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TB is preventable and curable

Tuberculosis (TB) is a disease, which is caused by a germ - the tubercle bacillus. It is scattered into the atmosphere by persons having the illness, usually during a bout of coughing or sneezing. This germ most often strikes the lung causing pulmonary TB; but it can affect almost any other part of the body such as the lymph glands, brain (causing TB meningitis and other lesions), bones (e.g. spine), joints (e.g. hip and knee), intestine, kidneys and testes.

The germs can infect anyone, at any age, and at any time. Untreated patients can remain infective (i.e. infect others) for years, and continue to spread the disease, thus posing a danger to others. People do not inherit TB - they are not born with it. They get it only from someone who already has the illness.

Most often, the germs are transported on tiny drops of moisture propelled into the air when people cough. When there are less people with TB in the community, there are less bacilli in the air, and therefore less chances of spread of the disease.

Anyone can get TB, and it does not spare any particular social class. It can affect the rich or poor, old or young; but healthy people are better able to fight it off because they have a better resistance.

The lower immunity in patients with HIV infection may lead to reactivation of a latent TB infection. In several countries, including some developed ones in the West, there is a recent trend towards a rise in the incidence of TB due to this association with HIV infection. So far such a situation has not occurred in Sri Lanka. Symptoms

Initially, it may be difficult to pinpoint a particular symptom. As time goes on, you will begin to feel unwell with a low grade and intermittent fever (usually an evening fever), malaise, chills, night sweats, loss of appetite, and loss of weight. You may get cough, which does not respond to normal medications; the cough may be associated with blood stained sputum.

The most infective patients, (i.e. those infecting others) generally have symptoms. In the case of babies and children, these symptoms may not be noticed. When the disease presents in an acute generalised form, affecting many parts of the body, including the lungs. It is referred to as miliary TB, and when it affects the coverings of the brain, as TB meningitis; both these conditions are extremely serious.

Tests

There are several ways of finding out whether a patient has TB. Doctors usually use a combination of methods. The doctor would examine you (physical examination) and do an X'ray examination.

The only sure way to say you have tuberculosis is when the bacilli have been detected.

This can be done by microscopic examination of the sputum (in pulmonary TB) to see if the bacilli are present.

It is the only examination, which confirms beyond any doubt that a person has the disease. However in babies and children, who invariably swallow their sputum, it is difficult to get sputum for examination. An X-ray of the chest shows whether there is any damage to the lungs.

However, an abnormal X'ray shadow does not prove that a person is ill with TB, since other illnesses too may give similar abnormal shadows. A third test, which can give some indication, is the tuberculin skin test, also referred to as the Mantoux test. It indicates whether the tubercle bacilli (TB germs) have entered your body and caused a reaction in the defence system. It is therefore a measure of the body's reaction to the invading tubercle bacillus, irrespective of whether the germs have been successful in causing disease or not.

Thus, a positive tuberculin test, by itself, does not indicate that a person is ill with tuberculosis. Another test is the biopsy of an enlarged lymph gland or some other affected tissue of the body.

Treatment

Drugs form the core of treatment of TB. The national policy of treatment shows a tremendous stride forward, and today we have one of the best forms of treatment available anywhere in the world. The treatment is costly, but it is given free to every diagnosed case of TB.

It is a great misfortune if, due to a lack of interest of awareness, instructions regarding treatment are not followed by patients and their families.It is imperative that the patients understand the necessity of proper drug intake. The drugs must be taken for the prescribed period of time, even if they feel better, as often the patient does feel better and quite well after a few weeks of treatment. It should be emphasised that regular treatment for the prescribed number of months is extremely important in order to arrive at a complete cure and to avoid relapses.

The present schedule of treatment, if taken in the prescribed manner, gives a cure rate of almost 100%. When you have TB, it is not necessary to stay in bed, or to give up working for the entire period of treatment. The only important thing is to take the drugs correctly. A 'cured' person will no longer spread the germ. Treatment very quickly stops the spreading of the germs - usually in 2 to 3 weeks.

Prevention

With the introduction of BCG vaccination, and the advances in treatment, TB is not the feared disease it used to be. However, though its incidence has been much reduced, the disease still remains a major health problem in Sri Lanka and other developing countries.

TB does not run in families. There should be no shame if a member of your family gets the disease.

(From 'Your Child, Your Family')

(by H. A. Aponso et al)

Headaches and their causes

Compiled by Carol Aloysius

by DR. SAMPATH R. NANAYAKKARA

Headaches are among the most common health problems in the Doctor-Patient encounters.

The vast majority of headaches are due to instability of the chemical substances such as Serotonin levels in the system. They act as Neurotransmitter. Abnormal levels affect blood vessels round the head and neck and as well as the flow of pain messages in to the brain.

Fortunately 90% of headaches are not associated with any underlying diseases, of the brain and surrounding tissues. They are, "Tension Type' 'Migraine' and 'Cluster headaches' without causing much serious complications. But if you do get headaches with the following features you should call your doctor promptly.

* If you are over 50 years particularly, and develop a sudden onset of headache.

