Produce a chemical present - to a series of chronic diseases

Missing element

our inability to produce a chemical present in every other primate may be linked to a series of chronic diseases.

What does it mean to be human? For most people, it all comes down to that extraordinary object between our ears, and how it blesses us with language, laughter and logic.

But not for Prof Ajit Varki, a doctor-cure-scientist who works in Califnmia. For him, being human is also about a single chemical that separates us from our closest relatives, and which could be linked to many of our most debilitating illnesses.

The story began in 1984, whenVarki was working at the University of California, San Diego. When treating a woman with bonemarrow failure, he injected her with horse serum, The treatment carried the risk of a side effect called "serum sickness", in which the patient's immune system launches an attack on a molecule present in the serum called Neu5Gc.

Sure enough, her skin erupted with an itchy red rash. Investigating further, Varki found that NeuSGc was foreign to humans, even though we carry a very similar version of the same molecule - which may be one reason why animal-to-human organ and tissue transplants do not work well.

But in recent years, he has come to believe that the implications of this molecular difference are much wider, He has built up a range of evidence that potentially links
Neu5Gc, a so-called sialic acid, to chronic disease. This is because the animal version is absorbed by humans as a result of eating red meat and milk products, and there is evidence that the body views it as an invader. Eating these foods could trigger inflammation and, over the long term, heart disease, certain :ancers and auto-immune illnesses. Jarki stresses, however, that "we lave not proven any link to disease, ust suggested that it is something o explore".

This sialic acid plays a number of roles: it helps us recognise cells and helps ceils stick together. It also helps regulate our immune response, which may influence the progression of diseases and even play a part in human evolution. Varki's team, along with Prof Elaine Muchmore of the University of California studied blood from chimps, bonobos, gorillas, orang utans and humans, and found that we ate the only primates whose bodies do not produce NeuSGc - although further research established that our Neanderthal cousins were missing this version of the sugar acid, too.

Instead, human (and Neanderthai) cells bristle with a sugar called Neo5Ac. The two molecules are identical, apart from onedittle detail: the ape molecule has a single extra oxygen atom. Because of the many different jobs this sugar does throughout the body, this one atom was the first example found of a fundamental genetic and biochemical difference between humans and our closest relatives,

Muchmore and Varki then found out why this oxygen atom is rfiissing: our molecule is the precursor of the animal version. Unlike chimpanzees and other great apes, humans lack a particular version of an enzyme that converts NeuSAc (or, to give it its full name, N-acetyl-neuraminie acid) into Neu5Gc. This tiny change could potentially explain some of the more unusual differences between humans and apes, Chimpanzees do not seem to suffer from heart disease, cancers, rheumatoid arthritis or bronchial asthma - common conditions in humans. Nor do they get sick from the human malaria parasite, which uses sialic add to latch on to our blood cells.

In recent studies, Varki's team has found tantalising evidence that this mysterious molecule could be exerting a wider effect on our health, through the substances we eat.
After testing a range of foods, they found the highest levels of Neu5Gc in red meat: up to 11,600 microgrammes could be absorbed from the recommended daily serving of beef, 5,100 from pork and 4,900 from lamb, The level in goat's cheese was 5,500, but fell to around 700 in milk and salmon. Cod, tuna, turkey and duck were in the 20s.

Given that food is broken down in the stomach, did eating animal tissue present the same dangers of provoking an immune attack as transplanting it? Following that great scientific tradition of self-experimentation, Varki, Muchmore and Pascal Gagneux ate pure NeuSGc to see what would happen. Not only did the foreign sugar show up in the body soon after earing, but tests also revealed that many people carry antibodies that react to Neu5Gc - a protective immune response, but one which could trigger damaging inflammation.

Varki's colleague - and wife -Pmf Nissi Varki then found that small amounts of NeuSGc were present in normal human tissue, probably as a result of long-term consumption. And as well as food, many biotherapeutic products made in animal cells and/or using animal materials were also contaminated with Neu5Gc.

This raised the fascinating possibility that anti-Neu5Gc antibodies are involved in auto-immunity. Auto-immune diseases, such as type-1 or juvenile diabetes and some types of arthritis, occur when the body mistakenly attacks healthy tissue. Chronic inflammation is also linked with cancer; intriguingly, the team found that NeuSGc was concentrated in turnouts, particularly those that spread throughout the body. This could aid detection of
such diseases, by getting scientists to look for the animal acid rather than the turnouts themselves. .

Some of this might sound familiar: several previous studies have linked ingestion of red meat to cancer and heart disease, and possibly to some other disorders involving inflammation, such as arthritis and lupus, gut these focused mostl) on the role of saturated fats, and on products that arise from cooking.

Varki, however, believes that his little molecular difference could also be to blame: NeuSGc elicits an immune reaction that might contribute to a whole spectrum of human-specific diseases. Although they have not proven this yet, the evidence is sufficiently compelling for his team to start work on ways to eliminate NeuSGc from the body.

But the question remains: why are humans unique among primates in not producing Neu5Gc? By study- ing the mutations in the enzyme that makes this molecular difference between apes and humans, Varki, along with Prof Naoyuki Takahata of the Graduate University for Advanced Studies in Kanagawa, Japan, estimates that the genetic change first appeared up to three million years ago, which coincides with the emergence of Homo erectus, the first of our ancestors to venture out of Africa.

At the time, life was nasty, brutish and short: any subtle but chronic effects of this foreign sugar would not be felt until old age, and Homo erectus did not survive that long. If the mutation that kept us producing NeuSAc rather than Neu5Gc helped shrug off a particular disease, it would have spread rapidly through the population. It is ironic that what may have protected our ancestors then could be responsible for much of the pain of their long-lived descendants.

Tell your doctor - Hormonal dietary supplements might promote prostate cancer progression.

Tell your doctor

Hormonal dietary supplements might promote prostate cancer progression.

HORMONAL components in over-the-counter dietary supplements may promote the progression of prostate cancer and decrease the
effectiveness of anti-cancer drugs, researchers at UT Southwestern Medical Center have discovered.

The findings, which appeared in the most recent issue of Clinical Cancer Research, reaffirm that patients should inform their doctors about any herbal or hormonal dietary supplements they are taking or considering taking. The researchers also recommend that documentation of supplement usage become part of routine health assessments for all patients, particularly cancer patients.

"Physicians need to ask their patients not only about the prescription drugs they may be taking, but - perhaps even more
importantly - about the over-the-counter drugs and supplements, which may have a profound impact on certain health conditions," said Dr Claus Roehrberu, chairman of urology at UT Southwestern and one of the study's authors.

The researchers began their investigation when two patients being seen by UT Southwestern doctors developed aggressive prostate cancer within months of starting daily consumption of the same dietary supplement. Both men purchased the same product. one to develop stronger muscles and enhance sexual performance, the other to gain muscle.

Dr Roehrborn, Dr Shahmkh Shariat, a resident in urology and the study's lead author, and their colleagues analysed the supplement, which is not named in the study. They found that the product's label listed ingredients that were not present, misrepreser/ted the concentrations of the ingredi- ents present and failed to list all the steroid hormones contained in the product.

Hormone analysis revealed that the supplement contained testosterone and estradiol, a sex hotmone. Researchers then tested the effect of the product on human prostate cancer-cell lines. The product proved to be a more potent stimulator of cancercell growth than testosterone, Additionally, attempts to stop the cancer-cell growth with increasing concentrations of the anti -cancer drug bicalutamide proved to be futile.

"Bicalutamide is an oral nonsteroidal anti-androgen used to treat prostate cancer," Dr Shariat said. "The fact that this supplement caused the drug to be less effective is very troubling."

