Youth more at risk of spinal cord injuries

By Nilma DOLE

Causes of spinal cord injury 1. Destruction from direct trauma 2. Compression by bone fragments, hematoma, or disk material 3. Ischemia from damage or impingement on the spinal arteries 4. Vascular disorders 5. Tumours 6. Infectious conditions 7. Spondylosis 8. Iatrogenic injuries, especially after spinal injections and epidural catheter placement 9. Vertebral fractures secondary to osteoporosis 10. Developmental disorders Courtesy: www.emedicine.medscape.com

Your spine is a delicate bone structure in your body which supports your posture and is indeed your backbone supporting a whole host of your bodily systems. People don't realise the value of their spine until they fracture it accidentally or damage it. Once they are confined to a wheelchair only do they realise the gravity of the fracture. Bread winners and sole income earners are reduced to being immobile once an accident takes place. Be it traumatic or non-traumatic, spinal cord injuries affect individuals differently.

A seminar at the Health Education Bureau was held to understand more about spinal cord injuries, statistics and what we must do to prevent it. Spinal injury encompasses fracture, dislocation, nerve injury and this results in disability as it depends on the level of severity. Part of the central nervous system, the spinal cord is 10 millimetres in width and 18 inches in length which is an extension of the brain and it is the cord that communicates between the brain and the rest of the body.

Government hospital consultant in Rheumatology and Rehabilitation Medicine, Dr. Lilani Panangala said that spinal cord injury is a devastating neurological injury resulting in varying degree of paralysis sensory loss and uncontrollable bowel and bladder movements. She said, "The causes of spinal cord injuries are domestic and industrial accidents, road traffic accidents, sports injuries, self-harm and criminal assault, war casualties and diseases such as tuberculosis, transverse myelitis, neuro-degenerative conditions."

In Sri Lanka, 1,200-1,500 people are affected annually by spinal cord injuries and the RRH (Rheumatology and Rehabilitation Medicine) at the Ragama Hospital is the only specialised unit in Sri Lanka to help in spinal cord injury therapy. Dr. Panangala said, "About 75 percent of patients die within 18 to 24 hours of complications such as pressure sores which can be avoided with the right education."

Moreover, the doctor said that effects of spinal cord injuries encompasses spinal shock, loss of sensory and motor function below the level of lesions, immobility, dependence on others, stress and worry. She said, "Other fatal effects include sexual dysfunction (more in males than in females) bowel and uncontrollable bladder and bowel movements and high injuries can result in loss of involuntary functions such as breathing difficulties.

However, there is hope for spinal cord injured patients as the RRH does proper therapy and curative treatment to help cure such patients. "The goals of rehabilitation offer education for patients and families on this condition, we maximise proficiency in mobility and self care," she said. She said that by educating on other problems arising from spinal cord injuries would help prevent the other conditions to follow. A vital aspect of rehabilitation is counselling and psychological assessment to talk about well-being and integration into the community and vocational reintegration.

President of the Sri Lanka Orthopaedic Association Dr. G.L. Punchihewa also spoke at the seminar. He said, "It is the young and middle-aged population and males more than females who are more at risk of spinal cord injuries. However, it varies from individual and what occupational hazards and recreational activities the person does."

There is no magical cure for spinal cord injuries and it can't be reversed but with the right therapy there could be some hope for patients. "Out of those affected with spinal injuries, cervical (neck) spine injuries amounts to 55 percent, thoracic spine injuries are 15 percent, thoracolumbar junction injuries encompass 15 percent and Lumboscaral spine injuries is believed to be 15 percent," said Dr. Punchihewa.

The primary step in initial injury is that it cannot be reversed as there is no cure and the goal will be to prevent further injury to the spine. "The patient should be immobilised and should be transferred to a hospital immediately but improper handling and undue hurry may do more harm than good," said the doctor.

Safe transport is a must and facilities should be in place with trained paramedics on the job who know how to properly handle the patient. "More often than not, if medical personnel do not get to the scene of the accident immediately, ordinary people take matters into their hands and cramp the victim in a three-wheeler in a bad position or get the patient to sit upright in a fast-moving vehicle which would be more fatal than benefit. This is due to lack of education and awareness," said the doctor.Management at the hospital is done through assessment of the damage and resuscitation, x-ray is taken of the spine and if required, a MRI or CT scan if the injury is severe. "There is no drug or miracle treatment to cure this condition but support mechanisms will be fitted to the patient depending on the level of fracture," he said.

Stabilisation of the spine is a necessity as it is required for early mobilisation. "The outcome of spinal cord recovery can be either full recovery or partial paralysis or to a certain degree," said the doctor.

