World TB Day on March 24:

Sri Lanka on the road to eliminating TB

by Nilma Dole

“Compared to India and the African countries, Sri Lanka is better equipped to tackle tuberculosis (TB) and we are confident that we can eliminate TB soon,” said the director of the National Programme for Tuberculosis Control and Chest Diseases (Ministry of Health) Dr. Sunil de Alwis.

According to the doctor “A simple example of earliest TB problems in popular culture is in the scene of the book/film Gamperaliya where the character of star-crossed lover Piyal takes Nanda to the doctor immediately after suspecting she has TB because she spits blood with her sputum.”

He said that TB affected people five thousand years ago to even the time of Egyptian mummies which can be recorded from their skeletons.

Tuberculosis is an infectious disease brought about by the bacteria called Mycobacterium Tuberculosis.

“It can affect any tissue in the body but in 80 percent of cases, it affects mostly the lungs which is called Pulmonary Tuberculosis,” said Dr. de Alwis.

The disease also has the ability to affect other parts of the body such as the central nervous system, genitourinary system, circulatory system, lymphatic system, gastrointestinal system, joints, bones and even the skin and this is called Extrapulmonary Tuberculosis.

“TB can generally be identified in the sputum of the person thought to be affected which is the actual deep-throat phlegm that is drawn from a person’s spit,” said the doctor.

Active TB indicates that bacteria are multiplying in the body and symptoms will soon show up. If the TB is located in the lungs also called Pulmonary TB, it can spread easily to others. “A little sputum can infect 10 to 15 healthy people, so it is important to check your sputum if you suspect of contracting TB,” said Dr. de Alwis.

According to the doctor, one-third of Sri Lanka’s total population is already affected by TB which is called Latent TB but only in 10% symptoms will show up, giving rise to Active TB.

“Symptoms of active TB include persistent coughing for more than two weeks which could be accompanied by blood in the sputum. Other symptoms include weight loss, fatigue, fever, chest pains and sweating during night,” he said.

In patients having Latent TB this means that the bacteria is dormant in the body but provided the immune system is strong enough to ward off the bacteria.

“The bacteria can be restained from turning into an active one where no symptoms of TB are seen and the disease cannot spread to others. Yet, if TB is latent, it can turn into active at any time as soon as the immunity drops,” said the doctor.

About one-fifth of HIV patients die due to TB and Pulmonary TB (in the lungs) is highly infectious that spreads via droplets from the throat and lungs of those already infected with the disease.

“Transmission of the disease happens when an infected person coughs or breathes out air containing the TB bacteria or if the sputum isn’t burned and has the ability to thrive in certain conditions,” said Dr. de Alwis.

In diagnosing TB, Latent TB is diagnosed with the help of a Tuberculin skin test where TB antibodies are injected under the skin of the wrist. The doctor said that the presence of the TB bacteria in the body will cause a red bump to appear on the skin exactly where the needle pierced the skin.

“The test can also report what degree of the infection has spread including its potency, indicating if it can be passed to others,” said Dr. de Alwis.

“Active TB is treated with a combination of four antibiotics to be taken at the same time, called as Multiple-drug Therapy for a period of 6 months at least. This can be a problem for patients because it isn’t easy to swallow it all at once,” said the doctor.

Unfortunately, there is no solution to the swallowing problem and Dr. Alwis said that the National TB program is now involved in educating family members and medical personnel in doing a procedure called the Harlem Directly Observed Therapy (DOT) program.

“This is used where patients are supervised while medication is administered, has been effective in controlling the spread of TB,” he said.

Victims of latent TB need to take just one antibiotic for a period of nine months, which cuts the risk of latent TB turning active.

There are several antibiotics which are used that can completely cure a TB patient and some medicines are administered in case the patient does not respond to treatment or is infected with drug-resistant TB bacteria.

“It is important that the prescribed medicines be taken strictly for the stipulated period for a successful treatment. If patients stop taking the medication prematurely, the condition may worsen and lead to a more dangerous form and drug resistant TB is tough for treatment,” said Dr. de Alwis.

Sri Lanka’s good health policies have increased life expectancy which has improved the quality of life compared to other countries including industrialised nations such as Russia. “However, in order to eliminate the disease, this is to be achieved by controlling preventable diseases and by health promotion activities,” said the doctor.

Even though tuberculosis is still continuing to be a major public health problem in the country, a good program is in place to help patients totally cure themselves with a good treatment plan.

“About 2000 new cases of tuberculosis are reported every year in the Colombo district and 10,000 annually in the rest of the country.

Out of this number, around 60% are smear-positive pulmonary TB cases.

The National Programme for Tuberculosis Control and Chest Diseases is a decentralised unit which controls tuberculosis as well as other chest diseases in the country. It functions through a network of 26 District Chest Clinics and two Chest hospitals in close coordination with other general health institutions,” doctor de Alwis said.

