Monday, January 21, 2019
Tuesday, February 13, 2018
Scope of Stem cells in Regenerative medicine
5:23 PM
During the journey of conception till birth, the
body structure of any species is generated through biological processes.
In Human, development of a mature fetus from a
zygote undergoes multiplication of cells and their subsequent controlled and
co-ordinated tissue growth, movement, and differentiation. In addition, it also
crosses phases of degeneration and regeneration of tissues and organs till a complete
Man.
Regeneration continues throughout human life. As a
natural process, it is speedy healing of any injury or ill developed body organs
by de-differentiation & development of these cells into new similar tissue.
Organ such as liver is known to regenerate easily.
But every organ of our body cannot regenerate
naturally. Inability to regenerate the responses to injuries or diseases
threats our life.
Regenerative Medicine is directed to heal fractured
bones, burns, blindness, deafness, damage of muscle, nerve, blood vessel etc.
to extend lifespan. Age-related degeneration & damage can also be repaired
by such therapy.
The therapy uses patient's own tissue from other
part of body to repair the injured site. Similarly, biomaterials, metallic
& plastic types are also used to repair tissue damage depending upon the
nature of trauma. Often due to bio-incompatibility these materials are rejected
by the body & creates great problem in healing the damage.
Body itself has a great role in regenerative
process. In case of trauma damaged tissues are replaced naturally by the help
of primitive progenitor cells or Stem cells of the body.
Stem cells are broadly categorized in two types: Embryonic
stem cells & Adult stem cells.
The embryonic stem cells (ESC) are the inner cell
mass of an embryo at blastocyst stage, which has the ability to differentiate &
develop into any cell type of our body. These cells have unlimited capacity to
self-renewal in culture.
Their abilities were explored only when the cells
were available to manipulate in laboratories. The major contributor of these
stem cells study is the In Vitro Fertilization (IVF) as an Assisted Reproductive
Technology.
IVF generates numerous embryos for the treatment of infertility.
Usually 2-3 embryos fertilized in vitro are transferred into uterine cavity per
cycle. If conception takes place, the
leftover embryos not necessary for those couples are usually donated for
research purposes. Thereby, extensive studies are underway on the use of these
embryonic cells in regenerative medicine & cell therapy.
In the mean time, there have been controversies
about the use of such embryonic cells for research. Some belief that use of
embryonic cells destroys the embryo which could have been born as a Human.
Others belief that artificially fertilized embryos unless implanted in the
uterus have no legal status & they are not even part of a human being. However,
the research is also a means of the welfare of mankind.
The embryonic stem cells are being cultured & engineered
into the necessary cell type. For example, development of structurally &
functionally similar cells of pancreas which can produce insulin can save life
of many suffering from Type1 diabetes (Insulin dependant type). In this
condition the cells of pancreas are diseased or damaged, cannot produce insulin
to digest the glucose containing meal, hence glucose level rises in blood. Thereby
diabetes develops which is controlled only with the help of insulin injections
life-long.
Adult Stem cells are localized within wide variety
of tissue & organ such as skin, muscle, bone marrow, blood etc. with
limited ability to divide, differentiate & self renewal into other cell
type. The hematopoietic cells which develop blood cells are also adult stem
cells. They have great role in tissue regeneration & repair. In tissue
damage, they migrate to the site of injury & differentiate into blood
cells, cartilage, bone, fat cells & even outer layer of blood vessels to
repair the damage.
Stem cell based therapies currently available
adult-derived stem cells are from bone marrow and skin. Little is known about
the degree of their plasticity and there are difficulties in purifying and
culturing these cells.
Regenerative medicine researches have found similar
ability as embryonic stem cells of differentiation & development in
Umbilical Cord blood cells. In animal model it has been reported that these
cells can be engineered to produce many cell types. In comparison to embryonic
stem cell, availability of the cord blood cells is easier. Due to its easy
availability, now -a -days, cord blood is used in a variety of conditions as an
alternative of bone marrow for transplant, in stroke, in heart diseases etc.
The Human umbilical cord blood stem cells multiply
fast & increase their number in laboratory culture. These cells can also
change into muscle, liver, bone, nerve, skin cells etc. according to culture
conditions. However, culturing these tissues for therapy is not so easy. It
utilizes high-tech such as Reverse Transcription–Polymerase Chain Reaction
(RT-PCR), Immunostaining and imaging, Flow cytometry analysis techniques etc.
By this method, the cultured specific cells can be
isolated, stored & transplanted in need. In case of liver disease, they can
be used for replacement of liver cells.
Burns or skin diseases use skin grafts for
treatment. These grafts if developed from patients own stem cells there is no
danger of tissue rejection.
Researchers have found that bone disease such as
osteoporosis can be treated using umbilical cord blood cells.
In neurological diseases, the damaged nerve can also
be repaired by these cells.
These cells also have profound role in Cardiology
for repairing heart tissue & blood vessels. Extensively concentrated areas
of medical research include Diabetes, Parkinson's disease, Alzheimer's & Cancer.
The disadvantage on the use of cord blood is that it
contains not only stem cells but also the non-stem cells with specific
immunological properties may sometimes be rejected with severe immunological
reaction. More attention is on that line to make these cells easily acceptable
to any individual.
Researches are underway around the world to make
proper use of the cord blood cells. Large scale expansions of these stem cells
into numerous cell types are produced by culture. They are packed & stored
at an appropriate temperature before use. These cells have a very good
International market & are promoting medical industries. There is a great
need of such activities in this country as well. At least cord blood storage
& transfusion would have saved a lot of life.
