Heart ultrasound

Risk of heart attack, death in HIV patients can be predicted:

An ultrasound test can tell if people with the human immunodeficiency virus (HIV) and heart disease are at risk of heart attack or death, according to new research reported in Circulation: Cardiovascular Imaging, an American Heart Association journal.

Stress echocardiography, better known as a “stress echo,” is an ultrasound of the heart during rest and stress that determines risk of heart attack and death in patients with known or suspected blockages in the blood vessels supplying the heart.

People with HIV are at increased risk for accelerated blockages and subsequent heart attack or death.

“We looked at whether stress echo can help predict risk in a high-risk group, HIV patients with known or suspected heart disease and determine whether they have a high or low risk of heart attack and death in the future,” said Farooq A. Chaudhry, senior author of the study and associate professor of medicine.Chaudhry and colleagues performed a stress echo and analysed follow-up data on 311 HIV patients (average age 52 years and 74 percent male) with suspected or known heart disease. Among the patients studied, 26 percent had an abnormal stress echo.

During the average 2.9-year follow-up, 17 non-fatal heart attacks and 14 cardiac deaths occurred.

The prognosis was good for HIV patients who had normal stress echo findings, researchers said. These patients’ average risk for heart attack or death was less than 1 percent per year - the same as that of the general, healthy population. The risk of heart attack and death rose significantly for HIV patients with abnormal stress echo findings. Their average risk was nearly 12 percent per year - 10 times higher than that of the normal population and more than three times that of people without HIV who have an abnormal stress echo.

The cumulative survival for HIV patients with normal stress echo results was 100 percent at one year and 98 percent at four years, which is in stark comparison to 92 percent at one year and 62 percent at four years in those patients with an abnormal stress echo.

“Although we did not study which treatments are most effective for these patients, HIV patients who have abnormal stress echocardiography should probably be monitored and treated more aggressively to prevent heart attack and death,” said Chaudhry

“Conversely, patients with a normal stress echo might not need such aggressive interventions.”

Source: Maggie Francis American Heart Association.

Iodine deficiency

Most common cause of preventable brain damage:

Micronutrients enhance the nutritional quality of food and improve the health condition of the body. They are required in little quantities in a diet. But there are some adverse effects to the body if they lack in the diet and they are called micronutrient deficiencies. These deficiencies may not be identified easily at their early stages (subclinical), but at later stages (clinical). That is the danger of micronutrient deficiencies.

Iodine is one of the micronutrient deficiencies that had become a public health problem in Sri Lanka. According to the national survey 1986, the total goitre prevalence was 18.2%.

With the launch of ‘Universal Salt Iodization’ the total goitre rate has decreased up to 3.8% by 2005. Then furthermore it is not a public health problem but it may prevail hidden in some pockets of areas in Sri Lanka, especially Western, Central and Uva provinces (according to the report iodine Nutrition Status in Sri Lanka, MRI 2005) That is why we should still be aware of that....

What is iodine deficiency?

It is very easy to gain required amount of iodine by iodized salt. According to Sri Lankan recommendation, MRI it is 150 micrograms for normal person per day. You have to take only a half a tea spoon of iodized salt to fulfill your daily iodine requirement. If you are unable to get that sufficient amount of iodine, it creates iodine deficiency. If the intake is very much less, it may cause disorders in your body.

Who may suffer from iodine deficiency?

From foetus to elderly, all the age groups may suffer from iodine deficiency. But it may be crucial during pregnancy and foetal stages. If a mother is limited in her own production of thyroid hormones on account of iodine deficiency the foetus will quite vulnerable to iodine deficiency. Females have been found more vulnerable for iodine deficiency disorders than the males.

How goitre occurs

Iodine is the raw material for thyroid hormone (thyroxine, triodothyronine) production in your body (by thyroid gland). When there is an iodine deficiency in your body, the production of thyroid hormones is reduced and you may get hypothyroidism.

Those reduced hormone levels are not sufficient for your body functions and then the body tries to produce thyroid hormones more and more. It leads to an enlargement of thyroid gland and is called GOITRE. It is the commonly used clinical symptom of iodine deficiency in adults. It can be identified by a skilful person by touching the neck (by palpation).

Cretinism is the severe form of damage of iodine deficiency characterised by a severe mental retardation. Sometimes myxedematous form is the other extreme end. That can be seen among children who have been born with severe iodine deficiency in their mothers. They may have problems with nervous system, muscle & bone development as well as metabolism of the body. Their brain has not developed and matured well. Therefore they have lot of problems in thinking, speaking and moving their hands and legs as they want. They will not perform well in their education. That will end up in poorer performances in most of the works at their later life.