Based on the clinical data and cell culture experiments, the researchers filed an adverse event report with the Food and Drug Administration. The government agency in turn issued a warning letter to the manufacturers, which led to the removal of the product from the market.

"Unlike prescription and over-the-counter drugs, the law does not require nutritional supplements to undergo pre-market
approval for safety and efficacy," Dr Shariat said. "The current FDA regulatory system provides little oversight or assurances that dietary supplements will have predictable pharmacological effects or even that product I`abels provide accurate information for consumers."

The researchers SaY expanded research is needed co define the mechanism, safety ,and efficacy of common herbal and hormone dietary supplementS.

"For most supplements efficacy is not established ifl randomised, controlled trials, wlaat is worse, safety is often equally poorly established," said Dr Roehthorn, who directs the Sarah M. and Charles E. Seay Center for Pediatric Urology.

An estimated 42% to 69% of US adults use dietary supplements, at an estimated out-of-pocket expenditure of about US$34.4bil
(RMl13.5bil), according to published reports cited in the study.

Individuals often use supplements because they believe these natural products are safe and drugfree. The sale of androgenic
steroids is exponentially increasing. In 2004, US expenditures on testosterone supplements were estimated to be US$425mil
(RM1,402.Smil),

"Given that testosterone supplements are in high demand, there is significant concern that supplements, in addition to the one we evaluated, may pose an urgent human health risk," Dr Shariat said,

Researchers from Baylor College of Medicine in Houston also contributed to the research.
Visit http://www.utsouthwestern.org/patientcarejmedicalservices/eaneer/urologic.html to learn more about UT Southwestern's clinical services in prostate cancer.- HealthNewsDigest

Heath Ledger and Brokebock Mountain are names that ring a hell for many people

His legacy
One to be remembered: Father of Angiogenesis, Dr Judah Folkman -1933 to 2008.

HEATH Ledger and Brokebock Mountain are names that ring a hell for many people who have been following the recent entertainment news.

Few would recognise, much less have heard of, Dr Judah Folkman.

Though both men died in the same month (January 2008) each event received a different level of publicity.

Quite often, for people who work hard behind the scenes, it takes a substantial amount of effort to be reeognised. Dr Folkman, a cancer treatment revolutionist, was one that contributed his greatest to mankind but remains unfamiliar to the majority of the six billion people on earth.

Dr Folkman was the founder and director of the vascular biology programme at the Children's Hospital in Boston and a professor of paediattic surgery and cell biology at Harvard Medical School, also in Boston.

He was very passionate about his work and many have said they were not surprised to hear that Folkman, 74, was working till the very end. He collapsed at the Denver International Airport on his way to a speaking engagement in Vancouver.

His departure is indeed a great lost not only to his family, but the world at large. Dr Folkman is sur-vived by his wife, Paula, with whom he lived in Brookline, Massachusetts, two daughters and a granddaughter (Hannah).

The early days
Born in Cleveland in 1933, Moses judah Folkman was the son of a rabbi. He had a brother and a sister and, as a boy, started making house calls to the sick with his father.
He began his medical career in high school in Bexley, Ohio, volunteering in a hospital laboratory at Ohio State University. This early calling led Dr Folkman to Ohio State University, where, by the end of his freshman year, he was performing surgery on dogs under the mentorship of Dr Robert Zollinger, then president of the American College of Surgeons.
The young Dr Folkman even designed a device to cool the liver during surgery without causing organ damage and then, he became coauthor on his first academic paper.
With this extraordinary achievement, he was accepted into Harvard Medical School at the age of 19. After graduating in 1957, Dr Folkman began his surgical residency at the Massachusetts General Hospital and served as chief resi-dent in surgery from 1964 to 1965.

Discovery of Angiogenesis Theory
In the midst of his residency at Massachusetts General Hospital, Dr Folkman was suddenly drafted into the Navy, assigned to do research on artificial blood at a facility in Bethesda, Maryland.
The assigned work was finished far earlier than expected, so Dr Folkman and a colleague, pathologist Fred Becker, had free time in the laboratory and decided to study tumour cells growiug in a special apparatus.
Dr Folkman saw something unusual when their black melanoma cells only grew briefly. All the little tumours were exactly
the same size. He knew that this wasn't natural and something must have halted their growth at a maximum size.
That initial observation led to years of experimenting, thinking, arguing, and exploring until he concluded that the tumours had all stopped growing because they couldn't get enough blood.
As this research continued, Dr Folkman returned to his internship at Massachusetts General Hospital, and then began work at Boston City Hospital as a young surgeon.
In 1967, when he was only 34, Dr Folkman was recruited to become chief of surgery at Children's Hospital. While serving as chief of surgery, he continued pursuing his research, believing that "angiogenesis" was the factor that made tumours grows larger.

A lonely voice and a breakthrough
In the 1970s, Dr Folkman's team applied for their first grant based on the hypothesis of angiogenesis and its role in tumour development and growth.
However, the reviewers at the National Cancer Institute turned them down. Dr Folkman never gave up pursuing his research. In subsequent years, as a result of a huge number of experiments, failures, breakthroughs, and insights, Dr Folkman and his colleagues were able to prove four major points:
1. Tumours do require blood to grow;
2. Turnouts do recruit the blood vessel systems that bring in fresh blood;
3. The recruiting mechanism involves hormone-like growth factors emitted by the tumour;
4. The body makes natural factors that can shut down abnormal blood vessel growth; a phenomenon that Dr Folkman named "anti-angiogenesis".
The journey of discovering a new agent which could stop angiogenesis was not smooth sailing. The media troubled him with over-whelming publicity on his research. His innovative ideas drew attention, especially from reporters covering science and medicine.
As a result, news stories often proclaimed his successes, and desperate patients quickly besieged their doctors seeking a new "cure" that didn't exist.
The publicity problem became most extreme in May of 1998, when a New York Times reporter quoted Nobel-winning biologist James Watson as saying "Judah's going to cure cancer in two years."
This placed tremendous pressure on Dr Folkman and his colleagues, especially when some of their antiangiogenic agents failed to deliver the exoected results.
The turning point came about five years ago, in 2003, when San Francisco's Geneutech lnc reported success with a drug they ca]led bevacizumab, an anti-angiogenesis agent which blocked the action of the stimulators of blood vessel growth.
Clinical trials showed that infusing regular doses of bevacizumab actually extended the lives of patients with colorectal cancer.
Since then, bevacizumab has been approved worldwide for use ir such patients. It has also been approved for breast cancer patients in the U5 and Europe, and is showing promising results against various solid tumour cancers.
Dr Folkman's tenacity and determination culminated it the breakthrough discovery that has changed the entire landscape of solid tumour cancer treatments.
His efforts have helped thousand', afflicted with cancer and remain one of the most promising approaches in future cancer treatment development and management.
His passion for results and his determination in pursuing the seemingly impossible have touched the lives of many colleagues and patients alike and earned the highest level of respect and reverence.
"A bright light has dimmed at Children's Hospital and for the cancer-research world. May that light shine again and guide the way as others are inspired to continue Dr. Folkman's vision and research for a cure for cancer. This is truly what he would want," adds Jo-Ann Rose RN.
"To honour his memory we should all follow his example - pursue your dreams, never give up. and believe in yourself. May his memory be eternal."

Optimistic about lungs - Nihilistic no more about lung cancer

Nihilistic no more about lung cancer-treating the lung cancer patient optimally and effectively

WE approached the patient with advanced lung cancer nihilistically until about 10 years ago. Back in the sad old days, the patient was largely given what was euphemistically called "best supportive care".

