The New Nation - Internet Edition

Fresher blood poses fewer surgery risks

Reuters, Boston

People who got old, stale blood during surgery were 30 percent more likely to die than people who got fresh blood, US researchers reported on Wednesday.

Two weeks seemed the be the cutoff, with older blood causing more complications, the researchers reported in the New England Journal of Medicine.

"We report that the relative risk of postoperative death is increased by 30 percent in patients given blood that has been stored for more than two weeks," the researchers wrote.

This can cause a dilemma, as many blood banks and hospitals cannot keep enough blood on hand that is so fresh.

The US Food and Drug Administration allows blood to be held for as long as six weeks, and blood banks typically give out the oldest blood first.

One solution may be to use the freshest blood first. Another is to use techniques to reduce the need for a transfusion in the first place, said Dr. Colleen Gorman Koch of the Cleveland Clinic Foundation, who led the study.

Her team studied 6,002 patients who received heart surgery at the Cleveland Clinic Foundation. Koch and her colleagues compared the outcome with the storage time of the blood transfused in each operation.

The rate of death while in the hospital was 1.7 percent among fresh blood recipients versus 2.8 for older blood. Rates for kidney failure, infection, respirator use and multiorgan failure were also higher if older blood was used.

However, a system that uses blood no older than two weeks would make it harder to keep blood banks properly stocked, and much more blood would be discarded. There are times when the blood supply falls to critically low levels, even with the current six-week limit.

"It is just not feasible to shorten storage time significantly without restricting the blood supply," Dr. John Adamson of the University of California at San Diego wrote in a commentary.

Adamson also said there are important unanswered questions about whether the results would apply to other medical procedures where transfusions are common. For example, the process of sending blood through a heart-lung machine may be causing damage to blood cells, reducing the shelf-life of each pint.

Older blood may be acceptable for other uses.

Koch said patients should be asking their surgeons if the hospital has a blood management program in place.

"For cardiac surgery there are a lot of things you can do in the operating room to minimize the risk of receiving a blood transfusion at all," Koch said. One method scavenges and recycles blood that would normally be lost in an operation.

And if surgery is being done on a nonemergency basis, doctors should first be treating any underlying anemia a patient might have, Koch said. "So they're getting themselves in tip-top shape prior to surgery to decrease their need for blood."

In October, researchers reported that donated blood quickly loses nitric oxide in red blood cells-which is key to transferring oxygen in the blood to tissues.

But if nitric oxide is restored, banked blood appears to regain its power, the team at Duke University in North Carolina found.

Currently, about 5 million Americans receive blood transfusions each year, according to the National Institutes of Health.

Information about Tuberculosis

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Feature: Tuberculosis

Name type of causative organism: The cause of tuberculosis is Mycobacterium.

tuberculosis (MTB) which is a slow growing ·aerobic bacterium that divides every 16 to 20 hours.

Is it a newly evovled disease: No. Tuberculosis has affected people since ancient times;

archaeological evidence based on characteristic damage to bones suggests since at least 5000-4000 BC.

Number of deaths per year worldwide : Tuberculosis (TB) is the greatest infectious disease killer killing approximately 2 million adults and about 100 000 children. Symptom: Bloody coughing/bleeding from the lungs, fever, paleness prolonged wasting, sputum, night sweats, loss of weight and tiredness.

Route of transmission:

(i) droplet infection e.g. coughing, sneezing, talking.

(ii ) via infected food

( iii ) faces

(iv) water

( v ) infected hands

( vi ) transmitted by milk

( vii) transmitted by flies

Reservoir of infection: The bacteria causing tuberculosis (TB) can be transmitted from cows to people in infected milk. Nevertheless, in developed countries TB (of the lungs) is now nearly exclusively spread through person-to-person contact, this has been accomplished by eradicating TB from cattle herds. Type of cells affected: It commonly affects the lungs i.e. necrosis of lung epithelial cells (pulmonary TB) but can also affect the central nervous system (meningitis), lymphatic system, circulatory system (Miliary tuberculosis), genitourinary system, bones and joints.

Time course of active disease: Tuberculosis of the lungs normally results in no or minimal symptoms in its primary stages because it is contained by the immune system, and the lesion, called a tubercle, becomes calcified. The course of this disease is slow, and it may take months or years to develop. In others it may break out again and become' active years later - when immune defenses are low. If untreated it can progress until large areas of the lungs and other organs are destroyed.

