Sunday Observer Online


Sunday, 1 May 2011





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Oh! for a breath of fresh air!

About 20 years ago, it was an incredulous thing to carry bottled water to your workplace or college because it was taboo. More often than not, your workplace had water you could drink off the tap but today, this situation is entirely different.Like water bottles, imagine if you had to buy a bottle of fresh air?

It might seem ironic but might be true one day with rampant air pollution problem we are facing.

Very soon, we might be going to the supermarket and buying some fresh air to breathe.

Prof. O. Illeperuma of the University of Peradeniya who is one of the pioneers in checking air pollution levels in Sri Lanka said that air pollution is a growing health problem in Sri Lanka that is on the verge of being one of the leading cause of deaths among the population.

"It is a researched fact that the second leading cause of death for those in the 5-14 age year group is due to respiratory diseases caused by air pollution," he said.

Children who grow up in the city have lung particle deposits similar to chain smokers making this a grave concern.

"The condition is known as Chronic Obstructive Pulmonary disease or Emphysema and 45 percent of total outpatient morbidity accounts for respiratory diseases, which is quickly growing among city dwellers," said the Professor. He said that while people working around the beach area of Colombo might have the occasional sea breeze to look forward to, it is the concentrated sections of inner Colombo that is the problem. "With the help of an air pollution monitor located at Thurstan Road near some leading schools, air pollution rates have soared. What is especially dangerous is that our younger generation is slowly dying due to air pollutants in the air," he said.

Even indoor pollutants such as mosquito coils are a cause for concern.

"We assume it is made out of organic material but research indicates that there is a direct link to babies exposed to mosquito coils having respiratory problems," said Prof. Illeperuma.

According to Prof. Illeperuma, Chronic obstructive pulmonary disease (COPD) is the condition where patients find it difficult to breathe.

"There are two types namely, Chronic bronchitis, defined by a long-term cough with mucus and Emphysema, defined by destruction of the lungs over time," he said.


Exposure to certain gases or fumes in the workplace and exposure to heavy amounts of secondhand smoke and pollution will lead to COPD. He said, "Emphysema is one of the leading problems in young people where the alveoli or lung sacs become inflamed and this is becoming increasingly common in Colombo residents."

Symptoms include coughing and spitting out phlegm, shortness of breath (dyspnea) that gets worse with exercise, fatigue or tiredness, frequent respiratory infections and wheezing. "Since the symptoms of COPD develop slowly, some people may be unaware that they are sick," he said.

A simple lung test called spirometry is used where the patient blows hard into a machine and a stethoscope can also be used. to listen to the lungs although sometimes the lungs sound normal even when COPD is present.


Sometimes it is necessary to do a blood test (call a 'blood gas') to measure the amounts of oxygen and carbon dioxide in the blood. There is no cure for COPD but patients can do many things you can do to relieve symptoms and keep the disease from getting worse.

According to researcher Amal Kumarage, health damage and respiratory diseases account for Rs. 32 billion losses in Sri Lanka.

Another statistic by the Central Environmental Authority stated that a loss of 1.5 percent GDP is accounted due to pollution. When people can't go to work on time delayed due to traffic and if they spend on respiratory problems such as asthma, there is an un reported loss that reveals that we are losing the war on air pollution.

"In addition to this, burning firewood is also a problem and this has cancer causing problems.

Why is it that our pantries are fitted with beautiful French windows and airy fans but a dingy place where the fire-hearth is kept is in a poorly-ventilated area? We should change it the other way around because if we are to stop respiratory conditions in women, kitchens should be well-aired," Prof. Illeperuma said.

According to him, at the moment, pollution in the rural areas is one-fifth time less than in the city and health problems are 50 percent lower than in the urban areas.

The course of action we should take to minimise air pollution shouldn't be just curbing traffic, by widening roads and building flyovers but enforce it at a grass root level. He said, "Strict emission testing for all buses and limit the import of three-wheelers and motorcycles that do not comply with approved vehicular emission standards is the start to air pollution control", Prof. Illeperuma said that Montessories and nurseries should be located away from the city as possible. Convenience might be the key, but when your child's health is at stake, this is vital. "Since highway usage is subsidised, a policy should be formulated that highway users can pay so that vehicle ownership will be reduced. We need to look at saving not only our lives but our children's lives as well".

Treatment for COPD

1. Persons with COPD must stop smoking, but if you are in a very polluted area, it would be helpful to think of an alternative location to live

2. COPD medications such as inhalers (bronchodilators) can open air passages and inhaled steroids can significantly reduce lung inflammation

3. Antibiotics are prescribed during sudden symptom as infections can make COPD worse

4. Another treatment method is oxygen therapy at home where a patient having a low level of oxygen in their blood can do breathing exercises such as ones used in yoga.

