Balanced diet during pregnancy leads to healthy births -Dr. Jayasiri Jayawardena

By Nilma DOLE

Revealing a pearly white smile, baby Bandula was loved even before he was born and was the apple of his family's eye. Little did they know that when he became a toddler, he wouldn't be able to walk, run or play with other toddlers.

It was later that he was diagnosed with a condition known as hydrocephalus referred to as 'water filled in the brain'.

Speaking to the Sunday Observer was one of Sri Lanka's leading Ayurvedha specialists and consultant of the National Hospital, Dr.Jayasiri Jayawardena who said, "A deformity happens when a baby is born with a major difference in the traditional shape of the human body." In toddler Bandula's case, his condition was where an abnormal expansion of cavities (ventricles) inside the brain caused the accumulation of cerebrospinal fluid. The doctor said, "Before he came to me, Bandula had a big head, problems with walking, couldn't control his bowels or his bladder and he was on the verge of being mental impaired".

One in 500 children are estimated to be stricken with hydrocephalus but often the ones that are reported are very rare. Dr. Jayawardena said,

Bandula, before he was treated, and walking after

"The causes of hydrocephalus are still not well understood as it could be due to various unexplained reasons but in Bandula's case it was a complication of premature birth. I believe that if Bandula wasn't cured at this age, he would have grown into a mentally-imbalanced patient."

A deformity can also be termed as dysmorphism or a dysmorphic feature where a part of the body can have unusual appearance. "In Sri Lanka, a major cause of deformity in children are due to complications during birth which can be easily prevented. Some can be due to hereditary or even a sort of under-development of the foetus during the pregnancy," he said. He said that a good pregnancy and a healthy delivery determines the overall well-being of a child.

According to the doctor, a growth or a hormone disorder can also be the cause of a deformity and so can conditions such as arthritis and rheumatoid disorders, but in Sri Lanka, the focus must be placed on good labour techniques during childbirth.

"There have been cases where pregnant women have given birth to children with deformities after being poisoned by Carbon Monoxide or Barbiturates," he said. In fact, certain drugs administered in therapeutic dosage to the mother during the first three months of pregnancy may also be responsible for foetal malformation.

"Most babies who have severe deformities where they can't be cured die quickly due to a missing vital organ but in cases where they have survived it is the simple fact that a baby wasn't delivered properly where a deformity has occurred," said Dr. Jayawardena.The phenomenon of deformities have been in existence since humankind first walked the earth but for many sufferers who are born with it, shouldn't ashamed.

International celebrities who, in our minds, are the perfect example of beauty and handsomeness do actually have their own stories of childhood or adult deformities. From Bollywood heartthrob Hrithik Roshan to Hollywood's leading lady, Jennifer Garner, some of the world's beautiful people are in fact physically deformed.

While surgery can rectify a majority of deformities including the one Bandula suffered with, it is basic principles that can prevent such shortcomings.

"My advice to pregnant women is to make sure that they are not stressed and live comfortably. If they have a little mental strain, it is likely to cause an impact for the unborn child. In addition to this, make sure the delivery will be done at a reputed hospital where measures are in place should something problematic happen to the baby," said the doctor.

He also said that pregnant women should breathe fresh air, shouldn't be near dangerous factories exuding toxic fumes and should be careful with what they eat.

"We can't change or control the environment we live in but we can ensure that we live in a healthy environment by relocating ourselves to a nicer location.

It would make a world of a difference to not only your baby but to your whole family," he said.

Dr. Jayawardena has the cures of deformities in his Ayurvedha treatment and has extensively practised in the sector for nearly 50 years.

A skin specialist and a therapeutic Ayurvedha practitioner, Dr. Jayawardena believes that the food we consume has much to do with our bodies.

"Eat a balanced and healthy diet with less salt and less sugar. I've seen many pregnancy complications arising because of poor diet and not eating the right nutritious foods," he said.

