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Feb23
Antiaging medicine comes back to India
With the sudden increase in the baby Boomer Population , The medical community has faced some drastic changes and is now preparing to deal with them. One of the major changes seen in the area of medicine is about the approach in Medicine . It used to be treating diseases, then preventing diseases, now it is promoting health. Medicine is no longer just taking care of the sick but is also keeping the healthy person healthier and disease free.

To make this happen there is a paradigm shift in the way we look and deal with patients healthy as well as sick ones. Antiaging medicine is now the fastest growing medical speciality.

Amaya Cllinic , Antiaging Medicine and Research India and the World Society of Antiaging Medicine have come forward to bring bach the science of Antiaging Medicine to India. In an attempt to make it more wide spread and acceptable a peer to peer network of antiaging physicians called World Antiaging Network is started

www.worldantiagingnetwork.com

It is a portal backed up by World's largest Anti-aging - Society The World Society of Anti-aging Medicine , Euromedicom:- The World's Largest Anti-aging and Aesthetics Conference Organizing Body, Anti-aging Medicine and Research AMAR- India and Society For Anti-Aging, Aesthetic and Regenerative Medicine Malaysia (SAAARMM).

The main goal of this portal is to connect like minded Physicians, Educational Societies,Conference Organizers, Anti-aging Product Manufacturers and Sponsors who make the events successful with there presence and constant support. Above all it is very important for the worldwide population ,not only for the baby boomers but also for those who would like to stay healthy and learn more about Anti-aging, Regenerative, Aesthetic and Life Span Medicine.

This is a unique portal where you can get your answers in real time from the best Anti-aging Physicians in the world, you can discuss cases, start your own case presentations, Peer reviews with specialists worldwide, Promote your anti-aging products plus most importantly post literature on latest advances in Anti-aging Medicine.

You will find all the international anti-aging events posted on this portal . In addition finally this portal is also going to be used for different online anti-aging Certification courses and exams.
Please do not forget to visit www.antiagingindia.com to register for "INDOMEDICON 2010 "upcoming Antaging Conference and Certification course in India in June 2010.

I personally invite you to join hands with this network to promote the fastest growing specialty of Anti-aging, Aesthetic,Regenerative and Life Span Medicine.

Lets Heal the World together and make it a place to live Longer and Healthier.

Dr. Anoop Chaturvedi
International Scientific Advisor: World Society of Anti-aging Medicine
International Scientific Advisor : Euromedicom
President: Antiaging Medicine and Research, India


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Feb22
Dietary supplements in Osteoarthritis Glucosamine , Chondrotin, S-adenosyl methionine Vitamin C, Beta carotene
INTRODUCTION:

Osteoarthritis (OA) is the commonest form of arthritis found worldwide that can affect the hands, hips, shoulders and knees. It is responsible for the largest burden of joint pain and is the single most important rheumatological cause of disability and handicap.1,2 In Osteoarthritis, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. Drug and non-drug treatments are used to relieve pain and/or swelling. Osteoarthritis commonly affects the hands, feet, spine and large weight-bearing joints, such as the hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis. These are food supplements show promise for helping people with osteoarthritis, those are Glucosamine sulphate, Chondroitin sulphate, SAMe (s-adenosylmethionine), Vitamin C ( ascorbic acid), Beta Carotene3 and many more.
Glucosamine:
Glucosamine is almost synonymous with osteoarthritis as it has benefits for osteoarthritis. It can be found naturally in the body and is used by the body as one of the building blocks of cartilage.Glucosamine is an amino sugar produced from the shells of shellfish (chitin) and it is a key component of cartilage. Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. Glucosamine is part of the structure of the polysaccharides chitosan and chitin, which compose the exoskeletons of crustaceans and other arthropods, cell walls in fungi and many higher organisms, glucosamine is one of the most abundant monosaccharides.3
Glucosamine is necessary for the construction of connective tissue and healthy cartilage. It is the critical building block of proteoglycans and other substances that form protective tissues. These proteoglycans are large protein molecules that act like a sponge to hold water giving connective tissues elasticity and cushioning effects. This also provides a buffering action to help protect against excessive wear and tear of the joints. Without glucosamine, our tendons, ligaments, skin, nails, bones, mucous membranes, and other body tissues can not form properly.