5. Specified and tailor-made exercise programs such as pulmonary rehabilitation can help maintain muscle strength in the legs

6. Avoiding breathing very cold air

7. Don't let anyone smoke near you and avoid smoking areas

8. Reduce air pollution by eliminating fireplace smoke and other irritants

9. Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables.

If it is hard to keep your weight up, talk to a doctor or dietitian about getting foods with more calories.

10. Surgery to remove a lung and lung transplants are done to patients with severe emphysema.

TB discovery paves the way for drugs that prevent lung destruction

Scientists have identified a key enzyme responsible for destroying lung tissue in tuberculosis (TB), they report in the Journal of Clinical Investigation. Drugs that inhibit this enzyme are already available, meaning that the finding could lead quickly to new treatments.

TB is caused by the bacterium Mycobacterium tuberculosis. The infection destroys patients' lung tissue, causing them to cough up the bacteria, which then spread through the air and can be inhaled by others.

The mechanism behind this lung damage is poorly understood, and no treatments currently used prevent it from occurring. Patients require at least six months of antibiotic treatment, but drug-resistant strains of the bacterium are becoming increasingly common.

The new research shows that in patients with TB, there is an increase in levels of an enzyme called MMP-1 in their lungs. When the researchers infected human immune cells with TB in the lab, they found that the cells greatly increased production of this enzyme.

Since the mouse version of MMP-1 is not expressed in the lung, the researchers developed a transgenic mouse with human MMP-1 to investigate whether the enzyme causes lung damage in TB. When these mice were infected with TB, MMP-1 levels increased significantly and the infection led to lung damage similar to that seen in humans with TB.

The scientists also found that a drug proven to be safe in humans was effective at suppressing MMP-1 activity driven by TB infection in human cells.

The findings suggest that similar drugs might prevent lung damage in TB patients and help limit the spread of the disease.

The study was carried out by researchers at Imperial College London with collaborators at Columbia University in New York and the University of East Anglia, and it was supported by the National Institute for Health Research (who funded the work on human cells), the Scadding Morriston Davies Travel Fellowship and the US National Institutes of Health.

Dr Paul Elkington, from the Department of Infectious Diseases and Immunity at Imperial College London, said:

"A third of the world's population is infected with tuberculosis, and almost 2 million people die from the disease every year.

"Standard TB treatment has remained unchanged for 35 years, and no current treatments prevent the lung destruction that TB causes. These findings suggest that drugs available now might be able to reduce deaths from TB."

Many MMP inhibitor drugs were developed in the 1990s because they showed initial promise for treating cancer. The researchers now plan to carry out further studies to see whether these drugs can prevent lung destruction in patients with TB.Professor Jon Friedland, senior author of the study from the Department of Infectious Diseases and Immunity at Imperial College London, said:

"Until now, we haven't had a convincing explanation of how lung destruction is caused by TB.

We hypothesised that protease enzymes must be involved, since nothing else could break down the strong collagen fibres that make up the scaffold of the lung. The results of this study provide strong evidence to support that idea."Dr Elkington and his colleagues first put forward thaeir hypothesis that MMP enzymes play a key role in TB in a review article published earlier this year in the journal Science Translational Medicine.

Source: Sam Wong Imperial College London

Managers' conceptions can be self-fulfilling prophecies

American companies and organizations spend billions of dollars every year on leadership training for their managers. To improve job performance they ought instead to focus on what managers believe about their employees, a study by the University of California, Riverside shows.

How leaders view their employees tends to become a self-fulfilling prophecy, concludes Thomas Sy, assistant professor of psychology at UC Riverside and a longtime business leadership consultant.

In what he describes as the first study to examine leaders' conceptions of followers, the psychologist found that "if managers view followers positively - that they are good citizens, industrious, enthusiastic - they will treat their employees positively.

If they think of their employees negatively - that they are conforming, insubordinate and incompetent - they will treat them that way," he said. "Manager beliefs about employees impact organizational outcomes."

These include interpersonal liking and relationship quality between leaders and followers, as well as followers' job satisfaction and trust in leaders.

Sy suggests that it is possible to change what leaders believe about their followers, a business strategy that could improve worker performance.

The results of his study appeared in the paper "What do you think of followers? Examining the content, structure, and consequences of implicit followership theories," which was published in the peer-reviewed journal Organizational Behavior and Human Decision Processes.

In a five-phase study involving hundreds of workplace leaders, Sy identified six core conceptions by which managers categorize their employees - industry, enthusiasm and good citizen, qualities representing positive conceptions of followers; and insubordination, incompetence and conformity, qualities representing negative conceptions of followers. This process of categorizing others operates automatically and spontaneously, he said. Managers act on those conceptions - known as implicit followership theories (IFTs) - even if they don't realize they hold those beliefs about their employees.