The patient needs to rest and be stabilised after surgery and the rehabilitation process should include physical, social and psychological aspects. Occupational therapy and body weight supported treadmill training that physiotherapists may assist with healing a patient with spinal cord injury and also play an important role in the management of this condition. "Social service is also imperative if we are to ensure that spinal cord injury patients have a better tomorrow.

Also, prevention is better than cure so you could be a healthy and fit individual but you shouldn't overdo things especially when it comes to sports," said the doctor. Disability access in buildings, public institutions and the homes of these patients should be enforced and even though there are various measures in place, implementation is virtually slow.

Lack of education and awareness also contribute and architects should be mindful of designing buildings to accommodate disabled access.

Researchers on why steroid treatment for COPD is ineffective

Chronic obstructive pulmonary disease (COPD) leads to persistent inflammation of the airways and is typically managed with corticosteroids, a class of anti-inflammatory medication. However, corticosteroids do not improve survival nor alter the progression of COPD and may reduce lung symptoms as little as 20 percent.

A new study found why corticosteroids do not work well for COPD patients and how additional treatment with sulforaphane an ingredient of broccoli and other vegetables can improve the effectiveness of corticosteroids.

COPD is a major public health problem for both the developed and the developing world, and is most often caused by cigarette smoking or exposure to pollutants from combustion. Characterized by chronic bronchitis and emphysema, COPD is the third leading cause of death in the U.S. and affects 24 million Americans and 210 million people worldwide.

Histone deacetylase 2 (HDAC2) is critical component in a chain of reactions that enable corticosteroids to reduce inflammation. However, HDAC2 is substantially reduced in the lung tissue of individuals with COPD.

In the study, researchers found that S-nitrosylation causes HDAC2 dysfunction and leads to corticosteroid insensitivity in the alveolar macrophages of the lungs of individuals with COPD. S-nitrosylation of HDAC2 occurs from exposure to cigarette smoke, a primary cause of COPD.

"This study provides the mechanism of exaggerated inflammation observed in COPD patients during exacerbations, which has been a barrier to developing effective therapy," said Rajesh Thimmulappa, PhD co-author of the study and an assistant scientist in the Bloomberg School's Department of Environmental Health Sciences. Furthermore, the research team found that treatment with sulforaphane restored HDAC2 activity and corticosteroid sensitivity.

Previous studies by the research team showed sulforaphane activates the Nrf2 pathway (nuclear factor erythroid 2 related factor 2) and it is being tested in clinical trial for patients with COPD.

Courtesy: Medical X Press

Cells are crawling all over our bodies

For better and for worse, human health depends on a cell's motility the ability to crawl from place to place. In every human body, millions of cells are crawling around doing mostly good deeds though if any of those crawlers are cancerous, watch out.

"This is not some horrible sci-fi movie come true but, instead, normal cells carrying out their daily duties," said cell biologist Tom Roberts. For 35 years he has studied the mechanical and molecular means by which amorphous single cells purposefully propel themselves throughout the body in amoeboid-like fashion absent muscles, bones or brains.

Meanwhile, human cells don't give up their secrets easily. In the body, they use the millions of tiny filaments found on their front ends to push the front of their cytoskeletons forward. In rapid succession the cells then retract their rears in a smooth, coordinated extension-contraction manner that puts inchworms to shame. Yet take them out of the body and put them under a microscope and the crawling changes or stops.

But now Roberts and his research team have found a novel way around uncooperative human cells.

In a landmark study led by Roberts and conducted in large part by his then-FSU postdoctoral associate Katsuya Shimabukuro, researchers used worm sperm to replicate cell motility in vitro in this case, on a microscope slide.

Doing what no other scientists had ever successfully done before, Shimabukuro disassembled and reconstituted a worm sperm cell, then devised conditions to promote the cell's natural pull-push crawling motions even in the unnatural conditions of a laboratory. Once launched, the reconstituted machinery moved just like regular worm sperm do in a natural setting giving scientists an unprecedented opportunity to watch it move. Roberts called his former postdoc's signal achievement "careful, clever work" and work it did, making possible new, revealing images of cell motility that should help pinpoint with never-before-seen precision just how cells crawl.

"Understanding how cells crawl is a big deal," Roberts said. "The first line of defence against invading microorganisms, the remodelling of bones, healing wounds in the skin and reconnecting of neuronal circuits during regeneration of the nervous system all depend on the capacity of specialized cells to crawl.

"On the downside, the ability of tumour cells to crawl around is a contributing factor in the metastasis of malignancies," he said. "But we believe our achievements in this latest round of basic research could eventually aid in the development of therapies that target cell motility in order to interfere with or block the metastasis of cancer." Funding for Robert's worm-sperm study came from the National Institute of Health. The findings are described in a paper ("Reconstitution of Amoeboid Motility In Vitro Identifies a Motor-Independent Mechanism for Cell Body Retraction") published online in the journal Current Biology.

