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| Sunday, 24 August 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Towards a measles free world Measles remains one of the major causes of illness and deaths in South Asia. The Health Ministry is currently spearheading an islandwide Measles immunisation program to immunise schoolchildren between the ages of 10-15 years. The programme which began in June initially covered the North Eastern Province. Next month, the program will be extended to other parts of the island, starting with Colombo schools. In all 2 million children aged 10- 15 will be covered by the Measles Catch-up programme which will start on September 5. Dr. Sanath Lamabadusuriya, Dean of the Faculty of Medicine and Professor of Paediatrics, University of Colombo, speaks to Carol Aloysius on why the program has been initiated and the effects of measles especially on children. Q. The schoolchildren you have targeted have already received a measles vaccine at the age of 9 months. So, why is it necessary to give them another dose of the same vaccine?
Q. What caused them ? A. There are several reasons for these outbreaks. One is although the first dose of measles vaccine is given at 9 months, the vaccine efficacy is estimated to be approximately 90 percent due to the presence of maternal antibodies against measles at nine months of age. This means that 10 percent of those who receive the vaccine do not develop an adequate immune response and remain susceptible to the disease at a later stage. Furthermore, the antibody levels of some of those who sero-convert following immunisation with the measles vaccine at 9 months, may decline over a period of time and so may not be sufficient to provide immunity. Finally, if the coverage is less than 100 percent, it means that some children have not received the vaccine at all. Q. Why target the 10-15 year group? A. Actually, we are targeting a wide group - upto 19 years. But initially, this year only school going children between 10-15 years will be immunised. Next year we shall be extending the program to include adolescents upto 19 years. The reasons we have chosen this age group is because in the last epidemic of measles in 1999 almost 48 percent of the cases were from the 10-19 age group. This means they are the most vulnerable group. Q. Of these two groups which age group is most at risk of getting complications following an attack of measles? A. The younger the child the greater the risks of developing complications. Generally the complications are less in a school going child than in a pre-schooler, and even less in older persons. Q. What kind of complications are very young children likely to develop? A. Pneumonia, especially staphylococcal infection that affects the lungs. Another complication is Middle Ear Infection or Otitis Medi A. Additionally, around 20 percent of children with measles get diarrhoea which can lead to dehydration and if untreated can cause death. Q. Any other complications? A. They can also get Encephalitis or Brain Fever although this is very rare. Another adverse fall out of the disease is Optic Atrophy leading to blindness. Q. Who is most at risk of this particular disease? A. In malnourished children having a marginal vitamin A deficiency, measles can exacerbate this deficiency, causing Keratomalacia and corneal damage leading to blindness. Q. Can one get measles after this second dose? A. Rarely. Q. It has been said that when a child receives a measles vaccine, he sometimes develops measles-like symptoms. Is this true? A. The measles vaccine is a live attenuated vaccine but it is less potent and so does NOT cause the disease. But some children can develop a rash and fever similar to measles in a mild form and without complications such as pneumonia in the case of measles. This fever however will last only for a few days so will the rash. So parents should not be worried. Q. What advice can you give when treating a patient with measles at home. A. FIRSTLY don't let him go outside the house as he can infect others especially very young children. SECONDLY, if he develops fever simply give him paracetamol to bring down the fever. If he develops a cough give him a cough syrup. But DON'T give him any antibiotics as measles is a virus and antibiotics have no effect on a virus. Q. As the campaign you are carrying out in the next two months is a school based program, what about children who do not go to school for various reasons? A. We have lists of their names and we shall be visiting their homes personally to see that they too are immunised. Q. How do you expect to achieve your target within this short space of two months? A. We have everything in place. All we need is the fullest co-operation of the parents and children. ###### Piles If left untreated piles could seriously undermine your health, says Dr. Sampath R. Nanayakkara in the following article. All bleeding conditions of the lower passage of the bowel are not "Piles." The common man calls it piles but the surgeon call it "Haemorrhoids." In latin piles means "a ball." Piles are also a type of varicose veins (what you get in your legs) but occurring in the terminal part of your bowel, originating in the network formed by veins draining blood from that area. Two different situations are identified in relation to the anal Orifice. Internal and external piles Piles may be found as a symptom of some other disease. e.g. (1) Cancer of the rectum, in which case the compression of the cancer mass on the Rectal vein, gives rise to "piles." That is why the symptomatic treatment for bleeding piles is