What treatment is available : Antitubercular chemicals combat TB in several ways .i.e. measures to prevent infection before or after exposure to TB organisms, treatment of the infected patient and its adverse conditions.

Is a vaccine available? Yes. BCG-vaccination

Medicine at our doorsteps: Chola (Bengal Gram)

-Jamayet Ali

Chola (Bengal Gram) is an erect or spreading much-branched annual herb with small compound leaves, small pea-like small flowers and small pods enclosing angular brown seeds cultivated as a pulse in many districts of Bangladesh. It is also largely cultivated in most parts of India and most probably in some parts of S.E Europe. It is a multipurpose crop and is used in more diverse food preparations than any other pulse. Almost all parts of the plants are used. It is chiefly used for human consumption as an adjunct to starchy diet. It is mainly used as pulse, but the manner of use varies with seed type and between regions. Seeds are used in almost all forms, starting from fresh greens to dried split grains and flour. Fresh seeds are well liked in most countries that cultivate gram. Often uprooted plants with pods containing green seeds, sold in the market, are eaten raw and relished as a snack. The fresh seeds are also eaten in soups, curries and rice dishes. Parched fresh seeds are also eaten. Ripe seeds are mostly eaten in curries, roasted or parched. Deshi types are generally used for making dal and besan. Kabuli and greenseeded varieties are utilised in soups, curries and stews. Roasting and parching imparts a desirable flavour, modifies taste and also destroys some anti-nutritional factors.

Botanical name of Bengal Gram is Cicer arietinum Linn. Gram is an important source of dietary proteins, B-group vitamins and certain minerals extensively used as a protein adjunct to starchy diet. Several fermented, deep-fried, sweetened and puffed gram products are popular in Asia. It can be used to prepare a composite flour and high protein feeds of improved nutritional quality. The nutritive value of seeds harvested at 28 to 35 days of maturity is superior to that of fully matured seeds. Germinated gram is recommended as a prophylactic against deficiency diseases, particularly scurvy. Gram meal or flour or besan is prepared by milling or grinding gram pulse or dhai. Proximate chemical composition of gram meal is as follows: moisture, 10.93; protein, 22.68; fat, 4.90; fibre, 2.09; and ash, 2.05%. The average amino acid composition of the meal is as follows: alanine, 1.91; arginine, 1.01; aspartic acid, 2.36; glycine, 1.33; glutamic acid, 3.00; histidine, 1.21; isoleucine, 2.88; leucine, 3.79; lysine, 2.88; methionine, 0.20; phenylalanine, 1.33; praline, 7.58; threonine, 2.50; tryptophan, 0.02; tyrosine, 0.80; and valine, 2.78%. The meal proteins are deficient in serine and cystine and contains smaller amounts of methionine, tryptophan and tyrosine (Tawda & Cama, J sci industry Res, 1962, 21 C, 238). Gram contains some anti-nutritional constituents too. The activity of these constituent can be reduced or destroyed by heating, fermentation or germination of the seed. They are mainly carbohydrates and cause delay in digestion or incomplete digestion of protein. These constituents are mainly stachyose and manninotriose; presence of both these sugars is reported to be one of the major constraints in the full utilization of gram as human food. Other anti-nutritional factors in gram are protease inhibitors, flatulence-causing oligosaccharides (rafmose, stachyose and verbascose), phenolic compounds, amylase inhibitor, phytohaemagglutinin (Jectins), saponins, etc. and mycotoxins. (Wealth ofIndia, Raw Materials, Vol· 111,526-553)

Medicine: In medicine the seeds are considered antibilious. The chief interest medicinally is, however, in the acid liquid obtained by collecting the dew-drops from the leaves. The fact that the drops of dew are thus chemically changed through contact with a living plant is a point of great botanical interest not at present fully understood. The liquid is found chemically to contain oxalic, acetic, and malic acids. This vinegar is mentioned by the old Sanskrit writers as a useful astringent, which might with advantage be given in dyspepsia, indigestion, and costiveness.

