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Posted: 17 Oct 2012 07:58 AM PDT

Some gains have been made, but many mysteries remain as Alzheimer's epidemic looms.

MORE than 100 years after it was first caught in the act of decaying a patient's brain, Alzheimer's remains one of medicine's greatest challenges as it robs ever more people of their memory and independence.

Researchers make halting progress, reporting small steps forward along with many frustrating setbacks.

And while care for Alzheimer's sufferers has improved since former US president Ronald Reagan and British fantasy author Terry Pratchett helped lift the stigma, the key workings of the illness remain a riddle.

Alzheimer's disease causes two-thirds of dementia cases – attacking one in 200 people – and finding a cure has never been more pressing as the world's population grows and ages.

"There is going to be a tsunami in terms of (cost) burden," said Dean Hartley, director of science initiatives at the US Alzheimer's Association.

A door to hope slammed shut recently when drug giants Eli Lilly, Pfizer and Johnson & Johnson stopped tests of eagerly-anticipated therapies that failed in clinical trials.

On Sept 6, French researchers announced plant extract ginko biloba, widely marketed as a natural Alzheimer's remedy, did not actually prevent dementia.

Blaming insufficient funding, at least in part, researchers say they still do not know quite what to make of the plaques and tangles that German doctor Alois Alzheimer first spotted in the brain of a dementia patient who died in 1906.

Little follow-up work was done until the 1960s, partly because fewer people were then living to an age when the disease shows up.

Today, the sole drugs in our arsenal treat some symptoms but are powerless to slow the progression of Alzheimer's.

"People are absolutely desperate for medicines – people suffering from the disease, and people close to them," said Eric Karran, research director at Alzheimer's Research UK.

"Where we are at the moment is a critical period for this disease," he added.

"The pharmaceutical industry has had a range of very, very expensive failures. I worry they might be thinking: 'this is very difficult and we will just have to wait until the science is more evolved'."

Hartley and Karran said Alzheimer's received a fraction of the money governments spend on disease research despite being one of the costliest illnesses in terms of suffering and spending.

Alzheimer's Disease International (ADI) projects the number of people with dementia will rise from 35.6 million in 2010 to 65.7 million by 2030 and 115.4 million by 2050. The cost, including hospital and home care, drugs and clinic visits, is expected to soar some 85% by 2030 from about US$600bil (RM1.8tril) in 2010 – roughly the GDP of Switzerland.

But money is not the only problem.

The disease is a particularly complicated one to crack, not least because its effect on humans is nigh impossible to replicate in lab animals. Its slow progression is an added hurdle.

"The disease seems to be present in people's brains maybe 15 years prior to suffering symptoms," said Karran.

Alzheimer's normally becomes apparent around the age of 70, when family members observe a loved-one becoming forgetful and confused.

"When patients are available to be studied in clinical trials, you are actually looking at a disease that has been going on for 15 years," by which stage neurons would already have died, said Karran.

Scientists disagree on the respective roles of beta amyloid plaque build-ups and of a protein called tau which forms tangles inside these brain cells.

Most test therapies have targeted beta amyloids, but some now suggest it is actually tau killing the braincells.

"We still do not understand the relation between the structural damage and cognitive symptoms exactly," said Dutch neurophysiology PhD student Willem de Haan.

Researchers are aiming for a treatment that will halt the disease at an early stage – even before the onset of symptoms.

And while they have not succeeded, their work is throwing up some valuable clues along the way.

Already known is that a small percentage of people, more women than men, are genetically predisposed to developing Alzheimer's. A family history of the disease boosts the risk.

Some studies suggest healthy living may reduce the chances of those people who do not carry Alzheimer's-related genes of developing the disease.

Diagnostics, too, are improving: New research shows that a simple eye-tracking test and sleep disruption may be early indicators, helping victims make lifestyle choices before the disease steps into higher gear.

The experts believe that if governments, researchers and drug companies work together efficiently, a treatment may be available within 20 years.

But they also warn against giving false hope to desperate people.

"Finding a medicine for a chronic disease is far, far more complicated than, say, putting a man on the Moon," said Karran. – AFP

Problem of abnormal curvature of the spine

Posted: 17 Oct 2012 07:57 AM PDT

Abnormal curvatures of the spine can lead to multiple problems.

I NOTICED that my son has an abnormal curvature of his spine. It bends sideways. I have heard of hunchbacks, but this is not considered hunchback, is it?

No. What you term as "hunchback" is called kyphosis.

What your son probably has is a sideways curvature of the spine. This is called scoliosis.

A person's spine has some curves, which are considered normal if you look at it from the side of the person. But when you look at it from the front or back of the person, the body should be straight. The thoracic (chest) spine is normally slightly curved forward.

The cervical (neck) and lumbar (lower) spine is normally bent a little backward. These are considered normal. But if the curves are exaggerated, then they are not normal.

Kyphosis is a curve where the spine is bent forward if you look at a person from the side (as in "hunch").

Lordosis is a curve where the spine is bent backward if you look at it from the side.

Scoliosis is when the spine bends to either side with additional curves, forming a "C" or "S" shape.

Does it happen only in children?

No. It occurs in all ages. It is most commonly seen in children over 10 years old, however. Girls are twice as likely to be affected compared to boys.

It's also an extremely common disorder in the world. As much as 2% of all females can be affected by it in varying degrees.

Oh dear. What causes it?

Mostly, the cause is unknown. Another term for this is idiopathic. More than 80% of all scoliosis is attributed to this.

When scoliosis develops before your child is three years old, it is called infantile idiopathic scoliosis. When scoliosis develops in your child who is aged three to 10, it is called juvenile idiopathic scoliosis.