* You need more and more drugs to control headache as you go on.

* Your headache becomes worse by exercise, coughing, bending or sexual activity.

* Your headache is associated with fever, stiffness of the neck, slurred speech, confusion of thoughts, drowsiness or repeated vomiting.

* The character of your headache is different from what you have had earlier. Tension - type headache.

This is the most common form the headache. In some of the sufferers there is no clear link to stress, therefore it is called 'Tension-type.' One can have bout of headaches occasionally or when it becomes chronic it may occur more than 15 days per month.

Pain is felt as Pressure, Ache or Tightness, generally as both sides of the head. One episode of headache may last from 30 minutes to several days. Usually the mind form responds well to "Over the counter painkillers." (OTC). For chronic type sometimes stronger medicines such as muscle relaxants or Antidepressant to be prescribed to control.

Applying heat or cold to the affected area, massaging the temples of your head may also help. Regular physical exercise, 'Progressive Muscle Relaxation Techniques (PMRT) and meditation have been proved to be effective. The author has found the hypnotherapy by a qualified clinical hypnotist is also an effective mode of treatment.

Migraine: Migraine attributes to about 15% of people, out of which 75% are women. At least 10% of sufferers experience a warning sign called "aura" (AURA) - i.e. flashing lights in the eyes, numbness and tingling feeling of the tongue, arm or face.

Pain is usually of a throbbing character, usually one side of the head, is often made worse by walking up and down the stairs. Feeling of nausea, and irritation to light and sound. Pain may last for 72 hours.

Most of the sufferers need Prescription Medications to control the pain.

Apart from the dry treatment, migraine sufferers should avoid certain triggers such as foods like - chocolate, cheese, red wine, beer, stuffy environment and perfumes.

Cluster Headaches:

Perhaps this may be the most severe type, but relatively rarely 90% sufferers are men, who smokes and drinks heavily. Cluster headache has a typical character it comes at the same time each day and last for days, weeks or months and then disappear for months or years.

Headache confines to one side associated with stuffy and runny nose droopy eye lid and watery eye of the same side. Single attach may last for 15 minutes to three hours. Best preventive measure is to quit smoking and drinking.

Many people with headaches "overdose" the pain killers in order to control the pain. But most of them are not aware that pain returns worse than before after the action of the drug wears off unaware of this fact sufferers take more painkillers leading to lot of side effects.

Stress - Type A or B Personality and Heart disease

by Dr. R. A. R. Perera

Stress is generated by various environmental inputs, such as crowds or noise, exams, interviews, sickness or the death of a loved one or the loss of a job. However, stress does not always originate outside the person.

Some people are stress prone - that is, they choose life styles that place them great stress. And they often suffer the consequences of the life style, the most extensive research on the stress prone person distinguishes between the Type A personality and the Type B personality. The Type A personality is engaged in a relatively chronic struggle to obtain an unlimited number of poorly defined things from the environment in the shortest period of time, and, if necessary, against the opposing effects of other things or persons'. This struggle is maintained in three ways.

* Competitive striving for achievement

* An exaggerated sense of urgency

* Aggressiveness and hostility

The Type B personality does not display these characteristics. To determine who fits the patterns, respondents are asked such questions as:

Do you eat your meal very fast? Do you undertake any task given to you in a competitive way? Are you very active most of the time? If the answer is "yes", you are most probably a type. A personality.

The origin of Type A and Type B behaviours is unclear. However, data from a study that assessed people's experiences in high school and college indicates that these patterns are discernible at an early age.

In contrast to Type A students. Type B high school students participate in more sports and social activities and Type A College students participate in more non-athletic extracurricular activities and win more academic honors. This evidence suggests that the Type A person strive for high achievement while the type B person seems to be more social.

In order to gain a better understanding of the Type A and B personalities, investigators have examined reasons to various experimental situations. For example, when given various tasks that require different amounts of effort Type A's tend to work at maximum speed regardless of instructions. Type B's tend to work at whatever sped is required by the instructions.

When their task performance is threatened in various ways, type As continue to strive without paying attention to environment inputs while Type Bs vary their activities according to their experience. If interrupted during work on decision making task. Type A's show greater irritation than do Type Bs.

When placed in a stressed in a stressful situation, Type As are more likely to evaluate their progress by comparing themselves with others. When placed on treadmill for along time Type As are less willing to admit fatigue than were Type Bs. Presence of others, stimulates Type As to increase their efforts on a task, while Type Bs are less affected.

When you consider the physical effects, Type As respond to many tasks with a greater increase in blood pressure and heart rate than do Type Bs. This effect is particularly noticeable when challenges are great. Sympathetic nervous system reactions of the kind that damage the cardiovascular system are more frequent in Type As than Type Bs.Contracting coronary heart disease and recurring heart attacks are greater in Type As than in Type Bs. This shows that an individual generates his or her own chronic stress, and the result may be deadly.

Food for thought

Many people erroneously believe that sugar causes hyperactivity in children when in fact sugar, as a carbohydrate, seems to have the opposite effect!

