Sunday, July 1, 2018

Let food be thy medicine, not medicine be thy food


Hippocrates, the Greek physician (377 B.C.) is called the Father of Medicine. He gave the message to the people that healthy food could cure the disease, not medicine. The actual quality of food is probably much more important for our health than the proportion of fat, carbohydrate and protein. The highly recommended diet is the Mediterranean diet which include lots of fish, nuts, vegetables, beans, whole grains and olive oil. People have lived on high- protein high –fat diets, on low-protein high-carb diets, on diets high on raw milk and cream and even on diets high in animal blood. They have done so without ravages of degenerative diseases that are epidemic in modern life- heart disease, diabetes, obesity, neuro-degenerative diseases, osteoporosis, and cancer. Eat the real food which the grandmother recognized as food, does not come in a package, minimal processing, contains nutrients, phytochemicals, enzymes, vitamins, minerals, antioxidants, anti-inflammatories and healthful fats. It can keep alive into tenth decade. How we eat is as important as what we eat.
What about Organic?
There are certain terms to define as we talk about food. Those are “grass fed,” “organic,” “cage-free,” and the natural. All are deceptive and dishonest term in food marketing. “Natural” has no legal definition. It is purely a marketing scam. “Organic” is a label seen everywhere and on everything. The organic food movement is a desire to return to basics. The healthy products of fruits and vegetables, goats and chickens lived in an independent atmosphere of pastoral tranquility, where food- whether animal or vegetable- was raised or grown the old-fashioned way. The animals are not fed growth hormones, steroids, and antibiotics. The crops are left to fend off the elements with their own protective antioxidants and anthocyanins, rather than chemical pesticides and carcinogens. The “Roundup Ready. “Genetically modified plants” (GMO) were unknown.  The real considered fruit fell from a tree, or was harvested from healthy animals grazing on pasture or wild fish from uncontaminated waters are true organic.
Antioxidants:

Antioxidants fight oxidation. Oxidation can be visibly seen when a cut apple is left in the air. Oxidation-or oxidative stress-is a factor in every degenerative disease. Antioxidants help fight oxidative damage. Deficiencies of antioxidants are implicated in the early stages of heart disease, cancer, eye disease, and age related decline in memory. A healthy food is loaded with antioxidants.