Leaders who have more positive conceptions or IFTs may behave differently toward followers than those who have more negative IFTs, he wrote. Because how leaders think often affects what leaders do, IFTs may determine leadership style and leaders' treatment of followers.

Because performance evaluations often correspond with perceivers' implicit theories, leaders may more easily recognize potential in followers that fit their implicit theories of followership and may not recognize potential in equally capable followers who exhibit less congruence, Sy explained. As part of the research Sy also developed a management tool to assess leader beliefs about followers.

"We've confirmed what people intuitively know," he added. "Now we're providing practical ways to impact leadership outcomes."

Source: Bettye Miller University of California - Riverside

Sleeping late can prove to be a killer

Late to bed and early to rise could well be the New Age recipe for heart disease. It is no longer only what you eat and drink that determines your ill-health.

Sleep deprivation is also emerging as a key reason for heart ailments.

Recent research from London shows a person who sleeps less than six hours a night has a 48% higher risk of developing or dying from heart disease. This could hold true for Mumbaikars too, say doctors.

Cardiologist Brian Pinto recalled the death of a friend's 43-year-old son who collapsed on the road while jogging at 5.45am. "Youngsters are cutting down on sleep to accommodate more work hours and exercise. But without seven hours of sleep, this could spell disaster," said Pinto.

Cardiologist A B Mehta said, "More than 60% of patients who land up in a hospital's emergency room with a heart attack are first-timers who have never suspected they had heart disease. In many cases, excessive exercising and sleeplessness are common features.''

The University of Warwick studied over 400,000 people across eight countries, including the US, the UK and Japan, to establish this equation. "If you sleep less than six hours a night and have disturbed sleep you stand a 48% greater chance of developing or dying from heart disease and a 15% greater chance of developing or dying of a stroke,'' the university team said. It added, ''Late to bed and early to rise is a ticking time bomb for health.''

In 2000, Hinduja Hospital's Dr Zarir Udwadia studied the a disorder called obstructive sleep apnea and found 8% of 700 people who underwent a check-up at their hospital suffered from sleep apnea.

"There is a strong risk factor between obstructive sleep apnea and hypertension. If a patient's blood pressure is not controlled by medicines, then we recommend that he undergo a sleep pattern test as sleep apnea is most likely the cause,'' he said.

Endocrinologist Shashank Joshi said, ''Sleeping less than five hours leads to diabesity (diabetes and obesity) in Mumbai." He also adds that sleep of beyond 10 hours is harmful

Cholesterol-lowering drugs and strokes

Cholesterol-lowering drugs known as statins may help clot-busting drugs treat strokes, according to researchers at Washington University School of Medicine in St. Louis.

The research involved 31 patients with ischemic stroke, a disorder when a clot blocks blood flow to part of the brain. In 12 patients who were already taking statins to control their cholesterol, blood flow returned to the blocked areas of the brain more completely and quickly.

"We've known that patients on statins have better stroke outcomes, but the data in this study suggest a new reason why: Statins may help improve blood flow to brain regions at risk of dying during ischemic stroke," says senior author Jin-Moo Lee, MD, PhD, director of the cerebrovascular disease section in the Department of Neurology.

"If that turns out to be the case, we may want to consider adding statins to the clot-busting drugs we normally give to acute stroke patients."

The results appear online in the journal Stroke.

The stroke team first established that patients were having an ischemic stroke and treated them with a clot-busting drug. An MRI scan was performed during treatment with the clot-busting drug and again three hours later to assess the restoration of blood flow to blocked areas.

"To our knowledge, this is the first time someone has looked at the effects of statins on restoration of blood flow using brain tissue-based measurements instead of looking at the opening of blood vessels," says lead author Andria Ford, MD, assistant professor of neurology.

"It's harder to do, but we feel it gives us more accurate measurements."

Within three hours after treatment, blood flow restoration in the 12 patients already on statins averaged 50 percent. In the 19 patients not taking statins, though, the average was 13 percent.

Doctors tested the patients on arrival to the hospital and at one month after their strokes using the National Institutes of Health Stroke Scale, an assessment that evaluates a variety of functions including speech, movement, attention and sensation.

Patients taking statins had greater improvements in their scores at the one-month test, an indicator that their strokes were less damaging or that they were recovering more quickly.

Statins already are recognized for having beneficial effects beyond lowering cholesterol, Lee says.

These include beneficial effects on the health of cells that line blood vessels and increased production of nitric oxide, a compound that dilates blood vessels. He says a larger study is needed to confirm that statins improve restoration of blood flow after stroke, leading to less disability.

"We don't know yet if this potential effect depends on taking statins every day, or if giving statins to patients when they have a stroke can have similar benefits," Lee says. "Based on our data, though, these questions are worth looking into."

Source: Michael C. Purdy Washington University School of Medicine



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