Oh, my aching back

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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The human spine is the body’s main upright support and the spinal column gives the body its form.

Segmented from the neck to the waist, the human spine is comprised of 24 articulating spinal bones. The upper part of the spine consists of seven vertebrae in the neck, called the cervical spine (C1-C7), 12 vertebrae in the thoracic spine (T1-T12), and five vertebrae in the lumbar spine (L1-L5). The lower nine are fused, with five in the sacrum and four in coccyx or tailbone. Each vertebrae has facet joints that make you flexible and enable you to bend and twist. All 33 vertebrae are separated from each other by intervertebral discs and it is here that problems occur.

When the outer lining that surrounds a disc tears, the jelly-like centre in the disc can squeeze out and press on the nerve through the opening, leading to a herniated disc and back pain.

A common source of back pain is the lumbar spine L1-L5. This is commonly found in older adults and people of working age. The patient may experience pain from the waist down. There are two types of back pain:

  • Acute muscular pain that may last from a few days to one to two weeks. In most cases, this is the result of playing sport or having an accident.
  • Pain caused by a spinal abnormality. The pain often lasts two weeks or more and is caused by a herniated disc, spondylolisthesis or spinal stenosis. The most common type of abnormalities are those affecting the intervertebral discs.

When the fibrous outer covering of the disk loosens, breaks or tears to the point where the disc moves and presses on the spinal nerve, the result is a herniated disc.

Warning signs that require immediate medical attention are pain running down the back of the legs lasting for more than two weeks, numbness beginning at the waist and continuing down the legs or the instep of the foot, leg muscle weakness, and loss of control in the bladder.

When experiencing these symptoms, you can assume that you likely have a herniated disc. You should see a doctor to receive a professional diagnosis and identify the cause of the symptoms. The likely causes include age-related degenerative disc disease, a disc injury after an accident, and possibly damage caused by improper movement in daily activities, such as lifting heavy objects the wrong way or exercising the wrong way.

There are several treatment options, depending on each patient’s decision. If the symptoms are mild, |surgery is not necessary and non-surgical treatments may be sufficient, such as medications for pain and inflammation, physical therapy, or epidural steroid injections

In the case of severe nerve compression, the doctor may suggest surgery. The latest medical technologies and advanced surgical techniques for treating a herniated disc make patients feel safer. With Minimally Invasive Surgery (MIS), a C-Arm fluoroscope x-ray and microscope are used to identify the optimal position to place a small incision of only 1 to 1.5cm. Microsurgical instruments are inserted through a small tube and the segment of the herniated disc compressing the nerves is removed. Patients undergoing this procedure experience less pain and only need to stay in hospital for one to two days.

Chronic back pain can be treated once the diagnosis is completed and the exact cause of the pain is identified. Today, there is no longer as much need to worry about the surgery due to the advances in medical technologies.

There are several safe surgical techniques for chronic back pain that are less painful and with a shorter recovery time than traditional surgery.

DR CHALAT WINMOON is an Orthopaedic Surgeon attached to the Sports & Orthopaedic Centre of Samitivej Sukhumvit Hospital. Call (02) 711 8494-6.

Frozen shoulder: symptoms and solution

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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If you find it painful and difficult to carry out the full range of normal shoulder movements and perform everyday tasks, such as putting on a belt or reaching the bra hook behind your back, you are experiencing shoulder movement problems.

Stiffness and pain in the shoulder joint are early symptoms of frozen shoulder.

While the exact causes of frozen shoulder are not known, it has been theorised that an autoimmune reaction may be responsible. Normally, the body’s defensive system protects it from bacteria, viruses, foreign objects and abnormalities such as cancer cells and affected tissues. In the case of a frozen shoulder, the defensive system mistakenly begins to attack the tissues of the body and this causes an inflammatory reaction in the tissue that is under attack. When the resulting inflammation in the shoulder joint becomes so severe that it causes the joint capsule to contract and become “frozen”, the shoulder joint will no longer move normally.

No one knows why frozen shoulder occurs so suddenly. It may begin after a shoulder injury or surgery. It can also start if the shoulder has not being used for a while, such as after a wrist fracture when the arm is kept in a sling, or even while recovering from cardiovascular disease.

Frozen shoulder might be an antecedent symptom for other shoulder problems like tendonitis, rotator cuff tear, or shoulder impingement syndrome. These problems may cause chronic inflammation that leads to the patient using the shoulder less than normal, leading to a situation that can cause frozen shoulder. The frozen shoulder should be treated first before the underlying problems are addressed.

