How laser therapy heals wounds

By Carol Aloysius

All of us suffer from wounds at sometime or the other in our lives. Some wounds heal quickly and require no special attention. Others may take much longer to heal and even get aggravated if neglected or treated in the wrong manner. This is especially so in people with diabetes. In their case, most injuries afflicting their bodies take a long time to heal - depending on their current health status. Chronic skin wounds in such patients are particularly difficult to heal, even with good management.

Venus ulcer in a diabetic

Today, the number of diabetic patients in Sri Lanka has increased considerably over the past few decades and diabetes has climbed to the rank of the second leading cause for morbidity and mortality.

Consequently our hospitals are flooded with diabetics who have been admitted because they have ulcers, infected wounds or bed sores that refuse to heal. Although with conventional treatment and careful nursing, many patients are able to return home, several are forced to return to the hospital with recurring wounds.

According to health authorities, the recent Christmas and New Year festivities have had their most severe impact on diabetic patients whose wounds have been aggravated by excessive ingestion of sweetmeats during the season.

Now, after years of research and experimentation to find an alternative method of healing wounds in diabetic patients with minimal invasion and in the shortest possible time, medical researchers have come up with a new approach to healing such injuries: Laser Therapy. This new technique has given hope to millions of diabetic patients not just in Sri Lanka but elsewhere in the world, as it can accelerate the healing of such injuries like diabetic ulcers, pressure and bed sores, infected wounds, says chartered Physiotherapist Dr Gopi Kitnasamy.

In an interview with the Sunday Observer, he cites his own hands-on-experiences of patients with severe diabetic injuries making a speedy recovery which he says, “is nothing short of a miracle.”

Following are excerpts…

Q. First of all, what is Laser Therapy?

A. Laser means Light Amplification by Stimulated Emission or Radiation. Laser Therapy involves the application of a narrow spectral width light over injuries or lesions to stimulate healing within those tissues. The application can improve wound healing rates and reduce pain and risk of infection. This therapy has been used to treat ulcers, pressure sores, infected wounds, burns, traumatic wounds and postoperative wounds that are failing to heal.

Q. How does it work?

A. Laser therapy works through a variety of mechanisms. It is a type of Photobiomodulation i.e. the use of photons to modulate biological activity. The photons, which are produced by lasers, although light emitting diodes are sometimes used, can stimulate the healing of chronic wounds and of acute wounds if these are healing slowly. To produce an effect, the photons must be absorbed. Different substances absorb light of different wavelengths, and the cells of injured skin are more sensitive than those of intact tissue. It is therefore possible to target specific cell types. Once cells have absorbed the photons a cascade of biochemical events occurs, whose ultimate result is accelerated wound healing.

Q. How do these photons help in wound healing?

A. Photons from a laser probe are absorbed into the mitochondria and cell membranes of the cells. Single oxygen molecules build up which influences the formation of adenosine triphosphate, which in turn leads to replication of DNA. Increased DNA leads to increased neurotransmission. A cascade of metabolic effects results in various physiological changes.

Q. What is the end result?

A. It results in improved tissue repair, faster resolution of the inflammatory response, and reduction of pain.

Q. Have you any successful case studies that you can share with us?

Case study

A. One such case comes to my mind. It concerns a 72 years old male with Diabetes who was referred to us by a Consultant Surgeon. He had a Diabetic Foot Ulcer in his right foot, which was infected and the pus was oozing out. He was advised to have his leg amputated in a hospital in Batticaloa where he lived, He however refused to undergo such drastic treatment and instead opted for Laser Therapy. Within two weeks of Laser Therapy with cluster and routine dressing, the wound started healing and the infection was controlled, and the pus drained out and the wound became clear.

Q. Is a laser therapy applicable only or mostly to diabetic wounds? Or are there other wounds that also respond well to this treatment?

A. Laser therapy is used for treating many types of wounds. But we have found that some of the most encouraging results have been in the case of diabetic patients. Take Diabetic ulcers. Diabetic patients are particularly susceptible to developing ulcers.

Q. Why?

A. People with advanced diabetes have a diminished perception of pain in the extremities due to nerve damage, and therefore may not initially notice small scratches or bruises on their legs and feet. Diabetes also impairs the immune system and damages capillaries. Repeated injury, compounded by impaired healing, can cause even the smallest cut or bruise to become dangerously infected. Next we have Chronic wounds that diabetic patients suffer from. There are three main types of chronic wounds: venous ulcers, diabetic ulcers, and pressure sores.