Often, all that meant was paiukillers and a comforting hug.

Today, the situation is quite different, Buoyed by the positive effects oftbe anti-cancer agent, cisplatiuum, 20 years ago, many clinical trials were launched to search for new cancer drugs or new combinations of drugs.

Today, patients with advanced lung cancer live longer and live better. This is all thanks to the scientific endeavour of researchers and clinicians working in cooperation and in concert with pharmaceutical companies.

But first, a word about early lung cancer. "Early" lung cancer implies that cure is a realistic goal.

Unfortunately, only about 10% of lung cancer can be considered early. Staging is all-important. To stage is to determine the extent of the cancer in the lung and whether it has spread to a distant site.

The PET/Whole Body CT Scan is indispensable in distinguishing early from advanced lung cancer. When there is doubt even with a sophisticated tool like PET/Whole Body CT, we can use an ultrasound guided technique via the trachea (windpipe) or oesophagus (food pipe) to sample any suspicious lymph node lying deep inside the chest. If the lymph node is involved with cancer, surgery is out.

The patient with lung cancer can then be assigned one of the following stages: 1, II, IIIA, IIIB and IV. For Stages l & II, the treatment is surgery followed by chemotherapy. For Stages Ilia & early IIIB, it is a combination of chemotherapy and radiotherapy.

Unfortunately, 90% of lung cancer patients will be found to have Stage IIIB or Stage IV disease i,e, what we call advanced lung cancer. This is the group of patients where there are many stirrings of new effective treatments. This is the group of patients which this article is all about.
Three sets of drugs are routinely used to treat advanced lung cancer namely
1. The monoclonal antibodies, bevacizumab (Avastin) and cetuximab (Erbitux) 2. The tyrusine kinase inhibitors, gefitinib (lressa) and erlotinib (Tarceva) 3. Conventional cytotoxic agents e.g. cisplatinum, carboplatin, docetaxel, paclitaxel,gemcitabine, vinorelbine, pemetrexed
It is good to have so many drugs and so many combinations of drugs. Patients with advanced lung cancer come in different
shapes and sniffles. They have different expectations and pockets.

Some are fit and can withstand a more robust treatment, for example, a combinations of two or three drugs.

Other patients may be less well and only one drug should be used.

And to each patient, I say "We have something to prolong your life and something to give your life quality."

Today, that comforting hug becomes an encouraging embrace. When patients don't do well with first-line treatment (the first set of anti-cancer agents employed) they can often be given effective second-line treatment.

There is even talk of third-line treatment.

Until the day comes when all advanced lung cancer patients can be cured, surely these patients deserve the best that science can offer today.

With the current therapies, patients with advanced lung cancer live, on the average, 12 months instead of eight.

Put another way, 50% of these patients will live a year if they are treated with current protocols instead of a paltry 20% two decades ago. There is always that 5% of patients wholive over three years having undergone two to three optimal lines of chemotherapy.

I write this essay not to announce "Lung Cancer Can Now Be Cured". Of course advanced lung cancer cannot be cured,

My point is that we have moved from therapeutic nihilism to therapeutic enthusiasm. And I believe that this is an important

Rubicon that we have crossed.

I end this essay with a reality check. We turn to pseudoscience (e.g. scalar energy), alternative medicine (qigong) and early Phase I trials (Cytotron) because we fear death.

Nothing is quite so simple and stark as that. But we have to accept that we cannot cure all cancers yet.

And your best bet of staying alive longer and more comfortably is still evidence-based and science-based medicine,

"All of us, among the ruins, are preparing a renaissance beyond the limits of nihilism. But few of us know it."

Winning the war against colon cancer: we are curing more patients than ever before

Gut wars
Winning the war against colon cancer: we are curing more patients than ever before.
COLON (or large intestines) cancer is one of the most common cancers in the world. It is the third most common cancer found in both Malaysian men and women, with the National Cancer Registry reporting over 1,446 new cases in 2003L
Recent advances in treatment have resulted in more patients living a longer and more productive life compared to a decade ago.
Cancer awareness campaigns and early detection combined with advancements in chemotherapy treatment have increased the likelihood of cure for early-stage colon cancers.
Misconceptions about chemotherapy can deprive a patient of effective treatment. Many are still ignorant about the recent
advancements in the treatment for colon cancer. We really should understand the benefits of additional therapy after surgery, and not be influenced by misconceptions surrounding chemotherapy.
Misconceptions may do harm and could potentially deny patients the possibility of cure.

How colon cancer starts
Colon cancer refers to cancer that forms in the tissue lining of the colon. Unlike most cancers, colon cancer grows slowly, often starting with a tiny non-cancerous growth of tissue known as a "polyp", which may then become cancerous after many years.
Regular screening helps in early detection of polyps, which can be easily removed before they turn cancerous. It may also aid in detectmg cancer still at its early stage. Early detection remains an important step in curing colon cancer.

What are my risks?
Some of us are at higher risk of getting colon cancer than the average population, We need to recoguise these risk factors, which include some of the following:
* Age
The chance of developing colon cancer increases with age, commonly affecting those above 50 years of age.
* Diet
Certain diets may increase the risk of colon cancer, such as one that is rich in red meat (e.g. beef, lamb) and processed meat (e.g, hotdog) and low in vegetables and fruits.
* Family history
Having a close relative with colon cancer increases a person's risk of getting colon cancer, This risk increases further if the dose relative had colon cancer at a young age.
* History of bowel diseases
A history of inflammatory bowel diseases increases a person's chances of getting colon cancer.

Treating colon cancer
Surgery is tile main treatment for colon cancer4, and in early stages, surgery alone will suffice.
However, in patients with highrisk features, a combination of surgery and chemotherapy gives better outcomes.
Chemotherapy given after surgery is known as "adjuvant" treatment.
In this context, chemotherapy is used to mop up microscopic or unseen cancer cells that may still be present in the body, therefore reducing the risk of recurrence. Chemotherapy here serves as extra "insurance" to back up the surgical procedure.

Chemotherapy - emergence of a new era
5-fluorouracil(5-FU) is a chemotherapy agent that has been used for the past few decades in the treatment of colorectal cancers.
Research has shown that adjuvant treatment with 5-FU, given after surgery, will lower the risk of cancer relapsing, compared with no adjuvant treatments. Today, 5-FU is still widely used and is given either through injection into a vein or taken by mouth.
It has taken many decades and years of research to come up with new drugs that are suitable for the treatment of colorectal cancer. Since the late 1990s, significant progress has been made in drug therapies.
in June 2007, the long awaited final results from years of research have confirmed that a two-drug combination of chemotherapy can cure patients with early-stage colon cancer who have high risks features2. These patients call now hope to live longer than ever before2.
This two-drug combination chemotherapy involves the use of 5-FU together with a drug known as oxaliplatin.
In selected patients, such as those with stage Ill colon cancer, oxaliplatin, when added to 5-FU treatment as a two-drug
combination, has been shown to increase the survival rates by as much as 20%, compared with just 5-FU alone2.
Oxaliplatin is a chemotherapy agent that has been approved in Malaysia for the treatment of late-stage (stage IV) colorectal cancer since the late 1990s. Years of research have proven it to be an effective treatment in patients with stage IV diseaseL
And finally today, with intensive research, we call now confirm that oxaliplatin plays a definitive and significant role in the treatment of early-stage colon cancer2.