In adults, iodine deficiency may be responsible for weight gain. Some serious health effects can occur in pregnancy. Iodine deficiency during pregnancy may cause increased rates of abortions. Those mothers will give birth to stillborn babies and problematic children. Most of the time mothers may suffer from less or no pregnancy due to iodine deficiency. It is a critical point that you should give your attention carefully.

What are the symptoms?

As mentioned earlier, goitre is the common symptom of iodine deficiency. But some other symptoms are there, such as slowness of movements, hoarsening of the voice, elevated blood cholesterol levels, cardiac insufficiency, cold intolerance, obesity, increased sensitivity to some drugs (eg. Morphine), etc.

Iodine supplementation is done early in the second drimester to prevent most of the damage. If it is delayed, the neonates may have permanent impairments in nervous system.

Impaired performances can be corrected by administration of iodine but the nerve and the cognitive deficits are not. Then the problems of moving hands and legs, speaking and thinking may not be reversed even if they are treated with iodine or thyroid hormones.

But the mothers may improve their fertility by iodine or thyroid hormone replacement therapies.

Prevention is better than cure...

Iodine deficiency is the most common cause of prevantable brain damage, mental retardation and psychomotor development in the world. Then if you pay further attention, those serious health complications can be completely removed from Sri Lanka.

D.L.P. Peiris - Wayamba University of Sri Lanka.

‘Popular’ TV shows teach children fame is No. 1 value

Fame is the No. 1 value emphasised by television shows popular with 9- to 11-year-olds, a dramatic change over the past 10 years, psychologists report in a new study.

On a list of 16 values, fame jumped from the 15th spot, where it was in both 1987 and 1997, to the first spot in 2007. From 1997 to 2007, benevolence (being kind and helping others) fell from second to 13th, and tradition dropped from fourth to 15th.

The study assessed the values of characters in popular television shows in each decade from 1967 to 2007, with two shows per decade evaluated, including “Andy Griffith” and “The Lucy Show” in 1967, “Laverne & Shirley” and “Happy Days” in 1977, and “American Idol” and “Hannah Montana” in 2007.

“I was shocked, especially by the dramatic changes in the past 10 years,” said Yalda T. Uhls, a doctoral student in developmental psychology and the lead author of the study. “I thought fame would be important but did not expect this drastic an increase or such a dramatic decrease in other values, such as community feeling. If you believe that television reflects the culture, as I do, then American culture has changed drastically.”

Community feeling (being part of a group) was the No. 1 value in 1967, 1977 and 1997, and it was the No. 2 value in 1987, the study found. By 2007, however, it had fallen out of the top 10, to 11th.

“The rise of fame in preteen television may be one influence in the documented rise of narcissism in our culture,” said the study’s senior author, Patricia M. Greenfield, a professor of psychology. “Popular television shows are part of the environment that causes the increased narcissism, but they also reflect the culture.

They both reflect it and serve as a powerful socialisation force for the next generation.”

The top five values in 2007 were fame, achievement, popularity, image and financial success. In 1997, the top five were community feeling, benevolence (being kind and helping others), image, tradition and self-acceptance. In 2007, benevolence dropped to the 12th spot and community feeling fell to 11th. Financial success went from 12th in 1967 and 1997 to fifth in 2007.

Source: Stuart Wolpert University of California.

Before animals first walked on land, fish carried gene program for limbs

Genetic instructions for developing limbs and digits were present in primitive fish millions of years before their descendants first crawled on to land, researchers have discovered. Genetic switches control the timing and location of gene activity.

When a particular switch taken from fish DNA is placed into mouse embryos, the segment can activate genes in the developing limb region of embryos, University of Chicago researchers report in Proceedings of the National Academy of Sciences. The successful swap suggests that the recipe for limb development is conserved in species separated by 400 million years of evolution.

“The genetic switches that drive the expression of genes in the digits of mice are not only present in fish, but the fish sequence can actually activate the expression in mice,” said Igor Schneider, lead author on the paper. “This tells us how the antecedents of the limb go back in time at every level, from fossils to genes.”

The genetic hunt was inspired by a famous fossil find - the 2004 discovery of the transitional fossil Tiktaalik in the Canadian Arctic by a team led by Neil Shubin of the University of Chicago.

A transitional species between fish and the four-legged tetrapods, Tiktaalik possessed fins containing a skeletal structure similar to the limbs of later land-dwelling animals.

Those similarities - particularly the wrist and hand-like compartments present in the fins of Tiktaalik and its peers - inspired a laboratory experiment to look at the homology, or shared physical and genetic traits, of fish and limbed animals.

