese are all cereals and products made from cereals. Obese person should avoid eating more than 100 gm cereal products in a day. Fat consumption should not be more than 15 gm in 24 hours.

Prohibited Food Items' List
Prohibited food items for the obese are jams, honey, ice cream, dry fruits, nuts, cold drinks, alcohol, sugar and products containing sugar.

Obesity is associated with hyperlipidemia (elevated level of cholesterol and triglyrerides in blood), hypertension (high blood pressure), non-insulin dependent diabetes mellitus (NIDDM) and high prevalence of some cancers. Other serious implications of obesity are coronary heart disease and renal disease. Abdominal fat has been documented as major risk factor for coronary heart disease. The risk of NIDDM is more in overweight men aged between 25-50 years of age. The patient is said to have severe obesity if his W/H index is more than 40. Natural history and consequences of obesity in children are not well understood till date. Strict dietary control and weight reduction would definitely help patients with severe obesity to overcome its serious implications like - NIDDM, hyperlipidemia, hypertension and coronary heart disease.

Thursday, February 20, 2014

High-grade Fever with Pain in Tummy and Vomiting: May be Typhoid

Cases of typhoid fever are up during rainy season due to poor public health measures. Sanitation-wise filthy cities, uncovered and unwashed food stuffs are hazardous for travelers since typhoid infection is food borne. Typhoid fever is caused by bacteria known as Salmonella typhi or Salmonella paratyphi. There are two strains of Salmonella paratyphi, known as Salmonella paratyphi-A & Salmonella paratyphi-B. High-grade fever with pain in tummy associated with vomiting may be typhoid. Fever may rise upto 106o F creating a scare in the family but never panic and call a physician or take the patient to the hospital. For an accurate diagnosis, germs of typhoid can be grown from the blood (Blood Culture Test) of the patient. However, there are some viral fevers which may mimic the symptoms of typhoid. If untreated, typhoid may lead to dire complications like perforation of intestine, hemorrhage (bleeding) and sudden bacterial shock. My contention is not to horrify people by citing the manifestations of this disease but spread awareness about prevention and timely treatment of it.

Science has enabled us to diagnose and treat typhoid effectively with antibiotics. Patient may be treated at home or at a hospital. But complete course of the recommended antibiotics should be taken to avoid relapse. Other members of Salmonella family (Salmonella paratyphi-A & Salmonella paratyphi-B) producing paratyphoid fevers and food-poisoning can also be treated well with antibiotics. Bacteria of Salmonella family are facultative bacteria and carriers of the disease continue passing the germs in their stool and urine.

Prevention is always better than cure and till we catch-up on community prevention; individual prophylaxis has to be very tight through vaccination. TAB vaccine is used worldwide to acquire protection against bacteria of Salmonella family. A variety of antibiotics are available to treat typhoid fever. Many countries have eradicated indigenous typhoid through meticulous and efficient public health measures. However, people traveling abroad are advised to get shots of TAB vaccine and cholera vaccine.

Sunday, February 16, 2014

Tuberculosis: A killer of the poor !

The human race is indebted to Dr. Robert Koch of Germany for his landmark discovery of causative bacillus of tuberculosis in 1882. This discovery later won him (Dr. Robert Koch) the Nobel Prize. Dr. Koch worked on many other diseases also. He discovered the causative agent of Cholera in 1883 in Egypt. Both the discoveries of this renowned microbiologist are remarkable and revolutionary in the field of medical science. Dr. Robert Koch’s fundamental discovery of causative agent of tuberculosis set the pace of efforts worldwide to eradicate tuberculosis on the pattern of smallpox. Many nations in the world have already done so. Developing countries are still putting in efforts to eradicate the killer disease of the poor who cannot afford timely diagnosis and treatment in-spite of the free supply of anti-tuberculosis drugs.

Tuberculosis is still on the top of communicable diseases in many countries. Lack of awareness, poverty and associated malnutrition are the invitation for this communicable disease. BCG is the vaccination used to generate immunity against tubercle bacilli, but unfortunately the same has been failed to provide effective immunity in some geographical areas. The laboratory diagnosis of tuberculosis is largely based on x-ray study of the chest and examination of sputum for tubercle bacilli. Once diagnosed, the disease is curable.  Home-based treatment of tuberculosis is as effective and safe as the isolation ward of a hospital. At present the standard-regimen for treatment of tuberculosis is for six-months. However, a re-investigation and follow-up is must.  Extra-pulmonary tuberculosis can be diagnosed by cytological evaluation of 'fine needle aspirate' for tubercle bacilli. Polymerase chain reaction (PCR) is newer diagnostic method for Extra-pulmonary tuberculosis.