Glycemic Index:
It is a measure of how much a given food raises the blood sugar level. High sugar foods- or foods that convert quickly to sugar in the body- are considered high glycemic. High blood sugar raises level of the hormone insulin high enough for long time frequently contributes to diabetes, heart disease, aging and Alzheimer’s now referred as “type 3 diabetes”. Eat less sugar. Eat fewer foods that converts quickly to sugar in the body (almost all processed carbohydrates).
Healthy polyunsaturated fats (Omega- 3s):
·      Saturated fat is not always bad. It does not cause heart disease as previously believed. Coconut oil, dark chocolate, ghee from grass-fed cows- are healthy.
·      Trans fat, however, is poison. Metabolic poison. It’s found in cookies, crackers, baked goods and snacks, doughnuts, French fries and most margarines. There is hydrogenated oil in the ingredient list.
·      Monounsaturated fat- found in nuts and olive oil – is good and heart healthy.
·      Polyunsaturated fats come in two flavors: omega- 6s and omega-3s. We consume many omega-6s having some health benefits, but not enough omega-3s. There are three different omega-3 fats. One of them is called ALA (alpha-linolenic acid found in flaxseed.) It is considered an essential fatty acid because the body can’t make it, so it must be obtained from the diet. But the other two omega-3s- DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) - are found in fish such as wild salmon and Hilsa. These two are more important to the body than the first one. Omega-3s are incorporated into cells, making their membranes more fluid so they can communicate with one another. The feel-good neurotransmitters such as dopamine and serotonin can get in and out of the cell more easily, translating in better mood. It may have positive effect on depression, behavior, feeling, and thinking. The developing brain in human fetus is about 60 percent fat by weight. The child’s intelligence, fine-motor skills depends on fish diet during pregnancy.
Omega-3s are anti-inflammatory. Inflammation is a critical component of every degenerative disease from heart disease to diabetes to obesity to Alzheimer’s. Inflammation is the silent killer. They transport oxygen from red blood cells to the tissues. They prevent blood cells from clumping together (blood clots can be a cause of heart attack and stroke). They act as a blood thinner, much like aspirin, without the side effects.
The great cholesterol Myth:
Cholesterol might be the most misunderstood molecule in the whole world. It is not a health risk. It is the parent molecule of the sex hormones and vitamin D. It is an integral part of the cell membrane. The effect of eggs on heart disease has exactly zero to do with their cholesterol content. Eggs contain many valuable nutrients, such as protein and choline (which is great for the brain). Eye-nutrition superstars, such as lutein and zeaxanthin, healthy fats, vitamins and minerals are present in eggs. The cholesterol present in them is good thing. High cholesterol is protective in older people. High-risk men achieved a 30 percent reduction in heart disease with cholesterol-lowering statins. The women showed 31 percent reduction in heart disease just by eating fish once a week (WOSCOP study).
Fiber:
Fiber is roughage essential to the care and feeding of a healthy microbiome. There are two kinds of fiber (soluble and insoluble). Insoluble fiber doesn’t break down in the gut, so it acts as a bulking agent and is good for relieving constipation. These are seeds and skin of fruits, wheat bran and brown rice. Soluble fiber does break down in the gut. It is specifically broken down by good bacteria which convert it into short-chain fatty acids, the most important of which is butyric acid (butyrate). The cells lining the gut depend on butyrate for food. It has potent anti-inflammatory and anticancer effects. Lack of enough soluble fiber does not make enough butyric acid. The soluble fibers are prebiotics. They are food for the probiotics in the gut. A healthy, well-fed gut lining helps for a healthy microbiome. Soluble fibers are present in beans, oatmeal. Flax seeds, sprouts, apples, nuts, pears, black beans, unripe bananas. Bananas are high in soluble fibers called fructooligosaccharides which is prebiotic serving good food for good bacteria (probiotics) in our gut. “Wherever flax seed becomes a regular food item among the people, there will be better health” said Mahatma Gandhi. It was one of the original medicines, used by Hippocrates himself.
Superfoods:
Superfoods help neurons in the brain communicate with one another effectively. They are brain food. “Old neurons are kind of like old married couples.” They don’t talk to each other so much anymore. Memory goes down, coordination and balance tend to decline. Communication between the neurons is signaling. One neuron can talk to another efficiently and new neurons grow. Polyphenols, anthocyanin present in superfoods turn on the signals. Inflammation and oxidative stress (damage done to cells and DNA by oxidation) are involved in virtually every major killer disease. “An apple a day keeps the doctor away”. Apples have highest level of antioxidants among the commonly consumed fruits. Its pectin content is a good source of soluble fiber that can lower LDL (bad cholesterol) cholesterol and help regulate blood sugar. Carrots “the king of the vegetables “and could possibly cut the rate of lung cancer in half”. They are high in carotenoids and antioxidants with wide health benefits. The great source of lutein and zeaxanthin protect the eyes and help to prevent macular degeneration and cataract. It raises the effectiveness of the light sensitive area of the retina preventing night blindness.
Pomegranate: Pomegranate protect LDL cholesterol from oxidative damage. It is capable of anticancer effects, to fight inflammation and prevent progression of Alzheimer’s disease. There is fair amount of natural sugar in the juice. It is associated with love and erotica.
Coconut:
The fat in coconut oil- a form of saturated fat (medium- chain triglyceride) - is among the healthiest fats in the world. This is more likely burned for energy. It has significantly higher HDL (good) cholesterol and an improved LDL: HDL ratio. The fatty acids (lauric acid) in coconut oil are powerful antibiotics. It kills Streptococcus (throat infections, pneumonia. sinusitis). Staphylococcus, Neisseria, Chlamydia and Helicobacter pylori. Dozens of pathogenic viruses are inactivated by the lauric acid it contains. This acid kills the bad bacteria but does not harm the friendly intestinal bacteria that we need for healthy digestion. Medium-chain- triglycerides also kill Candida and other fungi in the intestinal tract, supporting healthy gut ecology. Always buy virgin coconut oil which is not hydrogenated or processed with high heat and chemicals.
Avocado:
It is a poster child for a healthy high-fat food. The fat is largely monosaturated (oleic acid) benefits cholesterol profile, reduces risk of cancer and diabetes. Its significant source of lutein and zeaxanthin prevent macular degeneration.
Turmeric:
It is a member of ginger family. Its medicinal value is curcumin having anti-inflammatory, anti-tumor and powerful antioxidant properties. Curcumin inhibits lipid peroxidation. It fights damage from oxidizing substances that age the body and contribute to disease. It prevents significant protection from cataract of eye. A paste of turmeric with honey heals sore throat.
Garlic:
Garlic fight leprosy, toothache and chest pain (Hippocrates). It lowers cholesterol and prevents blood clots. The active ingredient from garlic- allicin- has significant antiplatelet activity. It is also antimicrobial, ant viral and anti-parasitic. The crushed raw garlic combining it with cooked food shortly before serving is highly beneficial.  Garlic supplements are not healthy.
“Know thyself” is the Greek aphorism to take healthy food for a healthy life.
References:
1. The 150 Healthiest Foods on Earth, 2017-Jonny Bowden, the Nutrition Myth Buster.
2. The Great Cholesterol Myth- Stephen T. Sinatra, Fellow of the American Cardiology.
Dr. Dwijesh Kumar Panda, M.D.Ph.D. (Medicine), Consultant Lymphologist, Pathologist & Microbiologist. M5/12, Acharya Vihar, Bhubaneswar, 

