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| Sunday, 30 June 2002 |
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Features |  |
| News Business Features Editorial
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Smoking Making a sinister comeback by Don Asoka Wijewardena Around 23,000 people die of smoking-related diseases in Sri Lanka per year, whereabout Rs 66 million is spent on tobacco annually. Over 50 people between the ages of 40 to 60 die of smoking-related complications in Sri Lanka everyday, endorsing the WHO warning that tobacco will soon become the leading cause of death worldwide. Dr. Kumar Weerasekara, Senior Clinical Oncologist attached to the Maharagama Cancer Institute in an interview with the Sunday Observer spoke on the health hazards of smoking and its current trends. Excerpts of the interview: Q. many people die of tobacco-related diseases in Sri Lanka despite the fact that they are aware of the fatal effects of smoking. How do you see this problem? A. Smoking is especially high among the low-income groups and around 50 people between 40 to 60 age group die of lung cancer and heart diseases every day in Sri Lanka. And also around 23,000 people die of vascular diseases and lung cancer for a year in Sri Lanka and there are about 1.5 million regular smokers in the country. Q. What are the fatal effects of smoking? A. Tobacco contains nicotine, a drug which is a stimulant and can be addictive, as well as tar and other toxic substances. Smoking has been proved to cause lung cancer and cancer of the mouth, larynx, esophagus, vascular diseases and chest diseases,such as bronchitis and asthma. Q. What are the commonest diseases in smokers? A. What most smokers don't realise is that smoke curling from the tips of their cigarettes doesn't just disappear. It leaves behind a mixture of chemicals, many of them potentially deadly, including at least 43 known chemicals that can cause cancer. The commonest diseases that smokers are get bronchitis, emphysema, lung cancer and diseases of the circulatory system. Q. In Sri Lanka is smoking on the increase or decrease? A. Although smoking trends in Sri Lanka was on the decrease a few years ago, there has been a resurgence since the year 2000 as teenagers have taken to smoking. The adolescent smoking rate has been going up because tobacco companies are enticing the younger generation to smoking through attractive advertisements and sales promotional campaigns, resulting in a new trend of smoking among teenagers. A research carried out by the Alcohol and Drug Information Centre shows that the more you advice the young on dangers of smoking the more they become habitual smokers. They treat health advice as a symbol of fun. Q. What are the dangers of passive smoking? A. Passive smoking has become a major health threat to other people, because each time a smoker draws on a cigarette, the temperature of the burning tobacco incinerates a certain percentage of the chemicals that otherwise would have entered their lungs. So, non smokers are at greater risk because of the volume they inhale. Exposure to environmental tobacco for non-smokers is estimated to be roughly a 100th the amount from direct exposure by smoking. Q. How does passive smoking affect children? A. Medical experts believe that the risk of Sudden Infant Death Syndrome (SIDS) is triple if mothers smoke during pregnancy, and double if the child is exposed to cigarette smoke after birth. All of the diseases associated with passive or involuntary smoking, SIDS has one of the highest risks. Breathing in cigarette smoke lowers a child's resistance to certain viral and bacterial infections. Due to passive smoking asthmatic children get life-threatening attacks of desperate wheezing and coughing. Q. Has the Ministry of Health started educational and awareness programs on hazards of smoking ? A. Yes. The Ministry with the assistance from the private sector has commenced anti-smoking campaigns, with the participation of youngsters who are ex-smokers, as lecturers. These young men and women are better at convincing others on the deleterious effects of smoking. Most public and private sector organisations have banned smoking at working premises and it is everybody's duty to discourage smoking habits of people, especially teenagers. If smoking is eliminated 30 per cent of the non-communicable diseases can be prevented. Of the 12,000 cancer patients detected annually in Sri Lanka about 60 per cent diseases are tobacco-related. We need to have stringent regulations to control massive advertising campaigns launched by tobacco giants and it is advisable to provide effective educational programs to students on the "dangers of smoking". Fevers - a symptom of many illnesses by Dr. Sampath R. Nanayakkara (Family Physician) Fever is not a disease or an illness, but a symptom of many illnesses. What is fever? It is simply an indication that the body is generating heat faster than it is losing it. Most people believe that higher the body temperature graver the illness, but it is not so! Is fever a friend or foe? This is a question worth being discussed at a time where viral fevers like Dengue etc. are prevalent in epidemic levels. The normal body temperature is round about 98.4 degrees Fahrenheit when taken in the mouth. A rise in temperature is the usual reaction of the body to the presence of some substance to which it objects. Most commonly the substance is a germ like bacteria or virus, but an allergic cause is also a possibility. Your body has a remarkable HEATING SYSTEM. The temperature in your body is maintained by the heat generated by burning of the food you eat. The whole system is under the control of a SPECIFIC organ called Hypothalamus which is located under side of your brain. This is the "Body thermostat". When it is pushed high there is fever. What Induces Fever? By far the commonest cause of Fever is viral/bacterial infection. Doctors believe that bacteria and virus, attack the white blood cells, releasing fever producing chemicals called Pyrogens which initiate the body Thermostat (Hypothalamus) into action. Other causes of fever are Brain injury, tumours of the body (i.e. Cancers) and anxiety in children who are frightened. Are Fevers harmful? Some fevers are clearly dangerous particularly those caused by Brain injury, Tumours and rarely sunstrokes. Fevers following heart attacks are also life threatening. When you have fever the cellular activity of the body may be greatly increased, demanding more oxygen and nutrition, thus there is an added load