With the upcoming monsoon rains:

Be alert to prevent Dengue

By Manjula FERNANDO

'Dengue fever' can raise its ugly head again with the upcoming monsoon rains,Health authorities issued this warning last week.

It would be timely to remind residents how deadly the disease could become and educate them of the importance of personal vigil and individual contribution on Dengue control.

By March and April every year the mosquitoes almost vanish, then people are quite relaxed during this period. Even 'fogging' and other mosquito control activities by the Colombo Municipal Council (CMC) takes a breathing space in March and April.

But once May approaches the problem raises its ugly head again. Hence, notwithstanding the usual trends, we must have a consistent program right throughout the year so as to fight this menace effectively.

Dengue Fever comes in two types. The mild Dengue Fever DF and the fatal Dengue Hemorrhagic Fever, commonly known among the medical practitioners by the abbreviation DHF.

Patients with ordinary Dengue fever will undergo a 'Feverish Phase' and the 'Recovery Phase' and get cured without suffering any complications. Some people with DF may not even develop a significantly high temperature. About half of the DF patients record platelet counts below 100,000.

In DHF there is a fatal critical phase in between the feverish phase and the recovery phase. The number of patients who suffer DHF is about 100 out of 10,000 dengue patients. DHF patients have their platelet counts dropping below 100,000. This should not be cause for panic.

The critical phase of DHF has to be managed with extreme caution. This is the phase the patients could die due to 'shock' if inadequate fluid is given to them. Nevertheless, too much fluid could also cause death.

Too much fluid during this critical phase of the disease can result in fluid overload.

During the critical phase that can develop within the 3rd to 7th day of the onset of fever, the patients start plasma (the fluid in the blood) leakage through the tiny blood vessels. This phase lasts for about 48 hours.

During the height of the leakage (after first 24 hours), the patients could completely leak one bottle of ordinary saline into his abdominal or chest cavities within 1-2 hours.

As a result he would develop breathing difficulties due to fluid in the lungs.

Clinical administration of fluid is needed to retain the lost fluid in a DHF patient who develops plasma leakage, in order to prevent them going into 'shock'. Shock is one of the two reasons for death in Dengue Fever. But during the 48 hour 'critical phase' the IV administration should be done with extreme care and strict supervision of a skilled medical practitioner.

The Health Ministry has brought down a special Intravenous fluid Dextran 40 to treat patients in this critical phase.

This drug which is similar to 'Saline' does not seep through as easily as Saline.

Therefore the drug can minimize fatalities caused by 'fluid overload' - the second cause of death in Dengue. Dengue deaths can be minimized if the patient and the condition is properly managed during the critical stage of the disease.

Tests - when and what

* After second day of fever - Check Full Blood Count

* If the test results indicate a drop of white blood cells and platelet count( eg.4000 WBC / 150,000 PLT) see doctor and repeat FBC

* If the platelet count is below 100,000 - see doctor immediately -

patient needs hospital admission

* The special Dengue test in hospitals can not be deemed accurate, if the patient has had a mild dengue attack recently he may carry antibodies in the blood stream so the test will show a 'positive' reading. Since antibody development will take time, sometimes Dengue antibody tests specially the rapid tests will be negative.

Indications

Headache or severe headache

Loss of appetite

Pain behind the eye ball

Red colour rash on skin

Slight nasal or gum bleeding

Red colour stools and urine

* Some of these symptoms are synonymous with viral flue conditions as well

Water

Dengue patients should get,

* A reasonable amount of fluids (electrolyte solutions) like fruit juices, king coconut, and jeevani. Water alone is not sufficient.

* Rest during the first few days of illness is a critical factor. A child or any person with suspected Dengue Fever should be allowed to rest at home.

* Patients should not be given too much fluid after day 2 of illness because excessive fluids (even oral) can lead to fluid overload in Dengue Hemorrhagic Fever (DHF).

* Spread of Dengue from a person to person (via mosquitoes) occurs when the patient develops fever. So the patient should be under a mosquito net when he is having fever.

