Wednesday, March 10, 1999

Aspirin is 100
By Sarah Boseley
ASPIRIN is officially 100 years old and yet the medicinal powers of the little white tablets once found in every handbag and bathroom cabinet are still astonishing scientists. It is the nearest thing the world possesses to a wonder drug.

Tomato & cancer
By Dr K.C. Kanwar and Dr Usha Kanwar
TOMATOES, known for their high vitamin content, may also protect people from developing cancer primarily of the gut and the prostate.

Arpana: stitches of love
CHANDIGARH: Arpana is a registered spiritual and charitable organisation located at Madhuban (Karnal). Its volunteers have made a life-long commitment to put their expertise and experience at the disposal of the underprivileged.

The bald truth
By Dr Gurinderjit Singh

People take their hair for granted. They wash it, rub it dry, run a comb through it and are ready to face the day. They should take care to use the right shampoo and pair it with a good conditioner. When left to nature, it often lets people down. They have to cope with hair loss, receding hairlines and incipient baldness.

The hair roots on top of the head are genetically controlled, while those at the rear side of the head are independent of genetic influence and usually permanent. So, even a bald person has hair at the back of his head. Hair can be taken from the sides and the back of the head and transplanted to the front.

There are two methods of doing hair transplantation. One is the traditional punch grafting and the other is mini and micro grafting. In punch grafting, grafts of 4.5 mm diameter are taken with a biopsy punch from the donor area and transplanted into holes made with a punch of 4 mm size in the recipient area. In mini and micrograft, a narrow strip of scalp, 6-10 mm in width, is taken from the back of the head. Hair follicles are separated in groups of one, two or three, the plugs are cleaned and trimmed and planted on the bald region at an interval of 1 to 1.5 mm diameter.

The transplanted hair fall off along with the scabs in three or four weeks. Within three months new hair starts growing at the rate of 2.3 cm per month. The hair subsequently needs to be trimmed and cut.

Hair thus transplanted looks natural and cannot be differentiated from the normal hair.

Moreover, this surgery is performed under local anaesthesia without any hospital stay. Healing is easy and fast because the operation is performed on the outside skull bone and the scalp tissue is rich in blood supply. Every patient has to follow certain post-operative instructions for at least two weeks like not to lift heavy weight and not to wear a turban or a helmet as it might rub against the grafted area!

Baldness caused due to severe burns or accidents cannot be cured by grafting. In such cases, hair is transplanted by several other methods lile the flap method, the scalp reduction method or the tissue expansion method. In the flap method, strips of scalp, about one inch wide and four to six inches long, are moved from the sides of the head to the front. The old hair does not fall as is the case with the grafting method, but continues to grow from the new area. Three to four operations may be needed to create the required hair line.

But each time the scalp-strips or flaps are removed, a one-day hospital stay and periodic dressing care of seven days are necessary. Hair growth is denser in this method than in the graft technique, but the patient develops a noticeable scar in the process. This can be remedied by further corrective measures.

Another curative procedure is the scalp reduction method where long vertical bald strips of skin, about one inch wide, are removed from the vertex (top of the head), and the sides are moved closer and stitched. Similar strips are removed at an interval of six months till the bald area is reduced to almost nothing. This surgery does not require any hospital stay. But this method works only in small areas.

In the tissue expansion method, a balloon-like flat device is placed under the skin with normal hair, usually on the sides of the head, and fluid is injected into the device periodically to expand the scalp skin. Once optimum expansion is reached, this device is taken out, the central bald area is cut and removed, and the expanded skin is stretched to cover the patch. This method is no longer in use.

More sophisticated and easier methods are being invented every day. Some dermatologists use the method of single hair transplant. In this, hair roots are transplanted from the donor site to the bald area, taking one hair at a time without trimming the plugs.

Dermatologists feel that the invention of the pill, Finesteride, has marked a watershed. The FDA-approved pill can delay premature baldness. Finesteride helps to suppress the enzyme (five alpha reductase) responsible for converting the hormone testosterone to dihydrotestosterone, which weakens hair roots resulting in rapid hair loss. It has been successfully tested in the age group 18-41.

These surgical methods, however, cannot provide a solution for those who have less dense hair at the back of the head. Besides, hair from any other part of the body or from some other person cannot be used for transplant.

Hair weaving, a non-surgical technique, is ideal in such cases. A wig is tied on the periphery of the existing hair line to fill up the embarrassing bald patches. It can be shampooed and styled. But when the hair comprising the rim grows, it pushes the hairdo forward. People who wear it often complain that it looks unnatural and has to be tightened regularly with professional help.