on the already damaged heart muscle. On the other hand fever may be a valuable defence to the body to overcome its commonest causes, i.e. infection by germs - colds, sorethroats, 'flue' etc. It stimulates the body to produce more and more "bacteria-fighting" white blood cells and "bacteria-killing" antibodies. Research has shown that it increases the production of a hormone called ACTH, which in turn combats the stress brought up at the same time by the illness. It also enhances the action of some antibiotics. Since fever is not a disease but a symptom of a trivial or dangerous disease, giving temperature reducing drugs without properly finding out the cause is a grave mistake. In fact over dosing of some anti fever drugs by over anxious parents may damage the liver permanently or cause bleeding. Speaking mainly of childhood fevers, Anti Fever drugs therapy is for the benefit of the Anxious parents or the doctor than the child. It is doubtful whether the body temperature in the range of 101 degrees F - 102 degrees F is harmful, without any underlying "signs," even if prolonged for several days. "Symptom Fever" may be the only available sign for following up the course of an illness as many diseases have their own temperature patterns. For example, Malaria has a relapsing pattern (i.e. temperature swing in every 2nd day), Typhoid has step ladder pattern, viral fevers continuous temperature, tuberculosis - evening temperatures etc. What are safe limits for fevers? No clear cut answer. Human beings rarely survive temperatures above 109 degrees F. Anyway the body has some emergency mechanism to face such a situation. Patient becomes drowsy, blood flow to the surface of the body increases and patient starts shivering and sweating profusely producing a cooling effect. High temperature does not necessarily means that the patient is serious. On the other hand low temperature does not mean the condition is only mild. A child can have a temperature of 103 degrees F with Measles but recover, in a matter of days where as more serious illness like Meningitis (Brain Fever) the temperature may not exceed 100 degrees F. How to measure temperature? By Thermometer, under the tongue for adults, for children under the arm pit should be kept in place for 1/2 to one minute. Due to the advancement of medical science many rules regarding the management of fevers have been changed. Instead of starving the fever patient today's rule is a high protein, high vitamin diet with plenty of liquids the patient can take. Instead of covering the patients with blankets today's rule is to loose clothing, tepid water sponge and stay under a fan or open room. Avoid giving antibiotics until at least a tentative diagnosis is made. If Paracetamol is being given, adjust dose strictly according to the body weight. Avoid Aspirin in children and in whom the fever is suspected to be dengue. Avoid rectal suppositories as much as possible. You and your doctor... Q. My 2nd child who is now 2 1/2 years old developed fits all of a sudden and I had to rush him to the hospital where he was resuscitated by the OPD doctor and was warded for 3 days. After having done some tests the child was discharged without any medicine, but issued a diagnosis card - stating he had 'Febrile fits'. What is the meaning of this term? Will it occur again in the future? If so, why wasn't he given any medicine on discharge? Please explain. - A worried parent A: Your child has had a fit due to rise in body temperature. Children below five years old are specially prone to this illness. This is because at this age group the child's brain is unusually susceptible to a sudden rise in body temperature. About 10 per cent of children have at least one such fit during their early years. By the age of 5, a majority of the children develop resistance to this. Getting febrile fit doesn't mean that they will suffer from epilepsy in late life. In fact, most children who have had one febrile fit will never have another. Many infections of the throat, ears, chest or urinary tract can lead to a febrile fit if the temperature rises too high, too quickly. It is one of the most frightening illnesses for a mother. But do not panic. Do not attempt to restrain your child's movements. Remove any sharp objects - toys, furniture etc. from the immediate vicinity to avoid possible injury to the body. Never attempt to put anything in the mouth. Turn the child gently on his side while straightening of his neck to facilitate breathing. Keep airways clean. Loosen his clothing and sponge him down with tepid water. Do not attempt to give anything by mouth. Take him to your family doctor in the same position. To prevent future attacks keep him generally cool whenever he has fever. Dr. Sampath R. Nanayakkara Mukunuwenna vs Alligator weed Considerable anxiety was expressed in recent times by consumers throughout the country about a kind of weed resembling the local favourite leafy vegetable 'Mukunuwenna' and health consequences of its consumption. Most consumers steered clear of 'Mukunuwenna' since differentiation between the two plants is said to be rather difficult. Here are some facts and method of identification of the weed and 'Mukunuwenna'. The incriminated weed, commonly known as the Alligator weed belongs to the family Amaranthacea (Alternathera philoxeroides). Its leaves are opposite, elliptical 4.5 cm in length and 1.5 to 2.5 cm in breadth. It has glossy sheen leaves (dark green waxy leaves) shaped like spears, stumps are somewhat leathery and hollow unlike in normal cultivated 'Mukunuwenna' (Alernanthera sessilis) stumps. Flowers are large (10 mm), white in colour, carried at the end of stumps. Flower stalk is visible and 1.0 to 1.5 mm in length. Flower heads are shaped like balls and found only in mature stumps. Flowers of 'Mukunuwenna' are smaller than those of Alligator weed - less than 5 mm and carried in clusters at leaf joints along the stumps (absence of stalk). Alligator weeds are potential danger to health unlike 'Mukunuwenna'. It accumulates hazardous heavy metals which stay in the body. These metals including cadmium and copper cannot be processed by the body and if enough accumulates can damage vital organs. Alligator weeds contains moderate levels of poisonous calcium oxalate crystals. Health experts believe that extended use of Alligator weed dishes could lead to cancers. Consumers are therefore advised to select the right variety using the comparisons. (Fig. 1 and 2) Courtesy: Hordi and Agnote Australia |
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