Influenza A(H1N1) under control - Health authorities

Influenza A (H1N1) virus is a subtype of the Influenza virus A and the most common cause of influenza (flu) in humans. Some strains of H1N1 are endemic in humans and cause a small portion of all influenza-like illnesses and a large portion of all seasonal influenza. H1N1 strains cause roughly half of all human flu infections and other strains of H1N1 are endemic in pigs (swine influenza) and in birds (avian influenza).

In June 2009, World Health Organization declared that flu caused by a new strain of swine-origin H1N1 was responsible for the 2009 flu pandemic. This strain is often called "swine flu" by the media.

According to Chief Epidemiologist, Dr. Paba Palihawadana, Swine Influenza is a respiratory disease of pigs that is caused by 'type A' influenza virus. From March 17th to April 25th 2009, 878 cases of swine influenza with 60 deaths were reported in Mexico. A total of 7 laboratory confirmed cases have been reported in USA and it was discovered that a new strain of influenza virus sub type A/H1N1 was responsible for this outbreak.

Influenza A virus strains are classified according to two proteins found on the surface of the virus which are hemagglutinin (H) and neuraminidase (N).

All influenza A viruses contain hemagglutinin and neuraminidase, but the structures of these proteins differ from strain to strain, due to rapid genetic mutation in the viral genome.

In Sri Lanka, Influenza A9 (H1N1) has already affected many who bring it in through their only airport at Katunayake while sea transportation is never used.

"The World Health Organisation (WHO) has commended Sri Lanka's preventive mechanism on the Influenza A9 (H1N1) since we have a minor number of cases that had been promptly treated compared to the devastating 4000 deaths around the world," said Dr. Palitha Mahipala, Deputy Director General, Health Services (Public Health) of the Ministry of Health.

"There is a fair degree of sensationalised reporting that A9 (H1N1) is deadly with people dying tragically but it isn't so. Even though we just had 115 cases in Sri Lanka so far, we have treated the patients swiftly" said Dr.Mahipala. Talking about the stringent methods in place for Influenza A9 (H1N1) detection, Dr.Mahipala said that it was because at the point of entry, the flu is detected. "The moment a tourist or Sri Lankan enters the country, we have a two thermal scanners to check for any sign of fever. If a temperature change is detected, we will get the person for an interview," he said. There are PHIs(Public Health Inspectors) at the airport all 24 hours to do rigorous checking, who have been given the required training and skill to identify if a person has flu symptoms. "If the person has normal flu symptoms, we treat it like an Influenza A9 (H1N1) case, isolate him and screen him to determine the exact cause" said the Deputy Director. In addition to this, every person arriving at the Bandaranayake International Airport is given a form to fill the details of the country they came from and if they have any symptoms of the Influenza A9 (H1N1). The Deputy Director said that some can carry the infection but not have symptoms which would explain how the children in the Kandy and Nugegoda schools would have caught it. "In severe cases, the flu can affect the risk group encompassing young children, elderly people with sicknesses and pregnant women" Dr. Mahipala pointed out.

However, Sri Lanka has done well despite the rapid outbreak of the disease in the South East Asian region. "When countries like India, Malaysia and Thailand had been having plenty of Influenza A9 (H1N1) cases, Sri Lanka had been effective in preventing the spread of the flu" said Dr. Mahipala.

The Deputy Director attributed the success of Sri Lanka's strategy to three aspects. "The first is we have a strong surveillance mechanism, suspected cases are quarantined and then treated promptly" he said.

"In Sri Lanka, we have strengthened the isolation facilities of the 20 major hospitals and the IDH (Infectious Diseases Hospital) is equipped to handle serious cases" said Dr.Mahipala. Further he commented, "Some cases need to be treated with anti-viral drugs while others wouldn't have to take drugs." Critical cases would have an advisory committee to look into matters and quick action will be taken but so far, Sri Lanka has effectively managed to deal with the Influenza A9 (H1N1) disease.