If we want to have healthy families who are not a burden to society and have better lives, be careful and take your pregnancy seriously.

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[ Deformities:]

Proteus syndrome - It is a rare congenital disorder with highly variable manifestations, including partial gigantism of the hands and feet with hypertrophy of the palms and soles, nevi, hemihypertrophy, subcutaneous tumors, macrocephaly and other skull abnormalities, and abdominal or pelvic lipomatosis. The cause is unknown, although a genetic origin, possibly of autosomal-dominant transmission, has been conjectured. Although symptoms can be treated, there is no known cure.

Maxillofacial Multiple Fibrous Dysplasia - Patients with typical, relatively limited facial bone disease have this condition.

Craniofacial fibrous dysplasia is present where there is extensive involvement of facial bones and bones of the skull.

Micromelia - It is the abnormal shortness or smallness of limbs and it is also called nanomelia.

Mongolism or Down's Syndrome - It is the abnormal condition of a child born mentally deficient, with a flattened skull, narrow slanting eyes, and a short, flat-bridged nose and it is usually known as Down's syndrome.

Hydrocephalus - This is the result of an imbalance between the formation and drainage of cerebrospinal fluid (CSF).

Hydrocephalus comes from two Greek words: hydros means water and cephalus means head. There are two main varieties of hydrocephalus: congenital and acquired. An obstruction of the cerebral aqueduct (aqueductal stenosis) is the most frequent cause of congenital hydrocephalus.

Acquired hydrocephalus may result from spina bifida, intraventricular hemorrhage, meningitis, head trauma, tumors, and cysts.

(References from www.medical-dictionary.thefreedictionary.com)

Obese patients and airway problems

A major UK study on complications of anaesthesia has shown that obese patients are twice as likely to develop serious airway problems during a general anaesthetic than non-obese patients. 'The airway' means the air passages from the outside world to the lungs, which must be kept open to keep the patient alive. The study also shows that the use of a simple breathing monitor, called a capnograph, could significantly reduce deaths and brain damage from such problems in intensive care units (ICUs); it found that absence of a capnograph contributed to 74% of deaths from these events in ICUs during the study.

The report, which is published in two parts online in the British Journal of Anaesthesia, is the result of a yearlong prospective study by the Royal College of Anaesthetists (RCoA) and the Difficult Airway Society.

The full report is available on the RCoA website on the same day. The project, which identified that 2.9 million general anaesthetics are given in the UK each year, monitored all major complications of airway management that occurred in these patients and in ICUs and in emergency departments throughout the UK in 2008-2009. It studied only events serious enough to lead to death, brain damage, ICU admission or urgent insertion of a breathing tube in the front of the neck.

The report has several findings and recommendations; but those on obesity and the monitoring of breathing are among the most striking.

Obesity

In addition to the two-fold increased risk of obese patients developing serious airway problems during an anaesthetic, the study also found that patients with severe obesity were four times more likely to develop such problems. In addition, obese patients were more likely to die if they sustained airway complications in ICU. Some obese patients died from complications of general anaesthesia whilst undergoing procedures that could have been performed under local or regional anaesthesia (where only part of the patient's body is anaesthetised). In some cases this alternative appeared not to be considered.

Dr. Nick Woodall, Consultant Anaesthetist at the Norfolk and Norwich Hospital (Norwich, UK), and an author of the report says: "Our findings show that patients who are obese have twice the risk of major airway problems during anaesthesia, compared to non-obese patients. In the very obese this risk is even higher. The report is important for patients and anaesthetists alike. The information will enable obese patients to be better informed about the risks of anaesthesia and to give informed consent. We hope our findings will encourage anaesthetists to recognise these risks and choose anaesthetic techniques with a lower risk, such as a regional anaesthesia, where possible, and also prepare for airway difficulties when anaesthetising obese patients."

Airway problems were more likely to result in death in patients sedated on ICUs than if they occurred during anaesthesia for surgery.

