'Sleep lab' wakes up!

The newly-opened Sleep Lab General Hospital is now gaining popularity as many patients and even the general public are inquiring about it. "What we would like to tell patients is that you can't just walk in and do the sleep test but it's important to obtain a referral from a doctor to do it," said Dr. Chandra Jayasuriya, E.N.T specialist of the Colombo General Hospital. The other doctors who will refer patients to the Sleep Lab and monitor them are Dr. R. P. Dayasena, Dr. S.C. Perera and Dr. S. Fernando.

No more worries!

"In the first instance, we give the patients a questionnaire called the Epworth Sleepiness Scale and depending on how severe their sleep disorder is, then we'll have the sleep test," said Dr.Jayasuriya.

There is a big waiting list now at the Colombo General Hospital after the publicity given to the new sleep laboratory that monitors a patient's body due to sleep disorders or patterns.

Generally, Sleep Apnea is categorised into two types:Central Apnea affecting the central nervous system and Obstructive Sleep Apnea which obstructs the airways and breathing passages.

"There are many sleeping disorders that a patient can have but what we are mostly interested in is Obstructive Sleep Apnoea (OSA)," said the doctor. She commented, "For example, a patient can have obstructed breathing difficulties when they snore. OSA is a disease that can be cured through an operation which opens the respiratory track or using a special machine to breathe while sleeping".

She explained that often snoring can lead to marital problems if the partner can't tolerate it.

But in other cases, the patient has nothing wrong but it is just that they make noise by snoring. "For obstructions we need to monitor the patient through the Sleep Lab by checking how their throat is blocked. These problems can arise due to large bulky tongue, nasal polyps, septal deviation, infection or growth in the throat or large tonsils," she said.

If such problems arise, the patient is susceptible to breathing difficulties where oxygen can't enter the lungs causing life-damaging consequences.

"If a patient doesn't get enough oxygen, they can suffer from hypoxia which would mean you wake up in the middle of the night to breathe properly. You don't remember it but when you wake up, you feel tired," highlighted Dr.Jayasuriya. Hypoxia is a pathological condition in which the body as a whole (generalized hypoxia) or a region of the body (tissue hypoxia) is deprived of adequate oxygen supply.

Sleep lab comes to the rescue!

"We advise obese people on proper nutrition because fatty deposits in the neck can block the windpipe which can also cause OSA," noted the doctor.

In such cases, the doctor would treat the patient with Continuous Positive Airway Pressure (CPAP) which allows ventilation for patients to prevent the need for endotracheal intubation, or allow earlier extubation.

The Colombo General Hospital has introduced the Sleep Laboratory (worth nearly Rs. 200,000) for the first time in the government sector while majority of the private hospitals have already set it up. "Even if a patient uses the General Hospital's Sleep Laboratory, there are disposable items that a patient has to buy which amount to Rs. 2000," said Dr.Jayasuriya. The patients are asked to enter the sleep room by 7pm and leads (nodes) are attached to various contact points in their body.

"The leads are connected to a device to interpret the sleep readings through a computer and then we can check the readings to determine what is wrong with the patient," said the doctor.

The Sleep Laboratory has now opened a new chapter in government medical history so you'll have pleasant dreams!

Genetic mutations may play a role in childhood leukemia

by Allie MONTGOMERY

There could be a new breakthrough on childhood leukemia that could help with better, less punishing treatments in the future. Children that have particular gene mutations are at an increased risk of developing leukemia, according to the first studies to show that genetic inheritance can play a role in developing the disease.

Research into the development of acute lymphoblastic leukemia, also known as ALL, is the most common childhood cancer, suggests that the individuals who inherit specific genetic variants are approximately twice as likely to develop the disease. The findings, which come from the first complete genome search for possible inherited risk factors for ALL, also offer some potential advances in treatment with the identification of a gene that could help predict drug response with the disease. Two studies that have been published in the journal *Nature Genetic*s confirm that alterations in the 1KZF1 and ARID5b genes are linked to the development of ALL, which accounts for approximately 80 percent of leukemia cases in kids.

Scientists have described these findings as a significant advance in helping us understand leukemia. While ALL does not appear to run in families as some other common genetic diseases, the scientists have established that inherited risk factors are also involved in its development. Most cancers are thought to be triggered by a certain combination of factors, which include exposure to the environment, inherited genetic susceptibility, and chance.

Researchers, from the Institute of Cancer Research in Sutton, southwest London, identified inherited variations in genes that control the development of lymphocytes, which are white blood cells that play a very important role in the body's defenses, by comparing the whole DNA genome of approximately 1,000 British kids that suffered from ALL against the children that did not have the disease. The scientists said that these mutations, individually, could increase the risk of developing All by approximately 30 to 60 percent.

The second study, which was done by a team at St. Jude Children's Research Hospital in Tennessee, identified the same variant genes from genome scans of 441 children that suffered from the disease. Although adults can also develop this kind of leukemia, it is much more common in children ages 2 to 5, which accounts for about 400 pediatric cases in Britain annually.

Professor Richard Houlston, who is the head of the Sutton Institute's Molecular and Population Genetic Team, said that the genes encode proteins that are involved in the development of white blood cells that are called B-cells, which produce antibodies to help fight disease and are most commonly affected in ALL. "These findings provide the first evidence that genetic make-up plays a major role in the risk of ALL," he stated.

Professor Mel Greaves, who is a leukemia biologist and chairman of the institute's section of haemato-oncology , described the work as "a very significant advance" in helping us understand the complex process in which children develop leukemia. He also added that it should not be taken to mean that children can develop the disease just because of an accident of inheritance. He said, "Genetic risk factors are just one component of the cause. Finding the triggering exposures still remains a focus of intense effort, particularly with respect to possible future prevention."

Mary Relling, who is the lead author of the American study, said that the ARID5B gene was important in embryonic development and the IKZF1 gene was critical for the development of lymphoid cells, which are cells that are found in the lymph nodes. She also added that even with the genetic mutations, the risk of developing ALL remained at a low rate. "Like all cancers, pediatric ALL is a multifactor disease. But these findings may give us a handle on the mechanism of the disease and drug responsiveness to it."

David Grant, who is the scientific director at Leukemia Research, which funded the British study, stated, "A complete understanding of how leukemia develops will lead to new, less punishing, treatments to cure all children with this cruel cancer."

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* Novel influenza (H1N1):

How to protect yourself and others

* Wash hands regularly with soap and water.

* Avoid touching eyes, nose or mouth with unwashed hands.

*If you have flu like symptoms such as fever, headache, body pains, sore throat, cough, runny nose,vomiting and or diarrhoea, seek medical advice immediately.

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Courtesy: Epidemiological Unit Ministry of Health