Science of de-pigmentation

Vitiligo or leukoderma is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of the disease though is complex and not fully understood but there is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors

 By Dr Hena Jawaid

Vitiligo is the skin condition which results from loss of pigment that produces white patches. Common areas of involvement are the face, lips, hands, arms, legs, and genital areas, but in general every part of the body may be affected. The disease may occur with other autoimmune diseases, diseases in which immunity turns against ones own body.

Melanocytes are the cells, that produced the pigment which determines colour of skin, hair, and eyes, the Melanin. If these cells die or are unable to form melanin then the skin becomes lighter in colour. The degree of pigment loss can vary within each vitiligo patch. Vitiligo begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn't change, may continue indefinitely. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin colour. Although their skin is all one colour, they still have the disease.

There is no way to predict how much pigment an individual will lose. The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo and suntanned skin in the summer. Vitiligo is more apparent in people with darker skin. Individuals with severe cases can loss pigment all over the body.

In fair-skinned individuals, avoiding tanning of normal skin can make areas of Vitiligo almost unnoticeable because the (no pigment) white skin, of the disease has no natural protection from sun. These areas are easily sunburned, and people with vitiligo have an increased risk to skin cancer. They should wear a sunscreen with a SPF of at least 30 on all areas which are not covered with cloths. Avoid the sun when it is most intense to avoid burns.

The primary goal of therapy is to bring back the skinís colour by restoring melanocytes in the skin. Repigmentation of the skin with melanocytes allows the skin to regain its normal immune or inflammatory functions and improves the appearance.

There is no easy treatment of the disease. Cover-up cosmetics work well. Mask vitiligo with make-up, self-tanning compounds or dyes is a way to make it less noticeable. Waterproof cosmetics to match almost all skin colours are available.

Stains that dye the skin can be used to colour the white patches to more closely match normal skin colour. These stains gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan colour. The colour from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance. Micropigmentation tattooing of small areas may be helpful.

If sunscreens and cover-ups are not satisfactory, your doctor may recommend other treatment. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). But none of the repigmentation methods are permanent cures.

Topical Corticosteroids - Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist's care.

PUVA is a form of repigmentation therapy where a type of medication known as psoralen is used. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. Sometimes, when vitiligo is limited to a few small areas, psoralens can be applied to the vitiligo areas before UVA treatments. Treatment with PUVA has a 50 to 70 percent chance of returning colour on the face, trunk, and upper arms and upper legs.

Hands and feet respond very poorly. Weekly two treatments are required. Side effects of PUVA include sunburn-type reactions. When used in long-term, there is an increased risk of skin cancer. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women.

Narrow Band UVB (NBUVB), is a phototherapy that requires the skin to be treated two, sometimes three, times a week for a few months. It's useful in treating children with vitiligo.

Sleep apnea linked to increased risk of death

In apnea, the frequent pauses in breathing disrupt sleep and prevent adequate amount of oxygen from entering the bloodstream. Interruptions in breathing are potentially serious medical conditions and should be evaluated by a physician to determine whether treatment is needed.

Sleep-disordered breathing (also known as sleep apnea) is associated with an increased risk of death, according to new results from the Wisconsin Sleep Cohort, an 18-year observational study supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Researchers found that adults (ages 30 to 60) with sleep-disordered breathing at the start of the study were two to three times more likely to die from any cause compared to those who did not have sleep-disordered breathing. The risk of death was linked to the severity of sleep-disordered breathing and was not attributable to age, gender, body mass index (an indicator of overweight or obesity), or cardiovascular health status.

Researchers followed 1522 generally healthy men and women for an average of 13.8 years after testing them for sleep-disordered breathing using a standard overnight sleep test. Participants with severe sleep-disordered breathing were three times more likely to die during the study than those without breathing problems during sleep. Those who were not treated were at even greater risk. Participants with untreated severe sleep-disordered breathing were four times more likely to die from any cause and five times more likely to die from cardiovascular conditions.

