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| Sunday, 27 July 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius When male hormones need a boost... by Dr. R. A. R. Perera Testosterone deficiency is one of the commonest hormonal-disorders in men, affecting one in two hundred men under the age of 60 years. But it is under-diagnosed, as the presentation is non-specific. When it is diagnosed and treated it is highly effective in restoring normal sexual and overall health and potentially reducing heart disease risk. Testosterone is a male hormone, which is produced in the testicles, and its production is controlled by the brain (pituitary). The commonest condition which causes testosterone deficiency in young men, is a genetic condition called the Klinefelter syndrome. They have one extra sex chromosome (47xxy). They are diagnosed during puberty (small testicles, small penis, large breast, absence of body and facial hair in a man) or in association with infertility. A recent study in Australia suggests that as many as 75 per cent remain undiagnosed and untreated. One of the commonest causes for infertility in men is this condition. Clinical features of testosterone deficiency in adult men - . Lethargy and tiredness . Low mood . Poor concentration . Impaired short-term memory . Osteoporosis (thinning of the bones) . Loss of muscle strength and size . Enlargement of male breast(gynaecomastia) . Decreased sexual activity and impotence Total testosterone in the serum (blood) could be measured to see if there is a deficiency and this should be done in the morning. Ageing is associated with a 1 per cent annum decline in serum (blood) testosterone beginning in the thirties. It is important to note that both acute and chronic illness, increasingly prevalent as men age, result in decreased testosterone in the blood (serum). Obese men are more likely to have lower testosterone level. The role of testosterone replacement therapy in older men remains controversial. Although libido and sexual activity decline with age there is no correlation with testosterone levels. There was no effect on physical strength with testosterone treatment. But there was an increased level in the mental activity (cognition and the mood). Hormone replacement (testosterone) can be performed in number of ways. The most effective ways are as skin patches and 'under the skin' implants. Testosterone can be given as injections and oral tablets but the effectiveness is not so satisfactory. Men who are taking anticoagulants (blood thinning drugs) should be careful in taking testosterone injections. The effect of the injection usually lasts 2-3 weeks. Oral tablets should be taken for a longer duration (4-6 weeks) and should be taken with meals for better absorption. Exclusion of prostrate disease is a must before starting hormonal replacement in men. Most of the new preparation of testosterone drugs does not cause liver damage. Before starting hormonal replacement therapy, all men should consult their family physician and get their advice. The benefits of treatment in testosterone deficient men are well established. Eventhough hormonal replacement therapy for men is new to Sri Lanka; it is a well-established method of treatment in developed countries. ######## Eggs are safe and healthy to eat - says veterinary surgeon Dr. A. Nandakumar Eggs are Nature's most nutritious creation. They are rich in nutritions, inexpensive and easy to prepare. Eggs are a important source of Protein, essential vitamins and minerals and could make a significant contribution to an healthy diet. Egg protein is of high biological value as it contains all essential amino acids needed by the human body. Eggs are also low in sodium and contain 11 minerals and 12 essential vitamins. The egg is a good source of all the B vitamins, plus the fat soluble vitamin A. It also provides a useful amount of vitamin D as well as some vitamin E. The egg also provides significant amount of Zinc, important for wound healing, growth and fighting infection. Selenium an important antioxidant, calcium needed for bone and growth structure and nervous function. It is also an excellent source of iodine, required to make thyroid hormone. Eggs are rich source of lutein and zeaxanthins, two carotenoids that are yellow orange caratenoids known as xanthophythis which reduce the risk of cataract. Lutein is also being found to reduce the risk of heart disease. Cholin in the yolk supplies about half the daily needs which help the brain at all ages. The high quality of protein in an egg can reduce muscular loss in old age, while antibody production against disease was also helped by eating eggs. Recent scientific studies have shown eggs actually lower the risk of cardiovascular disease instead of contributing as a popular belief. Studies have shown increased consumption of folates effectively decrease elevated Homocysteine which is a dangerous risk factor in heart patients. Though doctors prescribe folic acid, high homocysteine has been correlated to low serum levels and low dietary intake of B12, B6 and folates. Eggs are a rich source of Vitamin B6, B12 and folates. Daily intake of eggs contributed to 20 to 30 per cent of B6, B12 and folates. Low egg consumption Among SAARC countries, Sri Lankans consume the most number of eggs, followed by Pakistan and India. It is believed that the best and cheapest source of protein is from eggs which according to the American Heart Association do not alter blood cholesterol levels. ######## Socio-legal aspects of Assisted Reproduction It appears that there are a number of couples in our country who are childless. Childlessness can be due to causes such as abnormalities in the formation of spermatozoa, fundamental infertility of the wife and even anatomical formation that may hinder or stop her from having children. Some couples are not advised to have children because of genetic reasons. For example one of them may carry a dominant or pre-eminent harmful gene or because both bear recessive characteristics. A notable example is "Down's Syndrome". Unfortunately there is still no curative treatment for this and other genetic disorders. Artificial Insemination (AIF) In countries such as America, UK and Canada there is what is termed 'sperm banking'. By this means the husband's or partner's sperm can be used by a woman even after the death of the man. The child born in this manner would have a single parent and problems may arise regarding judicial determination of a will and the right of succeeding to a title. The 'Human Fertilization and Embryology Act of 1990' found a biased solution in which the child born by his sperm after his death cannot be specifically regarded as the father of that child. Artificial Insemination by Donor (AID) is personal and secretive. It is a subject of concern just between husband and wife including a third person which can bring on a legal problem. Some strongly object to this form of insemination because there are moral and religious factors of marriage to be considered. Others believe that