Into the future
For many years, chemotherapy treatment for early-stage colon
cancer only involved 5-FU. However today, a two drug combination of 5-FU and oxaliplatin has emerged as the new standard of
care for high risk early-stage colon cancer.
Medical research and advancements will continue to propel us forward to search for more effective treatment options for early-stage colon cancer. Researchers are now carrying nut investigations on three-drug combination treatments, using 5-FU, oxaliplatin and biologic agents (cetUximab or bevacizumaby. We await with optimism on the results of these studies.
We hope to cushion offthe breaking of bad news to colon cancer patients with an even more optimistic message of better cure rates and survival in the near future.
The war against colon cancer is far from over. However, the future looks optimistic.

References:
1.2rid Report of the National Cancer Registry - cancer incidence in Malaysia 2003
2. de Gramont et al. Final results of MOSAIC presentation. ASCO 2007
3. American Society of Cancer, http://www.cancer.org. Accessed on 5th April 2008
4. National Comprehensive Cancer Network ( NCCN ). Colon and rectal cancer - treatment guidelines for patients. Version V/October 2007. 5. O'Connell MJ, et al.J Clin Oncol 1997;15:246-50
6. www.bpflcgov.my
7. de Gramont et aI. J Clin Onco1 2000; 18:2938-2947
8. de Gramont et al. Semin Oncol 33(suppl 11) : $42-45

Smoking early in pregnancy raises risks of heart defects in newborns

My baby doesn't smoke

Smoking early in pregnancy raises risks of heart defects in newborns.

MOTHERS who smoke early in pregnancy are more likely to give birth to infants with heart defects, according to a study funded by the Centers for Disease Control and Prevention (CDC).

The study, published in the April issue of Pediatrics, shows that women who smoked anytime
during the month before pregnancy to the end of the first trimester were more likely to give birth to infants with certain congenital heart defects (CHDsl compared to women who did not smoke during this time period.

The association was stronger for mothers who reported heavier smoking during this time period.

"Most people know that smoking causes cancer, heart disease and other major health problems," said Dr Margaret Honein, one of the researchers in the CDC's National Center for Birth Defects and Developmental Disabilities, "The indisputable fact is that women who smoke during pregnancy put themselves and their unborn babies at risk for other health problems."

The findings from the study, "Maternal Smoking and Congenital Heart Defects", were based on the US National Birth Defects Prevention Study, which is the largest population-based study ever done on the causes of birth defects in the United States.

Nine states participated in the study: Arkansas, California, Georgia, Iowa, Massachusetts, New York, North Carolina, Texas and Utah. This research included 3,067 infants with CHDs and a comparison group of 3,947 infants with no major birth defects.

The study found that septal heart defects - a hole in the heart between the left and right heart chambers, which disrupts the flow of blood and oxygen to the body - were the most common defect found among infants who were born with a cardiac defect.

Researchers also found conotruncal (poor blood circulation from lower heart chamber), right-side obstructive (blood is blocked from flowing freely from the right side of the heart) and left-side obstructive (blood is blocked from flowing freely from left side of heart) defects.

CHDs are the most common type of birth defect, occurring in eight to 10 of every 1,000 live births in the United States. Many infants with CHDs die in the first year of life, and infants who survive often require numerous surgeries, lengthy hospitalisations and a lifetime of treatment for related disabilities.

Women who smoke should know that in addition to smoking being a possible cause for heart defects, the following are also of concern:

* Smoking makes it harder for a woman to get pregnant. * Women who smoke during pregnancy are more likely than other women to have a miscarriage. * Smoking during pregnancy causes major health problems for both mother and baby. For example, smoking is one of the causes of problems with the placenta - the source of the baby's nutrition and oxygen during pregnancy. * Smoking during pregnancy can cause a baby to be born too early and have low birth weight - making it more likely the baby will become sick or die. * Babies born to women who smoke are more likely to have a cleft lip or cleft palate-types of birth defects. * Smoking during and after pregnancy is one of the causes of sudden infant Death Syndrome (SIDS).

For information about birth defects, please visit http://www.cdc.gov/ncbddd.for more information about smoking please visit
http://www.cdc.gov/tobacco or call 1-800-CDC-INFO.-HealthNewsDigest

Drink Water On Empty Stomach - Method of treatment

It is popular in Japan today to drink water immediately after waking up every morning. Furthermore, scientific tests have proven its value. We publish below a description of use of water for our readers. For old and serious diseases as well as modern illnesses the water treatment had been found successful by a Japanese medical society as a 100% cure for the following diseases :-

Headache, body ache, heart system, arthritis, fast heart beat, epilepsy, excess fatness, bronchitis asthma, TB, meningitis, kidney and urine diseases, vomiting, gastritis, diarrhea, piles, diabetes, constipation, all eye diseases, womb, cancer and menstrual disorders, ear nose and throat diseases.

METHOD OF TREATMENT

1. As you wake up in the morning before brushing teeth, drink 4 x 160ml glasses of water.

2. Brush and clean the mouth but do not eat or drink anything for 45 minutes.

3. After 45 minutes you may eat and drink as normal.

4. After 15 minutes of breakfast, lunch and dinner do not eat or drink anything for 2 hours.

5. Those who are old or sick and are unable to drink 4 glasses of water at the beginning may commence by taking little water and gradually increase it to 4 glasses per day.

6. The above method of treatment will cure diseases of the sick and others can enjoy a healthy life.

The following list gives the number of days of treatment required to cure/control/reduce main diseases :

1. High Blood Pressure - 30 days

2. Gastric - 10 days

3. Diabetes - 30 days

4. Constipation - 10 days

5. Cancer - 180 days

6. TB - 90 days

7. Arthritis patients should follow the above treatment only for 3 days in the 1st week, and from 2nd week onwards - daily.

This treatment method has no side effects, however at the commencement of treatment you may have to urinate a few times. It is better if we continue this and make this procedure as a routine work in our life.

Drink Water and Stay healthy and Active.

This makes sense...... the Chinese and Japanese drink hot tea with their meals..... not cold water, maybe it is time we adopt their drinking habit while eating..!! Nothing to lose, everything to gain......

For those who like to drink cold water, this article is applicable to you. It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion. Once this "sludge" reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.

A serious note about heart attacks : Women should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw line. You may never have the first chest pain during the course of a heart attack. Nausea and intense sweating are also common symptoms. 60% of people who have a heart attack while they are asleep do not wake up. Pain in the jaw can wake you from a sound sleep. Let's be careful and be aware. The more we know, the better chance we could survive...

A cardiologist says if everyone who gets this mail sends it to everyone they know, you can be sure that we'll save at least one life.

Quantum physics and qi

TODAY I want to tell you the story of the universe. I was fortunate to attend a lecture by an American nuclear scientist who said that he found God through his understanding of quantum physics. And I marvelled at his theory on the origin of the universe, and the nature of light and matter.

Although I am not a physicist, quantum physics has always been a favourite subject, and I try my best to understand this fasdnating subject because it leads me to appreciate more the simphdty behind this very complex universe. And ff you believe in God, you will marvel at His brilliance. Even if you don't believe in God, this is still interesting reading.

According to Prof Muhammad Al-Mahdi, God created the universe by first creating the primordial light. Then God "slowed down" and "reduced" the energy of light to what it is now so that matter can materialise. Now, many religions describe God Himself as Light, but the created light is of a different nature than Divine Light.

For a start, created light has a lower energy. This is an interesting statement, since we have been told that nothing exceeds the speed of light, and everything in this universe is gnverned and limited by that (Einsteins' E=mc2). Created light had a much higher energy initially, and the energy was so intense that it resulted in the Big Bang.

According to current scientific understanding, the Big Bang occurred about 13-15 billion years ago. In the first few millionths of a second, the universe expanded extremely rapidly while fundamental particles (the most basic unit of all matter, called quarks and leptons) and from these the elementary particles (protons and neutrons), were being formed. All this took less than 0.000001 sec. Then atoms were formed and the formation of matter and the physical universe as we know began.

