Asthma can be triggered by cigarette smoke
A beautiful girl, about three years of age was sleeping on the
shoulder of an elderly woman. The fair complexioned girl with long
strands of curly black hair on her face caught my eye, although she
looked frail and unusually pale.
Using inhaler with
A paediatrician at the Lady Ridgeway Children's Hospital examined the
child. Soon after she was sent away to a treatment ward, Consultant
Paediatrician Dr. Deepal Perera spoke to the Sunday Observer. But not
before speaking to the grandmother of the child and said' "ask your
husband to stop smoking immediately".
Beginning the conversation he said smoking has become a curse for our
younger generation. The little girl was there to get treatment for
asthma. For those who do not know the situation with asthma, it is a
terrible sickness. How an asthmatic suffers for breath is sickening to
watch, if not for modern day wonders of medication. The girl has got
asthma because her grandfather is a chain smoker.
Dr. Perera began to explain the situation with asthma and wheezing
among children and the position in Sri Lanka.
Infants up to six months can have noisy breathing which is a normal
condition. A high pitched sound (a strido) can be heard when the child
breathes in. This is due to a condition called congenital laryngeal
stridor, caused due to a birth defect in the voice box.
In most conditions this will settle within the first six to 18 months
but sometimes in a persistent condition the child may have to be
referred to a doctor for medication. This is due to asthma or wheezing
triggered by any allergic condition.
What is an asthma attack?
The mucous membranes in the small branches of the airways (bronchi)
swell and the circular muscles contract ('spasm' or bronchospasm).
More mucus is produced in the already restricted airways, which makes
breathing a struggle. This usually produces a wheezing sound, when
How to identify if a child is wheezing:
Shortness of breath,
Respiratory breaths can be higher than his or her age, for a child
under five years the respiratory is 50 breaths per minute.A dry cough
without a cold, especially nocturnal coughing (night cough), aggravated
when he is in a lying down position.
The child between three to 15 years may have bouts of a cough that
makes him wake up in the middle of the night.
Dislike for physical activity
Persistent and prolonged cold
In severe cases -
The skin may change colour to white or blue (especially on the lips)
Filariasis and TB
But the child could also be having nocturnal coughing due to
filariasis as well. This and the possibility of Tubeculosis (TB) has to
be ruled out if the child is suffering from persistent cough or night
coughs before treatment for wheezing can be given.
According to doctors, a child could contract TB from an adult.
Transmission from another child has not been established.
the family should first ascertain if a member of the family is having TB
but has gone undetected before checking out the possibility of
contraction from daycare, school, etc.
The child could also show suprasternal recession (a hollow appearing
below the neck while breathing in) or intercostal recession (inward
movement between the ribs while breathing in) when he is straining to
breathe while having an attack of wheezing.
A sleeping child may change his position to a 'bent inward sitting
position' to ease breathing.
There are no specialist paediatricians for asthma in Sri Lanka at the
moment. The child has to be referred to a general paediatrician. In the
future there will be specialised respiratory paediatricians.
What causes asthma in children? In young pre-school children,
wheezing is usually brought on by a viral infection causing a cold, ear
or throat infection.
Some people call this 'viral-induced wheeze' or 'wheezy bronchitis',
whilst others call it asthma.
Most children will grow out of it, as they get to school age.
In older children, viruses are still the commonest cause of wheezing.
But other allergens may also cause an asthma attack like those listed
pollen, eg grass or birch
animal hair or fur
food, eg milk or eggs
house dust mites
The most common factor for wheezing in Sri Lanka is dust. However,
wheezing due to allergies caused by pollen can be ruled out since there
is no pollen season here.
Dr. Perera says if a young child is asthmatic or shows allergic
reactions to water, sand or pets, the child should not be immediately
taken away from these allergens as water and sand play and playing with
pets are closely related to his mental growth and may have a greater
negative effect than the health risk.
What makes the condition worse
Exposure to situation for which they are allergic
Pollution and dust
Exertion or exercise
If the child is allergic to dust, the mattress and pillows should be
covered in polythene. Curtains and mosquito nets should be washed every
two weeks. Thick blankets and clothes should not be used.
Padded, non-washable chairs too are not recommended.
Execising however, should be encouraged while relieving the condition
A significant number of children brought to Lady Ridgeway Hospital
with wheezing, have developed the condition due to cigarette smoke. In
most of these instances the child has a grandfather who smokes at home.