very dangerous, and a thorough examination of the anal canal and rectum manually is a must. During pregnancy the bulky uterus can compress the same veins and produce "Piles": also hormones play a part. Rarely, straining on urination consequent upon a block in the urinary passage can cause piles. Internal Piles Internal piles or Haemorrhoids are exceedingly common in human beings. Piles is frequently seen in the same family over generations. So it could be due to hereditary factors. Varicose veins of the legs and "Piles" often occur together. Straining accompanied with constipation or that induced by over-purgation with drugs is known causes of piles. Symptoms Bleeding is the most common and earliest feature. At the beginning bleeding is slight and not very frequent, it is bright red in colour and occurs only during defecation - like a splash. Patient may go on like this for years. After some time the "pile mass" may protrude further down, sufficiently to be nipped by the anal sphincter (i.e. a ring valve like structure) for a moment at stool by the patient himself. This is the stage of "First Degree Haemorrhoids." Once the faeces has passed the reduction of protruded pile mass is spontaneous. As time goes on, the Pile mass does not reduce itself, but has to be pushed in manually by the patient using his finger. This stage of the disease is called "Second Degree Haemorrhoids." Still later, the protrusion of the "Pile Mass" occurs apart from passing stools, other times of the day when the patient exerts himself. This stage when the pile mass" is permanently protruded out the anal canal is called "Third Degree Haemorrhoids." A whitish discharge from the anal canal which soils the clothes of patient is a very common feature. Itching of the area is almost certainly present. Pain is usually absent. The instrument that used to examine the piles by doctors is called Proctoscope. Profuse bleeding is not rare. But continuous slight bleeding for a long period may cause severe "Anaemia" later on. Strangulation of the protruded pile mass by the sphincter of the anal canal (i.e. gripped by the ring valve like structure) is one of the dangerous acute complication. Ulceration of the pink colour exposed skin of the "Pile Mass" is also another complication. "Pile Mass" may become infected by germs, but this is a rare occurrence. Gangarene formation or death of the affected part of the anal canal due to constriction of the blood supply (Arteries) is another major complication. Treatment In First Degree and Second Degree of the disease ointment, creams and suppositories are helpful to overcome the discomfort. Injection treatment is also very effective for the First and early Second degree Haemorrhoids. For the 3rd degree Haemorrhoids and failures of the conservative treatment, the only answer is surgical treatment - "Haemorrhoid Ectomy." ###### When your voice becomes a growl... Hoarseness Few people recognize what complicated machinery is required in human voice production. It is amazing how well for most of us nature keeps the voice in operation day after day, month after month, and year after year. On the midline of the neck between the chin and the collar-bone, there is a prominent projection sometimes called the Adam's apple. It is more noticeable in men than in women. You can feel its excursion up and down by placing your finger on it as you swallow. It is the site of the voice-box, the larynx, which is the gateway to the lower air passage. There are four pairs of muscles and one single muscle within the voice-box. Two ribbon like muscles are placed one on top of the other, stretching from immediately behind the Adam's apple to the back wall of the voice-box. These muscles are vocal cords. The movements of the vocal cords are under the control of the speech centre in the brain. The examiner, by aid of reflected light on his head mirror, can observe the intricate movements of the muscles of phonation (the utterance of vocal sounds) and respiration. One of the disorders of the larynx that brings the patient to a specialist is hoarseness. Webster defines hoarseness as having a harsh, grating, discordant, raucous, rough, and gruff voice. Thus we see there are several degrees of hoarseness. Also there are several causes of this condition. Disorders of the larynx may be acute or chronic. They may be caused by infection, chemical irritation, dust, vocal strain, mechanical injury, and (secondarily) malfunction of bodily mechanisms. Hoarseness associated with an acute head cold is familiar to everyone. It usually is ushered in with a rise in temperature and generalized discomfort. Sometimes there is pain, prostration, and hoarseness. It lasts two or three weeks when there are no complications. Syphilis and tuberculosis of the larynx are still prevalent in some areas of the world where social and economic states are below a proper standard of sanitation and hygiene. These diseases are among the prominent factors causing hoarseness there. Injury to the voice-box in an automobile accident, from a gun-shot wound, or from a blow to the neck sometimes causes a serious form of laryngitis associated with hoarseness, even suffocation. Public speakers and other people who do work that demands excessive strain on the vocal cords develop at times a husky voice. A thirty-year-old lecturer was in the habit of speaking loudly and with much force. Eventually he developed an ulcer of the larynx in the area where the two vocal processes meet. This condition is known as a contact ulcer. Surgical removal of the growth was successfully performed, and his voice was