Half of the reports of events on ICUs described a patient death from the complication, whereas 12% died when the complication occurred during anaesthesia. Of the events reported from ICU 61% led to death or brain damage, compared to 14% of events during anaesthesia.

The most important finding was that the absence of a breathing monitor (capnograph) contributed to 74% of airwayrelated deaths reported from ICUs. The authors say that if the monitor had been used it would have identified problems at an earlier stage and so could have prevented some of the deaths altogether.

The capnograph, which detects exhaled carbon dioxide, is used almost universally in anaesthesia but only sporadically in ICUs. Several authors and organisations have recommended that it should be used routinely in ICUs but, at present, this does not appear to be happening.

Dr Tim Cook, a Consultant in Anaesthesia and Intensive Care at the Royal United Hospital, Bath (Bath, UK), and one of the report authors, says: "The findings of this report indicate that when airway problems arise in this group of sick patients the consequences are often very severe. The report makes several recommendations to improve the safety of airway management in the ICU.

Breathing

The single most important change that would save lives is the use of a simple breathing monitor, which would have identified or prevented most of the events that were reported. We recommend that a capnograph is used for all patients receiving help with breathing on ICU; current evidence suggests it is used for only a quarter of such patients. Greater use of this device will save lives."

Although the poor physical condition of patients needing to be in ICU possibly accounted for some the difference in outcome, the report identified several other causes:

* patients on ICU who are at risk of airway problems were less likely to be identified (and their management changed) than when undergoing anaesthesia; * the range of equipment available to manage patients with difficult airways is often less extensive in ICU compared to patients being anaesthetised in operating theatres; * changes in training mean that the junior doctors looking after patients out of hours on ICU may have little experience in the management of difficult airway problems; * rescue techniques (procedures performed to resolve a problem with the airway) are less likely to be successful in ICU compared to during anaesthesia.

Dr Cook says: "Despite the finding of this project, it is clear that anaesthesia remains extremely safe. The report estimates that a life-threatening airway complication occurs in less than one in 20,000 general anaesthetics (0.005%) and death in approximately one in 180,000 anaesthetics. Most patients who had complications that were reported to this project had identifiable risk factors such as obesity or head and neck cancer; these patients are at a much higher risk of airway complications than healthy patients undergoing anaesthesia and surgery."

Dr. Peter Nightingale, President of the RCoA, comments: "I believe this report highlights areas of critical concern for all doctors involved in maintaining the airway of patients receiving anaesthetics or in intensive care units.

The report provides a specific insight into the high risks and complications associated with airway management and obese patients which should act as a focus for all healthcare professionals treating such patients."

Dr. Ellen O'Sullivan, President of the Difficult Airway Society, adds: "The Difficult Airway Society welcomes the publication of this important study which emphasises the critical importance of high quality airway management in providing safe care of patients during anaesthesia and in intensive care.

The report shows that in a small number of cases there is room for improvement and it is important that as a profession we listen to these lessons."

Source: Charlie McLaughlan Oxford University Press

Turning unhealthy dependency into healthy dependency

Think of a dependent person and you think of someone who's needy, high-maintenance, and passive. That's how many psychologists and therapists think of them, too; passivity is key. But dependency is actually more complex and can even have active, positive aspects, writes Robert Bornstein of Adelphi University, the author of a new article published in Current Directions in Psychological Science, a journal of the Association for Psychological Science.

Bornstein was sent towards a different concept of dependency by a series of experiments he did in graduate school. He paired a dependent person with a less dependent person and set them to debate an issue they disagreed on. He expected that the dependent person would give in to their peer. But the opposite happened; 70 percent of the time, it was the nondependent person who gave in. So the assumption of psychologists was wrong; dependent people aren't always passive. The reason, he realized, was that they wanted to impress the professor running the experiment.

