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Today is world Health day. the focus is on physical activity as the key to good health.

Benefits of food irradiation

One of the greatest health benefits of food irradiation is its ability to destroy the microorganisms and parasites that cause food-borne illnesses and death.

by S.S. KULATUNGE, Atomic Energy Authority Senior Scientific officer

Food can be preserved by many methods such as refrigeration and chemical fumigation. Food preservation can also be done by radiation where it is exposed to gamma or X radiation for a specified length of time. Food processed by this method is known as Irradiated Food.

It is a simple process. In commercial application, large cases of food or food products are loaded in pellets onto a conveyor system which will carry them into the irradiation chamber, past the irradiation source and back out to an unloading station.

Because waves of gamma irradiation energy are very short, they penetrate food and food packages easily. The energy level is so high, it can even penetrate and breakup molecules. Exposure of the food to irradiation energy is controlled so that the dose only causes physical and chemical changes in targeted cellular components, not nuclear changes in the atoms that make up food. Food irradiation can extend the shelf life of many fresh foods.

This is done through preventing of sprouting, deactivating mold, and killing of spoilage bacteria. In this process the food never comes into direct contact with the radiation source. As such irradiation under controlled conditions does not make food radioactive.

In general the irradiation process produce very little chemical change in food and none of the changes known to occur have been found to be harmful or dangerous. Also there is no evidence to suggest that free radicals which can be formed during irradiation process affect the safety of irradiated food. These free radicals also can be found in certain other food treatments such as toasting of bread, frying and freeze-drying and during normal oxidation processes in food.

Nutrients such as Protein, carbohydrates and fat are not affected by radiation doses of up to 10 kilograys. Different types of Vitamins such as Vitamin C and Thiamin have varied sensitivity to radiation and to other food processing methods such as heat treatment.

Extensive research has shown that the quality of irradiated food is similar to the food preserved by other methods and there isn't any creation of harmful new substances in irradiated food.

(Courtesy: Nuclear News)

Can strokes be prevented?

The National Stroke Association of Sri Lanka celebrates its first anniversary today. This article is written by Dr. Jagath C. Wijesekera, President of the Association.

Stroke or cerebrovascular accident is one of the most devastating illnesses that can afflict man. It is the second commonest cause of death next to heart disease. Annually about 15 million people are afflicted by strokes worldwide. Of these about 5 million die of the stroke and a another 5 million are left disabled for rest of their lives, causing a major burden, on the family and the community.

There have been new developments in the treatment of individuals who have already suffered a stroke, such as drugs used to dissolve the blood clot in the brain (thrombolytic agents).

These drugs though promising have to be given within a few hours of the onset of the stroke. Furthermore, they are available only in a few countries such as the USA and will be too costly for routine use in a developing country like Sri Lanka. Hence prevention of stroke is the main strategy used worldwide to lessen the burden of stroke.

This is not only true to developing countries but is also applicable to developed countries.

Risk factors for stroke

There are well documented risk factors which are modifiable and treatable. These include: high blood pressure (Hypertension) Heart disease, smoking, previous stroke or transient iscaemic attacks (TIAs) also referred to as mini strokes.

High blood pressure

High blood pressure is the most important of the risk factors, which is modifiable. It has been shown that adequate control of high blood pressure can significantly reduce the incidence of stroke in the community.

In fact the incidence of stroke has been significantly reduced especially in the developed countries by effective control of blood pressure. Both diastolic and systolic high blood pressure control will help reduce stroke incidence.

Recent studies have also shown that reduction of blood pressure even when in the average range will result in reduction of stroke incidence. Hence the importance of regularly checking the blood pressure and taking suitable medication on a long term basis, once high blood pressure is detected under medical supervision.

Heart disease

Proper treatment of those individuals who suffer from heart disease can prevent the occurrence of stroke. In the Sri Lankan perspective, Rheumatic Heart Disease which results from inadequate treatment of Rheumatic Fever, is of particular importance as it is both preventable and treatable.

Heart disease which result from insufficient blood supply to the heart muscle (ischaemic Heart Disease - IHD) and those resulting from irregularities of heart rhythm (e.g. Atrial fibrillation - AF) could also result in stroke, and hence their early detection and treatment is of utmost importance.

Cigarette smoking

The association between smoking and stroke has been clearly demonstrated by large clinical trials.