Glucosamine works to stimulate joint function and repair. Everyone produces a certain amount of glucosamine within their bodies. Normally we generate sufficient amounts of glucosamine in our bodies to form the various compounds needed to generate connective tissue and healthy cartilage. But gradually the rate at which our bodies use glucosamine begins to gradually change with our increased athletic activity, injuries, burns, arthritis and other inflammatory disorders, age and other chronic degeneration.3 In such situations our bodies may not be able to keep up with the demand for glucosamine, leading to a decrease in the amount of proteoglycans produced. This can lead to a decrease in the amount of protective lubricating substances like the synovial fluids, which cushion our joints, and protects them from damage. In a nutshell, more glucosamine is needed but less is produced.
As the age advances, body loses the capacity to make enough glucosamine. Having ample glucosamine in the body is essential to producing the nutrients needed to stimulate the production of synovial fluid, the fluid which lubricates cartilage and keeps the joints healthy. Without enough glucosamine, the cartilage in weight-bearing joints, such as the hips, knees, and hands deteriorates. The cartilage then hardens and forms bone spurs, deformed joints, and limited joint movement. This is how the debilitating disease of osteoarthritis develops.4
Therefore, in short, glucosamine is a major building block of proteoglycans needed to make glycosaminoglycans, proteins that bind water in the cartilage matrix which also acts as a source of nutrients for the synthesis of proteoglycans and glycosaminoglycans. It is also a stimulant to chondrocytes and playing key factor in determining how many proteoglycans are produced by the chondrocytes needed to spur chondrocytes to produce more collagen and proteoglycans acts as a regulator of cartilage metabolism which helps to keep cartilage from breaking down. 5
Glucosamine is the supplement most commonly used by patients with osteoarthritis. It is an endogenous amino sugar that is required for synthesis of glycoproteins and glycosaminoglycans, which are found in synovial fluid, ligaments, and other joint structures. Exogenous glucosamine is derived from marine exoskeletons or produced synthetically. Exogenous glucosamine may have anti-inflammatory effects and is thought to stimulate metabolism of chondrocytes.
Glucosamine is available in multiple forms. The most common are glucosamine hydrochloride and glucosamine sulfate. Some products contain a blend of these, and many combine one of the forms with a variety of other ingredients. Glucosamine has been safely used in long-term clinical trials Overall, the evidence supports the use of glucosamine sulfate for modestly reducing osteoarthritis symptoms and possibly slowing disease progression.
Chondroitin
Chondroitin, an endogenous glycosaminoglycan, is a building block for the formation of the joint matrix structure. Chondroitin sulfate is a sulfated glycosaminoglycan (GAG) composed of a chain of alternating sugars (N-acetylgalactosamine and glucuronic acid). It is usually found attached to proteins as part of a proteoglycan.6 Chondroitin sulfate is an important structural component of cartilage and provides much of its resistance to compression. Along with glucosamine, chondroitin sulfate has become a widely used dietary supplement for treatment of osteoarthritis. Chondroitin is a molecule that occurs naturally in the body. It is a major component of cartilage,the tough, connective tissue that cushions the joints. Chondroitin helps to keep cartilage healthy by absorbing fluid (particularly water) into the connective tissue. It may also block enzymes that break down cartilage, and it provides the building blocks for the body to produce new cartilage.
Chondroitin sulphate Chondroitin is the most abundant glycosaminoglycan in cartilage and is responsible for the resiliency of cartilage and it has various effects in relieving symptoms of osteoarthritis and those are its anti-inflammatory activity, the stimulation of the synthesis of proteoglycans and hyaluronic acid, and the decrease in catabolic activity of chondrocytes inhibiting the synthesis of proteolytic enzymes, nitric oxide, and other substances that contribute to damage cartilage matrix and cause death of articular chondrocytes. chondroitin sulfate reduced the IL-1β-induced nuclear factor-kB (Nf-kB) translocation in chondrocytes. In addition, chondroitin sulfate has recently shown a positive effect on osteoarthritic structural changes occurred in the subchondral bone.7 A number of scientific studies suggest that chondroitin may be an effective treatment for osteoarthritis
Therefore, chondroitin sulphate is effective as it reduces osteoarthritis pain, improves functional status of people with hip or knee osteoarthritis, reduces joint swelling and stiffness and ultimately provides relief from osteoarthritis symptoms for up to 3 months after treatment is stopped
S-Adenosyl methionine
S-Adenosyl methionine (SAM, SAMe, SAM-e) is a dietary supplement that has been clinically shown to support and promote joint health, mobility and joint comfort.It is a compound produced by our bodies from methionine. Methionine is an amino acid found in protein-rich foods and a common co-substrate involved in methyl group transfers. SAM-e is critical in the manufacture of joint cartilage and in the maintenance of neural cell membrane function.8
Administration of SAMe exerts analgesic and antiphlogistic activities and stimulates the synthesis of proteoglycans by articular chondrocytes with minimal or absent side effects on the gastrointestinal tract and other organs and improving pain and stiffness related to osteoarthritis
Vitamin C
Vitamin C( ascorbic acid) may help reduce the progression of osteoarthritis. Vitamin C is involved in the formation of both collagen and proteoglycans (two major components of cartilage, which cushions the joints). Vitamin C is also a powerful antioxidant that helps to counteract the effects of free radicals in the body, which can damage cartilage. Ascorbic acid(vitamin c) is a sugar acid with antioxidant properties. Its appearance is white to light-yellow crystals or powder, and it is water-soluble. One form of ascorbic acid is commonly known as vitamin C. In human plasma, ascorbate is the only antioxidant that can completely protect lipids from detectable peroxidative damage induced by aqueous peroxyl radicals. Ascorbate appears to trap virtually all peroxyl radicals in the aqueous phase before they diffuse into the plasma lipids. Ascorbate is a highly effective antioxidant, as it not only completely protects lipids from detectable peroxidative damage, but also spares alpha-tocopherol, urate, and bilirubin.Ascorbic acid stimulates collagen synthesis and modestly stimulates synthesis of aggrecan (a proteoglycan present in articular cartilage), Sulfated proteoglycan biosynthesis is significantly increased in the presence of ascorbic acid thus it may offer some protective effect against the super oxide and free radicals and limiting and delaying the osteoarthritis progression