For those who are absolutely bald, only wigs can serve as a saving grace. In fact, they even have an inherent advantage. They can flaunt a new hairdo every week, if not every day, while others have to wait for their hair to grow before adopting a new style. But good wigs are expensive and have to be changed every four or five months. Moreover, they can be very uncomfortable during the summer, specially in humid conditions. Here, constant perspiration results in fungal infection of the scalp.

What most people need to remember is that baldness need not be a life-altering condition. But a condition like alopecia areata can make a person really depressed when he loses hair not only from the head but also from the eyebrows, the moustaches, the beard and then the whole body. Doctors are yet to find the reason behind such a disease, but the treatment done in the initial stage can be quite rewarding.

Those who have good confidence and self-esteem don’t mind when they go bald, a la Sean O’Connery or Persis Khambatta, and establish a style which is entirely their own.

DR Gurinderjit Singh, MD, is a senior consultant and the Head of the Department of Dermatovenereology and Hair Transplantation at Mohan Dai Oswal Cancer Treatment and Research Foundation, Ludhiana.

Aspirin is 100
By Sarah Boseley

ASPIRIN is officially 100 years old and yet the medicinal powers of the little white tablets once found in every handbag and bathroom cabinet are still astonishing scientists. It is the nearest thing the world possesses to a wonder drug.

Like the sticking plaster, we have known it so well and for so long that the name has been absorbed into the metaphorical stockpile of the language. It was all Bank of England Governor Eddie George could offer a boss struggling to do businesses with the crumbling Asian economies, he said this week. “I could seek to ease his pain but only by giving him an aspirin. And the underlying pain would be worse later on if I did.”

Aspirin fell into such pejorative use before anybody realised it deserved more respect. In the 1950s it was overtaken by paracetamol as a painkiller, but since John Vane in 1971 won a Nobel prize and a knighthood for revealing how it worked and scientists picked up on the potential, it has been saving lives.

Swallowing an aspirin is the smartest thing anyone with the onset of a heart attack can do to improve his or her chances, after making a 999 call. It is used to lower the risk of heart disease and stroke in some people, it is thought to stave off some cancers, helps rheumatoid arthritis and is even given to women to control dangerously high blood pressure during pregnancy.

All this from the bark of the willow tree. Aspirin began as herbal medicine. It was patented on March 6, 1899, but Hippocrates, the Greek father of medicine, was giving women a brew made from willow to ease the pains of childbirth in the fifth century.

Hundreds of years later, a British clergyman had an important part to play. In 1763 Edmund Stone, said to have been in the habit of chewing willow bark, used it for pain relief in some of his parishoners. His report of what was in effect one of the earliest clinical trials, in 50 patients, was published in the journal of the Royal Society.

Scientists discovered that the active ingredient was salicylic acid, which the willow, and the meadowsweet flower, produce as a defence against infection. But although the acid gave relief from pain, it was distressingly corrosive to the stomach and many patients suffered acutely from vomiting.

There were lots of fruitless attempts to add something that might ease the side-effects. Eventually in 1853 a French chemist, Charles Frederic Gerhardt, induced a reaction between salicylic acid and acetyl chloride. He produced, had he but known it, the aspirin we know today, acetyl-salicylic acid (ASA). But because the procedure was tedious and complicated, he did not pursue it.

Felix Hoffman, who worked for the German firm Bayer, did. His father, so the story goes, took salicylic acid for rheumatoid arthritis but could not bear the side-effects. Hoffman gave him ASA, which worked brilliantly, and then developed better ways of making the drug, which Bayer named aspirin. The “spir” came from the Spiraea plant family which produces salicylic acid, and the initial A was from acetyl.

Bayer nearly shelved ASA from lack of interest, but it eventually made countless millions for the company. Aspirin is generic in Britain, but Bayer owns the trademark in more than 80 countries.

Aspirin’s painkilling heyday in Britain was in the 1950s, but the arrival of the better-tolerated paracetamol and later ibuprofen hit sales, although many cold and flu preparations, such as Beecham’s powders, contain it.

It was to have a miraculous transformation in 1971 when Professor Vane, of the Royal College of Surgeons, discovered exactly how aspirin worked, by blocking the creation of prostaglandins in the body’s cells. Without them we cannot experience pain, fever or inflammation.

At low doses aspirin interferes with blood clotting, at higher doses it reduces fever and aches and pains, and in larger doses again it reduces pain and inflammation in rheumatoid arthritis.