More common in women than men, frozen shoulder mostly affects people ages 40 to 65 years old and is found in 10 to 20 per cent of patients with diabetes. It is also associated with other health conditions such as thyroid, ischemic heart disease, depression, Parkinson’s disease and upper limb injuries

The symptoms of frozen shoulder typically begin with shoulder pain and a reduced range of motion in the joint. The range of motion is the same whether you are trying to move the shoulder yourself or someone else is trying to move it for you. There comes a point in each direction of movement where the motion stops, as if something is blocking it and the shoulder usually hurts at that point. The shoulder can be painful at night. The tightness in the shoulder can make it difficult to do daily activities like combing hair, getting dressed, putting on a belt, or reaching for things, such as a bra hook or zip.

The diagnosis of frozen shoulder is usually made on the basis of the patient’s medical history and a physical examination. With the above symptoms, simple x-rays are not usually helpful. As the ability to move the shoulder increases, doctors may perform tests to rule out underlying conditions, such as impingement or a rotator cuff tear. The tests include:

l X-rays to find any bone abnormalities

l Ultrasound or magnetic resonance imaging (MRI) to view the tissues around the shoulder joint

Treatment mainly involves range-of-motion exercises though corticosteroids and numbing medications injected into the joint may sometimes be given. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

DR CHATHCHAI POOKARNJANAMORAKOT is an orthopaedic surgeon attached to the Sports and Orthopaedic Centre of Samitivej Sukhumvit Hospital Call (02) 711 8494-6.

Digestive tract infection in children

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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HEALTH MATTERS

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Although diseases of the digestive system are not lethal, they can cause suffering to children and their parents.

The cause of these diseases is basically down to behaviour. Children have a natural tendency to be adventurous. When they find something attractive, they put it in their mouths. This habit makes them vulnerable to gastro-oral route infections through their saliva.

A gastrointestinal virus means children will experience queasiness, upset stomach, low-grade fever, dehydration, vomiting of green stomach bile and general lack of energy.

Six-month old babies tend to be particularly exposed to this virus because, at this stage of their development, they regularly put their hands or contaminated toys into their mouths. Another environment where the virus is highly contagious and effectively circulates is in schools, the result of children sharing toys with their classmates. Here the virus may spread through the saliva or through saliva-soaked hands touching surfaces and toys. Although a gastrointestinal virus is highly contagious, it is not dangerous and can be prevented through good hygiene habits. In general, it is recommended that parents teach their children to wash their hands frequently.

However, certain cases may present with severe symptoms. For instance, if a child is vomiting two or three times per day, they run the risk of dehydration so a visit to the doctor is recommended.

Much of the food that we do not prepare ourselves these days tends to be presented in such a way as to be attractive to children. Whether on special occasions such as the National Children’s Day or on ordinary weekends, children enjoy the new experiences of participating in a variety of outdoors activities and oe of the most enjoyable parts of these adventures is the food and drink. The very hot and humid climate in a country like Thailand naturally makes people sweaty and thirsty, but parents should not just allow their children to consume whatever they wish. Bad consumption habits can harm their children’s digestive systems.

Diarrhoea is caused by a pathogen in unclean food or drink, the germs from which penetrate into the stomach and the large intestine. Symptoms include having three episodes of watery stool per day or one mucous bloody stool. Diarrhoea can be caused by a virus or bacteria.

Children infected with virus-induced diarrhoea experience a low-grade fever and watery stools, although with minimal loss of energy. While it is not necessary to see a doctor in such cases, it is important to keep the child well hydrated in order to alleviate the symptoms. Prepare a glass of oral rehydration solution to be gradually fed to the child every three to four hours. Avoid feeding the child from a milk bottle or through a tube as the intestine does not adjust to absorb fluids well in this way. As a result, the minerals will quickly be excreted in the stool.

Symptoms of rotavirus-induced diarrhoea are more pronounced with eight to 10 episodes of watery stool that leave the child dehydrated and weak. In these cases, a visit to the doctor is recommended and the child may need to be admitted to hospital to allow the doctor to observe developments.

Bacterial diarrhoea from dysentery and salmonella infection is much more dangerous. Noticeable symptoms of bacterial diarrhoea include high-grade fever, mucous bloody stool and cramping abdominal pain. Children with bacterial diarrhoea need to take antibiotics and should visit a doctor immediately.

Physicians provide symptomatic treatment to cure digestive tract infection in children, However, the most effective way to handle this problem is prevention. It has been found that school children have a high propensity to experience digestive tract infection, as they spend a great deal of time engaged in communal activities and sharing objects together. Each child should have his or her own water bottle, and teachers should encourage children to wash their hands and shared objects frequently.