restored. Both benign and malignant tumours develop in the larynx, causing an unpleasant voice. A wartlike growth on the vocal cords known as a papilloma appears in adults and children. It tends to be implanted in any part of the airway. Papilloma in children has a remarkable capacity for recurrence after surgery. Another interesting feature of papilloma in children is its complete disappearance as the patient reaches the age of puberty. Cancer of the larynx is relatively rare. Unless the tumours are completely removed they tend to spread, and there is a high death rate. In the early stage of larynx cancer the voice sounds much like that of a cigarette smoker. Herein is its danger. The patient's family and friends may recognize the altered voice, but the speaker too often falsely attributes his voice change to his smoking habit. Thus he delays the needed specialist's examination, highly important in establishing early diagnosis. When the growth is limited to a small area in the larynx it can be dealt with by either X-ray or surgery. If the tumour is too extensive, the only known treatment is complete removal of the larynx before the cancer spreads. There are several shades of voice change in laryngeal cancer. Such changes are nature's warning for quick action on your part. Anyone who has an alteration in his voice production should seek the advice of a competent throat specialist. He may be harbouring cancer of the larynx. There is no substitute for competent examination of your voice-box and biopsy of a growth by a trained pathologist. Medical science has also unmistakably proved that cigarette smoking is one of the potent factors in causing cancer of the larynx and lungs. If you want to save your life, stop smoking. Courtesy: Herald of Health ###### Post-traumatic stress disorders Ever suffered from a life-threatening experience such as floods, earthquake, a bomb blast or fire or even being raped or witnessing a murder? - by Dr. R. A. R. Perera, Consultant Psychologist. You could become a victim of Post-traumatic stress disorders. It is a common occurrence in people who have undergone a life-threatening incident. A life threatening condition could be a natural disaster like floods, earthquake, fire, or an incident like a bomb blast, an accident, rape, attempted murder, or witnessing a murder taking place etc. This could be an incident, which can happen to the patient or one that the patient has witnessed happening to a person close to him or her. This can cause immense problems to him or her and to his normal lifestyle. Post-traumatic stress disorder does not happen to all the individuals who have undergone this life-threatening event. Vulnerability to Post-traumatic stress disorder Perceived threat to life and personal safety at the time of a traumatic event. When a person undergoes this traumatic experience he or she shows specific psychological symptoms, which is characteristic to post-traumatic stress disorder. How to diagnose post-traumatic stress disorder A life-threatening event outside normal human experience Re-experience the trauma - intrusive memories - repeated thinking about the incident, Dreams/nightmares, Flashbacks - sense of reliving the event, Distress at exposure to 'resembling events'. Avoidance of stimuli associated with the trauma Evidence of increased arousal-sleep disturbances, Irritability, Hyper vigilance, Exaggerated startled response Duration for more than a month In Sri Lanka, most of the people who have this disorder presents themselves as if having a physical problem and are generally treated by physicians. These patients do not want to label themselves as having a psychological (mental) disorder as this often leaves behind a stigma. It is very important to educate and direct these patients to a psychologist so that they can be evaluated and be treated accordingly. Established treatment up to now Psychological therapies - establish a good therapeutic relationship with the patient. Group therapy - particularly useful when dealing with the victims of a shared trauma e.g. Combat, disaster rescue workers. Dynamic psychotherapy - early developmental experiences are explored in depth. - Has been widely advocated particularly for victims of multiple trauma. Cognitive techniques and exposure based behavioural techniques - e.g. Audiotape desensitization (tape the conversation as he/she describes it and playback the tape frequently in the subsequent days) Drug treatment - although drugs alleviate some of the symptoms of post-traumatic stress disorder, they are not, in general effective following acute post-traumatic stress disorder, and are of particular benefit in reducing 'positive' symptoms e.g. Nightmares, intrusive thoughts. Depression and other psychiatric disorders are also indication for drug treatment. These drugs include antidepressant and anti-anxiety drugs. Drugs generally need to be used in higher doses and for a long duration (One year or more, than in the treatment of normal depression). There may be a latent period of eight weeks or more before the effect of drug treatment are seen. A variety of psychological interventions and drug treatments have been shown to relieve at least some of the symptoms of post-traumatic stress disorder. |
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A. To give them a second chance. Inspite of the fact that measles
vaccine is part of the Expanded Program of Immunisation (EPI), there have
been at least two outbreaks of the disease in epidemic proportions, during
1990 when 4000 cases were reported, and in 1999 when as many as 15,000
suspected cases were reported.