The Big Bang

The known universe contains billions of galaxies, reaching across 10 billion light years in distance (1 light year is the distance travelled by light in one year = 9.3 billion kiiometres).

To give some idea of this vastness, the distance to the moon is 385,000 kin; the sun is 150 million krn (which equals 1 ALl, Astronomical Unit); Pluto's distant position (it has an elliptical orbit around the sun) is 40 AU or 4 billion km; and the distance to the nearest star, Proxima Centauri, is 4.3 light years, or 40 billion km.

As to the vastness of the entire universe, only God knows!

The Orion Nebula
Although science has unravelled most of the secrets of the universe, having discovered (or at least observed)what is believed to be the complete array of the fundamental particles (six quarks and six leptons, and their anti-matter parmers), and also the force-carrying "particles" (called bosons; of which the electromagnetic energy-carrying photon is one of them), the picture is still incomplete. The so-called "standard model" of current scientific understanding cannot yet fully explain gravity (scientists predict the existence of gravity-carrying particles called ,'gravitons" but have yet to observe this) and several other things.

Scientists are still cracking their heads over how to explain everything into one coherent unified theory. Einstein's General Theory of Relativity, Newton's Law of Motion and other established scientific formulae cannot explain the observed
nature in full.

As we understand more, it gets more interesting, Now we know that space can be "bent", time itself can be "slowed", and that matter and antimatter can annihilate each other!

What is different about this new concept and current science? By saying that light was slowed down implies that everything need not be governed by the known behaviour of the photon (which is the unit of light, and of other electromagnetic energies
we know - electricity, sound, heat, radio waves, radiation, etc, or of other bosons (force-carrying particles).

It also brings Creationism (that God exists and created everything) closer to secular scientific theory (that the universe began as an immensely-dense coin-sized matter that exploded and everything we see now is a result of random events not under the influence of a supernatural force/God; from where or how that coin-sized matter came to existence is anybody's guess).

Many other things may be explained by assigning different energies/speed to the force-carrying particles. The accepted speed of light explains the physical universe well, but cannot explain the spiritual world, the nature of angels and jinns,
and the nature of qi! Now you know why I am fascinated by all this.

The spinning universe
One interesting observation from the quintessential realm of quantum physics and the expansive world of astronomy is that everything spins. All the fundamental particles and elementary particles spin and/or have orbits. At the other dimension, all
celestial satellites (eg. the moon around the earth), planets, stars and galaxies spin or orbit around an axis. These are what we can observe using the most cutting-edge particle accelerators and space-telescopes.

The most awesome dance of nature is the spiralling galaxy. This is what the Sufi dance tries to convey. It tells the story of the Oneness of the Creator and the creation - and that the DMne plan is one Unified Plan.

Qi still an enigma to science
While science is coming close with the understanding of gravity and nuclear forces, it has very little knowledge of life-force, or qi.

In my research, I did find one scientist that came up with something fascinating. Over 60 years ago, Anton Bovis, a French archaeologist-physi-cist' while doing research regarding the pyramids, noticed that there appeared to exist an energy phenom-
enon within the structures. He called it life-force, and proceeded to invent a method to measure it. Interestingly, this scale was able to also measure the life-force in various items such as food or water. This energy is also referred to as "biophotons".

It turns out that his method (called the Boris Scale) measures the life-force according to the charge and spin of the atoms. Low life-force readings of O to 6,500 (Bovis Energy Units, BELl) are life-detracting, while those above 6,500 BEU are life-enhancing. The desired minimal energy level for humans is between 8,000 and 10,000 BELl. The Earth itself creates energy in the 7,000 to 18,000 BELl range.

Further, scientific research has correlated the clockwise or right spin of atoms and molecules with low energies of below 6,500 (i.e. life-depleting). Even our chromosomal DNA is a left turning spiral. In contrast, cancer cells are grossly mutated with DNA in a right-turning spiral.

So we have here another convergence of scientific knowledge and life-force or qi, and the mystery of qi and the healing effects of qigong will slowly but surely be better understood.

Prof Muhammad Al-Mahdi passed away peacefully last week. I humbly dedicate this artide to him. May his soul rest in peace.

Radicals that cause disease

THERE is a "paradox" about oxygen in that we cannot live without oxygen, yet it is dangerous to our existence. A war is being waged within every cell of your body. It is called oxidative stress (refers to a condition where antioxidants in the body cannot cope with free radicals generated) and is believed to be the root cause of more than 60 degenerative diseases, from arthritis to cancer, heart disease, premature ageing and even the breakdown of your immune system.

The same process that causes iron to rust and cut apples to turn brown is going on in every living cell in your body. We
are essentially rusting inside and are not even aware it is happening. We must gain an understanding of this process and learn how to protect ourselves against its destruction.

Free radicals In the process of using oxygen for the production of energy in the cell, free radicals are created. Free radicals are also formed in the body when you inhale smog, house cleaning chemicals and cigarette smoke, consume polluted drinking water and drugs. Exercise, exposure to sunlight, illnesses, high blood sugar - also contribute to production of free radicals.

Bruce Ames, a research scientist at University of California-Berkeley estimates that each cell in the human body suffers
about 10,000 "hits" per day from free radicals, The extent of the damage is impressive: free radicals destroy enzymes, pro-
teins, fat compounds, DNA molecules, and cell membranes and structures - altering the way cells code genetic material.

"In fact," says biochemist and antioxidant researcher Richard A. Passwater, "free radicals can also activate the socalled cancer genes, also known as oncogenes, and suppress the immune system."

Free radical damage has a cumulative effect that interferes with cellular function, bogs down chemical reactions and neurological communications between cells, and speeds the growth of mutant cells and degenerative diseases like cancer, heart disease, and arthritis. The highly reactive free radicals are also implicated in other diseases including diabetes, Alzheimer's, cataracts and macular degeneration.

The good thing is that we are not completely powerless. Antioxidant supplements can help protect us from the damage of free radical "bombardment".

Antioxidants
We have our own army of defence against free radicals and they are called antioxidants. Antioxidants have the ability to
render the free radicals harmless. As long as there are adequate amounts of antioxidants within our bodies to handle the free
radicals produced within the cell there is no damage to surrounding tissues.

The body has the ability to make some of its own antioxidants, five of which are superoxide dismutase (SOD), catalase,alpha lipoic acid, coenzyme Q10 and glutathione peroxidase, but the body may not be able to produce enough antioxidants on its own to neutralise all the free radicals that are produced.

Although many antioxidants can be obtained from food sources, it is difficult to get enough of them to hold back free radicals constantly generated in our polluted environment. That is why we need to get the rest of the antioxidants from
supplements.

* Primary antioxidants

Beta carotene - is a powerful free radical scavenger that attacks and neutralises the singlet oxygen, a dangerous free radical that affects our eyes, skin and lungs.

Vitamin C - is a powerful antioxidant that helps minimise free radical damage in the watery regions of the body, such as
blood plasma, lung fluid, eye fluid, as well as in between cells. It also helps protect the nervous system from free radical
attacks. Another amazing function of vitamin C is that it helps to recycle vitamin E to keep it actively fighting free radicals.

Vitamin E - is a potent antioxidant that prevents the oxidation of lipids (fats) in cell membranes, which strengthens the
outer cell layers against free radical attacks. Vitamin E works best in the presence of selenium, and helps protect vita-
min A. Research shows that vitamin E stimulates the immune system, improves the circulatory system and oxygen absorption, fights cancer, and has a role in preventing cataracts. It also helps keep low density lipoprotein (LDL) from the oxidation that creates arterial plaque.