Even if the smoker does it outside, he brings the smoke into the
house in his clothes and this is enough for a child to develop asthma.
Dr. Perera said this is a serious situation in Sri Lanka.
When is it the right time to see a doctor?
When you suspect the child is having asthma or if the medication
(relievers) he is already using is not responding, the child should be
taken to a doctor.
If the child has difficulty in breathing and the condition seems to
be getting worse. If the child's skin colour changes or if the
(salbutamol) ventolin puffer has to be used every four hours, for a
longer period the child has to be taken to a hospital immediately.
In an acute attack of asthma you need nebulisation with salbutamol
and ipratropium. This can be done in a hospital. If it is a mild attack
after one nebulisation, the child will be sent home.
In an acute attack the medication has to be combined with steroids.
Parents should not be afraid of the use of steroids. This will be
prescribed for five days. Steroids control asthma for a longer period,
while salbutamol is used for immediate relief.
Medicines for asthma can be separated in two main groups.
Relievers : These are quick-acting drugs that relax the muscles of
They relieve the symptoms of wheeze, cough and breathlessness and are
the first-line treatment of an acute asthmatic attack.
eg. ventolin evohaler
Preventers : These act over a longer time and work by reducing the
inflammation within the airways.Parents should never be afraid to use
inhalers as they carry minimal side effects compared to orally taken
For very young children who are unable to use the inhaler alone will
be recommended the use of a spacer and a mask by the paediatrician.
Swallowing not required for bitterness to induce nausea
The mere taste of something extremely bitter - even if you don't
swallow it at all - is enough to cause that dreaded feeling of nausea
and to set your stomach churning, according to a new study reported in
the April 12th issue of Current Biology, a Cell Press publication.
work shows that our body and our physiology anticipate the consequences
of foods we might eat, even if those foods contain toxins or
anti-nutrients," said Paul Breslin of the Monell Chemical Senses Centre
and Rutgers University. Of course, it is well known that the promise of
something tempting to eat can cause a physiological response. Think
Pavlov and his salivating dog. It also seems intuitive that bitterness,
a taste associated with most plant-derived toxins, might be linked to
nausea. However, Breslin says, the evidence was lacking.
In the current study, Breslin and the study's first author, Catherine
Peyrot des Gachons, asked 63 healthy (and brave) individuals to sample
an intensely bitter but non-toxic solution. He says the flavour could be
compared to a typical concoction of liquid cold and flu medication on
the bitterness scale. Participants held the bitter solution in their
mouths for 3 minutes before spitting it back out. The experience led
most people to report feelings of nausea that were either mild to
moderate or strong. A second bitter solution had the same effect on
people, unlike sweet, salty, or umami tastes.
During the taste-testing sessions, the researchers also recorded the
electrical activity in the stomach using electrodes. Certain irregular
patterns of stomach muscle activity are a hallmark of nausea, Breslin
Those results made it clear that the self-reported nausea wasn't all
in the study participants' heads. The exposure to bitter solutions
produced responses in the stomach that were comparable to those caused
by extreme motion sickness, the researchers report."It was known that
our body can anticipate the ingestion of nutrients and prepare for
them," Breslin said. "It was not known if our bodies anticipated the
ingestion of toxins or anti-nutrients and prepared for this. Here we
show that our bodies punish us for holding strong toxins in the mouth
and that our stomachs respond so as to trap them and likely vomit them
back up if swallowed." The findings suggest that those already prone to
nausea - including pregnant women and patients undergoing chemotherapy -
should take particular care to avoid bitter tastes. "In some instances,
extreme nausea is worse than extreme pain, and anything we can do to
help manage this is important," Breslin said.
(Source: Elisabeth Lyons Cell Press)
Study illuminates the role of laminin in cancer formation
Laminin, long thought to be only a structural support protein in the
microenvironment of breast and other epithelial tissue, is "famous" for
its cross-like shape. However, laminin is far more than just a support
player with a "pretty face." Two studies led by one of the world's
foremost breast cancer scientists have shown how laminin plays a central
role in the development of breast cancer, the second most leading cause
of cancer death among women in the United States. In one study it was
shown how laminin influences the genetic information inside a cell's
nucleus. In the other study it was shown how destruction of laminin can
play a detrimental role in the early stages of tumour development.