These simple steps will not only cultivate good hygiene habits in children but also keep them safe from many avoidable diseases.

Finally, children and parents planning outdoors activities that involve food need to be aware that food stand operators tend to decorate their products to attract buyers, so always take the benefits, safety, and economy of the food into consideration. Try always to select food with natural colouring, dine in restaurants free of flies, and avoid food created obviously to attract attention, such as giant meatballs and red velvet crushed ice.

These items may contain harmful substances to which some children may be allergic.

Parents are much better off preparing simple food, such as fried egg sandwiches, for the kids. And make sure they always wash their hands before meals.

DR PATCHARIN AMORNVIPAS is a paediatrician gastroenterologist and hepatologist at Samitivej Children’s Hospital – Srinakarin Campus. |Call (02) 378 9082-83.

How about a poke in the eye?

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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American tattoo artist Luna Cobra in a Melbourne restaurant. Cobra invented eyeball tattooing in 2007. /dpa

American tattoo artist Luna Cobra in a Melbourne restaurant. Cobra invented eyeball tattooing in 2007. /dpa

Pierced tongues and noses are so passe, you need an eyeball tattoo – or maybe not

American body-modification artist Luna Cobra invented “eyeball tattooing” in 2007. In a procedure he has performed on hundreds of clients, he colours the white of the eye by injecting pigment.

Cobra got the idea while attending a body-art convention with his colleague Shannon Larratt, who in self-portraits had digitally made the whites of his eyes blue.

Larratt was a fan of “Dune”, the celebrated science-fiction novel by Frank Herbert, and wanted to resemble the Fremen, the residents of the desert planet Arrakis, whose eyeballs were all blue.

“I asked Shannon if he’d be interested in making his own eyes permanently blue if I figured out a way,” Cobra says. “He laughed and said, ‘Only if two other people try it with me.'”

Cobra recruited two other friends and, after intensive research, performed the first “eyeball tattooing”. A few months later, he says, the TV series “CSI: New York” had an episode based on the procedure, “and the rest is history”.

The procedure, which takes just a few minutes, is as simple as it is perilous – and as apparently painful.

The white of the eyeball, known as the sclera, is “tattooed with a solid colour or mix of colours” using the “hand-poking” procedure in which an ink-laden needle is poked into the skin.

Using a hypodermic syringe, the ink is “placed safely” in a super-thin layer of the sclera, between its mucous-covered outer membrane and the hard inner white of the eye, Cobra says. He’s since “streamlined” the procedure with better technique and materials.

Cobra got his first tattoo at age 15 after seeing the body art and tattoos in photos of indigenous tribes in National Geographic magazine. He offers piercing and tattooing services and surgical body modifications like putting points on ears, splitting tongues, implanting horns and scarring the skin in patterns.

Since inventing eyeball tattoos in 2007, he says, there has never been a complication with his clients. There are, however, reports of such procedures going wrong, including loss of eyesight at the hands of novice tattoo artists.

Cobra blames this on “people with very limited basic education, who see this just as a cool thing to do and do not care about their bodies”.

“In a way I am responsible – it was my invention – but I’ve always told people never to do this,” says Cobra, who recently moved from Paris to Melbourne, Australia, to start a new studio.

“It’s sad for me because it’s something I created to use as an art for people to express themselves so they can feel comfortable with their body and their place in the world.”

In February the government of New South Wales, where Melbourne is located, effectively legalised the eyeball tattoo by defining it as a “skin-penetration procedure”. The state wanted to regulate the practice so it will be performed in a clean and safe environment.

“Eyeball tattooing involves much the same risk of transmission of blood-borne viruses as other forms of tattooing, which is why we moved to tighten the regulations,” says Health Minister Jillian Skinner.

But Luke Arundel, a Melbourne-based optometrist, says the practice is “painfully dangerous”. “Cobra might have had a good record so far, but at the end of the day it’s the eyes – the most sensitive organ of our body. “Sticking things into an eye is a very risky business, no matter how safe you are. There is very little margin for error,” Arundel says. The ink dye has to be injected into a membrane less than half a millimetre thick.

“It’s a sight-threatening procedure that could lead to severe infection, retinal detachment and other problems.” There’s a chance of chronic headaches, ulceration around the area of penetration and severe sensitivity to light. “Also, there is no guarantee that it will not develop complications later in life.”