Q. What are venous ulcers?

A. Venous ulcers usually occur in the legs, account for the majority of chronic wounds.

Q. Who is most at risk of such ulcers?

A. Mostly the elderly.

Q. Why and how do such wounds occur?

A. They are caused by improper function of tiny valves in the veins that normally prevent blood from flowing backward.

The dysfunction of these valves impedes the normal circulation of blood in the legs, causing tissue damage and impaired wound healing. Then there are those who suffer from injuries caused by Peripheral Arterial Disease.

Here too, Diabetics are 2-4 times more likely than healthy individuals to have peripheral arterial disease (PAD), a term that covers an array of medical problems caused by obstruction of the large arteries in the arms or legs.

A more severe form of PAD is critical limb ischemia (CLI), a leading cause of lower limb amputations. The Angiogenesis Foundation estimates that 1.4 million people in the United States have CLI, with an estimated 350,876 new cases diagnosed each year.

Q. What are the other risk factors?

A. Smoking, high cholesterol, and high blood pressure are also significant risk factors.

Q. What about pressure ulcers or sores?

A. Pressure ulcers comprise the third main type of chronic wounds. These typically occur in people who are bedridden or whose mobility is severely limited.

Pressure ulcers are caused by a loss of blood circulation that occurs when pressure on the tissue is greater than the pressure in capillaries, thereby cutting off circulation.

Parts of the body that are particularly susceptible to pressure ulcers include the heels, shoulder blades, and sacrum (the triangular bone at the base of the spine forming the posterior of the pelvis).

Q. What is the most significant advantage of Laser therapy when used adjunct with the conventional method of treating these chronic wounds?

A. Chronic wounds either require a prolonged time to heal, do not heal completely, or recur frequently.

A large number of factors can impede wound healing and may predispose a patient to the development of chronic wound(s).

These include both systemic factors (poor nutrition, metabolic derangements, and drugs) and local factors (tissue hypoxia, infection, and dry wound bed).Conventional treatment for established wounds incorporates common principles that apply to the management of all wounds, including debridement of necrotic tissue, maintenance of a moist wound bed, and control of infection.

Laser therapy will speed up the healing process by increasing granulation tissue, early epithelialisation, increased fibroblast proliferation, increased extracellular matrix synthesis and enhanced neovascularisation, all of which lead to better tissue oxygenation and nutrition, and, in turn, enhanced wound healing. It also affects immune cells, and acts directly and selectively on the immune system. Stimulation of the immune system means that infected wounds can be cleared more readily.

Laser therapy should be used as an adjunct to the conventional treatment to get better and quicker results.

Q. Have you a message for the public with regard to laser therapy?

A. Laser therapy can be used for various other conditions like soft tissue injuries (like tennis elbow, plantar fasciitis, Achilles tendinitis, rotator cuff problems etc.), neurological problems, sports injuries, etc.

It is very safe and doesn’t cause any side effects. It not only helps reducing the pain and inflammation, but also helps in the healing process.

DNA changes causing disease identified

Many rare disorders are caused by gene mutation, such as sickle cell anaemia.

Yet until now the underlying genetic cause of more common conditions - for example, rheumatoid arthritis - has evaded scientists for years.

New research from Case Western Reserve University School of Medicine in Genome Research finds that six common diseases arise from DNA changes located outside genes. The study from the laboratory of Peter Scacheri, shows that multiple DNA changes, or variants, work in concert to affect genes, leading to autoimmune diseases including rheumatoid arthritis, Crohn's disease, celiac disease, multiple sclerosis, lupus and colitis.

Further, for each disease, multiple different genes are manipulated by several small differences in DNA. “We've known that rare diseases are due to one change within one gene with major effects.

The key take away is that common diseases are due to many changes with small effects on a handful of genes,” said Scacheri, associate prof of genetics and genome sciences.

The human genome includes three billion letters of DNA. Only one to two percent of the letters are used as the blueprint for proteins, the body's building blocks. Scacheri's team is part of group of scientists investigating where and why DNA goes awry in the remaining 98 percent - the regions between genes.

These regions contain thousands of genetic switches that control the levels of genes. This new finding shows that in common diseases, the fine-tuning of those switches is not quite right, leading to incorrect expression of some key genes - previously unidentified.