Armed with the new found ability to reconstitute amoeboid motility in vitro, cell biologists such as Roberts may be able to learn the answers to some major moving questions. Among them: How can some cells continue to crawl even after researchers have disabled their supply of myosin, the force-producing "mover protein" that functions like a motor to help power muscle and cell contraction?

For Roberts and his team, the next move will be to determine if what they've learned about worm sperm also applies to more conventional crawling cells, including tumour cells. "As always, there will be more questions," Roberts said. "Are there multiple mechanisms collaborating to drive cell body retraction? Is there redundancy built into the motility systems?"

Courtesy: Science Daily

The body rids itself of damage when it really matters

Although the body is constantly replacing cells and cell constituents, damage and imperfections accumulate over time. Cleanup efforts are saved for when it really matters. Researchers from the University of Gothenburg, Sweden, are able to show how the body rids itself of damage when it is time to reproduce and create new life.

'I have a daughter. She is made of my cells yet has much less cellular damage than my cells. Why didn't she inherit my cells including the damaged proteins? That's the process I'm interested in,' says Malin Hernebring from the Department of Cell- and Molecular Biology at the University of Gothenburg.

A few days after conception, the cells in the embryo all look the same - they are unspecified stem cells that can develop into any bodily cell type. As the process of cell specification (differentiation) begins, they go from being able to keep dividing infinitely to being able to do so only a limited number of times. This is when they start cleansing themselves.

'Quite unexpectedly we found that the level of protein damage was relatively high in the embryo's unspecified cells, but then it decreased dramatically.

A few days after the onset of cell differentiation, the protein damage level had gone down by 80-90 percent. We think this is a result of the damaged material being broken down.' In the past, researchers have believed that the body keeps cells involved in reproduction isolated and protected from damage. Now it has been shown that these types of cells go through a rejuvenation process that rids them of the inherited damage.

Some types of protein damage in the body increase with age. Although all the necessary information is stored in the DNA, something keeps the body from using it to keep repairing the body.

'These types of protein damages are what make us appear old, like wrinkles around the eyes. While wrinkles are relatively harmless, serious problems may arise elsewhere in the body. I'm thinking of age-related diseases like Parkinson's, Alzheimer's, type 2 diabetes and cancer.' Malin Hernebring can show that the damaged proteins in the cells are probably broken down by molecular machines called proteasomes. The proteasome activity increases considerably during the initial steps of embryonic stem cell differentiation in mice. Deciphering this rejuvenation process helps us better understand what ageing really is, which in turn may help us slow it down and also prevent the occurrence and ill effects of age-related diseases.

- e! science news

New Malaria vaccine to destroy world's most devastating killers

Millions of deaths a year could be prevented by a new malaria vaccine that has been shown to cut the risk of disease in young children by half.

The initial results from a final stage of vaccine testing were released last week, and the vaccine's developers hailed the results in helping to tame one of the world's most devastating killers.

Bill Gates, whose foundation has contributed $1.75bn to the effort, said it was a "huge milestone" in the fight against the disease.

"This is proof that it is possible to create a vaccine that is effective against malaria," he said. He added that it "has the potential to protect millions of children and save thousands of lives".

However, the vaccine won't be available for at least three years, as crucial further testing must be completed to see how well it works in infants and how long protection lasts. Then the vaccine must be reviewed by government agencies in Europe and in individual African countries.

"We still have a way to go," Tsiri Agbenyega, lead researcher for the African study, said in a conference call with reporters.

The early results, taken from a study in seven African countries, show the vaccine is only about 50 per cent effective, significantly lower than the protection seen in more common vaccines. But some experts said it's a vast improvement on the current situation, and could still save hundreds of thousands of lives.

Globally, malaria kills nearly a million people annually. More than 90 per cent of them live in Africa, and most are young children and pregnant women.

Scientists have been trying for decades to develop a malaria vaccine and the one tested is furthest along.

Without a vaccine, public health efforts have concentrated on malaria drugs and other ways to prevent infection such as mosquito bed netting and insecticides.

The new vaccine targets a malaria parasite found in sub-Saharan Africa. Malaria spreads through mosquitoes, which bite people and flush malaria parasites into the bloodstream.

The new study - still under way - began in 2009 and involves more than 15,000 children in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania.

Early results were released yesterday at a malaria conference in Seattle and published by The New England Journal of Medicine.

The findings focus on about 6,000 children aged five to 17 months.

A year after getting three doses, the vaccinated children had about half as many cases of malaria as a group that didn't get the vaccine.

- The Independent