Thirty-year-old Kylie Lee Garth had Cobra tattoo her eyeballs two years ago by Luna Cobra. The whites are now shiny sea green.

“It’s just a natural progression,” she says. “I liked the way it looked and I wanted this modification. There was no risk involved. I knew he had tweaked the method in the past 10 years to the safest possible way and I had witnessed that.”

The process was “scary, mentally”, says Garth, a New Zealander who also does body piercing professionally and is a rookie tattoo artist.

“The procedure itself was fine. I felt the cold of the needle. It was a bit scratchy at first. The ink was in blots the first day, but when I woke up the next day, my eyes were |green. It was the most exciting |day of my life!”

http://www.Instagram.com/|lunacobra/?hl=en

http://www.LunaCobra.net

A weighty problem

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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HEALTH MATTER

Once rare in Thailand, childhood obesity is today on the rise, with figures released by Thailand’s Ministry of Public Health in 2013 showing obesity growth rates of 36 per cent in pre-school age kids and 15 per cent in school age children.

Once rare in Thailand, childhood obesity is today on the rise, with figures released by Thailand’s Ministry of Public Health in 2013 showing obesity growth rates of 36 per cent in pre-school age kids and 15 per cent in school age children.

Obesity increases the risk of high blood pressure, diabetes and high cholesterol, which in turn heightens the risk of kidney failure.

Some obese children may have a darkening skin around the neck, which does not wash off no matter how hard you scrub. Known as acanthosisnigricans, this skin change indicates the body is resistant to insulin action, which increases the prevalence of diabetes. Insulin is a hormone produced by cells in the pancreas, which controls blood sugar levels by enabling the movement of sugar to the cells that need it. In the case of any insulin disorder, the body has trouble regulating sugar and cannot use glucose for energy supply effectively, thereby resulting in high blood glucose levels that consequently damage the kidneys as well as the body as a whole.

Other hormones that regulate energy use are also affected. The acanthosisnigricans is caused by an abnormality in a related hormone that over-regulates skin pigmentation.

Insulin resistance is one of the key factors leading to kidney failure in obese children even if there are no other complications.

Leptin is a hormone made by fat cells in the body. Leptin levels tend to be higher in people who are obese because it is produced by fat cells. The body does not respond well to leptin in these cases and that spells disaster as leptin is an appetite-suppressing hormone that sends signals to the brain. Leptin makes people feel full when the body has accumulated adequate energy levels and burns body fat for use as energy. Leptin also helps insulin to function properly.

When the brain does not respond well to leptin, the energy expenditure is less than usual and the hormone fails to suppress appetite. As a result, people tend not to feel full after a meal, thereby encouraging abnormal accumulation of body fat, developing a vicious cycle of obesity, and further worsening their insulin resistance.

In cases of obesity, there are some abnormalities of the blood vessels of the kidneys as well as of both renin and aldosterone, which are hormones that regulate renal blood flow, renal blood pressure and body blood pressure.

The hormonal disorders cause high blood pressure and abnormal filtration, thereby damaging the kidneys and altering the kidney tissue. Aldosteronein combined with other hormones may damage small blood vessels in the body. Although the blood pressure may not be very high, the kidneys can be directly damaged by these hormones.

Both adiponectin and resistin are “fat hormones”, like leptin. The roles of resistin and leptin are similar; whereas adiponectin helps control these misbehaving fat hormones. In obesity, the resistin level is usually high while the adiponectin level is frequently low, thereby decreasing the body’s ability to prevent complications.

In conclusion, “fat hormones” from body fat and high insulin level will stimulate reactive oxygen species (ROS) or free radicals that cause many illnesses. The ROS causes inflammation of the kidney cells, abnormal proliferation of tissues, increase in filtration pressure, and renal hypertension.

One initial abnormality is albumin leakage to the urine identified from a specific urine test, urine microalbumin. In the kidney tissues, free radicals cause fibrous bands and abnormal cells, which increase the risk of kidney damage, cause a domino effect of conditions, and ultimately lead to kidney failure. The free radicals also cause high blood pressure, which also affects the kidneys.

A urine test can show up apparent abnormalities in obese child as early as three years of age. This test can indicate the presence of kidney damage at an early stage. While a large number of studies have been conducted to examine the relationship between obesity and kidney disease in adult population, few have been conducted to examine the link between childhood obesity and kidney disease.

However, a recent study in teenage males unveiled potentially correlation between obesity and kidney failure. Additionally, findings from the other studies that have been conducted in this area show that childhood obesity significantly increases the risk of kidney diseases and complications in later adulthood or even during childhood, and the condition may start to develop before high blood pressure or diabetes has been detected.