Mina Bissell holds the title of "Distinguished Scientist" with the
U.S. Department of Energy (DOE)'s Lawrence Berkeley National Laboratory
(Berkeley Lab). She is famous for having discovered the critical role in
breast cancer development played by the extracelluar matrix (ECM), the
network of fibrous and globular proteins surrounding a breast cell. Her
"dynamic reciprocity" theory holds that the fate of cells whether they
stay healthy or become cancerous - hinges on the chemical signals
exchanged between the ECM and a cell's nucleus. In these latest studies,
Bissell and her collaborators focused on laminin and its connections
with two other proteins - actin, a cytoplasmic protein that has been
linked to nuclear activities; and MMP9, an enzyme that is secreted
outside the cells and is known to break down ECM constituents.
Laminin and cell quiescence
"Quiescence" is the process by which a biological cell stops growing
or dividing. This is the opposite of a cancerous state, in which cell
growth and division is often unchecked. Signals from laminin-111, an ECM
protein that helps the cell and its ECM stick together, have been linked
to cell quiescence but the mechanism was unknown. Bissell and
postdoctoral fellow, Virginia Spencer, in Berkeley Lab's Life Sciences
Division, have now shown that the addition of laminin-111 leads to
quiescence in breast epithelial cells through changes in nuclear actin.
"We found that high levels of laminin-111 depleted nuclear actin and
this in turn induced cell quiescence," Bissell says. "Furthermore, this
process can be prevented if a form of actin that can not exit the
nucleus is introduced. Under these conditions the cells do not stop
growing even in the presence of laminin."
In their study, Bissell and Spencer and their colleagues used a
unique three-dimensional cell culture assay developed by Bissell's
research group, and worked with mouse and human mammary epithelial
Through the addition of laminin-111, they were able to decrease
nuclear actin levels in the cultured cells, which reduced DNA synthesis
and transcription. When nuclear actin levels were deliberately
over-expressed, the effects were reversed and cells were prevented from
becoming quiescent even in the presence of laminin-111.
Furthermore, the high levels of nuclear actin were concentrated in
regions of the breast cells where there was little or no laminin-111.
Taken together, the results implicate laminin-111 as the regulator of
nuclear actin and nuclear actin as a key mediator of epithelial cell
"In collaboration with Ole Petersen's laboratory, we had found
previously that the ECM surrounding tissues from breast cancers has a
dramatic reduction in laminin-111 in comparison to the ECM surrounding a
normal breast cell, which is rich in laminin-111," Bissell says.
"However, just giving laminin back to cancer cells was not enough to
make them normal so other factors are clearly also involved and one such
factor we now know is how laminin-111 and nuclear actin talk to each
Says Spencer, "Ours is the first study to actually identify
laminin-111 as the physiological regulator of nuclear actin and to
implicate the loss of nuclear actin as a key step in reaching quiescence
and homeostasis in the mammary gland in vivo and in culture."
Spencer believes that the interaction between laminin-111 and nuclear
actin could provide a new target for diagnostic therapeutic efforts, but
this will require further study.
"While it remains to be determined whether dysregulation of the
levels or organization of nuclear actin is responsible for the inability
of malignant cells to respond to growth-inhibitory signals from
laminin-111, our preliminary results point in this direction," she says.
"In addition, the findings that laminin-111 expression is lost in
myoepithelial cells isolated from human tumours should place the
interaction of laminin-111 and breast tumour cells at the forefront of
future investigations."A paper detailing the results of this study
appears in the Journal of Cell Science. The paper is titled "Depletion
of nuclear actin is a key mediator of quiescence in epithelial cells."
Co-authoring the paper with Bissell and Spencer were Sylvain Costes,
Jamie Inman, Ren Xu, James Chen and Michael Hendzel.
Laminin, MMP9 and tumour growth
In the second study, which was related to the role of laminin-111 in
cell quiescence, Bissell and another group of collaborators examined
laminin-111 in the context of matrix metalloproteinase-9 (MMP9), a
zinc-dependent enzyme that plays a huge role in tissue function by
virtue of its ability to cleave or degrade many of the ECM constituent
proteins, including laminin-111.
"Organization into polarized three-dimensional tissue structures
defines whether epithelial cells are normal or malignant," Bissell says.
"We have shown that when MMP9 degrades laminin-111 in the ECM, the
tissue architecture of breast cells becomes lost and cell proliferation
is initiated. This is the first demonstration of how the degradation of
laminin-111 by MMP9 in a physiological context contributes to tumour
A paper detailing the results of this study has appeared in the
journal Genes and Development. The paper is titled "Raf-induced MMP9
Disrupts Tissue Architecture of Human Breast Cells in Three-Dimensional
Culture and is Necessary for Tumour Growth in vivo." Co-authoring the
paper with Bissell were Alain Beliveau, Joni Mott, Alvin Lo, Emily Chen,
Antonius Koller, Paul Yaswen and John Muschler.