"For the schools we have islandwide programs done by our field officers to help children understand more about the Influenza A (H1N1) disease and how they can prevent the spread and receive the best treatment" said Dr.Mahipala. He said that personal hygiene should be observed and if people sneeze, they should cover their nose and mouth. In the case of an infected patient, he should take plenty of bed rest by staying at home without infecting others.

"If fever persists for three days, medical advice should be sought from a qualified practitioner," he said. The standards and methods adopted by doctors in treating such cases conform to WHO standards. For delivering the message through the media, the Ministry organised two media seminars in creating awareness among the general public on how best they can diagnose and treat Influenza A9 (H1N1).

After Sri Lanka detected its first Influenza A9 (H1N1) case where the victim was a boy coming from Australia, the preventive measures have become better than before. "With the sudden influx of tourists, especially after the peace, until October 15th, we have only recorded 115 cases which have been treated quickly. "If we didn't have a good strategy to detect and treat the disease, we would have got more cases which would have resulted in deaths but it proved that Sri Lanka's A9 (H1N1) outbreak is very much under control" said Dr.Mahipala.

He added, "Often, people in Sri Lanka think of the dramatic figures of Influenza A9 (H1N1) internationally and imagine the worst but we should change the misconception and say that we are ready for anything."

The Airport & Aviation Services have invested in the best scanners to detect communicable flu under the advice of the Health Ministry. In their website, they have a special statement with regard to Influenza A9 (H1N1) which is: In connection with the outbreak of Influenza A9 (H1N1), all passengers arriving from influenza affected countries, will be asked to report to the relevant desk to record personal details and verify from the authorities whether they are not suffering from any symptoms of Influenza A9 (H1N1)".

In conclusion, Sri Lanka's Health Ministry is doing every thing possible to prevent Influenza A9 (H1N1) and to ensure that people are educated in all aspects pertaining to Influenza A9 (H1N1).

"Our health standards are unmatched with any other country in the South East Asian region because we always go to the grass roots level to tackle a problem. So we hope we have the trust and faith of the people because it is their health which is at stake" concluded Dr.Mahipala.

(ND)

'Mother can rarely pass cancer to her unborn baby'

by Madeline ELLIS

The placenta is an unborn baby's lifeline. Attached to the inside of the uterus and connected to the foetus by the umbilical cord, the placenta works as a trading post between the mother's and the baby's blood supply. Oxygen and nutrients in the mother's blood pass across the placenta to the foetus, and metabolic wastes and carbon dioxide from the foetus cross in the other direction. The placenta also helps protect the baby from infections and potentially harmful substances, but it's not a foolproof filter. Other substances, such as alcohol, drugs, and cigarette smoke can also cross the placenta, with effects including congenital disorders, drug addiction, and foetal alcohol syndrome in the newborn. And scientists have long suspected that cancer can cross the placental barrier and spread from the mother to her unborn child, but have had no proof-until now.

Researchers at the Institute of Cancer Research, a college of the University of London, working with colleagues in Japan, studied the case of a 28-year-old Japanese woman who gave birth to an apparently healthy baby girl after a normal, uneventful pregnancy. A month later, the mother developed vaginal bleeding and was diagnosed with acute lymphoblastic leukemia. She began chemotherapy but developed encephalitis and died 19 days later. The baby showed no signs of illness until she was 11 months old when she was taken to the hospital with a swollen right cheek. Tests revealed she had a tumor in her jaw and the cancer had spread to her lungs.By comparing DNA from the mother's bone marrow to that of the baby, the researchers were able to determine that the cancer cells of both mother and child shared the same mutated gene, called BCR-ABL1, but the baby had not inherited the gene. Subsequent testing of a neonatal blood sample taken from the baby confirmed that the cancer had spread before birth.So how could this have happened? Normally, if the cells crossed the placental barrier, the baby's immune system would have recognized them as foreign invaders and destroyed them, which is why mother-to-child cancer transmission is so rare. But in this case, the baby's tumor cells were missing a vital piece of DNA that plays a key role in immune system function. Without this, the cancer cells were able to pass through undetected.