The long-term complications in the form of heart disease and kidney failure in most adults can be traced back to childhood obesity.

So think hard before you let your kid eat unhealthy fast food, drink sodas and snack on crisps and ice cream. His or her kidneys will be glad you did.

DR NANTHIYA PRAVITSITTHIKUL is a Paediatric Nephrologist at Samitivej Children’s Hospital – |Srinakarin Campus. Call (02) 378 9082-83.

Knee replacement surgery offers 60 elderly patients a new lease on life

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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LIVING WELL

DR.Chamroonkait

DR.Chamroonkait

One of the most common afflictions among the elderly, knee osteoarthritis affects at least 10 per cent of the Thai population and is today also being found in younger patients.

One of the most common afflictions among the elderly, knee osteoarthritis affects at least 10 per cent of the Thai population and is today also being found in younger patients. Knee replacement surgery is the only viable solution for many of these cases but at prices that range from Bt40,000 to Bt500,000 or more is out of reach to all but the well-heeled.

But there is good news at hand for 60 arthritis sufferers as the Joint Replacement Centre at Bumrungrad Hospital Foundation has chosen to mark the 60th birthday of Her Royal Highness Princess Maha Chakri Sirindhorn by offering free knee replacement surgery.

The free surgery will be conducted on 60 elderly Thais using computer-based and robotic arm technology and will also cover both the pre- and post-operative processes.

The computer-assisted surgery, navigation system and robotic-assisted surgery ensures precision of the placement, reduction of improper joint alignment and better longevity of the replacement. The technological support also helps reduce pain during the post-operative period and a speedy recovery during rehabilitation.

Dr Chumroonkiet Leelasestaporn, the director of Joint Replacement Centre, and chair of the Joint Replacement project, says the precision and navigation afforded by the computer considerably lowers the risk of problems with small pieces of bone and tissue.

The project also includes a campaign to create awareness of preventive measures we can all incorporate into our daily lives to delay the deterioration of the all-important knee joint. This is seen as particularly important in light of the significant increase in the number of knee osteoarthritis patients seen by the Centre, which rose by a massive 89 per cent between 2013 and 2015 and is showing no sign of abating.

While some degree of osteoarthritis is inevitable as we age, doctors are increasingly worried by the prevalence of the disease among younger people. Causes include injury and infection, being overweight, eating junkfood and the sedentary lifestyle, which sees many sitting for long periods at work. Even crossing the knees plays a role in hastening the disease.

Osteoarthritis of the knee occurs when the cartilage that serves as a cushioning between joints wears away. When the cushion is narrowed down, the bones of the joints rub more against one another, leading to pain, swelling and stiffness. The decrease of cartilage can be seen through x-rays and MRI scanning.

Treatment depends on the condition, but in general, losing weight to decrease the knees’ weight-carrying burden, proper exercise to create muscles around the knee so as to share that burden, and taking pain-relief drugs have some effect.

However, when the condition becomes too painful and prevents the patient from leading a normal life, joint replacement is usually the only option. After the surgery, the patient will be able to work normally and take some exercise, though jogging is strictly not permitted.

The project has been operational since 2015 and 38 patients have so far been treated.

Criteria for participation in the project include being between are 60-75 years old and having attempted to improve osteoarthritis for at least six months through non-operative methods but without any result. The project is open to low-income Thais only and applications are being accepted through May 31.

To find out more, contact the Joint Replacement Centre, Bumrungrad Hospital at 02 667 2000 or check out http://www.Bumrungrad.com.

Helper or waste of paper?

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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White-page and yellow-page directories lie open at a German labour exchange where unemployed people use them to track down potential employers./ dpa

White-page and yellow-page directories lie open at a German labour exchange where unemployed people use them to track down potential employers./ dpa

The telephone book hangs on in the digital age

What’s the use of old-style telephone books when all the numbers can be looked up on the Internet?

Untold millions of people must have thumbed through the thin pages of directories seeking a plumber or a travel agent for a holiday. But today you can find all that information on the Internet. No longer do you need to run down columns of names in alphabetical order with your fingertip, muttering aloud the alphabet as you seek the entry you’re looking for.

Nevertheless telephone books are still printed and delivered round the globe. You find them piled up in the hallways of apartment buildings, in supermarkets or at collection stations and most are dutifully picked up by phone subscribers.

Why? Critics say the books are out of date when they arrive, and incomplete: most mobile numbers are not listed in them.