The Wisconsin Sleep Cohort is the most comprehensive assessment yet of mortality risks associated with sleep-disordered breathing and the first to study a randomly selected population of adults. The findings suggest that the treatment of severe sleep-disordered breathing may be protective, especially against cardiovascular deaths. An estimated 12-18 million people have moderate to severe sleep-disordered breathing. Periodically during sleep, the upper airway becomes narrowed or blocked, and air has trouble reaching the lungs; in some cases, breathing stops completely (called apnea) for seconds to minutes at a time. The frequent pauses in breathing disrupt sleep and prevent adequate amounts of oxygen from entering the bloodstream. Interruptions in breathing are potentially serious medical conditions and should be evaluated by a physician to determine whether treatment is needed.

Because affected individuals are asleep and typically unaware of the breathing problems, and the condition cannot be diagnosed during routine physician office visits, most people with sleep-disordered breathing are undiagnosed.

Untreated sleep-disordered breathing has been linked to a greater risk of cardiovascular disease and risk factors ñ including high blood pressure, stroke, and diabetes as well as to excessive daytime sleepiness, which can impair quality of life and performance on the job or in school, and increase the risk of injury or death from work-related accidents and vehicular crashes.

Common signs that should be discussed with a physician include complaints of snoring from bed partners, excessive daytime sleepiness, and morning headache. Sleep-disordered breathing occurs in people of all ages, but is more common in men, the elderly and overweight individuals. With the growing prevalence of overweight and obesity and the aging population, the number of individuals with sleep-disordered breathing is likely to rise.

--www.scienceblog.com

Flu vaccine doesn't protect seniors from pneumonia

Flu vaccine may not protect older people from pneumonia once they get the disease, researchers report 

By Steven Reinberg

Older, frail adults are more susceptible to getting the flu, even if they have been vaccinated, and once getting the flu, they are more susceptible to such complications as pneumonia. It had been thought that flu vaccine would prevent flu and pneumonia across all groups of seniors, but this benefit appears to be largely confined to younger, healthier seniors.

"In seniors, flu vaccine was not linked to a reduced risk of pneumonia," said lead researcher Michael L. Jackson, a postdoctoral fellow at the Group Health Centre for Health Studies in Seattle.

Jackson still recommends that seniors get flu vaccine. "There have been good randomised trials that show, at least in healthy seniors, that the vaccine reduces the risk of influenza," he said. "However, earlier studies have overestimated how well the vaccine works in reducing complications of influenza. So, the vaccine may not reduce the risk of complications as much as previously thought," he said.

Among young healthy seniors, the vaccine reduces the risk of flu, Jackson said. "When you look at the total population of seniors, which includes people over 75 and people that have chronic health diseases - lung disease, heart disease, diabetes, and things like that - we don't know if the vaccine is effective in the seniors," he said. "People with these chronic diseases are more susceptible to getting the flu, and they are more likely to develop pneumonia if they do get influenza."

For the study, Jackson's team collected data on 1,173 people between the ages of 65 and 94 who developed pneumonia. They compared these individuals with 2,346 people who did not get pneumonia. Both groups had similar rates of flu vaccination over the three seasons of studies, the researchers say.

The researchers found that vaccinated seniors who got the flu were as likely to develop pneumonia as unvaccinated seniors who got the flu.

Dr Pascal James Imperato, dean of the master of public health programme at the State University of New York Downstate Medical Centre in New York City, was not surprised by these results.

"We know that elderly people do not form sufficient antibodies to certain vaccines, the flu vaccine included," Imperato said. "In addition, people in their 70s and 80s and 90s are more prone to pneumonia with or without influenza. A number of these pneumonias may be secondary to other causes aside from influenza."

Even though many of the elderly will not develop sufficient antibodies to the flu vaccine, getting the shot is still worthwhile, Imperato said. "Having many people vaccinated builds up a herd immunity to disease, and you create barriers to transmission," he added.

Dr Marc Siegel, a clinical associate professor of medicine at New York University School of Medicine in New York City, said that the results of this study fly in the face of prevailing wisdom.