There is a direct relationship between the number of cigarettes smoked and stroke incidence. It has also been shown that with cessation of smoking the incidence of stroke is progressively lessened. In fact after 5 years of cessation of smoking the liability of having a stroke in one who has smoked previously will be the same as a non-smoker. Mini strokes

Transient neurological symptoms (transient weakness, numbness, visual loss or blurring, double vision, slurred speech, etc) which last for a few minutes or hours are termed transient ischaemic attacks (TIAS).

Patients who have TIAS and mild strokes are at a higher risk of having a major stroke within the next five year period, the maximum risk being during the period soon after the mini stroke.

Identifying the cause of the TIA/stroke and treating appropriately with medication or surgical procedures will significantly reduce the subsequent occurrence of a major stroke. Modifiable risk factors - less well established

Risk factors which are known to be important in the aetiology of stroke but which are less well documented than those mentioned above include:

Diabetes mellitus, elevated cholesterol and lipid levels, heart diseases other than IHD, AF and valvular disease, Obesity (excess body weight), Lack of exercise, Excessive alcohol intake and use of oral contraceptive pill.

The control of the above factors are also important in prevention of stroke. Recent studies have also shown that use of Vitamins such as Folic Acid, Pyridoxine (Vitamin B6) and Vitamin B12 in patients who have had strokes will reduce the possibility of having a subsequent stroke. It has been shown that diets rich in Potassium which is abundantly present in fruits is beneficial for stroke prevention.

Thus it would be seen that the most important aspects of stroke prevention would be to educate the public to have regular blood pressure checks and take medication if they are suffering from high blood pressure under the supervision of a Physician early detection and treatment of heart disease, refraining from smoking and be able to detect symptoms of a mini stroke and seek early medical attention.Furthermore, a lifestyle with a suitable diet in order to maintain optimum weight, control of blood cholesterol and lipids, consumption of fruits in adequate amounts, control of alcohol intake and regular physical activity/exercise will also be of help.

Living a healthier life with aspirin

Aspirin is a pain-relieving drug used widely the world over. The medical term for aspirin is Acetyl Salicylic Acid.

Professor Peter C. Elwood, MD, FRCP, FFP-HM Honorary of the University of Wales College of Medicine is a recognized authority on Aspirin, says that it can be used for many illnesses.

"More and more research is being done around the world to determine the uses of aspirin," he says.

"In 1974, it was used for the first time, to reduce the risk of heart disease and stroke. Today, its usage for heart disease and stroke is accepted all over the world. It is known that on experiencing sudden and severe chest pain, at least 300 mg of soluble aspirin chewed and swallowed can save a life."

The results of a randomized controlled trial (RCT) of a single daily dose of aspirin in the prevention of re-infarction in 1239 men who had had a recent MI showed a reduction in total mortality of 12% within 6 months and 12 months after admission to the trial.

Results showed that there is a 30%-40% possibility in reducing heart attacks, strokes, and vascular deaths. The benefits of long term, low dose aspirin prophylaxis after a stroke is proven.

Professor Elwood also believes that 100,000 premature deaths could be prevented worldwide every year if aspirin is taken by those diagnosed with heart disease or who have had a history of strokes in the family.

Studies have also shown that using anti-inflammatory drugs such as aspirin reduces incidence of dementia, especially with diseases such as Alzheimer's Disease, and suggest aspirin may have a hand in avoiding cancer of the colon and rectum.

If you know their case...

by Hana Ibrahim

...So begins the Kidney Patients' Welfare Society leaflet drawing one's attention to something many of us are probably aware of, but through inertia or indifference or whatever, prefer not to acknowledge. The plight of thousands of Sri Lankans suffering from kidney failure.

A debilitating ailment that has more than 100 patients being admitted to hospitals around the country daily, kidney failure can be either acute or chronic. The former, often caused by trauma is a temporary debilitation and is curable with proper treatment. But the latter, where the kidneys become progressively damaged over a long period, requires long-term treatment, with regular dialysis - renal-replacement therapy.

Although both forms of kidney failure are prevalent in Sri Lanka, it is the latter that is wide spread and cause for grave concern. Sadly however, the ailment is not identified as a key health problem in the country. And from this stems a myriad of other problems which has resulted in the needs of the patient, no matter how vital, being marginalised.