Beta-carotene
Beta-carotene belongs to a family of natural chemicals known as carotenoids. Widely found in plants, carotenoids along with another group of chemicals, bioflavonoids, give color to fruits, vegetables, and other plants.
Beta-carotene is another antioxidant that also seems to help reduce the risk of osteoarthritis progression. Beta-carotene is a particularly important carotenoid from a nutritional standpoint, because the body easily transforms it to vitamin A. While vitamin A supplements themselves can be toxic when taken to excess, it is believed (although not proven) that the body will make only as much vitamin A out of beta-carotene as it needs. Assuming this is true, this built-in safety feature makes beta-carotene the best way to get your vitamin A. A high dietary intake of beta-carotene is associated with a significantly slower progression of osteoarthritis, according to a study in which researchers followed 640 individuals over a period of 8 to 10 years .10
Conclusion:
In conclusion,there are nutrients and foods that may help to halt the progression osteoarthritis before it becomes severe as well as helping to reduce the pain and inflammation associated with it.



n.b.: This article was an exercise of e learning by final year medical student Saleh from Melaka Manipal Medical College


REFERENCES

1) Clinical Practise Guidelines. Management of Osteoarthritis http://www.msr.org.my/html/Bookleta.pdf accessed on 13 February 2010
2) Cochrane Library. Glucosamine Therapy for Treating Osteoarthritis http://www.cochrane.org/reviews/en/ab002946.html accessed on 13 February 2010
3) Spark People Life. Dietary Supplement for Osteoarthritis
http://www.sparkpeople.com/resource/nutrition_articles.asp?id=865 accessed on
14 February
4) Horton D, Wander JD (1980). The Carbohydrates. Vol IB. New York: Academic
Press. pp. 727–728.
5) Glucosamine and Osteoarthritis,How it works
http://www.arthritis-glucosamine.net/glucosamine-osteoarthritis.php accessed on
14 February 2010
6) Jamie G. Barnhill, Carol L. Fye, David W. Williams, Domenic J. Reda, Crystal L. Harris, and Daniel O. Clegg. Chondroitin Product Selection for the Glucosamine/Chondroitin Arthritis Intervention Trial. J Am Pharm Assoc. 2008; 46:14–24.
7) Davidson EA, Meyer K (2007). "Chondroitin, a mucopolysaccharide". J Biol Chem 211 (2): 605–11.
8) S-adenosyl methionine [SAMe]. Research Reports http://www.oralchelation.com/technical/SAM.htm accessed on 15 February 2010
9) McAlindon TE, Jacques P, Zhang Y, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996;39:648-656.
10) iHerb. Com. Beta Carotene http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21547 accessed on 16 February 2010


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Feb21
CHILDREN AND THEIR EYES
Children and their eyes

Dr Ramesh Murthy, MD FRCS MNAMS
Consultant Pediatric Ophthalmology, Squint, Oculoplasty, Ocular Oncology, Neuroophthalmology
AXIS EYE FOUNDATION, Punjagutta, Hyderabad
04066363100, 9248063100


The prevalence of blindness among children varies between 0.2 /1000 to 1.5/1000 with a global estimate of 0.7/1000. This means that there are about 1.4 million blind children worldwide. It has been said that a child goes blind every minute. Children who are blind have to live a life of emotional, social and economic difficulties which affect the child, family and society.