People who have suffered a heart attack are advised to take one low dose 75mg tablet a day to avoid another. Clinical trials have shown that it can substantially reduce the risk of a heart attack in people with heart disease: it “thins the blood” and reduces the blood’s propensity to clot.

Richard Peto, the Oxford University epidemiologist, headed a study which found that around 100,000 fatal and 200,000 non-fatal heart attacks could be avoided each year if people at risk took aspirin. It has also been shown to reduce the risk of bowel cancer if taken twice a week.

— By arrangement with The Guardian, London.

Tomato & cancer
By Dr K.C. Kanwar and Dr Usha Kanwar

TOMATOES, known for their high vitamin content, may also protect people from developing cancer primarily of the gut and the prostate. Scientists recently reported that people living in northern Italy, who consumed seven or more servings of raw tomatoes every week, had 60 per cent less chance of developing colon, rectal and stomach cancer than those who ate only two servings or less (cf. International Journal of Cancer). The famous saying, “an apple a day keeps the doctor away”, is perhaps outdated and not fully scientifically substantiated. Besides being a nutritious fruit, apple certainly is neither a complete and balanced diet nor an item of established medicinal efficacy. “Eat enough tomatoes a day and keep cancer away” is a more appropriate slogan which is quite close to the scientific truth. The consumption of tomatoes provides better protection from cancer than eating fruits and consuming fresh green and other types of vegetables.

Dr Graham Colditz of Harvard University corroborated these views when he reported in 1985 that older Americans “who often ate tomatoes in abundance were only half as likely to die from all cancers combined”.

Lately, Harvard researchers, in a massive survey, studied the eating habits of more than 47,000 men over six years and concluded that a diet high in tomatoes (four to seven servings per week) might significantly protect men from prostate cancer. Such individuals were 20 per cent less likely to develop prostate cancer than men who avoided tomatoes. According to these findings published in The Journal of the National Cancer Institute, a diet rich in tomatoes, tomato sauce and tomato juice seemed to have a dramatic protective effect against prostate cancer, the second most common cancer in men. Those who had more than 10 tomato servings a week had 35 per cent reduction in the rate of prostate cancer.

This is a boon for those who have a weakness for a high-fat diet since the latter is directly linked with the enhancement of prostate cancer. Such individuals on a high-fat diet are advised to neutralise their food fad with a diet rich in tomatoes.

What is in particular responsible for the anti-cancer effect of tomatoes? In the view of Prof George Truscott of Keel University, England, which also stands corroborated by the Harvard scientists involved in the above-mentioned survey, it is the red colour which makes the ripened tomatoes look attractive and tasty. Lycopene — the pigment that turns tomatoes red when they ripen — is now proved to be a powerful antioxidant, the substance which is able to disarm unstable free radicals that damage the biological systems, enhance aging and contribute to a variety of diseases including cardiovascular ailments and cancer.

The free radicals are toxic by products of the normal metabolism which damage cells, accelerate aging and are involved in the pathophysiology of many diseases including cancer.

The natural biological antioxidants of which lycopene is perhaps the most potent, selectively scavenges the free radicals as soon as they are formed and render them harmless. But when the body’s antioxidants run low, free radicals let themselves loose and play havoc with various systems.

A diet rich in antioxidants, nutritionists believe, can snare the unstable molecules (the free radicals) before they do any harm, thereby not only cutting down the risk of cardiovascular diseases but also substantially lowering the overall danger of cancer and a variety of other age-related diseases.

Above all, these antioxidants, if available in abundance, retard the ageing process.

According to Dr Colditz, tomatoes are one of the few foods rich in lycopene — a member of the carotenoid clan that has been overshadowed, so far, by its famous cousin, beta carotene — a predominant plant pigment and a precursor of vitamin A, both of which themselves are antioxidants of considerable merit. Tomatoes, it is estimated, supply as much as 90 per cent of the total lycopene many of us get in our daily food.

All carotenoids are antioxidants. The most common of these is the beta-carotene found in pumpkins, carrots, and fruits like cantalupes, papayas, ripened mangoes, apricot, peaches and many more such fruits which have pinkish or yellow pulp. The other carotenoids include beta-cryptoxanthine found in oranges, tangerines and canthaxanthine used as natural food colourant in jellies, salad-dressing and soft drinks.

Scientists feel that antioxidants from vegetables and fruits serve as natural commandos against free radicals, the root cause of many human diseases. Besides lycopene, tomatoes have vitamin C and certain chlorogenic acids which too are potent antioxidants and hence protective against cancer.