The boiled leaves are applied as a poultice to sprains and dislocated limbs. The fresh juice of the leaves mixed with crude carbonate of potash is administered with success in dyspepsia. The acid liquid is employed as a refrigerant in fever. It is much used in the Deccan in the treatment of dysmenorrhoea; the fresh plant is put into hot water and the patient sits over the steam. Dr. Walker observes that this is another way of steaming with vinegar. (Pharm. Ind.) "The free use of the vegetable, owing to the abundance oxalic acid, is apt to do harm to persons liable to calculus, as it leads to the formation of oxalate of lime in the bladder." (Drury, U. PI.) It is said "to increase the secretion of the bile; also, when roasted like coffee, is considered aphrodisiac; also used in cases of flatulency, and in retention of urine and cutamenia. It serves as a substitute for coffee." (Baden Powell, Pb. Prod.)

Special opinions : "The liquid obtained from macerating the seeds in water is used as a tonic among he natives" (Assistant Surgeon Nil Rutton Banerji, Etawah). "Is used to allay vomiting" (Surgeon-Major D.R. Thomson, Madras). "Cold infusion of chhola is also considered to be antibilious" (Surgeon Anund Chunder Mukerji, Noakhally). "The vinegar (Chana-amba, Born) - that sold in the bazaars is generally dilute sulphuric acid coloured with sugar" (Surgeon-Major W. Dymock, Bombay). "It is used with the tender leaves of nim in cases of leprosy. The water in which it has been macerated is used as a remedy for biliousness" (Brigade Surgeon J.H. Thornton, B.A., M.B., Monghir). "The vinegar, which is known here as chana khar, is used for enlarged spleen". (Surgeon Major J. Robb, Ahmedabad). "In bronchial catarrh, the seeds, eaten in a parched condition at night, followed by a cup of warm milk, give great relief' (Surgeon-Major A.S.G. Joyakar, Muskat, Arabia). "It is believed that the plant exhales acid vapour which is absorbed by the dew. It is also collected by spreading muslin cloth on the plants overnight, and wringing out the moisture from it early in the morning. The acid solution thus obtained is useful in vomiting and dyspepsia" (Native Surgeon T. Ruthnam Moodelliar, Chingleput, Madras Presidency). "The dewdrops are used to check nausea and vomiting successfully: also in cholera" (Surgeon-Major JJ.L. Ratton, Salem). "It is believed to have alterative properties" (Aligarh) (Dictionary of the Economic Products of India, Watt, Vol. II, 282-84).

Medicinal Properties: The leaves are sour; astringent to the bowels; improve taste and appetite; cure bronchitis; cause flatulence. The unripe seed is stimulant, tonic, aphrodisiac; cures thrust and burning. The seed is sweet, refrigerant dry; appetizer; tonic, anthelmintic; causes flatulence; useful in leprosy, bronchitis; cures skin diseases, blood troubles, ozoena, throat complaints, biliousness. The acid exudation is astringent and useful in dyspepsia and constipation (Ayurveda).

The leaves are purgative, abortifacient; tonic to the hair; useful in cold pains; cause flatulence. The seed is sweet when raw; indigestible, aphrodisiac, anthelmintic, tonic; good for diseases and enlargement of the lever and spleen, for complaints of the chest, throat troubles, foul mouth, and fever; enriches the blood; cures skin diseases, inflammations more especially of the ear (Yunani).

The fresh plant put into hot water is used in the Deccan in the treatment of dysmenorrhoea; the patient is made to sit over the steam. The acid exudation "vinegar" is considered a useful astringent. In Gujrat it is used as an antidote to snake venom. In Europe the seeds are used as a diuretic and as an anthelmintic.

In some parts an infusion is given to allay the pain due to urinary calculi. The acid exudation is useless in the treatment of snake-bite whether given internally or applied externally (Mhaskar and Caias). The bristles of the chick-pea contain free oxalic acid.

The proteins of Bengal Gram have been isolated and analysed by Nuggihalli Narayana (Journ. Ind. Inst. Sc.; 13, 1930) (Indian Medicinal Plants, K.R. Kirtikar & B.D. Basu, Vol. I, 768-69)

Properties and uses: Seed and its lipid are hypocholesterolemic in human and possess oestrogenic activity. Aerial parts are used in fevers, dysmenorrhoea, gonorrhoea and menstrual and urinary diseases. They are also useful in skin diseases and foul body smell.

Seeds are astringent, antibilious and tonic, and used in dysentery and flatulence. Boiled leaves are applied to sprains and dislocated limbs; roasted leaves are regarded as aphrodisiac, and diuretic. Total flavonoids reduced rat serum and liver cholesterol, triglycerides. When given orally prevented hyperlipidemia (Medicinal plants of Bangladesh, Second Edition, Abdul Ghani, 163-64).