"It appears that in this and, we presume, other cases of mother-to-offspring cancer, the maternal cancer cells did cross the placenta into the developing foetus and succeeded in implanting because they were invisible to the immune system," said lead researcher Professor Mel Greaves. "We are pleased to have resolved this longstanding puzzle. But we stress that such mother to offspring transfer of cancer is exceedingly rare and the chances of any pregnant woman with cancer passing it on to her child are remote."

Records dating back to 1866 include 17 cases where a mother and infant appeared to share the same cancer, usually leukemia or melanoma.

And while the most likely explanation was that it spread to the infants during pregnancy, other scenarios were theoretically possible. "People have believed that this has been the case for some time. This is really crossing the T's, dotting the I's and showing that that's really the case," said William H. Chambers, scientific program director at the American Cancer Society.

Health News

Advanced dementia redefined as a terminal illness

By Drucilla DYESS

Although early-stage dementia emerges as a memory disorder that commonly affects the ageing mind, the end-stage effects are extensive and the illness is terminal.

Based on new research, experts have redefined advanced dementia as fatal failure of the brain.The study revealed that patients who reach the end stages of dementia need comfort and care, but not aggressive intervention that offers no hope of improving patient outcomes.

Lead study author Dr. Susan L. Mitchell from the Hebrew Senior Life Institute for Ageing Research in Boston, said that dementia currently affects approximately 5 million Americans, and the number is expected to triple by 2050.

Mitchell also pointed out, "Dementia is a leading cause of death in the U.S., and yet surprisingly little is known about how these patients die."

To learn more about what happens during the advanced stages of dementia, the researchers conducted an analysis of 323 advanced dementia patients in 22 nursing homes.

According to Mitchell, the patients included in the study were unable to recognize family members, and were unable to speak six words. In addition, they were incontinent and totally dependent on other people for their most basic care.

The researchers tracked the progression of the disease, as well as complications and survival rates. In addition, they recorded the treatments received by the patients, their prognoses, and the understanding of advanced dementia among their caretakers.

The team found that many family members of patients with end-stage dementia don't view the condition as terminal. Therefore, aggressive interventions such as feeding tubes are often ordered when there is actually no hope of improvement, and sadly, patients suffer the consequences. Mitchell explained,

"When families are more prepared, their loved ones get less burdensome interventions." She said that only 27 percent of study patient's families understood that end-stage dementia was terminal, and were aware of the possible occurrence of complications such as fever, pneumonia or an eating problem.A total of 55 percent of the patients died during the 18-month study period. Of those, almost half occurred within the first six months of the analysis. The median survival period was 478 days, which is similar to that of terminal-cancer patients.

A total of 31 patients suffered major health events, including seizure, gastrointestinal bleeding, heart attack and stroke. However, only in rare cases did the events end in death. The most common complications related to death were pneumonia, fever, and eating problems.

Nearly half (46 percent) of patients experience shortness of breath, while 39 percent experienced pain. In addition, over 40 percent underwent at least one serious medical intervention including a visit to the emergency room, hospitalization, or tube feeding.

According to Mitchell there is much room for improvement in the communication between families and care providers. In addition, she believes that nursing home residents who suffer from dementia should be able to receive high-quality palliative care and hospice care as readily as those people who have other terminal illnesses. Regarding the study results, she concluded, "Our main findings confirmed dementia has high mortality. People in the study didn't have other devastating things happen to them before they died."

-Health News

Do's and don'ts for a patient with angina

By Dr. D. P. Atukorale

Thousands of Sri Lankans have some form of heart and blood vessel disorder including angina pectoris. If you are suffering from angina the first step you should take is to see your family doctor who will know how to treat your angina. The purpose of this article is to provide general guidelines for living with angina.

The heart and how it works

The beat of the heart is synonymous with life itself starting in the embryo within the first month of foetal life and continuing without rest throughout life. The heart is a very strong organ which is of the size of a large fist; most of its bulk is the muscle. Its one job is to pump blood into the arteries. Every cell in the body depends upon the circulating blood stream for oxygen and nourishment and for removal of the wastes. For a heart beat rate of 70 beats per minute, the human heart contracts 37,362,000 times a year.