* Physical exertion was closely associated with reported deaths in dengue patients.(On an analysis of 64 patients who died in 2009 in the Gampaha district, a majority has had excessive physical exertion within the first two three days of illness.)

Breeding grounds

In most cases the Dengue breeding ground is in your home itself. If not, it could be in your immediate neighbour's. The doctors say so because the Dengue mosquito cannot fly long distances. Therefore if your child contracts Dengue there is a definite possibility that there is a breeding ground within your house or surroundings. Start cleaning up!

Papaw juice remedy

No hard evidence has been found to prove that papaw juice boosts yourplatelet count.

It is not a chance you can afford to take when dealing with a fatal disease like Dengue.

(This article was prepared with the assistance of Dr. Lalkumar Fernando and his special medical team at Gampaha Hospital. Dr. Fernando uses a new and proven highly effective technique in treating Dengue patients after a special training in Thailand under a Health Ministry sponsored program).

Molecule that spurs cell's recycling centre may help Alzheimer's patients

Cells, which employ a process called autophagy to clean up and reuse protein debris leftover from biological processes, were the original recyclers. A team of scientists from Paul Greengard's Rockefeller University laboratory have linked a molecule that stimulates autophagy with the reduction of one of Alzheimer's disease's major hallmarks, amyloid peptide. Their finding suggests a mechanism that could be used to eliminate built-up proteins in diseases such as Alzheimer's, Down syndrome, Huntington's and Parkinson's.

Researchers found that SMER28 was the most effective compound, and focused their studies on it

The molecule, called SMER28, spurs autophagy, which in turn eliminates unwanted materials such as amyloid-beta, the protein aggregates that cause Alzheimer's plaques. Increasing autophagy, either through a drug or a natural process such as diet, could improve the outcome for people with neurodegenerative diseases, the researchers report in the FASEB Journal.

"Much effort has been carried out to prevent the formation of amyloid-beta without much success," says Greengard, who is Vincent Astor Professor and head of the Laboratory of Molecular and Cellular Neuroscience. "In order to develop better-suited therapies, alternative approaches are clearly needed. One approach would be the identification of potential therapeutic targets that enhance the removal of amyloid-beta, for example, by increasing autophagy."

Most prior strategies to develop Alzheimer's disease drugs were designed to inhibit the formation of the toxic amyloid-beta.

Greengard, who directs the Fisher Center for Research on Alzheimer's Disease at Rockefeller, and his colleagues propose a radically different approach: boosting a cellular mechanism to enhance their clearance. This approach, says Marc Flajolet, a research assistant professor in Greengard's lab, may also be beneficial for targeting a hallmark of advanced Alzheimer's disease, twisted fibers of tau protein that build up inside nerve cells and cause tangles.

The researchers, led by Yuan Tian, a postdoctoral fellow in Greengard's lab, tested various compounds for their ability to reduce the build up of amyloid-beta by exposing cultured cells to compounds known to activate autophagy. They then compared the effect of these compounds by removing growth factors from the culture medium, a well-established stimulant of autophagy known as "starvation."

The researchers found that SMER28 was the most effective compound, and focused their studies on it to characterize the cellular components involved in this phenomenon.

They compared the effect of SMER28 on amyloid-beta formation using normal cells or cells where the expression of genes known to be involved in autophagy was reduced or abolished. They found that three important autophagic players were involved, and one of them was essential for SMER28's effect.

Identifying a cure for Alzheimer's disease remains a major challenge.

Four drugs are currently approved by the Food and Drug Administration to treat Alzheimer patients. Unfortunately none of these drugs halt progression of the disease and their impact on cognitive defects are minimal. On top of that, current strategies are associated with severe side effects.

This limitation Four drugs are currently approved by the Food and Drug Administration to treat Alzheimer patients. Unfortunately none of these drugs halt progression of the disease and their impact on cognitive defects are minimal. On top of that, current strategies are associated with severe side effects. was highlighted recently by failures in various clinical trials.