Participation of community is must for successful eradication of tuberculosis. If somebody is under treatment at a home, he/she should be confined to a room for at least two months of treatment, and all members of the family should bear mask in case of pulmonary tuberculosis. The preventive and curative efforts should move 'hand-in-hand' for successful eradication of tuberculosis.

Wednesday, February 12, 2014

Role of Simian Vacuolating Virus-40 (SV-40) in Causing Cancer/Tumors

The Simian vacuolating virus-40 (SV-40) is a polyoma virus. The SV-40 is a DNA virus that has the potential to cause tumors. Simian vacuolating virus-40 is believed to slash/suppress the transcriptional properties of tumor-suppressing p53 gene in human beings through its large T-antigen (SV-40 large T-antigen) as well as small T-antigen (SV-40 small T-antigen). It has been genetically established that SV-40 large T-antigen is the major protein involved in neoplastic process. The SV-40 large T-antigen predominantly exerts its effect through deregulation of tumor-suppressing p53 gene, which is responsible for initiating regulated cell death (apoptosis). The regulated cell death or apoptosis is a natural phenomenon that is must for maintaining shape and size of our body organs and tissues. The p53 gene is the most often mutated gene in human cancers. Due to its tumor suppressor role the p53 gene is invariably called the guardian of human genome. The p53 protein present in the cells, plays a major role in the regulation of normal cell cycle, differentiation of cells and cell death. The p53 gene also takes care of DNA repair, aging process and formation of blood vessels. It provides switching mechanism for activation and deactivation of transcription of its target genes by binding to the corresponding DNA sequences in the nuclei of cells. The cell cycle is arrested normally when a cell is damaged. Mutations caused by SV-40 virus in p53 gene would contribute to uncontrolled cellular proliferation, leading to a tumor. It has very well been reported in the medical literature that SV-40 is associated with brain tumors, malignant mesothelioma, non-Hodgkin lymphoma and bone cancers.

Immunohistochemical (IHC) testing is required to detect and demonstrate the viral infection in tumor tissue/biopsy. The immunohistochemical detection of simian vacuolating virus-40 (SV-40) could be culminated, using anti-simian vacuolating virus-40 (anti-SV-40) antibodies. The IHC testing on formalin fixed, paraffin embedded tissues has an advantage over immunofluorescence testing that one would have the convenience of archiving IHC stained slides for future reference. The worldwide availability of anti-simian vacuolating virus-40 (anti-SV-40) antibodies has given a boost to the research in this field.

Carcinomas & Role of Diagnostic Pathology

The word carcinoma is synonym for cancer or malignancy in medical science. Carcinomas may develop from a variety of epithelial tissues of various sites of human body. Epithelial tissues (layers of body cells lining the wall) of respiratory tract, gastrointestinal tract (GI tract) reproductive tract (vagina, cervix, uterus and fallopian tubes), oral cavity, head & neck, breast and skin may transform as carcinoma due to viral infections, genetic mutations and/or biochemical changes in our body. The histopathological diagnosis based on varied morphology of cells and their nuclei is very challenging for the pathologists. For the accurate differential diagnosis of carcinomas found in the primary organs and at metastatic sites in the biopsy materials/specimens, pathologists have to depend on advanced techniques/methodologies like immonohistochemistry (IHC), in-situ hybridization, molecular genetics, microarray etc.

A variety of panels of tumor specific & cells’ phenotype specific primary antibodies have been chalked-out through worldwide deliberations for accurate diagnosis of carcinomas/malignancies with reference to established literature and WHO classifications of carcinomas/malignancies. An accurate diagnosis provides the direction for the line of treatment or surgical interventions. However, individual results of advanced investigations may vary somewhat within diagnostic centers, probably due to protocols followed. The storage conditions and exhausted lifespan of primary antibodies used for IHC may influence the outcome of final result, so there is need for strict quality assurance at pathological diagnostic centers.