Your heart normally rests twice as much as it works. During periods of strenuous physical activity or emotional stress, the heart may beat twice as fast as usual and pump twice as much blood. Faster the heart beats, less time it has to rest. Most hearts can endure great physical exertion without difficulty.

As the heart beats, it goes through 2 distinct phases known as systole (period of contraction and emptying) and diastole (the period of relaxation and filling).

When your doctor takes your blood pressure (B.P.) reading, he records 2 figures, one called systolic blood pressure (when the heart pumps) and diastolic B.P. (when the heart pauses between contractions; for a Sri Lankan adult the normal systolic B.P. is usually about 110 mmg Hg to 140 mm Hg and diastolic B.P. is about 65 mm Hg to 85 mm Hg.

The heart muscle is a strong active muscle as it pumps day and night and needs its own blood supply to function smoothly. The blood that flows through the chambers of the heart does not supply blood to the heart muscle itself. This task is handled by 2 coronary arteries (the right and left coronary arteries).

The coronary arteries and atherosclerosis

Angina pectoris is not so much a disease of the heart muscle itself and it is considered to be the result of a condition of the arteries supplying the heart muscle with blood (coronary arteries). The coronary arteries (and other arteries) undergo a process of hardening called atherosclerosis in which, deposits of fatty substances get deposited in the inside lining of the blood vessel wall. These fatty substances such as cholesterol start to collect in the inner lining of the arterial walls and as a result, the channel through which blood flows gradually narrows, in the same way as deposits of rust clog water pipes.

Atherosclerosis may begin to develop at a relatively younger age and may show symptoms such as angina at middle age or later.

Certain coronary risk factors play a role in the development of atherosclerosis. These are cigarette smoking, hypertension, high blood cholesterol, diabetes, lack of exercise, obesity, hereditary traits, stress and high blood levels of homocysteine (Homocysteinaemia). We sometimes come across heart attack patients without any of the above risk factors.

What causes anginal pain

Angina pectoris is a symptom of coronary atherosclerosis. Pain or tightening or heaviness of chest (or upper abdomen) are the outstanding clinical manifestations. Angina is due to deficiency of oxygen to the heart muscle (myocardium) due to narrowing of the coronary arteries.

Angina is usually precipitated when sudden extra demands are made on the heart (through exercise, overeating or emotional stress) that the artery narrowed by atherosclerosis may not be able to supply the sudden need for extra oxygen - carrying blood. When the patient stops or relaxes, the chest discomfort disappears as the extra need for blood ceases or arterial spasm ends.

The medical management of angina

The medical management includes 2 subdivisions (a) medication your doctor will prescribe for you and (b) advice and suggestions about your future activities.

Drug therapy for angina has 2 primary goals (a) rapid relief of the acute attack of angina and (b) the reduction in frequency of future attacks of angina.

Nitroglycerin - to stop the attack

In all probability your doctor will prescribe nitroglycerin (GTN) for you and is the drug of choice to manage the attack of angina and this drug is placed under the tongue and it works within one to three minutes; coronary spasm abates and the heart receives more blood through coronary vessels, and the heart muscle receives sufficient oxygen and pain will disappear. GTN also reduces the work of the heart and can have a blood pressure lowering effect. It is advisable to slow down or stop if you get an attack of angina.

You can use GTN to prevent angina immediately prior to some stressful situation or before going for a walk especially in cold weather when you go on a trip to Nuwara Eliya or Haggala or if you are going to eat a bigger meal than usual.

Long - acting Nitroglycerin - like Drugs

There are slower acting nitroglycerin like drugs such Isosorbide dinitrate and Isosorbide mononitrate (e.g. Isordil, Monotrate, Solotrate SR, Angifree) which are given once or twice daily, taken by mouth and which drastically reduce the need for nitroglycerin.

Beta-Blockers and calcium channel blockers

These drugs are given by physicians for the management of angina and are very effective and should always be taken under the supervision of your physician.

(Interviewed by Edward Arambewela)

(To be continued)