Have you ever wondered if what you eat affects your mood? Or if your mother's advice to eat fish because it's a "brain food" was just a way to get you to clean your plate? With the growing incidence of depression and aging of the "baby boomer" generation, scientists are now looking into the area of diet and brain function help with memory and improved mood.

B vitamins

A study by the Centre for Scientific and Industrial Research Organisation (CSIRO) in Australia in women aged 20 to 92 years, found that supplementation with folate and vitamin B12 improved memory and mental performance in women in their 20s and in those over 65 years of age. Vitamin B6 (found in soybeans, chicken and bananas) improved word finding ability in women of all ages. The researchers noted that the normal diets of women were low in some of these nutrients. Folate can be found in fortified breakfast cereals, fruits and vegetables while good sources of vitamin B12 are meat, fish, dairy products and eggs.

It is thought that the B-vitamins may help chemicals involved in thinking and improve blood flow to the brain.

Iron to the rescue

Teenage girls who are having trouble with their schoolwork, are irritable or constantly tired, may find that iron deficiency is their problem. According to Dr. Tony Helman, Chairman of the Australian Iron Advisory Panel, iron deficiency is found in 1 in 9 teenage girls in Australia.

A recent study in the Lancet of 76 teenage girls found that those who took iron supplements for eight weeks did significantly better on verbal and memory tests than the group that took the placebo.

The researchers concluded that even in the absence of anaemia, iron deficiency might impair learning in adolescent females.

Dr. Helman says "teenage girls are particularly prone to iron deficiency because they are losing iron rich blood through menstruation, they are growing fast, and they often don't eat enough food rich in iron. Parents should think about the possibilities of iron deficiency if their teenage daughters are having difficulties with their schoolwork, complain of tiredness, are eating poor meals or are having heavy periods."

"Red meat, chicken and fish are all good sources of iron, with red meat being the richest source," said Dr. Helman. "Breads, cereals, vegetables, nuts and eggs contain iron in a less available form but absorption can be boosted by combining them with vitamin C-rich foods such as broccoli or orange juice."

Iron is important in other age groups too.

* In infants, iron deficiency is associated with intellectual and psychomotor impairment such as poor eye-hand coordination. This may not always be completely reversed when iron status is corrected.

* Iron deficiency in adults can lead to an inability to concentrate, which in turn can hinder verbal learning, memory, mood and energy levels. Tiredness and irritability are both symptoms of iron deficiency.

Some foods are thought to have the potential to aid relaxation by their effects on brain neurotransmitters. Neurotransmitters are chemical messengers that are produced from nutrients in foods.

The manufacture and release of certain neurotransmitters can be affected by the type of foods eaten.

The amino acid, tryptophan, found in meat, milk and eggs, is a component of the neurotransmitter serotonin (the "feel good" neurotransmitter). Serotonin is needed for normal sleep. Hence the old advice to take a glass of warm milk to help get to sleep.

Meals that are high in carbohydrates have been shown to increase serotonin levels resulting in calmness and drowsiness. Many people erroneously believe that sugar causes hyperactivity in children when in fact sugar, as a carbohydrate, seems to have the opposite effect!

The FAO/WHO Expert Consultation on Carbohydrates in Human Nutrition (1997) makes the following comment on sugar and hyperactivity; "However, an extensive review of the literature in this area concluded that there is no evidence to support the claim that refined sugar intake has any significant influence on behaviour or cognitive performance in children."

Soothing chocolate

The good mood that comes after eating chocolate is not just due to its great taste. The cocoa, used in chocolate contains phenylalanine. Phenylalanine occurs naturally in the brain and is released when emotions are aroused.

Chocolates also contains theobromine and caffeine, both of which have been shown to increase alertness.

Moderate levels of caffeine have been shown to increase performance, alertness and concentration. That mid-morning cup of tea or coffee, or a lunch-time cola drink can help you plough through that loaded in-tray.

The area of diet and brain function is in its infancy and further research needs to be performed before any recommendations can be made.

One important fact of eating that is often forgotten though is the need to take time to savour and enjoy foods.

Too often, people rush through meals with little thought as to how the food actually tastes. Not only can this lead to overeating, it also takes away one of life's simple pleasures.

Give your brain a better diet!

Eat more fish - an omega-3 fatty acid found in fish called DHA might play a role in preventing dementia. A Dutch study reported that elderly men who ate the largest amounts of fish were the least likely to suffer from dementia. Research also suggests that fish oil may help prevent depression.

Skip fad diets - Restricting food intake interferes with concentration and mental performance not to mention the irritability associated with hunger pangs. It's still unclear whether the effects of dieting are due to a lack of food or the dieters preoccupation with weight.

Eat more fruits and vegetables - these are great sources of antioxidants to help protect brain cells against the effects of aging.

Eat breakfast - Studies show that breakfast eaters perform better on tests of concentration than non-breakfast eaters.

One theory is that an overnight fast depletes the brain of glucose, the only fuel it can utilise and which also helps the brain to store information.

Courtesy: Food Facts Asia

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