"Our work demonstrates that small molecules can be developed as therapies, by activating a cellular function called autophagy, to prevent Alzheimer's disease," says Flajolet. "By increasing our understanding of autophagy, it might be possible to stimulate it, pharmacologically or naturally, to improve the quality of life for aging people." The results also suggest the power of diet to prevent damage to neurons.

It has been known that a low calorie diet is beneficial for longer life expectancy as well as for neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease."Our results suggest that a low calorie diet might lead to a higher autophagy activity that might delay or prevent aging and neurodegenerative diseases," says Flajolet.Source: Rockefeller University

Diabetic retinopathy

by Nilma DOLE

Diabetic retinopathy which is damage to the retina, is caused by complications of diabetes mellitus, which can eventually lead to blindness.

"Those who have uncontrolled diabetes and do not get their eyes checked are at risk of developing diabetic retinopathy leading to loss of sight," said Dr. Irugalbandara of the Colombo General Eye Hospital and also of the College of Ophthalmologists.

It is an eye problem that affects nearly 80 percent of diabetic patients who have had diabetes for a long time. However, with proper treatment and round-the-clock observation, a majority of these cases can be reduced.

Traditionally, capillaries in the optic nerves get damaged or blocked as a result of uncontrolled diabetes that causes vision loss.

"Diabetics can also develop cataract and glaucoma if not detected and treated properly," said the doctor. As diabetes affects the circulatory system of the retina, the first stage is background diabetic retinopathy.

The retina is the light-sensitive tissue at the back of the eye and a healthy retina is necessary for good vision.

Circulation problem

The next stage is known as pro-liferative diabetic retinopathy where circulation problems cause areas of the retina to become oxygen-deprived. As new, fragile, vessels develop in order to maintain adequate oxygen levels within the retina, this causes neo-vascularisation. Unfortunately, these delicate vessels haemorrhage easily and blood may leak into the retina and vitreous, causing spots or floaters, along with decreased vision.

In the latter phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and glaucoma. "All people with diabetes, type one and type two, are at risk and they should go for a routine eye checkup with an ophthalmologist at least every six months to one year depending on your control of your diabetes" said Dr. Irugalbandara.

The longer someone has diabetes, the more likely they can get diabetic retinopathy. During pregnancy, diabetic retinopathy can be triggered in women with diabetes.

To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible.

"Often there are no symptoms in the early stages of the disease, nor is there any pain but don't wait, make sure you check your eyes even if you don't see a change because it will develop later," said the doctor. Blurred vision may occur when the macula, the part of the retina that provides sharp central vision, swells from leaking fluid.

Detection methods

"If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision," said the doctor. Detection methods pertaining to diabetic retinopathy tends to vary from one individual to another.

In general, however, a person tends to have blurred vision, making it hard to do daily routines such as reading.

Depending on the case, the vision will get better or worse as time passes.

She further added, "An ophthalmologist checks your retina for early signs of the disease which includes leaking blood vessels, retinal swelling, pale, fatty deposits on the retina which show signs of leaking blood vessels, damaged nerve tissue and any other changes to the blood vessels."

Diabetic retinopathy is detected during an eye examination that includes a visual acuity test, pupil dilation, ophthalmoscopy, Optical Coherence Tomography (OCT), Digital Retinal Screening Programs and Slit Lamp Biomicroscopy Retinal Screening Programs.

During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular oedema (fluid and protein deposits in the eye's mascular).

"To prevent diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol otherwise it will trigger the condition," said the doctor.Proliferative retinopathy is treated with laser surgery.

At the beginning, you may notice some loss of your field of vision but the scatter laser treatment can save the rest of your sight. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed.

That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding. If the bleeding is severe, you may need a surgical procedure called a vitrectomy where blood is removed from the centre of your eye.

"Have a balanced diet and control your diseases to an optimum to prevent diabetic retinopathy. Make sure you get plenty of exercise and go for regular eye checkups to an ophthalmologist instead of other experts because your eyes need to be checked with an ophthalmoscope," said Dr. Irugalbandara.