* Antioxidant support nutrients

These nutrients are not antioxidants themselves but are essential components of glutathione and superoxide dismutase (SOD) which are antioxidant enzymes made by the body.

Selenium - is a trace mineral that synergises well with vitamin E and is the key component in the powerful glutathione-based antioxidant enzymes that convert hydrogen peroxide free radical into water.

Zinc - has antioxidant properties that protects the body. Zinc is required to maintain effective levels of vitamin E and
A. It is also the key ingredient in the very important antioxidant enzyme called superoxide dismutase (SOD).

Copper and manganese - are both essential components of superoxide dismutase (SOD) that neutralises the most dangerous free radical in the body - superoxide.

* Targeted antioxidants

Alpha lipoic acid (ideal antioxidant) - Dr Lester Packer, professor of the University of California, Berkeley, Department of Molecular and Cell Biology, is among the world's leading antioxidant researchers, and perhaps the foremost researcher on
alpha lipoic acid. He has described alpha lipoic acid as very close to an ideal antioxidant.

Alpha lipoic acid works in both the watery as well as fatty regions of the cells. It also has the ability to regenerate oxidised vitamin E and C, CoQ10, glutathione and even alpha lipoic acid itself. It raises " blood levels of glutathione - nature's most powerfulantioxidant - better than any other substance known. It improves insulin sensitivity and improves glucose metabolism. Alpha lipoic acid has been used widely in Germany for over 30 years for treatment of symptoms associated
with diabetes such as neuropathy and retinopathy.

Grape seed standardised extract (super antioxidant) - The active ingredients found here are oligomeric proanthocyanidines (OPCs). Research indicates that OPCs may be 20-50 times more potent as an antioxidant than vitamin C and E. Because they bond to collagen, protecting against free radicals, OPCs keep joints and skin supple, promoting a youthful appearance. They also strengthen capillaries, improve circulation, reduce joint pain, and protect nerve tissue. OPCs can also help convert oxidised vitamin C back to its active form.

The body produces many species of flee radicals - singlet oxygen, superoxides, hydroxyl, hydrogen peroxide, peroxyl and
so on, and almost all are damaging to the body. Different antioxidants neutralise different species of free radicals. Hence when it comes to antioxidant supplementation, it makes sense to take a supplement that contains a variety of antioxidants.

Make sure that the ingredients listed are in adequate amounts thus providing a wider daily protection against degenerative diseases.

Fast foods under scrutiny

Inappropriate dietary patterns together with a sedentary lifestyle are major contributors to obesity and lifestyle diseases.

The topic of fast foods has been highlighted in this paper and other local press this past week. Several reporters have called me to seek information and explanation on the issue. Questions were mainly related to the ill effects of consuming fast foods and how to educate the consumer.

I feel it would be appropriate and timely for me to talk about fast foods in this installment of NutriScene. Through this article, would like to address several issues that would serve to educate the public regarding fast foods.

What are fast foods?

I do not believe there is an officially recognised definition of fast foods. What often comes to mind when we mention such foods is the Western franchised fast foods such as fried chicken, burger, hot dog, pizza and so on.

Taken more generally, fast foods can be taken to include meals that can be prepared in a short time and can be taken "on the go". They can also include a variety of local dishes and meals such as several noodle meals (for example,.fried, .soup or curry), several rice dishes (for example fried rice, chicken rice, nasi lemak, barbeque meat rice), and numerous others sold in hawker stalls and mamak restaurants.

The press write-ups these past few days have been referring to the Western franchised fast foods. The concept of "fast food" perhaps originated in the 1950s. The intense competition in the fast food industry brought about the concept of franchising these meals and the subsequent mushrooming of franchised fast food outlets in theUnited States and elsewhere in the world.

Fast foods probably made its first appearance in this country in the 1970s in the form of a bugger. The industry grew rapidly, spreading to even small towns throughout the Country.

What are the potential ill effects of consuming fast foods?

Non-communicable diseases, especially diet-related chronic diseases, have become the major disease burden and main causes of death in the country. These diseases include obesity, hypertension, diabetes, cardiovascular disease and certain cancers, It is now evident that the increase in these diseases is related to the changes in the lifestyle of the people. Major changes have taken place in the dietary pattern of Malaysians over the years. There has been a shift towards an "affluent" diet characterised by a reduced intake of starchy staples; decrease intake of fruits and vegetables; increased intakes of fats and oils, refined carbohydrates, meat/ fish/eggs; increased percentage of energy derived from fat; andincreased availability of animal sources of protein, fat and calories.

Western franchised fast foods have often been blamed for the increase in these chronic diseases.

Indeed, excessive consumption of fast foods does contribute to the increased risk of these diseases.

More correctly, the excessive consumption of ALL foods that arehigh in energy, fat, sugar, cholesterol, sodium and the insufficient intake of fruits and vegetables increases this risk. It is therefore inappropriate dietary pattern together with a sedentary lifestyle that are major contributors to these diseases.

Many of the risk factors for these diseases can be controlled. They can be prevented. It is thus imperative that all efforts be made to prevent these diseases. It is vital that we recognise the root causes of these problems and tackle them appropriately.

Empowering the people with knowledge to enable them to adopt healthy eating habits and an active lifestyle has been recognised as the long-term solution to reducing risk to these diseases.

Providing nutrition information on fast foods

As part of the effort to educate consumers on making food choices, the public should be informed of the nutrient content of fast foods. Fast food chains should contribute towards these efforts. The nutritional content of each type of food and drink sold in their outlets should be clearly and prominently displayed.

I find that at least one fast food chain is providing the content of several nutrients in a booklet that customers can pick up from the outlets. Such information is also available on the website of the chain. The serving size for each meal is provided, as well as the amount of calorie, protein, fat, carbohydrate and calcium.

I would urge that all fast food chains provide such information to the consumer. It should include

nutrient content for sample meals to be consumed, comprising several food items, such as a burger, chips and a soft drink. The industry and health professionals should help consumers understand and use such information to enable informed choices.

For example, the menu in a fast food outlet should inform a 20-year-old woman that consuming a meal comprising two pieces of fried chicken, a packet of French fries and a soft drink has 800 kcal and 36 grams of fat (which makes up 41% of the total energy). She should be aware that energy intake from this meal alone is already slightly more than half (40%) of her daily requirement of 2000 kcal:

Consumption of fast foods

There is no good data on consumption of fast foods by population groups in the country. But looking at the increasing number of outlets in the country over the years, fast foods are certainly gaining in popularity.

There is thus the concern that these fast foods may be gaining too strong a foothold in the dietary pattern of communities. I do understand and share such concerns.

Indeed it is important ~o address the issue in a comprehensive manner. The strategies should include providing education to the consumer on the role of such foods in the diet.

In addition to providing nutrition information of fast foods, the industry should be encouraged to provide healthier alternatives in these outlets. There could be greater scrutiny to reduce misleading advertising by these foods.

At the same time, it is important to be mindful that there are a number of other foods out there that may play a role in increasing risk to diet-related chronic diseases. There are some local dishes and meals that contain high fat and calorie. Several of these dishes also contain coconut milk (santan). These may also be called fast foods and they feature prominently in the daily diet of the community.

As more families eat out, the dependence of the population on these foods for meeting their nutritional needs become even more important.

Information to the people should include nutrient content of such local fast foods. The same young woman Should also be informed that eating a bowl of curry mee with a soft drink gives her 700 kcal and 37 grams of fat (47% of total energy)*. This energy intake is about 35% of her daily caloric need and the dish may contain a fair amount of santan.