Nevertheless, the he said that with global funds for preventing and eradicating diseases including TB worldwide, the Ministry of Health and Nutrition has given more mobility and freedom for the TB campaign to go smoothly.

More than just the TB disease, there is a social stigma surrounding TB patients because people fear being infected with the disease. “We are worried that sometimes TB patients do not divulge their identity and give wrong addresses so when we want to genuinely help them, they are worried that someone will discriminate them.

Unlike AIDS, TB is 100 percent treatable so we are always willing to help these people,” said the doctor.

Today, TB testing has been successful around the country. “We have a National TB testing laboratory in Welisara and opened the lab in Kandy last year. In addition to Colombo and Kandy, we also have special TB facilities in Gampaha, Galle and Kalutara,” he said.

He added, “We found that 200 new TB patients are identified in the prisons every year and we have installed an X-ray machine at the Welikada Prison to assist in curing the prisoners who have TB.”

Dr. de Alwis said that with all the successes of steadily eliminating TB every year with less cases, the National TB program did a special screening for the IDPs and have been doing tests for newly-settled Sri Lankans in the North and East to make sure they are TB free when they relocate to Sri Lanka.

This year Sri Lanka will mark World TB Day with special activities conducted in Polonnaruwa with several islandwide exhibitions, art competitions and TB walks to create awareness among the public about prevention and treatment of TB. The Global Plan to Stop TB is the general theme for 2006 until 2015.

The success of the Global Plan to Stop TB 2006-2015 relies on the assistance of family members of patients, healthcare providers and patients themselves to make sure that treatment is continued diligently for the stipulated period.

If the objectives of the Stop TB 2006-2015 are met, it can save the lives of 14 million people every year and offer treatment to 50 million people. “It will be a reality when we eliminate TB so that we all can breathe free and easily without fear,” said Dr. de Alwis.

How to survive at work despite your Chronic Fatigue Syndrome symptoms

by George Cranston

Chronic Fatigue Syndrome (CFS) condition can be as severe as depressive disorder or disseminated sclerosis. It can ruin your performance at work, incite conflicts with fellow workers, and even have you fired or demoted.

Troubles at work may lead to further financial, psychological, and emotional stresses, which can aggravate your condition. Taking actions to reduce worksite pressure, modifying your work plan, and learning effective coping skills may significantly improve your performance and reverse the painful downward spiral.

When you are newly diagnosed with a health condition that is incurable or has no predictable end, you deal with a set of intimidating challenges - medical, professional, social, and emotional - as you learn how to manage it. For people in the midst of developing careers, it could be difficult whether they should disclose their health conditions to supervisors and fellow workers.

You may be worried about how other people will react.

And because CFS symptoms are undefined and still are not fully recognized by some experts in the medical society, perhaps you are worried that your superiors won’t take your condition seriously.

You can become anxious, even dismayed at the effort of concealing your “little secret”; you realize that you will not be able to deal with your normal workload and perform well. You may also be concerned about your financial obligations.

If you can’t work, how will you cover your daily expenses?

If you’re applying for a job, you may feel vulnerable. Do you need to tell a future employer about your CFS condition, will he be okay with your special requirements? You may even feel that you need to hide your condition to improve your chance of getting a job.

The decision to notify others about your CFS condition is an entirely personal matter, one that you need to live with, whatever your decision is. After you tell them, you won’t be able to take it back. However, for many people, honesty isn’t negotiable.

They feel being forthright can reduce their stress level and allow them to know exactly where they need to stand.

For others, disclosing about CFS can become very risky; they fear loss of status, embarrassment, and the burden of knowing that your condition is no longer a secret. So should you tell them? The decision is completely up to you.

The aftermaths of disclosure can seem imprecating either way.

Certainly, you can be demoted to a less important job position for being sick and consequently your benefits and salary, may be significantly reduced.

You may try to deal with your illness by using vacation and sick time to rest each time your symptoms are especially debilitating, but what happens when your vacation or sick days is running out and you still can’t go to work? You can’t risk being fired, due to financial issues. Answering this dilemma won’t be easy, but there are ways to weigh in your options.

The only good way to decide whether you need to disclose your situation is by dispassionately reviewing your situation and taking these factors into account:

Considering your work culture:

Does your work only require you to work with a computer? Then you should consider disclosing your CFS condition and determine whether you are allowed to work from home for a few days each week. If not, you may need to find another job.Considering your employer: Are your superiors receptive and open, or are they intolerant types who despise those who go home “early” at 5 pm?

Hopefully, you have the former, but if you don’t, you should tell them that your CFS symptoms prevent you from working properly. If your CFS symptoms reduce your performance, you should take time off or even resign your position and if possible work at home.