“This is a paradigm shift for the field with respect to pinpointing the genetic causes of common disease susceptibility,” Scacheri said. The Scacheri lab's study provides a new model for understanding how genetic variants explain variation in common, complex diseases such as rheumatoid arthritis and colitis.

That is, the effect of an individual variant may be very small, but when coupled with other nearby variants, the manifestations are much greater, said Prof Anthony Wynshaw-Boris. “This model may also help to explain why genetic studies of these and other common diseases have so far fallen short of providing a satisfactory explanation of the genetic pathways important for the development of these disorders.” The Scacheri laboratory conducted a bioinformatics analysis of new and pre-existing data and developed computational tools to identify the switches and genes affected by DNA changes associated with common diseases.

“This is vital information for creating therapies to target these disorders,” said Olivia Corradin, a School of Medicine candidate and lead author on the study.

“For example, if an individual has a gene that is aberrantly high, he or she will need a medication that will dial it back down. Scientists can't begin to develop a drug to do this without first knowing the gene target and how it needs to be manipulated, either up or down.Now that the Case Western Reserve team knows the identity of the genes that affect six autoimmune diseases and also understands how the genes are disrupted, the next step is to identify therapies that can restore these genes to their normal levels, so that these diseases can be treated or altogether prevented.

In addition, the researchers hope that discovery can lead to improved diagnostic testing for common diseases.

- MNT

Vitamin E ‘may help slow down onset of dementia’

Daily doses of vitamin E may help slow down the onset of dementia, a new study has indicated.

In a study of 613 people with mild or moderate symptoms of dementia, those who were given a large dose of vitamin E supplements each day experienced a slower decline in their condition than those who were given a placebo.

After being followed up for more than two years, those who took vitamin E were found to be better able to perform daily cognitive tasks, and also required fewer hours of care.

The study, published in American Medical Association, was carried out among patients at care homes for veterans in the American state of Minnesota by government researchers.Overall, the authors estimated that cognitive decline was reduced by 19 percent in the vitamin E group, who also required on average two hours less time with carers per day.The study led some experts to call for vitamin E to be prescribed for dementia sufferers. Kenneth Davis, president of the Mount Sinai Health System in New York, said that supplements should be offered to patients with mild or moderate Alzheimer’s disease.

However, the doses of vitamins used in the study were large - about 1,300mg - and may be harmful for some, according to the UK Alzheimer’s Society, which urged people to seek advice from their doctor before taking supplements.

“Treatments which can help people with dementia carry out everyday tasks are key to enabling those with the condition to live well for as long as possible,” a spokesperson for the charity said.

“While this study into the link between vitamin E intake and reduction in functional decline is of interest, it is by no means conclusive.

“More research is needed to see if vitamin E really does have benefits for people with dementia, and whether it would be safe to be taking such a high dose on a daily basis.”

- The Independent

Even or odd: No easy feat for the mind

Even scientists are fond of thinking of the human brain as a computer, following sets of rules to communicate, make decisions and find a meal.

But if the brain is like a computer, why do brains make mistakes that computers don't? Research by Gary Lupyan, a cognitive scientist shows that our brains stumble on even the simplest rule-based calculations. Instead, humans get caught up in contextual information, even when the rules are as clear-cut as separating even numbers from odd.

Almost all adults understand that it's the last digit - and only the last digit - that determines whether a number is even, including participants in Lupyan's study. But that didn't keep them from mistaking a number like 798 for odd.

A significant minority of people, regardless of their formal education, believe 400 is a better even number than 798, according to Lupyan, and also systematically mistake numbers like 798 for odd. After all, it is mostly odd, right? “Most of us would attribute an error like that to carelessness, or not paying attention,” says Lupyan. “But some errors may appear more often because our brains are not as well equipped to solve purely rule-based problems.”

Asked in experiments to sort numbers, shapes, and people into simple categories such as evens, triangles, and grandmothers, study subjects often broke simple rules in favour of context.

For example, when asked to consider a contest open only to grandmothers and in which every eligible contestant had an equal chance of victory, people tended to think that a 68-year old woman with 6 grandchildren was more likely to win than a 39-year old woman with a newborn grandchild. “Even though people can articulate the rules, they can't help but be influenced by perceptual details,” Lupyan says. “Thinking of triangles tends to involve thinking of typical, equilateral sorts of triangles. It is difficult to focus on just the rules that make a shape a triangle, regardless of what it looks like exactly.”

- MNT