Sunday, July 27, 2014

Recent advances in the Diagnosis and treatment of Lymphatic Filariasis.

Recent advances in the Diagnosis and treatment of Lymphatic Filariasis.
                                             Dr. Dwijesh Kumar Panda, M.D, Ph.D(Medicine-Filaria)
Introduction;
  • Caused by nematodes those  inhabit the lymphatics and subcutaneous tissues.
  • Species are Wuchereria bancrofti  (95%), Brugia malayi, and Brugia timori.
  • It is usually acquired in early childhood.
  • Major cause of disfigurement and disability.
  • More than 120 million people worldwide are affected.
  • India accounts for 40% of global prevalence. (Map)
  • Transmitted by mosquito vectors. Humans are definitive host. (Fig 1-Life cycle)
  • Adult worms live for 5-7 years.
  • More than $ 840 million is lost each year.
Lymphatic Pathology:  In chronic lymphedema, lymph flow is stifled. Macromolecular protein deposition increases. Fibroblasts accumulate in interstitium. Fibrovascular proliferation results in worsening brawny edema. Obliteration of elastic fibers. Increased collagen deposition and fibrosis. Fig.
Clinical presentations:
Diagnosis:
  • Definite diagnosis by (a) detecting circulating filarial antigen. Og4C3 test procedure chart.
  • Demonstration of microfilariae in the blood- rarely seen after an attack of lymphangitis due death of adult worm. Picture
  • Filarial DNA in the blood. (PCR) Polymerase chain reaction used as a research tool to detect filarial infection in humans. Not commercially available. One pg of W. bancrofti genomic DNA added to 100 microliters of human blood.
  • Adult worms in the lymphatics- rarely detected.
  • Peripheral blood Eosinophilia- may exceed 3000/micro L. Other helminth infections frequently coexist- may increase eosinophils in the blood.
  • Tropical Eosinophilia- Confused with Tuberculosis, Asthma, Round worm infestation. Leads to progressive interstitial fibrosis, Hypersensitive immunological process. Total eosinophil count more than 3000/micro L.  Fig
Nonspecific diagnosis: Elevated serum IgE. Microscopic hematuria, Proteinuria and chyluria. Picture.
  • OG4C3 Test:   .
Detection of circulating adult filarial antigen in the blood. Positive even in amicrofilaremic          individuala.
The assay has excellent specificity and better sensitivity than microscopy.
The filarial antigens become undetectable in treated or “burned out” infection.
The quantitative OG4C3 test is useful in following patients after treatment as antigen levels decline with treatment.
Imaging:
  • Ultrasound techniques used to detect presence of adult worms in lymphatic vessels.
  • Living worms in continuous motion is described as “filarial dance” sign. Movie
  • Worms can be visualized in breast and scrotal lymphatic.
  • Lymphoscintigraphic technique:  Useful for assessing the extent of lymphatic damage in the regional lymphatic prior to development of clinical symptoms. Massive lymphatic dilation observed surrounding adult worms. The images cannot provide high resolution anatomical details. A small amount of radio isotope labeled colloidal substance is injected intra-dermally.
Treatment:
  • Medical:
  • Treatment of choice- Diethyl carbamazine (DEC) – Dose: 6mg/kg for 12 days alone or in combination with Albendazole- 400mg-once.
  • Ivermectin- It has microfilaricidal activity. No precedence over DEC in Bancroftian filariasis.
  • Benzopyrones and Flavonoids improve lymphedema through protein resorption and proteolysis.
  • Diuretics have no effect.
  • Antibiotics reserved for bouts of cellulitis.
  • Asymptomatic phase:  Due to the Cytokine IL-4 suppressing the activity of TH1 cells of immune system. This occurs for years until inflammatory reaction rises again.
  • Restriction of long chain triglycerides have some benefit.
  • Surgical:        
  • Largely disappointing.  
  • MLVA- Microlymphatic-venous anastomosis- encouraging in early stages of lymphedema.
  • Overall result disappointing in long-term edema.