The effectiveness of the flu vaccine varies year to year, however, depending on how good a match it is for the circulating strains of influence. "In the best years, the flu vaccine is really only 40 to 60 percent effective," Siegel added.

In addition, Siegel thinks that the flu vaccine protects against other complication including respiratory diseases, which can also be fatal. "There are plenty of flu-related complications that are life-threatening besides pneumonia," he said.

"This study is a reminder that flu vaccines are not a panacea, but they are valuable, because they cut down on the incidence of influenza," Siegel said. "Flu shots definitely cut down on the number of flu-related deaths."

--www.google.com

Can happy thoughts heal?

Leave a pendulum to its own devices and it most assuredly will swing the other way. So it has been lately with a theory of health and healing that treats the mind as a weapon at least as powerful as the best of modern medicaments. After nearly a century stuck on the side of the body, the pendulum has recently cut a wide arc towards the mind.

For most of human history, medicine was little more than a bag of mind altering tricks. Except for some potent herbs that later became the basis for effective pharmaceuticals, the early healers had little more going for them than their ability to inspire trust and invoke images of recovery.

In fact, it was not until the advent of scientific medicine near the turn of this century that physical ministrations began to overshadow and at times nearly obliterate the impact of mental states on resistance to and recovery from illness.

In the 1940's and 50's there was a brief revival of interest in the impact of mind on body as few renowned psychiatrists formulated and popularised what came to be known as psychosomatic medicine. This discipline depicted emotional upheaval and certain personality types as important contributors to certain physical ailments, suggesting that adjustments in feelings and thoughts might prevent disease or promote recovery. Unfortunately, rather than pursue scientifically the many remedial hints offered by psychosomatics, physicians who heeded the field at all tended to dismiss such diseases as all in the mind and their victims as crocks who took up far too much of the doctor's time or they simply shipped such patients off to psychiatrists.

Just in the last few years, researchers have shown, for example, placebos influence brain chemicals that in turn can relieve pain and promote healing that undue emotional stress can depress the body's immunological responses, and that an aggressive attitude toward illness can bolster those responses.

--www..msnbc.com

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Health update
Studies confirm Avandia's protection for diabetes patients

New data from three different clinical trials - Action in Diabetes and Vascular Disease (ADVANCE); Veteran Affairs Diabetes Trial (VADT); and Action to Control Cardiovascular Risk in Diabetes (ACCORD) - presented at the recently held annual meeting of the American Diabetes Association in San Fransico established that a leading drug indicated for diabetes, Avandia (Rosiglitazone) is not associated with any cardiac risk and confirmed its previously identified benefit of the lower blood-sugar strategy for Type 2 diabetes patients. Findings from VADT showed that while Rosiglitazone was used in a majority of patients in the study, it was not associated by any means with increased deaths.

Higher HIV infection estimate shows need of more funding for care

The Centres for Disease Control and Prevention (CDC) is expected soon to increase the estimate of new HIV infections by 40 percent. This highlights the need to make HIV testing a routine part of medical care and provide better funding to care for those who test positive, according to the HIV Medicine Association (HIVMA). CDC has published guidelines recommending HIV screening in emergency rooms, public health clinics, regular doctor visits, and other routine interactions with the health care system. This would increase the opportunities to find those who are infected and connect them with medical care before the disease does irreparable harm to their immune systems. Also, more and more research is showing that those with their HIV infections under control are less likely to spread the disease to others.

Frankincense provides relief to arthritis sufferers

An enriched extract of the 'Indian Frankincense' herb Boswellia serrata has been proven to reduce the symptoms of osteoarthritis. Research published recently in BioMed Central's open access journal Arthritis Research and Therapy has shown that patients taking the herbal remedy showed significant improvement in as little as seven days. Osteoarthritis is the most common form of arthritis; it commonly affects weight-bearing joints such as the knees and hips, along with the hands, wrists, feet and spine. The symptoms include pain, stiffness and limited movement. This randomised, double-blinded, placebo-controlled trial of 70 patients will be of great interest to sufferers, especially those who don't get adequate relief from existing treatments.

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