this form of conception affects marriage bonds because the wife was impregnated by another man and comes close to adultery. This subject was debated in a case in Scotland and it was determined that as there was no sexual conduct between woman and donor, adultery was ruled out. However USA and UK have introduced legislation controlling the extensive use of donor insemination. In vitro fertilization (IVF) The ovum is fertilised in a lab and the ensuing embryo is transferred to the uterus. Successful pregnancy and birth of the child occurs and there are no legal problems involved. Besides it is considered a natural process. This is recommended when the wife has some form of fallopian tube disease. If she ails with ovarian failure she may accept the ovum donated by another woman. In 1998, an act legislated in Australia stated that a woman who carries a child as a result of the placing in her of a donor's embryo is to be treated as the biological mother of that child. Now and again a mother of forty or over wants to gain access to motherhood. There is a strong opinion that an 'ageing mother' could be a disadvantage to a young child. Is it fair to discriminate against older women? The British Medical Association has settled the issue by supporting the procedure whereby they can have children by the means of Surrogate motherhood, also called the technique of 'womb leasing'. The older or infertile wife and her husband will come to an agreement with another woman who will carry the child conceived with the husband's semen. She should agree to yield the infant when born to its genetic parents. The 'surrogate' arrangement is complex because it also includes matters of human emotion. A few years back we were enlightened on 'sex selection of children'. There are scientific methods to alter the proportion of male and female bearing spermatozoa in a processed specimen. The stand taken on the ethical question has to be considered and this method cannot be entirely relied upon. India and Turkey have enacted a law banning 'sex determination'. - Caryl Nugara ######## Radiation and cancer therapy in Sri Lanka Cancer is on the increase in Sri Lanka. Although advances in medical science has made it possible to cure cancer if detected at early stages, it remains one of the main causes of death in the country. Dr. S.C.A. Abeyakoon, Consultant Radiotherapist and Oncologist at the National Cancer Institute Maharagama speaks to Chulika Nanayakkara on the role of Radiation and Cancer Therapy in Sri Lanka. About 0.03 per cent of the Sri Lankan population contact cancer every year. The incidence of cancer is higher in females than in males. Common forms of cancer in females are: Breast cancer 22.5%, Uterine Cervic Cancer 15.1%, Esophagus Cancer 10%, Oropharyngeal Cancer 8.4%, Ovarian Cancer 8.4%. Breast cancer - can be detected early if screening is carried out using mammography. Whilst there are several risk factors associated with breast cancer about 10% have a genetic cause. Cancer in uterine cervix is due to poor hygienic conditions and is more prevalent in low socioeconomic groups. Uterine cervix cancer can be detected early by a pap smear test. Common forms of cancers in males are: Orpharynx Cancer 26.3%, Lung Cancer 8.5%, Esophagus Cancer 8.3%, Larynx Cancer 5.6%. A major reason for cancer prevalence among males is consumption of betel, alcohol and tobacco. A lot of research is now carried out to find the cause for cancer and it is believed that some cancers could be caused by viruses specially blood cancers like Leukemia, Lymphoma and cancer of the nasopharynx. Research is also in progress to detect genetic abnormalities which result in cancers. Chemical carcinogens, radiation, hereditary factors and genetic changes are believed to be factors which cause cancers in human beings. Treatment Modern Treatment methods include: surgery, radiotherapy, chemotherapy or a combination of these is used presently. A lot of research is also in progress on immunotherapy, although it is not fully established as a frontline treatment. Surgery: is used to remove the tumours at an early stage. Surgery is usually combined with chemotherapy or radiotherapy. Cancers such as sarcomas (soft tissue tumours) are mainly dealt with surgery. For advanced oropharyngeal tumours a combination of surgery with radiation or chemotherapy would be needed. Brachytherapy is mainly used for treatment of oropharyngeal cancer and uterine cervix cancer. In early stage disease radiation can be curative. Radiation is also a very effective method to relieve pain in cancer patients with advanced disease. Chemotherapy is used as a curative treatment for blood cancers such as Leukemia and Lymphoma. In breast cancer also chemotherapy plays an important role as it can increase survival. In rare cancers such as testicular and ovarian cancers chemotherapy can achieve cures. According to Dr. Abeykoon, Atomic Energy Authority has been very supportive in providing infrastructures to improve and maintain the radiation facilities at radiation treatment centres at Maharagama, Kandy, Karapitiya (Galle) and Anuradhapura. In addition to provision of therapy machines, the AEA has provided services in the fields of personal monitoring of the staff at the cancer therapy centres, radiation monitoring of the centres, provision of advisory services, expert services and training of medical scientists, radiographers etc. From 'Nuclear News' ######## Preventing 'failures' in oral contraception When used correctly and consistently, oral contraceptives (OCs) are among the most effective reversible methods of contraception. But reported pregnancy rates during the first year of OC use are as high as 32 per cent, and a major contributing factor to these OC "failures" is thought to be missed pills. With the goal of increasing correct and consistent use of OCs, researchers are trying to determine how OC use is influenced by women's daily routines, their knowledge about OCs, and their interpretations of how OCs should be taken. Recommendations for family planning providers to help clients adhere to pill-taking regimens include: 1. Stressing the importance of a daily routine for pill taking. 2. Emphasizing that most OC side effects - especially spotting and bleeding - are transient. 3. Dispelling OC misinformation and discussing noncontraceptive health benefits of OCs. 4. Demonstrating correct use of the specific OC prescribed. 5. Providing easy-to-understand oral and written instructions about proper OC use and what to do if pills are missed. 6. Suggesting a backup contraceptive method (and providing a few condoms). 7. Telling clients how to obtain more information about OCs and their use, in case problems or questions arise later. Meanwhile, an OC initiation method called Quick Start - starting OCs while being supervised by a health care provider during the first clinic visit, regardless of the time in a woman's menstrual cycle - may also improve OC continuation rates. Courtesy: Family Health International |
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