                                                    THANK YOU.

Homage to Dr(Prof) L.N.Mohapatra, my Ph. D guide.

Wolbachia and filarial febrile episode

Wolbachia and filarial febrile episode:
Lymphatic filarial parasites contain endosymbiotic bacteria, Wolbachia.
These are rickettsia-like organisms required for homeostasis of the host parasite.
The inflammatory manifestations of lymphatic filariasis are attributable to immune responses directed to Wolbachia.
Filarial parasites stimulate innate inflammatory responses.
This is absent if the bacteria have been cleared with antibiotics.
Severe inflammatory responses have been observed when Wolbachia are released into the blood following death of the worms after antifilarial chemotherapy.







The pathogenic role of Wolbachia endosymbiotic bacteria in filarial diseases  is proved. The early inflammatory responses including TLR4-mediated signalling, chemokine and cytokine responses and inflammatory cell recruitment is seen in filarial disease.  The impact of the discovery and characterization of Wolbachia on filarial  worm is ascertained.
Wolbachia bacteria in a section of female Wuchereria worm.

Og4C3 ELISA TEST for Filaria

Og4C3 ELISA TEST for Filaria
This test is used to diagnose infection with wuchereria bancrofti The diagnosis is based on the use of a monoclonal Ab Og4C3 which is coated on to the surface of microtitre plates. The coating monoclonal antibody (Og4C3) has been shown to specifically recognise only Wuchereria bancrofti antigen in human sera. Principle:
1.Microtitre Plates Five U-bottom polystyrene microtitre plates pre-coated with Og4C3 monoclonal antibody.
2.Solution A (green solution) One 50 ml bottle for primary treatment of serum samples.
3.Solution B (YELLOW solution)One 50 ml bottle for secondary treatment of serum samples.
4.Antibody and conjugate diluent One 100 ml bottle (blue soloution)
5.Standard antigens (1-7) Seven dilutions of Onchocerca gibsoni 
antigen.
Each vial contains 600 ml of standard (orange cap)
6. Rabbit and-onchocerca antibody One 300 ml bottle(yelow cap)
7.Anti-Rabbit conjugate One 300 ml bottle (purple cap.) '
8.Chromogen One 60ml bottle of single component ABTS ready to use.
9.Washing buffer(X20) concentrate.
METHOD

All steps carried out at room temperature .
Ensure that all reagents and the microtitre plates are at room temperature before use.
Quantities indicated below refer to those required for the use of ONE plate.
To prepare washing buffer, dispense one measure from the x20 dispensing bottle into 500 ml of distilled water.
1. Preparation of serum samples.
Add 50 ul of each serum sample to 50 ul of solution A (green solution) in a suitable container.(e.g. any type of 96- well microtitre plate, BUT NOT one of the coated plates supplied with this kit.)
Mix the contents of the wells by tapping the plate, and leave at room temperature for 2 minutes.
Using a multichannel pipette ,add 50ul of solution B (YELLOW solution) to each well containing the serum sample/solution A mixture.
Mix well by pipetting u p and down several times, and IMMEDIATELY transfer 50 ul of the treated serum to each of two wells of the og4C3 Ab-coated plates supplied.
Up to 40 samples in duplicate can be tested per plate (see the plate layout diagram)
Add 50 ul of each Standard Antigen (no1- 7, Orange caps ) directly to duplicate wells of columns 11 and 12.Add the standards directly to the wells; DO NOT treat or dilute in any way.
For conjugate control (cc), add 50 ul of solution B to wells A11 and A12.
3. Place the plate in a humid container and incubate for 1.5 hours.
4. Wash the plate three times with wash buffer, invert and tap gently to remove residual droplets.
5. Prepare rabbit anti-Onchocerca antibody by adding 50 ul of rabbit anti-onchocerca antibody (YELLOE cap) to 6ml of antibody diluent (Blue solution)
Add 50 ul of the diluted rabbit antibody to all wells and incubate for one hour
8. Wash the plate three times as before.
9. Add 100 Ul of chromogen (ABTS)(do not dilute) to each well and incubate for one hour.
10.Plates can be read with a spectrophotometer at a single wavelength of 414 and 492 nm.
Blank the plate reader on wells containing conjugate control or a row of wells containing substrate in a separate blanking plate.

INTERPRETATION OF RESULTS
A standard curve may be drawn using the optical densities of the seven standard control samples as the Y values.
The X values can be the numbers 1 to 7 corresponding to the controls. The test samples can be allocated to groups on the basis of the optical density compared with the optical density of the standard curve samples. Samples with an OD>= Standard No 2 are considered to be the positive samples.
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