Tomatoes, therefore, are a store-house of natural antioxidants making these protective against cancer especially against tumours of the G.I, tract (particularly colon cancer) as well as bladder and prostate cancers.

According to Prof Truscott, the lycopene in tomatoes, is three or four times more effective as an antioxidant and anti-cancer agent than the other beta-carotenoids in general. Working with Dr Fritz Bohm of the Humboldt University in Berlin, Professor Truscott recently carried out tests that showed in vitro protection of human cells against NO 2 (a form of free radical) by a factor of 3.4 for beta-carotene and 8.6 for lycopene.

Professor Truscott, who recently reported his findings to a conference in California, suggested that lycopene in tomato juice is a worthwhile supplement to the diet of anyone at the risk of cigarette-smoke of air-pollution (both these generate free radicals).

According to WHO estimates, an inhabitant of Delhi daily inhales toxic gases equivalent to smoking three or four packets of cigarettes. If true, tomatoes may emerge as saviours of the Delhiites subjected to the worst kind of air pollution. Professor Truscott, however, warned that excessive and prolonged intake might cause an artificial tanning of the skin. “I am sure, people will not mind this latter effect”, remarks Professor Truscott. According to him, “it is, at any rate, safer to colour your skin than sunbathing which among the whites particularly could be hazardous”.

Luckily, lycopene survives heating and withstands cooking. So even if it is monotonous and at times difficult to procure ripened tomatoes everyday, think of tomato sauce, tomato chutney, tomato ketchup and tomato purree which can be prepared and stored when tomatoes are inexpensive, and made use of later.

Arpana: stitches of love

CHANDIGARH: Arpana is a registered spiritual and charitable organisation located at Madhuban (Karnal).

Its volunteers have made a life-long commitment to put their expertise and experience at the disposal of the underprivileged.

This dedication is seen in Arpana's wide-ranging medical and socio-economic services, including the 175-bed Arpana Hospital in Madhuban, Karnal (Haryana), two medical centres in Himachal Pradesh, mobile clinics, wide-ranging primary health programmes in Haryana and Himachal, as well as comprehensive programmes to tackle urban poverty in Delhi slums.

From Thursday, March 11, to Saturday, March 13, the Arpana volunteers will organise an exhibition-cum- sale at Piccadily Hotel, Sector 22, of exquisitely hand-embroidered baby frocks, ladies nightwear and table and bed linen to assist rural women. The sale will be open from 10 am to 8 pm. All proceeds will go to charities.There will also be a section on spiritual literature.

Arpana's exhibition will enable rural women to medically treat, feed, clothe and educate their children by improving their lives and binding families together with "stitches of love". It seems unbelievable that such exquisite embroidery is done in village homes. Arpana's primary goal is to help create income-generating opportunities with which rural women can meet their essential needs.

Detective mammography

An effective mammography X-ray unit was inaugurated at the Government Medical College and Hospital, Sector 32, Chandigarh, on Tuesday. The machine can provide excellent services in the examination of the breast where even a small cancer cell can be detected with precision and can be treated with almost 95 per cent success.

The unit is dedicated to the people of Chandigarh. Government Medical College will initiate a mass screening programme next month.

Mrs Anuradha Gupta, Home Secretary, Chandigarh Administration, performed the inaugural ceremony in the presence of Prof V. K. Kak, Director-Principal of the college and Prof B. D. Gupta, Head of the Radiology Department.

Mammography is the most widely recommended method for early detection and screening of breast cancer.

Opportunity for the sick

The private sector is coming up in a big way to lend a helping hand to the public sector in the sphere of tertiary and specialised health care in Chandigarh. INSCOL, the 40-bed hospital entirely unique in its field in the city's Sector 34, has increased the medical facilities tremendously.

Now, Indraprastha Apollo Hospital doctors from New Delhi will visit the institution and give advice on bypass surgery, angioplasty, radio-therapy, radio-surgery, etc.

INSCOL, a medico-spiritual venture, is already doing difficult operations and providing intensive care and indoor treatment to the needy.

Its next step is the opening of a full-fledged OPD comprising surgery, medicine, cardiology, gynaecology, obstetrics, etc. Its link-up with the Heart Command Centre at Apollo will cut down diagnostic delays and save many lives. The Delhi doctors will visit the hospital on Sundays, says Dr Daljit S. Gujral, Managing Director of the institute. — KPS