New hope.

The base of the letter is depends on Embryonic stem cells. The experiments are still restricted to laboratories. In the past few days there was a huge discussion about usage of embryonic stem cells to treat many untreatable disorders. Between those themes treating Parkinson's disease, Sub endocardial and transmural myocardial infarction were breathtaking. Let’s get introduced to the terminology which we are going to use this letter.

What are stem cells?

 Stem cells can be found in the multinuclear organisms. They can divide and transform in to vide variety of cell types. There are two major types of stem cells. 1) Embryonic stem cells, 2) Adult stem cells.

Adult stem cells also called as progenitor cells. Adult stem cells can be found in children and in adults.

The most important cell type in the embryonic cells is the Pluripotent adult stem cell. Pluripotent stem cells have the ability to transform in to vast number of body cell types.

Embryonic stem cell therapy for Parkinson's disease. 

The experiment had been carried out in Kiyoto University Japan. First the researchers destroyed the dopamine producing neurons by injecting a chemical. This induced Parkinson’s disease in Monkeys. Then they injected human embryonic stem cells in to the brains of the monkeys. At the beginning of the disease the monkeys lost considerable amount of movements due to Parkinson’s disease. Six months later they checked the abilities of the monkeys. The results showed 25-45 percent of recovery of the movements. In the postmortem studies scientists saw considerable amount of human embryonic cells have transformed in to functioning dopamine producing neurons.  According to the researchers it will take around 6 years to carry the trials on human patients. The green light is a major victory in the field of medicine concerned with diseases like Parkinson’s. 

Adult progenitor stem cells to treat Myocardial infarction.

The clinical experiment is yet on experimental mice. Results have shown some positive signs which may improve the hope of stem cell transplant techniques. This experiment uses the adult progenitor stem cells.  Aim of the experimenters was to prevent acute and chronic heart failure conditions after a heart attack by regenerating the necrotized heart muscle fibers. Usually after a MI patient’s condition deteriorate very fast. So their lifespan is less comparing to patients with other cardiovascular diseases.

Scientists saw the ability of epicedial cell’s to become progenitor cells. These cells don’t have the regenerative power in normal conditions in adults. These cells remain dormant in the epicardium.  First they used a group of mice to the experiment. Then they damaged the myocardium of the mice. This is a situation similar to a myocardial infarction. The group of scientists wanted to regenerate the necrotized areas of the myocardium. They have chosen group of epicardial cell which can transform in to stem cells. How can they transform these cells to stem cells which are having regenerative abilities? Scientists found a protein which has the ability to transform these epicedial cells to stem cells. The protein is thymosin beta-4. After damaging the myocardium scientists injected this protein to the heart. They saw some regenerative processes. Use of the method as a definitive treatment is still controversial. The experiment group suggests the usage of such a medicine as a oral pill which can stimulate regenerative processes in a heart attack. If the cellular areas treated on time and promptly the positive results are more likely. 

Experimenters are working to overcome other effects and weak points of the therapy recently. This is new information. The results are important very much.

There is a big hope about stem cell therapies.

  

To the western people.

My country is the small country spending its healing period after 30 years of a war. Probably all of your western countries sell armories to small countries like us or to other armed groups to earn money. You don’t even know what is happening in those countries. What you know is you have earned your share in the armory business. In some occasions there are discussions about huge peace missions. You were sitting in those forums in the front. You were there not because you want need to see the end but to show you political power and policies to other. Especially Americans, UK and EU politicians doing this again and again. I have seen through CNN what BBC was happening in Iraq and Afghanistan. Later I got used to know the news also support certain political agendas. In the international media back ground gives a beautiful picture about BBC and CNN. After some time I knew everything flows in one direction. What is the direction? Keeping the power. Even media goes under and in the under wears of western politicians. Their aim is the gain. What do they gain? They earn money and the publicity. An attack to a Iraqi village a tragedy and a sorrowful news to us, to CNN and BBC a business. All the politically powerful countries do this thing to keep the political stabilities in their countries and governments. What’s the best to show off? They can use small developing countries like us. Best picture we can see these days. A group of traitors goes around the world (According to them they are media characters) to speak the dirt and put the wealth in their pockets. Other hand same thing is doing in the international unrecognized media like CHANNEL 4. We know channel 4 runs by western government funds. They release false videos. Mean while America brings a resolution plan for Sri Lanka in the human rights council. I think there is something going really bad these days. Keep your eyes on. Let the country heal itself. History shows all the resolutions plans are failed attempts.