“I seldom look in a phone book myself,” admits Rhett-Christian Grammatik, a private telephone book publisher who is head of the Association of German Reference and Directory Media (VDAV).

The world’s first telephone directory was printed in 1878 in New Haven, Connecticut. Curiously, it had no numbers in it, just names. You relied on the operator to connect you to the right subscriber. New Haven had 50 of them.

Initially, people thought telephones were a useless, show-off toy. When Berlin’s first telephone book came out in 1881, it was colloquially referred to as the “Book of 99 Fools”. That was as many names as it held.

Despite the scepticism, the telephone and its associated book were only beginning their triumphant march. Then came the split into white-pages (residential) and yellow-pages (business) directories.

The Library of Congress in Washington DC has the world’s biggest collection of historic phone directories from round the globe: 100,000. Every year, another 1,500 arrive from 100 nations of the world, so it’s clear the printing presses are still rolling fast.

In Germany, and that would probably be true of most nations, there are big regional differences in how much a telephone book is used.

Grammatik’s association did a study in 2015 and found that “the older the user, and the more rural their residential area, the more they used the phone book”.

In hip, sophisticated Berlin just 28 per cent of people still leaf through a printed phone book to find anything, whereas in rural states such as Brandenburg or Saxony-Anhalt, the use can be as high as 70 per cent, surveys show.

Uwe Calm from a phone-book publishing company, Oeding Verlag, doesn’t have a simple answer as to why the printed phone book hasn’t died out yet. “People keep using them out of sheer habit, without really thinking about whether there’s an alternative,” he suggests.

What has kept phone books going in many countries is the advertising revenue they generate.

A full-page display in a German phone book costs 15,000 euros (Bt600,000), says Heiko Hanslik from the VFT, the association that represents commercial publishers of give-away directories in Germany.

He predicts local phone books will be around for a while yet.

This should make a lot of Germans happy. A YouGov survey of Internet users found that less than a quarter wanted to see the printed phone book abolished, even though half said they do use the Internet to look up telephone numbers.

“You can browse in them,” Calm says in defence of the printed book. “Perhaps you’ll discover something you weren’t looking for and lose yourself a bit.”

With 100 million units in circulation in Germany, where each locality’s directory is reprinted annually, the telephone book has managed to reach the same level of recognition as Chancellor Angela Merkel – 97.5 per cent. That’s how many people say they know what it – or she – is.

The power of thought…and computer software

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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Ian Burkhart, 24, who was paralyzed from the shoulders down after a diving accident in 2010, undertaking tasks after regaining the use of his hand through the use of neural bypass technology at the Ohio State University Wexner Medical Center/AFP

Ian Burkhart, 24, who was paralyzed from the shoulders down after a diving accident in 2010, undertaking tasks after regaining the use of his hand through the use of neural bypass technology at the Ohio State University Wexner Medical Center/AFP

US Quadriplegic learns to use hand in medical first: study

Six years after being paralysed from the chest down, an American man can use his right hand to stir coffee and swipe a credit card, a groundbreaking study reported on Wednesday.

The unprecedented feat was made possible by computer software replacing the damaged spinal cord as the communication highway between Ian Burkhart’s brain and his hand muscles.

“This is the first time a completely paralysed person has regained movement just by using their own thoughts,” said researcher Chad Bouton of the Feinstein Institute for Medical Research in Manhasset, New York.

Burkhart, a 24-year-old from Ohio, has a pea-sized chip in his head to read his brain signals, which are then deciphered by a computer and rerouted to the hand, wrist and finger muscles.

The muscles receive their instructions from an electrode sleeve worn on the right forearm – with which Burkhart can now also swipe a credit card, pick up a spoon, hold a phone to his ear and play the cords of a guitar video game.

The US-based researchers hope their work, still in an early phase, will one day allow paralysed people to feed and dress themselves.

Their device, called NeuroLife, reroutes messages from the brain to the muscles, bypassing the spinal cord.

Two years ago, they reported a major breakthrough when Burkhart was able to open and close his hand.

With a lot more training, he has since refined his skills and can now grip a “stir stick” with his fingertips, and use it.

Burkhart broke his neck in a holiday diving accident aged 19 and was left quadriplegic – meaning his arms and legs are paralysed.

“Doctors told me I’d broken my neck and that most likely I’d be able to move my shoulders around, but nothing else for the rest of my life,” he told journalists in a teleconference ahead of the report’s release.

He volunteered for the trial, Burkhart said, because he wanted to help people like himself regain their independence.

“Just not being able to use your hands does limit you quite a bit,” he said. “I have to rely on other people for things.”