“This is really a case where knowing something about the fossils and the morphology led us to think about genetic experiments,” said Shubin, PhD, the Robert R. Bensley Professor of Organismal Biology and Anatomy and senior author of the study.

“Tiktaalik and its cousins showed us that this limb compartment is not an utter novelty in tetrapods, as was thought for a long-time. So an antecedent of that program must exist.”

The research team compared a genetic switch region called CsB, known to regulate limb development in humans, with similar regions in mice, chickens, frogs, and two fish species: the zebrafish and the skate.

Because the last common ancestor of all these species pre-dates Tiktaalik-like “fishapods,” the comparison offered a glimpse at biology before animals made their first steps on land.

Schneider and colleagues compared the CsB regions from all five species and found that certain sequences were shared between the fish species and the tetrapods.

The conservation allowed the researchers to try swapping switch sequences between species to see if they could still drive gene expression in the fin or limb.

Remarkably, mouse CsB could turn on gene expression at the outer edge of the developing fin region of zebrafish, and both skate and zebrafish CsB were capable of activating gene expression in the wrist and proximal digits of the mouse limb.

“These sequences function in these organisms despite 400 million years of separation,” Schneider said.

“The homologies that are perhaps not evident by morphology - just comparing a hand and a fin - can be traced back to the genome, where you find that the regulatory regions that control the making of those structures are actually present and shared between these organisms.”

Source: Robert Mitchum University of Chicago Medical Centre.

A case for a Dengue Day

by Lionel WIJESIRI

The epidemic of dengue has again resurfaced in Sri Lanka. with thousands of patients reporting in different public and private clinics and hospitals.

Government as well as civic authorities are facing a lot of problems in tackling this scourge of dengue virus.

Dengue fever is the most common of all arthropod born diseases. It occurs in most of the tropical countries. Over half of WHO member states representing a total of 2000 million are currently threatened by Dengue.

According to our Epidemiology Unit, up to end June there were over 9000 confirmed dengue cases and out of them 73 had died. The most affected districts were Colombo, Gampaha, Kalutara, Batticaloa, Kurunegala and Ratnapura.

As a preventive campaign, Government declared a National Dengue Control Week from June 20 - 26. Reports indicated that nearly 10,000 mosquito breeding places were found and destroyed during this period. It really was a good successful exercise.

Individual Inspections

However, medical experts agree that the basic rule of Dengue control is that individuals should do inspections of their premises - homes, businesses and schools - weekly to ensure that there is no stagnant water and no containers that could contribute to mosquito breeding.

It is therefore imperative that the community, including individuals, groups and private sector entities join in partnership with the Ministry of Health in the prevention and control of Dengue.

It is easily said than done. What is the best strategy to mobilize people and institutions to come forward in one lot? I believe the Government should declare a Dengue Day (or D- Day). It will be good concept to organize a mass mobilisation of city residents to conduct dengue control activities on one specific day.

This day will be registered in the history of the Sri Lankan public health system as the date of the first large-scale social mobilisation activity carried out in the fight against dengue in Sri Lanka. D-Day will involve all citizens in the country field actions using insecticides (chemical control).

We have seen in the past that dengue field staffs who conduct house-to-house inspections had always been insufficient in stemming the proliferation of breeding. In our country, since 90% of the foci of the mosquito are found in and around the house, only the adoption of collective and simultaneous domestic actions for prevention will be able to produce a rapid impact on dengue. This was the premise for D-Day.

D-Day will be a massive house-by-house inspection to eliminate or treat any object that could be transformed into an active breeding site of dengue mosquito.

The success of this large- scale social mobilization activity depends upon partnerships between governmental entities, most importantly between the various levels of government and other nongovernmental organisations (NGOs).

Point Zero

Although the Ministry of Health has promoted dengue prevention and control campaigns, a D-Day can be established as ‘point zero’ in order to increase general consciousness that combating dengue is everyone’s responsibility, including the Central, Provincial, and Local levels and residents, all of whom must adopt, as part of their domestic routines, basic mosquito prevention and control actions.

In order for D-Day to take place, the MOH, on behalf of the Central Government, should request the support of the local governments, which then will join in partnerships with private industry and NGOs to mobilise the population.

The message to be delivered is simple. It just takes 15 minutes a week to keep the mosquitoes away. Simply take that time to look around your premises to identify anything that can hold ‘clean water’.

Then let commonsense kick in. Eliminate those breeding places promptly. Simple as that! ASEAN countries proved it could be done.