There is of course a large variety of local fast foods, with widely differing nutrient content*. There are dishes and meals that have a nutritional profile and can be encouraged. There are also healthier ways of preparing these local dishes. 1 am of the opinion that we should tackle the problem by looking at the broader picture, i fear that focusing on one single type of foods may not achieve the intended objectives.

I realise I am repeating myself, but I have to say that the solution lies in promoting overall healthy eating to the people. Strategies are already identified in the National Plan of Action for Nutrition II, including working with the fast food industry. Let us activate those plans.

Promoting fast foods to children

Intense marketing and advertising are certainly important reasons for the success of the fast food chains. In view of this lack of knowledge and the inability of children to choose wisely, it is certainly not right to be pushing such foods to young children without some form of guidance. Considerations could be given by the authorities to curb advertising to this group of the population.

Parents have an important role to play by understanding the nutritional value of these foods and providing appropriate guidance to their children. Parents themselves should serve as good examples and eat sensibly. School authorities can also play effective roles in these efforts. In this respect, inter-ministry coop: eration should be enhanced to have effective educational programmes,commencing from primary schools.

To ear or not to eat

No one single food or type of food can be said to be the cause of obesity or other diet-related chronic diseases. It all depends on how much of these foods you are eating. It depends on how frequent you are eating these foods. The answer lies in what else you are eating for the day.

There is no simple guideline for eating fast foods. There is no guide on what is the "safe" number of fast food meals that can be taken in a week or a month. There are however guidelines on healthy eating (information available on: www.nutriweb.org.my).

All this sounds too complicated? Not really. As I have often emphasised, remember the key points: be disciplined in your eating, eat in moderation, go for variety.

One puff above the limit

By Dr BERNADINE HEALY

One puff above the limit PEST easier, robbers. The cops have some new villains to track down. They're called smokers. Recently, police in Bangor, Maine, took on the job of ticketing people spotted puffing on cigarettes in their cars if children under l8 are on board.

Last year, Arkansas and Louisiana enacted similar bans, and many other states, including New Jersey. New York, California, Kansas, and Utah, are considering them. Some propose fines as high as U55500 (RM1,750) and jail time.

To be sure, public policies like advertising bans and smoke-free public places have been highly effective in reducing exposure to second-hand smoke. And the goal of these new laws is just as laud

able.

But this particular anti-smoking campaign has more than libertarians concerned that government is

going too far in policing behaviour and trouncing privacy. Next, the health police could ticket parents

for buying children junk food or for letting them get too much sun at the beach. A more practical and

immediate concern however, may be whether enlisting the police to punish smokers will improve children's health.

Smoking is an ugly habit. It pollutes the air with toxic vapours that can be inhaled by innocent bystanders. This seems to explain why non smoking spouses of smokers face a small but increased

chance of lung cancer.

For children, as pointed out by the US surgeon general's 2006 report The Health Consequences of

Involuntary Exposure to Tobacco Smoke, homes filled with smoke increase youngsters' risk of respiratory problems like bronchitis, pneumonia, and asthma attacks. The report also revealed that Mom's smoking has a greater negative effect than Dad's.

But it's not just smoking during pregnancy that can do damage, The lungs of infants and toddlers

are also vulnerable to passive smoke, a risk that trails off and disappears as children grow older and

move into their teens, What does not disappear, however, is a child's risk of becoming an active smoker, facing a greater chance of cancer and heart disease later on in life.

There are few data on smoking in cars per se. The danger is inferred because of smoke concentration in a contained space. You might also infer that people so into their cigarettes that they have to light up in the confines of a ear represent a pretty hard-core group of smokers.

Smoking them out of their cars will only drive these tobacco addicts to light up more in their kitchens and faSrnily rooms, out of Light or reach of the health police.

But even among those who have not yet become addicted, the threat of a ticket may not be a deterrent. Over the past 20 years, more than 30 states in the United States have enacted laws imposing hefty fines, court appearances, loss of driver's licenses, school suspensions, or other penalties on teenagers caught buying, possessing, or using tobacco.

But these penances haven't worked very well, Neither policy-makers nor police are enthusiastic

about punitive approaches, and the laws are often enforced in an erratic and seemingly selective

way.

This suggests another problem for the smoking police: The odds are that the adults they will be singling out for smoking in cars with underage passengers will be disproportionately poor, uneducated,

and female, as today's smokers are tilted toward lower incomes and less formal schooling. And even

though more men smoke than women, more often than not, women will be the ones ferrying young children around in cars, They're called Morns. So be real. Will a fine or 30 days in jail improve the well-being of these often disadvantaged mothers and their children7

A former professor of mine used to preach that when she's caring for a child, be sure to "build up

Momma". Remember to tell her what a good job she's doing, and help her when she may be struggling. Momma is the one who bears the major responsibility for young children, day in and day out.

5be - no offense, Dads is the one who typically sets the tone for health behaviour in the home.

Yet young women are tailing up smoking in droves, and in what seems to be a curious fact of gender biology, once hooked it's harder for them to quit than men. Women respond differently to

smoking cessation programs and may also face more intense withdrawal s3rinpt ores..

Most parents who smoke want to give it up and sure don't want their kids to start. Morns may be

just the pressure point for Change. But don't punish them. Encourage, educate, and motivate them, and

provide program tailored to assist them in kicking their addiction. He p smokers become better

mothers. And let health experts, not cops walk the smoking beat, US News and World Report/Premium health News Services/TMSI

menses, am i bleeding?

bleeding,the cause of the irregular bleeding is not found. For these women the most likely reason is a change in hormonal activity. This is described as dysfunctional uterine bleeding.

This is the most common cause of abnormal vaginal bleeding during a woman's childbearing years. Up to 10% of women may experience excessive bleeding at one time or another. African American women tend to have more episodes.

When the complex hormonal process that creates your menstrual period loses coordination and the hormones oestrogen and progesterone are out of balance, your body overproduces uterine blood flow. Thus, you may experience excessive vaginal bleeding. This bleeding is related to irregularities of your menstrual cycle without any evidence of disease.

The diagnosis of dysfunctional uterine bleeding is a diagnosis of exclusion, which means that all other causes for the bleeding (including trauma, lesions, or diseases) have been looked for and determined not to be the cause of the bleeding.

Diagnosis methodsDiagnosing abnormal bleeding involves a number of tests. Your healthcare provider will take a careful medical history. You will be asked questions about the following issues and other general questions regarding your health:

* This episode of vaginal bleeding

* Your last known normal menstrual cycle

* Previous episodes of abnormal bleeding

* Currently pregnancy (if any)

* Previous pregnancies

* Outcomes of previous pregnancies

* Present sexual activity

* Use of any form of birth control

* Number of sexual partners

*Any medications, over-the-counter, or illicit drugs you are taking

The doctor will also perform a complete physical, including a thorough pelvic exam. The exam includes careful inspection of your external genitalia, urethra, and anal area.
The vaginal walls and cervix or birth canal are inspected for the presence of any lesions or retained foreign objects.Sometimes a tampon or other object is left in the vagina and can cause bleeding.

While the doctor is examining your vagina and cervix, the doctor may take cultures (fluid samples) to test for sexually transmitted diseases such as gonorrhea and chlamydia.
The doctor may also take cells from the cervix that wil be examined for cancer. This is a Pap smear.

It is also important for the doctor to place his or her hand ito your vagina and sometimes your rectum to detect the shape of your uterus and ovaries as well as to feel for any masses that may be present.
Tests that may be performed with abnormal uterine bleeding include the following:

* A pregnancy test needs to be done to make sure that pregnancy is not the cause of your bleeding.