However it is worthwhile to note that nearly 50% of the 1.4 million children blind worldwide are needlessly blind. Most of the causes of blindness are preventable. Refractive errors are easy to treat with simple prescription of glasses. Vision needs to be checked for all children by the age of 3 years by a qualified health care professional as the child will never express that it cannot see well. Other important causes of preventable blindness include “amblyopia” or lazy eye, squint and childhood cataract.

When there is a difference in refractive error between 2 eyes or the eyes have squint or the visual axis is blocked by a cataract or any white opacity, the eye does not see and the brain recognises the image from the better eye and ignores the image from the poorly-seeing eye. The weaker eye is called the laze eye. In the early stages this may be reversible, however as the child grows older this becomes more and more difficult to reverse. Early detection is essential. It is important to recognise this condition as this is very common and affects approximately 3 of every 100 children. Vision screening is essential to diagnose this condition as the eyes will appear normal. With prompt treatment a reversal is possible though in many cases beyond the age of 6 years the condition may not be completely curable. The reason is the vision pathways develop faster in childhood and their development is complete by about 8 -10 years of age. Simple home exercises like patching the good eye are prescribed or sometimes only eyedrops are administered. It is important that the child is under the regular care of an eye specialist to monitor the vision in the eyes. Parents and guardians have a vital role to play in the treatment of this condition. The treatment may be needed for a few months till the vision is completely improved and needs patience and perseverance. Recent research has shown that amblyopia or lazy eye can be cured even when the child is older.

Squint is a misalignment of the eyes so that both the eyes do not focus on the same point of interest. This deviation results from the failure of the eye muscles to work together. When a child is born the eyes may not be able to focus on objects. But by the age of 3 months, an infant’s eyes should have the ability to focus on small objects and the eyes should be straight. A six month old infant should be able to focus on both distant and near objects. It is important to detect and correct squint early as an uncorrected squint may lead to a lazy eye. A person with squint can use only one eye at a time whereas a person with properly aligned eyes will be able to use both eyes to judge distance and depth more accurately. Certain careers need good binocular vision. Squint can also affect the appearance and self confidence of a child. A squint is easy to spot. One eye maybe turned towards or away from the nose. But small squints may not be seen easily and may need an eye specialist to pick up these squints.

While in most cases the cause of squint is not obvious, various conditions like refractive errors, focussing problems, nerve injuries and poor sight due to a cataract can lead to squint. Sometimes squints run in families. A child with squint needs a full eye check up. Young children are uncooperative and sometimes this may mean need for examination under sedation. Treatment often involves spectacles to correct the refractive error and the glasses need to be worn most of the day. Lazy eye if present may need treatment as well with patching. Surgery to straighten the eyes may be needed not only to improve the appearance but also to ensure the child uses both eyes together. Surgery is straightforward and involves tightening or loosening the muscles. Surgery is very safe. Modern techniques ensure recovery in a day and resumption of activities the next day. The success of squint surgery is very high and frequent follow up is not required.

Childhood cataract comprises about 14% of preventable childhood blindness. Cataract refers to cloudiness of the normally clear lens. Contrary to popular belief, cataracts can occur in children. Cataracts can cause decreased vision by preventing the light rays from reaching the eye and can lead to a lazy eye or amblyopia which can be irreversible. While in most cases the cause of the cataract is unknown, some cases can occur in conjunction with a genetic or metabolic abnormality. Amongst the preventable causes of cataract, rubella induced cataract can be easily prevented with appropriate vaccination. An estimated 2,38,000 children are born with congenital rubella syndrome every year. In south India, about 25 % congenital cataracts are known to be associated with rubella. Rubella immunization of women of the child bearing age can prevent congenital rubella syndrome. Some forms of cataract are genetic and occur following marriages within families. Early identification is essential. Recognition of the cataract is usually by a family member or teacher as the child is not going to express that he or she has cataract. A whitish opacity may be apparent in the child’s eye. The child’s eye learns to see only when clear images get focussed in the eye. If this does not happen the child’s vision will not develop normally.

Urgent surgery is usually required followed by the use of glasses or contact lens. Surgery is not as straightforward as in adults and the child’s eye behaves differently from adults’ eyes. Recent advances in surgical techniques and lenses which can be implanted in the eye, have made the surgery quite safe and successful. The parents are as involved as the eye health professionals in the rehabilitation of the child. With specialised services and modern technology, the outcome of surgery has improved. Early recognition, early intervention and early rehabilitation will increase the probability of good visual results.

A child may appear normal and yet have a visual problem. In most cases the child is unable to convey the problem and hence the eye diseases can go undetected. Hence it is our duty to ensure that all children are examined at least once by a qualified eye health professional, before the third birthday.


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