The problems range from lack of understanding the nature of the illness to low recognition of the illness which undermines the demand for improved medical care and support services; lack of funds to provide adequate services for patients; lack of dialysis treatment facilities throughout the country and patients facing acute difficulties in travelling to and finding accommodation in Colombo during treatment.

Perhaps the most telling of these woes, is the lack of dialysis facilities. According to Janet Gunasekera, Secretary, Kidney Patients Welfare Society (KPWS), as many as 1,300 chronic renal failure (CRF) patients and a large number of acute renal failure (ARF) patients require dialysis therapy to either save or prolong their survival. However, there are only 40 dialysis machines in Sri Lanka.

And this inadequacy is further compounded by the fact that a large percentage of the patients live in the rural and remote areas, and can ill afford the cost of travelling to and staying in Colombo during the course of treatment.

Each patient with CRF needs two to three session of dialysis treatment per week (eight per month), which cost anything from Rs. 4,000 to Rs. 6,000 per session, with consumables in the form of wires and tubes and other essentials costing a further Rs. 2,000.

The woeful lack of dialysis machines and transit homes, makes the case of kidney patients appear bleaker by the day, says Gunasekera, whose husband died of renal failure two years ago, propelling her to form the Society and lend a helping hand. "I watched how these patients suffered, and was determined to help them out," she adds.

Her efforts at helping them out has seen the society, with the assistance to teledrama actress Damitha Abeyratne, and side support from former cricketer Roshan Mahanama, drawing up plans to mobilise much needed funds to make available better facilities for these patients. The facilities include transit homes in close vicinity to the national Hospital in Sri Jayawardenapura and a Dialysis Unit at the Colombo South Teaching Hospital (Kalubowila).

"We plan to offer free dialysis facilities and free board to the patients with counselling and recreational facilities," says Gunasekera. Already the Society has received 11 dialysis units from the Monash University in Australia. The Urban Development Authority has approved a plan for the transit home to be built on land allocated by the Ministry of Health.

They also plan to train graduates and post graduates to treat CRF and ARF patients. At the moment there are only two professionals in charge of diagnosing and treating kidney failure patients.

Other plan also include carrying out public awareness programmes in order to promote research related to early diagnosis of kidney disorders and treatment at early stage; public awareness to promote the prevention of kidney disorders; establishing channels for the public to donate funds for need CRF patients and improving recognition of the plight of CRF patients.

However it's the dialysis unit at the Kalubowila Hospital and the transit home that heads the priority list of the Society.

"And to accomplish that we need approximately Rs. 12 million," says Gunasekera, explaining that they have organised a fund raiser dinner dance on May 10th at the Mount Lavinia Hotel. The dinner is sponsored by the hotel. Souvenir sales and tickets priced at Rs. 1,000 is expected to bring in Rs. 1 million, which is still a long way off the required amount.

The leaflet which begins with 'If you knew their case...' ends with 'You will support their cause'. So now you know their case and if you are interested in supporting their cause, maybe you'd wish to call the Kidney Patients Welfare Society. They can be contacted on 071 - 262121.

Pregnant women - more vulnerable to diseases

Women are more vulnerable to several infections during pregnancy because their immunity is either not yet fully formed or has been altered.

Malaria is only one of the factors which increase the risk for ill-health or death in pregnant women, but when associated with anaemia it is probably the most important one, especially if the level of immunity to malaria is low. Anaemia from other causes such as iron deficiency is very common in many tropical areas, further increasing the risk. Often 70% to 80% of pregnant women in malarious regions are anaemic.

This situation can be improved by controlling malaria transmission (for instance, by preventing mosquito breeding or using bednets) and by treating the anaemia with iron and folic acid.

In areas where malaria is endemic, pregnant women should be given antimalarial drugs and iron and folic acid supplements at their first antenatal visit whether or not they have symptoms. Ideally this should take place early in pregnancy as this is an important period of fetal growth. If delayed until later in pregnancy, the benefits to the mother and fetus may be limited.

Pregnancy in young girls increases the risk of complications from malaria and anaemia, because their own growth process is not yet completed; this leads to delivery complications and to competition between the girl and the growing fetus for nutritional requirements. In areas with high levels of malaria transmission adolescent girls should be screened for anaemia even if they are not pregnant those with anaemia should be treated so as to reduce the risk of starting their first pregnancy in an anaemic state.

Retardation of fetal growth, with resulting low birth weight, mainly affects babies born from first pregnancies.