A short guide to ischemic heart diseases (IHD)

What do you mean by a heart attack? Actually the term doesn't give you a full meaning about the underlying causes and the disease. My attempt is to give a short introduction and instructions about the major ischemic heart diseases. IHD (Ischemic heart diseases) is a group of diseases which are characterized by the ischemic conditions of the heart muscles. Heart muscle is the contractile apparatus which helps to pump blood through the body. For this we have a very complex network of blood vessels.

IHD group contains following diseases. Angina pectoris (Stable and Unstable), Myocardial Infarction, Majority of arrhythmias, and sudden cardiac death. What would happen if you can’t breathe? Sure you will die. The same conditions apply to the heart muscle. Underlying cases of majority of IHD are Atherosclerosis and coronary artery spasms.

Occlusion of coronary vessels may result decreased blood supply to the myocardium (Heart muscle). Keep in mind atherosclerosis is not the only reason for IHD.

An occluded vessel can supply the sufficient oxygenated blood to the heart muscle. Heart muscle needs oxygen and the other nutrients to its normal functions. If there is a misbalance between myocardial oxygen supply and demand it’s a problem. Such situations we called ischemic attacks. Ischemic attacks may be fatal but not always. The most dangerous IHD is MI. Due to the fatal effects. Some ventricular arrhythmias may be very dangerous too. In myocardial infarction there may be atypical types, which make it much dangerous.

Before that let’s discuss what are the typical and some of the common symptoms of IHD. First one is the Chest pain. In medicine this describes as a retrosternal pain. The same meaning! Sometimes this pain may be a dull, severe, just a discomfort, or a cutting like pain. 

The pain usually last some minutes. Lets consider angina pain. This is a transient ischemic pain. The pain is due to an atheroma. (Atheroma a aggregation of lipids and it is non soluble.) When the myocardial oxygen demand high and the supply are low the transient ischemic conditions rise. Gives such type of pain. This is the Stable angina pain. The common character of Stable, Unstable and MI pain is its radiation. Starting from the chest to the left shoulder, to the scapular (beck of the thoracic region) region, to Neck to the lower jaw usually.

What the stable angina pain duration? This last usually 15-20 minutes. What give the relief? Rest and Nitroglycerine. If you rest this is enough to decrease the stable angina pain. GTN is the best pain reliving drug. (Hospital admission is compulsory for such patients to put a clear diagnosis.)

Unstable angina is the worse type. Duration prolonged. Pain bit severe than the stable type angina. Pain lasts more than 30 minutes. Bed rest and GTN don’t give a relief from the pain. Such patients categorize as the patients with acute coronary Syndrome.  This is a borderline type of IHD between Angina and Myocardial death. There are several types of unstable angina. The main clinic shows that it doesn’t need physical exertion to provoke a heart attack (Ischemic episode) usually the unstable angina rise at the rest than the physical exertion. Types are as following-Accelerated type, new onset, Post MI, Variant Angina. Such patients need emergency medical intervention with cardiac reanimation facilities. Unstable angina attack management much like to Acute MI management. There are some differences. Medical approaches are the same.

In MI the ischemic myocardial damage is not reversible like Angina. MI causes Myocardial Death (Necrosis). Patients have a high mortality rate with MI. MI pathogenesis also associated with atherosclerosis. Rupturing the atheroma substances followed by activation of coagulation cascade and total occlusion of coronary artery causing myocardial death. Number of MI complications also very high. These severe complications increase the number of deaths due to MI.   

The atypical types of MI include Asthmatic form, cerebral form, gastrointestinal form, Silent form, and arrhythmic forms. These form Doesn’t have the usual clinic of MI.

Asthmatic form-a simple attack of asthma.

Cerebral form- Mimic a stroke and paralysis.

GIT form-Like gastritis or peptic ulcer disease.

Arrhythmic form- Several palpitations or tachycardia.  

Pain syndrome of MI (Myocardial Infarction) similar to Angina, but last long not responding to Nitrogycerines. Emergency hospitalization and medical intervention is mandatory.

Discussion is a short one. Theme is one of the biggest and most controversial. The treatment regimes still have big doubts. Management strategies change year by year according to the new epidemiological data and experiments. What we can do is to prevent from such diseases. I’m not going to write about prevention methods. Literatures about preventing heart diseases are very common. Anyone can read. Its not much difficult to prevent from a disease. Difficulty is to treat. Many chronic diseases have no definitive treatment. There is huge tendency to develop heart diseases, Diabetes and Chronic lung diseases in young age. Stay healthy! Don’t spend your good health to buy short satisfactions (Cigarettes, alcohols, and other narcotics) if you lost your health once, you can’t buy it again.

-Charith Kumara.

Kursk State Medical University. 

6th year.