Considering your fellow workers:

Are your co-workers super-competitive and always on the look for your soft spot? However, if they are supportive, you should honestly tell them about your condition.

If you can’t find a good way to disclose your situation, confide in a close colleague you consider a good friend and elaborate an effective strategy.

Perhaps your colleagues will be more acceptive if they understand that you are not simply slacking off after a wild party last night.

Certainly, you may need to consider for other more accommodating job if your colleagues consider you “too soft” for having CFS symptoms.

Your HR (human resources) department:

Will the head of HR department back you up and agree to accommodate your special requirements? Only you can choose how much to tell your supervisors about your CFS condition.

On the plus side, notifying them about your CFS diagnosis is a good way to safeguard your legal right to retain your job. The HR department should have a valid confirmation from reputable medical institutions about your disability. (Source: Health Guidance)

Risk to seniors of multi-tasking on the street

Older adults may put themselves at risk by talking on cell phones while crossing the street, researchers report in a new study.

The researchers found that adults aged 59 to 81 took significantly longer than college students to cross a simulated street while talking on a mobile phone, and their heightened cautiousness in initiating crossing did nothing to improve their safety. Older adults on cell phones also were more likely to fail to cross in the time allotted for the task.

The findings, from researchers at the University of Illinois, appear in the journal Psychology and Aging.

In the study, 18 undergraduate students (aged 18 to 26 years) and 18 older adults crossed simulated streets of varying difficulty while either undistracted, listening to music or conversing on a hands-free cell phone.

The older adults were significantly impaired on the most challenging street-crossing tasks while also engaged in a second activity, with the most pronounced impairment occurring during cell phone conversations.

The younger adults showed no impairment on dual-task performance, the researchers found.

“It should be noted that we have previously found that younger adults show similar performance decrements, but under much more challenging crossing conditions,” said lead author Mark Neider, a postdoctoral researcher who conducted the study with Illinois psychology professor and Beckman Institute director Art Kramer.

“Combined with our previous work, the current findings suggest that while all pedestrians should exercise caution when attempting to cross a street while conversing on a cell phone, older adults should be particularly careful,” Neider said

Source: Diana Yates University of Illinois at Urbana-Champaign

Obesity during pregnancy complicates delivery

A new study at Liverpool University has found that overweight pregnant women are more likely to be overdue and have more complicated births.

Women who were overweight or obese before they conceived were more likely to have a longer pregnancy, need to have labour induced artificially and to go on to require caesarean section births.

For the study, the research team examined the records of almost 30,000 women who gave birth over four years.

Three in ten obese women were overdue, defined as still pregnant ten days after their due date, compared with around two in ten of healthy weight women.

The study found more than a third of obese women had their labour induced, compared with just over a quarter of normal weight women.

In addition almost three in ten obese women had an induction of labour, which later resulted in a caesarean delivery compared to less than two in ten normal weight women.

“Maternal obesity has become one of the most commonly occurring risk factors in obstetric practice including greater risk of prolonged pregnancy,” the Telegraph quoted Dr Sarah Arrowsmith, from the University of Liverpool’s Institute of Translational Medicine, and lead author on the paper as saying.

The study has been published in the British Journal of Obstetrics and Gynaecology.

Youth with IBD are less fit than their peers

Children and adolescents growing up with inflammatory bowel disease (IBD) are less fit than their peers, says a study by researchers at McMaster University and the McMaster Children’s Hospital.

The study, published in the Journal of Paediatrics online, shows children and youth with the most common forms of inflammatory bowel disease have aerobic fitness levels 25 percent lower than the other children in their age, and their muscle function is 10 percent lower.

“Raising a child with a chronic condition is challenging, but we need to look at more than just ‘fixing the child’ and think about active living to reduce the risk of future health problems,” said principal investigator Brian Timmons of the Child Health and Exercise Medicine Program at the university and hospital.

The study showed that patients with inflammatory bowel disease in remission also have poor fitness that may start at an early age.

Fitness during childhood is an important predictor of adult health, said Timmons. “Closer attention needs to be paid to the physical activity levels and participation habits of youth with IBD. This starts with the child’s doctor.”

Investigators teamed up to measure aerobic fitness and muscle function in patients with either Crohn’s disease and ulcerative colitis, the most common forms of inflammatory bowel disease, while they were in remission. The prevalence of inflammatory bowel disease among Canadian youth is between 18 and 70 per 100,000, depending on the province.

Timmons said the study confirms that patients should be encouraged to be as active as possible and families should be provided resources about active living. Clinicians who specialize in paediatric IBD should consider referring patients with IBD for exercise testing and involvement of an activity therapist or physiotherapist in the clinical management of these youth.

He said there are no specific recommended activities, but “patients are likely to benefit from a variety of activities and sports that they find enjoyable and fun.”

(Source: McMaster University)