Pre-term delivery may also result from malaria, but this more commonly occurs in women with low immunity to malaria, such as those from non-endemic areas. In some endemic areas, as many as 40% of babies of first pregnancies have low birth weight because their mothers had malaria.

Courtesy: Mahjubah

Pain on the face and throat

by Professor Dr. Amarasiri Wijenayake

Pain on the face experienced by many could be caused either by disease or due to environment. Most Patients would be unable to take anything by mouth while experiencing such pain.

Trigeminal neuralgia, is the term applied to a certain type of meralgia that is located along the three branches of the Trigeminal nerve. Pain would last for a moment and vanish without leaving behind any sign. Shaving, washing the face, cold wind, talking, could irritate the trigger points of the nerve and stimulate pain. Patients usually complain that the pain starts at one point and spreads to different areas. The nerve along which the pain spreads would be localised at the middle of the face and sometimes mistaken for tooth ache.

The trigeminal nerve with its three branches would show locations of pain. Skin on both sides of the face may be involved at times giving the patient difficulty in taking any food. Other manifestations of pain include loss of weight, dehydration, and difficulty in speaking.

Pain may also be caused by other factors such as environment. Due to environmental changes certain waves found in the air may affect the ear drum resulting in ear and facial pain. Pores would appear in the ear drum and would spread along the gums irritating the inferior alveolar nerve or dental nerve. To stop this irritation patients could place an ear cork to avoid waves running along the ear drum into the gums of the mouth.

Pains on the forehead, above the eye lids could be caused by irritation of the nerve and needs to be differentiated from sinus patients could identify trigeminal neuralgic pain as sharp, stabbing and shooting and it is paroxysmal. pain from sinusitis would be sharp.

Dental pain is dull. Neuralgia that is caused by Herpes infection would be a burning sensation. At times it would be persisting or paroxysmal. Ocular pain would be dull and throbbing.

Trigeminal pain patients would not show any neurological signs. Facial pain would be associated with depressive illness in case of a typical facial sickness. Evidence of scarring would be seen with loss of sensation after Herpes infection. In Costens syndrome there would be tenderness in the temporo mandibular joint. Ocular pain would be associated with visual symptoms and blurring pain and glaucoma.

Cause for unexplainable paroxysmal attacks of severe facial pain could be due to more serious diseases of nerves or central connections to the brain.

Facial pain that does not react to tablets should be further examined neurologically during the initial period. Patients with pain on the face if suspected to have a brain lesion in the area mentioned complain of the difficulty in articulation, difficulty in walking (Ataxia) visual problems (nystagmus) and in coordination.

A CT examination of the brain to investigate brain tumours would make diagnosis easier.

Surgical techniques of relieving pain as well as injections of alcohol into the trigeminal ganglion could be effective.

A typical facial pain often found in middle aged or young women found to be associated with depression - and once the depression is relieved facial pain would be relieved.

Tolosa Hunt Syndrome manifests as severe orbital pain and loss of sensation of along the first division of trigeminal nerve. Cavernous sinus of the brain or superior orbital fissure would be affected by disease called granuloma which is similar to tumour.

Facial pain with closure of eye lids and small pupils known as Readers Syndrome would give loss of sensation to touching and pin prick on first and second division of trigeminal nerve. A tumour in the middle section of the brain as well as nasopharyngeal carcinomas and granulomas could also be suspected.

Pain triggered by swallowing could also be due to Glossopharyngeal neuralgia. Ear and throat are the two main areas of pain. Patients would be afraid to eat and would thus lose weight.The trigger spot would be on the back of the tongue and often ligrocaine spray would relieve pain. Reduced heart rate and blood pressure due to the affection of carotide sinus on the neck that is innervated ninth nerve is also a common finding.

Tumours in these areas known as Glossopharyngeal and vagal neuromas would produce these symptoms Surgical treatment could relieve pain.

Over and over

Though a relatively minor psychiatric illness, the suffering that Obsessive Compulsive Disorder causes is immense. The patient's ability to work, study or enjoy leisure is impaired. Dr. S. Mohan Raj examines its cause and treatment.

Obsessive Compulsive Disorder (OCD) gets its name from two of its main symptoms - Obsession and Compulsion.

Obsession is a thought with the following characteristics.

Repetitive: The thought keeps coming again and again. Its frequency varies with severity of the illness. For some, the thoughts are almost continuous.