Once your child is over 10 years old, this is called adolescent idiopathic scoliosis.

The other 20% of scoliosis can be divided into:

Functional – This is a type of scoliosis that doesn't develop because there's an abnormality in your spine.

Instead, the problem lies somewhere else in the body – for example, if you have injured your hip, or one of your legs is shorter than the other.

Neuromuscular – The bones of your spine are formed during the time when you are in your mother's womb (as a foetus). Sometimes, they don't form properly, or they fail to separate when they are supposed to.

So basically, when the child is born, he/she has some sort of birth defect, such as cerebral palsy. Kids with these conditions often have a long C-shaped curve in their spines and weak muscles that cannot hold their backs up straight.

This type of scoliosis is often very severe.

Degenerative – This type develops in older people. Your spine becomes arthritic due to age and wear and tear (spondylosis).

Your ligaments and tissues weaken and there may be bony spurs developing.

As a result of the weakening, the spine bends sideways.

Does scoliosis cause pain?

For the most part, it doesn't cause pain.

Scoliosis is usually detected by a family member, or you might notice it yourself because one of your hips is higher than the other, or one of your shoulders may be higher than the other.

You may notice that one side of your ribs is more prominent than the other side.

More severe forms of scoliosis can cause back pain, or difficulty in breathing.

Can scoliosis be cured? Will my son have to have an operation? Will it be painful?

You only treat scoliosis when it's severe. In many cases of infantile idiopathic scoliosis, it will improve on its own without any treatment. But the juvenile type can get worse if you don't treat it.

Basically, there are three components of treatment – observation, bracing and surgery. The objective is to prevent the curve from getting worse until your child stops growing.

Most adolescents and children try bracing. Surgery is recommended only if this doesn't work.

If you have functional scoliosis, then the treatment is concentrated on correcting the abnormality in the other part of the body that is causing it.

The neuromuscular type is usually severe and requires surgery. Surgery will correct the spine to as close as normal as possible, and involves spinal fusion – which is more scary-sounding than it really is.

It just basically involves some screws, hooks and rods which are attached to the bones of your spine to hold them in place.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Living with eczema

Posted: 13 Oct 2012 11:51 PM PDT

Educating parents about protease and its link to childhood eczema.

WELCOMING a child into the world is a joyful experience, but it can also prove to be daunting for many parents, what with the many infections and diseases that can at times plague their newborn.

The greatest gift these parents can give themselves and their child is the feeling of being in control of such problems. This can be achieved by gathering adequate information about the cause, effects and treatment options available for the condition their child is suffering from.

Dermatologists agree that eczema is one of the most prevalent of skin disorders, particularly in babies and children. The dry, itchy skin condition is common – it affects approximately 10-15% of children at any one point in time.

Did you know that protease attacks play a pivotal role in the severity of your child's eczema?

Protease is an enzyme naturally present in the skin that helps break down protein in the skin to allow for natural skin renewal. The trouble begins, however, when protease becomes overactive and stimulates ideal conditions for an eczema attack.

Syazana* learnt this the hard way, after having to go through a heart-wrenching period with her son Mokhtar*, who began to develop eczema (atopic dermatitis) within just five to six months of birth.

It began when Mokhtar suddenly started developing dry and flaky skin. Soon, there were red patches all over his body, and he became increasingly agitated, oftentimes rubbing himself due to the itchiness, and causing bleeding all over his body. This was when Syazana realised that this was far worse than just dry skin, and something was seriously not right with her beautiful little baby.

This was also the case with Liew*, whose baby began breaking out in rashes all over the body, but especially so at the joint areas. Baby Kean* often cried and acted out due to the discomfort and irritation caused by the rashes, which led to Liew spending hours looking for a solution to the rashes.

Frantic visits to pharmacies and drug stores resulted in prescriptions of antibiotic creams, oral steroids, emollients and bath oils, all of which had little effect on the rashes, leaving both these mothers anxious for an answer to their child's problems.

It was soon determined that their children were suffering from eczema. Eczema shows up as patches of red, leathery, dry skin, and is almost always itchy and rough to the touch. It leads to the skin becoming more alkaline in nature, which tends to enhance protease activity, leading to a weakening in the skin barrier, and making the skin more susceptible to infections.

The use of certain soaps and bubble baths has been known to raise skin pH to 7.5 and higher. This will lead to an increase in skin protease activity, which in turn leads to skin damage. Often, this becomes the trigger for flare-ups of eczema, especially in children.

The condition can be managed by using extra gentle cleansers that aim to soothe the inflamed skin, and reduce the activity of protease in the skin.

With the appropriate medication, coupled with several precautionary measures, Mokhtar and Kean began to recover. Their key to recovery was the use of an extra gentle cleanser, which aided in addressing the problem of overactive protease in their skin.

Both mothers immediately changed their babies' body cleansers and stopped using soap to bath them, instead, opting to use extra gentle cleansers that stopped protease activity.

It is important that eczema is treated with an extra gentle cleanser that is formulated for optimal skin pH to stop protease activity, and thus, strengthen the skin barrier.

In addition to this, cleansers should also be free from the foaming agents sodium lauryl sulphate (SLS) and sodium lauryl ethyl sulphate (SLES), which are powerful detergents used to create foam. These skin irritants often aggravate eczema and cause it to flare up further.

With the proper treatment, parents now have an easy and safe method of treating their baby's eczema.

*The names used in the article have been changed to protect the privacy of those involved.

This article is courtesy of Hoe Pharmaceuticals Sdn Bhd. For further information, e-mail enquiry@hoepharma.com.my.

Kredit: www.thestar.com.my

Rabu, 17 Oktober 2012

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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