"My understanding, based on what studies we've done so far, is that the core of a dependent personality is a perception of one's self as helpless, vulnerable, and weak," Bornstein says. He believes this often comes from growing up with overprotective or authoritarian parents. So dependent people decide "the way to get by in life is to find someone strong and never let go." That means they want to impress authority figures who might help or protect them later; they also want to maintain relationships at all cost.

The surprising part is that this need to impress can lead to some very active, non-passive behavior. The reliance on authority figures explains why dependent people are more likely to see a doctor when they have an alarming symptom, and more likely to stick to a treatment regimen or a weight-loss program when a doctor assigns it to them.

This can also make them conscientious therapy patients.

Other studies have found that dependent college students have higher GPAs than non-dependent college students. "If you're a non-dependent person, the general feeling is, 'well, I'll have to figure it out on my own,'" Bornstein says. "Dependent students, who are predisposed to seek help from an authority figure, will go to a professor and ask for help."

Of course, that's not all good. Seeking medical attention after every little twinge isn't necessarily useful, and a dependent college student can drive his professors up the wall. Another surprising finding is that dependent men are more likely to perpetrate domestic violence; they're so worried about maintaining the relationship that, "When they get desperate, they resort to coercive tactics," he says.

Bornstein thinks the new way of thinking about dependency is helpful to psychological scientists and also to therapists. "I'm trying to move toward a fundamental shift in the way that psychologists or therapists deal with dependent patients," he says. Traditionally, the goal was to make the dependency go away. "My take on it is, the most effective way to deal with dependent patients is to turn unhealthy dependency into healthy dependency."

(Source: Divya Menon Association for Psychological Science)

Tumours use white blood cells to halt treatment

Cancer Research UK scientists have discovered that tumours are able to recruit part of the body's defence system to protect them from the effect of a drug designed to block the supply of blood to the tumour.

The research, published in The Journal of Clinical Investigation, showed that white blood cells called macrophages, normally a key part of the body's defence mechanism against disease, are recruited in large numbers by tumours and reduce the effects of an experimental drug called combretastatin-A4P (CA4P).

This is a type of drug called a vascular disrupting agent (VDA) as it rapidly and selectively blocks blood vessels in tumours causing widespread tumour death.

Research groups in Sheffield, led by Professors Claire Lewis and Gillian Tozer - working with Professor Michele De Palma and colleagues in Milan - showed that after treatments with CA4P, tumours in mice begin to release a protein called CXCL12. This recruits these white blood cells from the bloodstream into the treated tumour where they then help to block the effect of the drug on the blood vessels and to encourage tumour growth.But this effect can be stopped. By blocking the receptor for CXCL12 on these white blood cells, so stopping their recruitment by the tumour, treatment with CA4P was significantly better at slowing tumour growth than when the VDA was used alone.Professor Claire Lewis, a Cancer Research UK-funded scientist at the University of Sheffield, said: "We know that drugs that block blood vessels in tumours have a really damaging effect on the cancer, but this is often only short-lived and tumours start to re-grow.

"By expanding our research into what prompts macrophages to drive a tumour's re-growth after therapy we should now be able to find ways of blocking their effects and making such treatments more effective."

Professor Malcolm Reed, Head of Surgical Oncology at the University of Sheffield, commented: "This exciting work provides valuable insights into the possible mechanism which may result in a cancer becoming resistant to treatment with chemotherapy. This has the potential to help develop new approaches to improve treatment for patients."

CA4P is an experimental type of drug that targets only the blood vessels that supply cancer cells. It is currently in trials for a number of cancers to find out the best dose and how effective it is.

Dr Julie Sharp, senior science information manager at Cancer Research UK, said: "This exciting area of research provides a critical insight into how cancers are able to use the body's own defences for their own survival. Cancer Research UK is funding further research into how these white blood cells are helping to resist anti-cancer drugs. By tackling this challenge of treatment resistance we will help more people beat their disease."

(Source: Cancer Research UK)