Intrusive: No matter what the person does, the thoughts intrude into his mind. The thoughts intrude irrespective of whether the person is reading, writing, watching TV, praying etc.

The thought is considered 'silly.'

The person tries to control or suppress the thoughts, but without success. The thoughts interfere with his work, studies and leisure.

As a response to the thoughts, he may become anxious or depressed.

Obsessions, are different from worrying. In the latter case too, the person has repetitive thoughts but considers them as relevant to the issue at hand. An obsessive thought is considered irrelevant and absurd.

Obsessive thoughts, can come with any theme. It could be a particular word, a phrase or a thought sequence. The commonest obsessive themes are religion, sex, blasphemy, aggression or contamination.

Obsessions are not limited to thoughts alone. It also includes images and impulses. Compulsion is a repetitive behaviour, which is invariably in response to an obsessive thought or impulse. There are two types of compulsions. The commonest is yielding compulsion where a person yields to his obsessive thought.

Divya always feels that her hands are dirty and, in response, she washes again and again. Each wash relieves her anxiety for a short while. But slowly, the obsessive thought builds her anxiety and she has to wash again. The commonest compulsions are washing, checking and counting rituals.

Some have elaborate compulsive rituals. Sandeep takes bath in the same pattern everyday. Any change in the sequence or a doubt about it will make him start again. His bath thus requires 60 to 90 minutes.

OCD occurs in two to three per cent of the population. It affects all age groups. Both sexes are equally affected. Though a relatively minor psychiatric illness, the suffering it causes is immense. The patient's ability to work, study or enjoy leisure is impaired.

Compulsions are obvious to an observer and can cause considerable shame and embarrassment. Not all obsessions are followed by compulsions. Others would know of the obsession only if the person chooses to tell them. Most of the time, he doesn't tell others, as he fears ridicule.

Some people have obsessive-compulsive personality traits. Traits are enduring patterns of perception, thinking and relating to the environment and self. The traits are not suggestive of illness. Orderliness, neatness, punctuality and rigidity are some of the obsessive traits. Everything is kept in a particular place in a specific order.

Perfectionism, if pursued to the extreme, would hinder the completion of the task before the deadline. This leads to anxiety as the person is also used to being punctual. Obsessive traits and OCD are not directly related. Though some person with obsessive traits develop OCD, not all of them do so. Similarly, a large number of persons with OCD do not have past history of OC traits.

Why does OCD occur? Current understanding has it that OCD is due to lesser turnover of a neuro-transmitter called Serotonin in specific brain pathways. A class of medication called 'Specific Serotonin Reuptake Inhibitors (SSRIs) helps in increasing the turnover of serotonin and this coincides with clinical improvement. Some experimental chemicals, like 'm-CPP' which reduces serotonin turnover, worsen the obsessive-compulsive symptoms.

Localisation in the brain is not conclusive. Some researchers postulate that OCD involves a brain circuit, which runs through the frontal lobe and certain basal brain structures.

Recent studies show that a small subgroup of children develops obsessive symptoms following rheumatic fever, which is caused by a bacterium called B-haemolytic streptococci.

The other well-known consequences of rheumatic fever are cardiac valve lesions and a movement disorder called chorea. It is important for paediatricians to look for obsessive-compulsive symptoms in children who have had rheumatic fever.

Treatment: Advent of SSRIs in the 1980s had a significant impact on the treatment of OCD, Medication along with specific behaviour therapy is effective in controlling the symptoms. Lack of awareness remains an obstacle that delays treatment.

(The Hindu)

Don't eat and run

If you are not used to regular exercise, don't try to run around the block immediately after that large dinner. A study of nearly 2000 heart attack survivors presented at the American Heart Association's Scientific Sessions 2000 found that the risk of a heart attack was four times greater within two hours after eating an unusually heavy meal. The researchers suggested several ways in which a heavy meal may adversely affect the heart., Eating and digesting food increases heart rate, blood pressure and oxygen needs thereby placing an extra burden on the heart.

High blood pressure may trigger the formation of a clot that in turn could block a blood vessel or increased insulin secretion following a heavy meal may affect the normal relaxation function of the coronary arteries that supply blood to the heart.

This study is one of the first to show that overeating may increase the risk of heart attack and further studies are needed to confirm the findings.

(Food Facts)

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