Using a model of human breast cancer where breast epithelial cells
were grown in three-dimensional cultures of basement membrane, a thin
layer of ECM material that envelops breast and other glandular tissue,
Bissell and her co-authors found that not only did excessive MMP9
activity disrupt tissue architecture, but that silencing MMP9 restored
tissue architecture and decreased the ability of human breast cancer
cells to form tumours in mice.
"We found that in all conditions where tumour cells could be reverted
to a normal phenotype in our 3D assays, a novel signalling loop through
a pathway of Raf/MEK/ERK proteins was responsible for MMP9 activity in
the breast tumour cells," says co-author Joni Mott, a researcher with
Bissell's group in Berkeley Lab's Life Sciences Division. "Once MMP9 was
activated, the proteinase targeted the destruction of laminin-111 within
the basement membrane."
Laminin-111 in the basement membrane, Mott explains, allows mammary
epithelial cells to establish a normal polarized structural unit called
an "acinus," which is responsible for storing milk and making it
available for babies when they suckle.
In their Genes and Development paper, Bissell, Mott and their
co-authors reported that when the integrity of the tissue architecture
was compromised by laminin proteolysis, the basement membrane no longer
provided the appropriate signals to restrain epithelial cell
proliferation. The result was a sustained signalling of the Raf/MEK/ERK
pathway that leads to continued MMP9 production and further disruption
of tissue architecture and loss of cell growth control.
"This work is particularly poignant because it provides potential new
therapeutic targets for controlling breast cancer and revitalizes the
possibility of targeting MMPs in cancer therapy," Bissell says. "New
information on how MMP9 and other MMPs truly function may provide highly
targeted and effective therapeutic strategies to control MMP activity in
cancer, and may soon lead to the development of novel cancer
treatments."Both studies were funded in part by grants from the U.S.
Department of Energy's Office of Science, the National Cancer Institute,
and the U.S. Department of Defence.
Source: Lynn Yarris DOE/Lawrence Berkeley National Laboratory.
Delhi superbug poses risk to antibiotic treatment worldwide
An estimated 500,000 people in Delhi are carrying bacteria highly
resistant to antibiotics acquired from drinking water, say researchers.
Tests on drains and public taps across the city found high levels of
contamination with bacteria carrying the NDM 1 gene (New Delhi
metallo-beta-lactamase) which confers resistance to almost all known
The discovery highlights the global threat from the spread of
An estimated 25,000 people die each year in the European Union from
antibiotic resistant bacterial infections.
The numbers affected beyond the EU are not known. Researchers from
Cardiff University tested water samples from drains and public taps in
They found 4 per cent of drinking water samples and 30 per cent of
drain samples contaminated with the NDM 1 gene. Further tests showed the
gene had spread to bacteria causing cholera and dysentery making them
Mark Toleman, an author of the study published in the Lancet
Infectious Diseases, said: "Half a million people in New Delhi are
carrying NDM 1 bacteria as normal gut flora.
"If we let it go, in the next two or three years we will see the loss
of antibiotics in India.
We will rapidly get to the stage where those bacteria are
Separate research showed that more than 80 per cent of travellers
returning from India to Europe carried the NDM gene in their gut. NDM
confers resistance to the most powerful antibiotics carbapanems.
Bacteria testing positive for NDM 1 genes had been isolated from 70
patients in the UK, according to the Health Protection Agency, but there
had been no cases of onward transmission.
Dr Toleman said the situation in India and the rest of south-east
Asia, which was the largest reservoir of NDM containing bacteria, posed
a threat to the world, and international efforts were needed to improve
He said the Indian government had expressed concern, but its hidden
attitude was one of denial. Researchers investigating contamination of
the water supply had been harassed.
At a briefing organised by the World Health Organisation, scientists
warned that reckless use of antibiotics was in danger of returning the
world to a pre-antibiotic era where infections did not respond to
David Heymann, chairman of the UK Health Protection Agency said that
within two years of Penicillin being discovered, 11 per cent of strains
of staphylococcus aureus were resistant and by the late 1990s over 90
per cent of hospital strains were resistant.
Courtesy: The Independent