Moreover, the technique would be of a great interest
to all the Medics. In India, there are many such institutions where
regenerative medicine has been well advanced. The potential of such activities
centre could be the Biomedical engineering institutions where tissue
engineering can be expanded with foreign collaborations if our hospitals
demand.
In the last decade all the miracles of stem cells were
highlighted. This decade some utilization of stem cells is underway. In coming
decade we may be using stem cells in every disease conditions as tablets, ointments,
injections etc. & reduce the use of chemicals.
The ability of stem cells seems much more than what
we know till date. We can assume that stem cell therapy & gene therapy may
even extend Human life expectancy.
Saturday, February 10, 2018
Friday, December 15, 2017
A guide to those seeking treatment of infertility at Infertility Centre, Bijulibazar, Kathmandu, Nepal
3:53 PM
A guide to those seeking treatment of infertility at Infertility Centre, Bijulibazar, Kathmandu, Nepal
Investigations of your infertility for proper diagnosis
1. Both the couple needs to see a Consultant Reproductive Endocrinologist (RE) at the Infertility Centre in addition to other doctors for counseling infertility. You need to bring reports of any treatment you had before. You can come any day of your menstrual cycle. The Centre is open 24 hrs. 7 days a week but you can see doctors strictly with appointments. Appointments are made at 10am-7pm except Saturdays. The clinic is open on Govt. Holidays
2. Counseling is a longer session when you will be told about the whole process & treatment pattern you may need.
3. On D2/D3 of your menstrual cycle you need to test your hormone levels.
4. Husband's semen will be tested after 3 days of abstinence within 1/2 hr. of ejaculation. Sperm Count >50million with >50% motility is accepted as normal test.
5. Hormones will be assayed if the sperm count is abnormal.
6. USG of pelvis is done on D2/D5 of period by trans-vaginal route to see any cyst or tumors around your uterus & ovaries. There may be multiple small cysts as black pearl necklace which is a case of Polycystic Ovarian syndrome.
7. A Radiological or Sonographic Hysterosalpingography (HSG) is done after the bleeding stops on D6/9 of your period to assess the patency of your fallopian tubes. Normally both are patent.
8. Those couples who had recurrent abortions are tested for TORCH test, Blood glucose & genetic testing.
Treatment of the problem you may be having
1. Fertility is possible only when all the above tests result are normal.
2. Treatment may take several months till fertility recovery.
3. In case of abnormal hormone profile RE will adjust hormone levels. RE will take care of this condition & also regularize your period if they are irregular. This may take several months.
RE will also guide you about your weight if you are overweight or underweight. If your ovaries are inactive RE will provide some ovarian stimulants to induce proper egg development in the ovaries. This will be followed -up by USG usually after a week of stimulation & hormone therapy may continue for sometimes till recovery.
4. Poor sperm count will be taken care by hormone therapy, sperm tonics as well as Intrauterine Insemination (IUI) of husband' sperm.
5. In case of nil sperm in semen analysis, IUI of donor's sperm is done with a written consent of the couple.
6. Recurrent abortions are treated according to their test results.
7. Blocked fallopian tubes are offered a very effective non-invasive technique of Clear Passage Therapy using pelvic maneuver followed by hydrotubation. This is non-surgical treatment, may take 1-3 cycles for recovery.
8. Unsuccessful treatment cases whom tubes could not be open, if they can afford, In Vitro Fertilization (IVF-test-tube treatment) is the treatment of choice for these couples.
9. Couples who cannot afford IVF are advised for adoption.
Saturday, February 25, 2017
Improvement of pain in endometriosis
6:53 PM
Endometriosis
is identified as 3D disease. There is Dysmenorrhoea- painful menses, Dyspareunia-
painful sex, & Dyschezia- painful defecation. The patients do not suffer
from the size of the cysts they develop, but they severely suffer from the
formation adhesions & inflammations.
After
a small study on 50 patients, the Infertility centre has been successful in
treating the 3Ds of endometriosis. A complex therapy of vitamins & calcium have
been very effective in reliving all three types of pain.
Thursday, August 11, 2016
Nepalese believe
10:05 PM
In Nepal infertility is bio-psychosocial
problem therefore counseling is the most important part of infertility
assessment before any medical intervention.
In
western part of Nepal some men prefer remarriage easier & cost-effective
than going through the diagnostic & therapeutic line in female infertility.
Similarly,
in male infertility, some men prefer to remain infertile than getting donor
inseminated children.
It is also widely believed that sons “open the gates
of heaven” by carrying out the last rites of parents. Daughters are “given
away” in marriage. These explain, to an extent, the prevalence of sayings like
“let it be later but let it be a son.”
Thursday, February 11, 2016
Blasctocyst transfer baby
9:24 PM
Blastocyst transferred Baby was born at 33 wks. gestation with 1.3 kilogram body weight four months ago. The baby survived with difficulty & has gained weight of 5 kilogram.
Wednesday, January 20, 2016
Asherman Syndrome
8:03 PM
A successful full term Baby girl delivered one month ago in a case of Asherman Syndrome.
Friday, May 29, 2015
Sunday, February 15, 2015
Good News
8:14 PM
The Infertility Centre team feels blessed to have 23 -25 pregnancies per month for last 4 months. In addition, there are some days even 5 pregnancy tests show positive results.
This is due to all hard work & dedication of the team members which includes the patient attandants, nurses & the doctors.
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