* Blood wil be taken to see if you are anaemic (have low red blood cell counts) or have a low platelet count.

* A clotting series that includes a prothrombin time (PT) and an activated partial thromboplastin time (PTT) gives information about your ability to form clots in your body to stop bleeding. Abnormal vaginal bleeding may be the first sign that you may have a bleeding disorder.

*Your doctor may also order thyroid tests, which are blood tests that examine the thyroid gland (a gland in the neck responsible for many complex functions of the body).

* Further tests, such as an ultrasound scan of the uterus, may be recommended. This is a simple test in which gel is placed on the lower abdomen and a special scanner is moved through the gel. If necessary, a vaginal ultrasound may occasionally be performed, in which the scanner is placed inside the vagina instead of on the abdomen. In this way, clearer and more accurate views of the uterus can be obtained.

* A vaginal ultrasound to look at the lining of the womb can also detect endometrial hyperplasia (thickening of the lining of the womb), uterine fibroids and routinely check for ovarian cysts and other pelvic abnormalities.

* An endometrial biopsy may be performed to take tissue form your uterus. This is performed in the doctor's office and is a little more invasive than a Pap smear.

* A hysteroscopy may be indicated. This involves a long fine telescope, used to look at the lining of the uterus(the endometrium) from the inside, usually under general anaesthetic. It may be performed as a day case or it may involve an overnight stay in hospital. At the start of the procedure, the doctor dilates the cervix slightly, so that the telescope can be inserted through the cervixtowards the inside of the uterus. With this technique, it is possible to take a biopsy (remove tissue for examination) from specific areas of the lining of the uterus.
Treatment options Fortunately, most heavy bleeding can now be easily treated without major surgery.

*Medicines.Prostaglandin inhibitors and tranexamic acid are non-hormonal therapy that works on the clotting mechanisms in the lining of the uterus. Tablets are taken only on days when you have heavy bleeding. it may decrease heavy flow, but may lengthen the time of bleeding. Birth control pills may also decrease bleeding by almost a third. Most bleeding caused by hormone imbalance can be treated medically.

* Progesterone Intrauterine System(IUS)
The Mirena progesterone IUS may decrease bleebing. It steadily releases a tiny amount of progestogen within the cavity of the uterus. This keeps the lining of the uterus(endometrium) thin and inactive rather than increasing in thickness as it normally would in the build-up to ovulation. Menstruation normally occurs when the lining of the uterus falls away, in this case, because the lining of the uterus has not increased in thickness the menstrual bleeding is reduced.
Treating uterine problems

* Dilatation and curettage (D&C)The cervix is dilated and the endometrium gently scraped away. If abnormal bleeding is caused by polyps, often, removing them with the curette will solve the problem.

* Endometrial ablationSometimes an endometrial ablation is done at the same time to further reduce or eliminate bleeding. Endometrial ablation is a day surgery procedure that will usually eliminate or greatly decrease menstrual bleeding.
Since an endometrial ablation destroys the lining of the uterus, endometrial ablation is not for anyone, especially those who desire to keep her fertility. Women who have a malignancy or pre-malignant condition of the uterus are not candidates for ablation. Women who have severe pelvic pain, unless the pain is coming from an intracavitary myoma, may be better served by alternative treatments. Although pregnancy is unlikely after ablation, serious complications could arise. It is essential for a woman to use reliable contraception after an endometrial ablation.
HysterectomyOne of the reasons women get hysterectomies is to control heavy menstrual bleeding. This is the only procedure that guarantees permanent elimination of any bleeding.
Hysterectomy is the removal of the uterus. The operation can be done in three ways:* Abdominal hysterectomy is when the uterus is removed through a cut in the abdomen

* Vaginal hysterectomy is when the uterus is removed through the opening of the vagina

* Laparoscopically assisted vaginal hysterectomy also involves removing the uterus through the vagina but there are small cuts made in the abdomen to allow the surgeon to do part of the operation. The aim of this operation is to reduce recovery time and discomfort after operation.
The type of hysterectomy a woman has is dependent on a range of factors, including the nature of her problem and her medical history. Any decision to undergo hysterectomy, other than pre-cancer or cancer changes needs to be carefully discussed. Sometimes it is wise to seek a second opinion and to review options for other treatments.
What should you do if you experience irregular vaginal bleeding?See your health care provider for any abnormal vaginal bleeding. It is not always necessary to go to a hospital emergency department for this problem. An office visit to a gynaecologist (a doctor who specialises in female reproductive organs) is usually sufficient if you are bleeding but do not have any other symptoms.
Be certain to record when the bleeding occurs during the month. Also, try to determine if the bleeding is vaginal or anal. Don't be frightened-most irregular vaginal bleeding has a benign cause. If you're having heavy vaginal bleeding-saturating a pad an hour for more than a couple of hours-seek prompt medical attention.
If you're taking birth control pills or are on hormone therapy, consult your doctor and follow the instructions he or she gives you. This may be as simple as taking more pills, but you may need to change medicines completely.
If you are having abnormal vaginal bleeding with other symptoms, such as lightheadedness, severe abdominal pain, or fevers, or if you're pregnant and experience vaginal bleeding, you should be evaluated as soon as possible. This includes being seen in an emergency department.
What is the outcome of having abnormal vaginal bleeding?The outcome depends on the cause of the problem, but abnormal vaginal bleeding rarely results from a serious condition and can usually be treated successfully.

* This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.
The members of the panel include: Datuk prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Assoc Prof Khoo Ee Ming, primary care physician.

Being a Woman Boss

Stopped having periods.

Whos's at risk?


What causes abnormal vaginal bleeding and who is at risk? Abnormal vaginal bleeding may occur between the normal menstrual bleeds (intermenstrual bleeding)or it may take the form of unusually heavy menstrual bleeding (menorrhagia). In postmenopausal women, it may develop after a number of years without any vaginal bleeding.



It's inportant to understand exactly what is causing the bleeding and where it's coming from (uterus, vagina, or some other organ or tissue) and to make decisions about how to control or stop the bleeding.



A wide range of "normal" menstrual periods Periods differ from woman to woman and from month to month. A period can last from three to 10 days, and occur every three to six weeks. This pattern can vary with age, stress, diet, exercise and inherited factors. The flow can also vary. Around 40ml (two tablespoons) of fluid is lost, which the body quickly replaces.
It is common for women to suffer some cramping pain with their period. This is felt just below the navel and may spread ito the legs or lower back. It can be felt as a dull ache or sharp twinge. During a period, it is also common to feel bloated and heavy, get more pimples, feel tense and emotional, and have sore breasts and greasier hair.



What gynaecologic conditions are associated with irregular vaginal bleeding?Irregular vaginal bleeding is a possible sign or symptom of a range of causes. For others, the cause depends on their age and the site of bleeding. Once pregnancy has been ruled out, some of the known causes include:

• Dysfunctional uterine bleeding


• Contraception-such as the pill, injection or IUD (intrauterine device)


• Vaginal infections


• Tumours, polyps or fibroids of the vagina, cervix, uterus or fallopian tubes


• Cervical disorders-such as cervical ectropion, a condition common among younger women, especially young women taking birth control pills-in which the cervical tissue becomes more susceptible to abrasion, often associated with bleeding after sexual intercourse


• Cancer of the uterus, cervix, vagina or vulva


• Some sexually transmitted diseases, such as chlamydia, gonorrhea or genital warts


• Vaginal injury from trauma or sexual abuse


• Some medications such as anticoagulants or anti-epilepsy drugs


• Underlying health problems such as bleeding or thyroid disorders.Dysfunctional uterine bleedingIn more than half the women with

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