Burkhart underwent surgery to have the chip implanted in the brain’s motor cortex area, which controls movement.

The chip was attached on top of the skull to a “connector” linking it to a computer which Burkhart “trained” to read his mind and decode which movements he wanted to execute.

The command to open, clench or pinch is then relayed to an electrode sleeve on Burkhart’s right arm.

“When we first hooked everything up… it was a big shot,” he recounted.

“I hadn’t moved in about three-and-a-half years at that point. Now it’s something that’s just so fluid it’s kind of like it was before I had my injury.

“I just think about what I want to do, and now I can do it.”

Some of the functions he has relearnt have the potential of changing his daily life for the better. But for now, he can only do them in the lab.

The researchers said they hope to improve the technology to help not only people with spinal cord injuries, but also those who suffered a stroke or traumatic brain injury.

“Maybe in a few years from now we can have a wireless system that allows a patient like Ian to be able to move his hand and his arm… without cables to connect,” said Ali Rezai of Ohio State University.

“This becomes more streamlined hopefully over time, maybe integrated into your cellphone… communicating with your sleeve.”

Several teams worldwide are researching ways to bypass a damaged spinal cord, many focusing on using the mind to control robotic limbs or exoskeletons.

But the holy grail is to allow quadriplegics to use their own limbs, limiting the need for surgery and prosthetics.

“If all the work we’ve been doing can help anybody get more independence back, I mean that’s great,” said Burkhart.

“I really cherish the independence I had before my injury, so if you can give someone that ability back, it’s huge.”

A video explaining the findings |can be viewed at: https://www.youtube.com/watch?v=60fAjaRfwnU

Aching joints: could it be rheumatoid arthritis?

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Aching-joints-could-it-be-rheumatoid-arthritis-30284186.html

HEALTH MATTERS

A chronic inflammation of the joints triggered by a disorder of the immune system, rheumatoid arthritis (RA) primarily affects the |cartilage and bone structures but can also damage many other organs leading to significant physical disabilities.

With the mechanisms |underlying the illness now better understood, new therapeutic approaches have greatly improved the long-term prognosis of the |disease. It is however essential to make an early diagnosis to prevent or minimise possible severe complications.

Although RA is encountered in both genders and at different ages, women around the age of 50 are mainly afflicted with the disease. It is estimated that 0.3 per cent of the population suffers from RA, which roughly corresponds to 200,000 individuals in a country such as Thailand.

The joint is the area of junction between bones that allows bone motion. The joint consists of the cartilage, a flexible tissue covering the surface of the bone, and the lining, the synovial membrane, that produces the synovial fluid to lubricate the joint. In RA, the inflammation process lies within the synovial membrane and leads to an excessive production of the synovial fluid, a damaging thickness of the lining and the release of inflammatory substances that further injure the cartilage, the bone and even the nearby tendons.

The initial symptoms include pain, tenderness and swelling on the joints typically on both sides of the body and especially in the hands, wrists, feet and knees. The pains primarily occur in the second half of the night and lead to morning stiffness of these joints that persists at least 30 minutes. Other common complaints include feverish sensations, fatigue and weight loss. The symptoms of RA often vary in intensity over time with alternate periods of apparent remission and boosts in severity, the latter known as flares.

Minor forms of the disease may last a few months or years while the more severe can last a lifetime. Left untreated, about 20 to 30 per cent will suffer serious deformities of the joints and bones that can impair the ability to perform daily domestic and/or professional activities.

In about 40 per cent of patients, the inflammation progresses and starts inducing disturbances on many organs including the lung, eyes, heart, vessels, lymphatic system, kidneys and nervous system. Fortunately the severe forms of RA are rare today thanks to the availability of multiple therapeutic options.

RA is an autoimmune illness in which some antibodies synthesised by the body’s immune system wrongly attack normal tissue structures. These antibodies induce a continual inflammation on the lining of the joints that may eventually destroy the cartilage and the adjacent bone leading to deformities and bone erosion. The exact cause of this phenomenon is still unknown but a genetic predisposition (a family history of RA increases the risk of the disease) and various environmental factors are involved such as tobacco smoking, exposure to asbestos and obesity.

The diagnosis of RA relies on suggestive clinical symptoms, the presence of inflammatory and antibodies markers in the blood and to a later stage, radiologic abnormalities. In its early stages, RA might be difficult to diagnose and it is wise to consult without delay a rheumatologist – a specialist in rheumatic diseases – if you suffer from swollen and painful joints for several weeks.

The core objectives of the treatment are 1, the control of the inflammation process and resulting pain, 2, the prevention or limitation of joints or other organ damage, and 3, the maintenance of satisfactory quality of life. Medications include painkillers, anti-inflammatory agents and multiple therapeutic options of so-called Disease Modifying Anti Rheumatic Drugs that act on the production or on the adverse affects of the harmful antibodies.

People afflicted with RA also need to maintain a healthy lifestyle taking regular appropriate exercise, avoiding smoking, using stress-lowering techniques and sticking to a healthy diet. This combined with the proper drug regimen often allows effective control of rheumatoid arthritis.

DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.

Batteries for the brain

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Batteries-for-the-brain-30283772.html

A Parkinson's patient undergoes a check-up by Alfons Schnitzler with his pacemaker at Dusseldorf University Clinic. / dpa

A Parkinson’s patient undergoes a check-up by Alfons Schnitzler with his pacemaker at Dusseldorf University Clinic. / dpa

A pacemaker implant gives new hope to Parkinson’s sufferers

Helmut Schroeder was 49 when he began noticing a loss of balance and an inability to slow his movements.

He crashed while attempting to turn right while skiing. He even started to experience difficulty doing everyday tasks such as opening a door.

A hospital visit revealed the traumatic news that the qualified psychiatrist was suffering the early onset of Parkinson’s disease, an incurable degenerative disorder that attacks the body’s motor system.

Now 67, Schroeder has since written a book in German about living with the disease, which he describes as a “roller-coaster ride for the hardcore”, and is now embarking on a new phase in his battle with Parkinson’s, thanks to a brain-implant procedure that is now coming into wider use.

Schroeder received the deep brain pacemaker at the Goettingen University Clinic 18 months ago. The US-made device sends tiny jolts of electricity through neurons, which helps control his tremors, rigidity and other kinetic symptoms. Schroeder’s speech has also improved and he now requires less than half the medication he used to take prior to the operation.

“I can now carry out all the movements I want. I can even ride a bike and again enjoy the old hobbies I used to love,” he says.

“My wife used to have to care for me all the time, but is now virtually unemployed.”

The operation has given Schroeder a new lease of life, but the decision to go under a surgeon’s scalpel was still a daunting one.

Two battery-operated electrodes were implanted in his brain to target the thalamus, subthalamic nucleus, and a portion of the globus pallidus. These areas of the brain control movement and the neurostimulator, which is similar to a heart pacemaker, blocks the abnormal nerve signals that cause tremor and other Parkinson’s symptoms.

The five-hour operation is normally carried out under local anaesthetic, since the patient has to assist in the procedure so that the electrodes are positioned correctly.

“The surgery is very unpleasant,” says Schroeder.

The electrodes are inserted through a small opening in the skull and implanted in the brain. An insulated wire is then passed under the skin of the head, neck, and shoulder, and connects the electrodes to the neurostimulator, which is implanted in the stomach or chest area.

The operation costs in the region of 30,000 euros (Bt1,200,000) and it can take up to two weeks until the neurostimulator is correctly calibrated.

The procedure is used only for patients whose symptoms can no longer be adequately controlled with medications.

Previously, neurostimulators were on average only implanted 12 to 14 years after diagnosis, but this delay has since been reduced to seven years, says Alfons Schnitzler, head of Institute of Clinical Neuroscience and Medical Psychology at Dusseldorf University Clinic.

Fellow neurology professor Lars Timmermann from Cologne University Clinic believes that in certain cases, implants are ideal for patients under the age of 61.

However, the procedure is not suited to all Parkinson’s sufferers and numerous tests have to be carried out first.

“It’s not a miracle cure, but it is a great option for some patients,” says Timmermann.

Patients suffering from strong tremors can enjoy coordination again within seconds, once the pacemaker is switched on.

“We have seen dramatic therapeutic effects, but still do not know to this day how it works in detail,” admits Schnitzler.

Technology is improving by the day and adaptive deep brain stimulation is the next step to more specifically identify the precise brain target that will be stimulated, thus reducing the effect on healthy brain area.

Schnitzler believes the technology will be in place within three years, meaning the brain is no longer under 24-hour stimulation but instead the brain’s electrical signals are only blocked when necessary.

The surgery can result in cranial haemorrhaging and even induce acute or manic depressive episodes, but Schroeder has noticed no side effects since undergoing his operation.

“I can play chess again and have even entered competitions again,” he says.

“People should realise, however, that this operation is not a cure for Parkinson’s, but simply slows its progress by years.”