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Sunday, 25 March 2012





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Sri Lanka free from TB by 2020

Tuberculosis affects about 10,000 Sri Lankans around the country. However, compared to Africa, Sri Lanka is far ahead in dealing with the disease with proper TB treatment measures.

At a press conference at the Health Education Bureau Deputy Health Minister Lalith Dissanayake said, "It is our duty to spread the message of TB treatment because we should tell people that we are well-equipped and are on the way to eradicating this infectious disease.

"The only issue is that we need a collective effort on the part of the sufferers, their families and health professionals around the country to take the message forward." He said TB is worse in other developing countries but Sri Lanka has always reported good indicators when it comes to curbing the disease.


"We have an efficient and effective TB control program called the 'National Program for TB Control and Chest Diseases' (NPTCCD) which is our milestone campaign for eradicting TB," he said.

Consultant chest physician, Dr. Bandu Gunasena said mycobacterium TB is the bacteria that is responsible for the condition.

"In gloomy humid conditions, it survives in the air for up to 12 to 24 hours which can infect a healthy person," he said.

According to the doctor, once inhaled, the victim's lymph nodes are affected and the lung begins to get infected.

"Usually 95 percent of those infected will heal naturally as part of the body's defence mechanisms where the bacilli will either be dead or dormant," he said.

Dormant bacilli will remain because the body's immune system will guard the site of infection.

"The primary disease spread is limited by the BCG (Bacillus Calmette-Guérin) vaccination when it is administered as soon as a baby is born," said Dr. Gunasena.

At the onset of the next attack, if the patient is infected with a bacilli and if they have a fading immune system then TB infection is likely.

"With lowered immunity especially for those suffering from diabetes, alcoholism or HIV, the infection can occur at any site in or outside the lung," he said.

Dr. Gunasena said diagnosis can be done by examining the sputum smears of the patient for two consecutive days for AAFB (Acid Alcohol Fast Bacilli). "Chest X-rays are also done to look for clues and signs of TB," said the doctor.

Symptoms of Tuberculosis

*Pulmonary - Symptoms include chest pain and a productive, prolonged cough. About a quarter of people however may not have any symptoms. Occasionally people may cough up blood in small amounts and in very rare cases the infection may erode into the pulmonary artery resulting in massive bleeding known as Rasmussen's aneurysm. Spitting up stones known as lithoptysis has been described due to bronchial lymph nodes communicated with the airways. Tuberculosis may become chronic with scarring usually in the upper lobes of the lungs. It is believed that the upper lungs are more frequently affected due to their poor lymph supply rather than more air flow.

*Extra-pulmonary - In the other 25 percent of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extrapulmonary tuberculosis. This occurs more commonly in immunosuppressed persons and young children. Extra-pulmonary infection sites include the pleura in tuberculous pleurisy, the central nervous system in meningitis, the lymphatic system in scrofula of the neck, the genitourinary system in urogenital tuberculosis, and the bones and joints in Pott's disease of the spine. When spread to the bones it is also known as "osseous tuberculosis", a form of osteomyelitis. A potentially more serious form is disseminated TB, more commonly known as miliary tuberculosis.

*Constitutional - Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, and fatigue. Finger clubbing may also occur.

Courtesy: World Health Organisation

For the infection outside the lung, a needle aspiration cytology and histology is done.

"These diagnostic measures reveal either the bacilli or inflammatory reactions and the Mantoux test will show the immunune reaction to past contact with TB. Though other blood tests are also done to check for TB presence," said Dr. Gunasena.

The doctor said treatment of TB is done by administering five effective TB drugs with the last drug being discovered in the late 1960s. "Slow-growing bacillus is resistant to standard antibiotics.

"However, nobody wants to do research to come up with an all-inclusive one miracle drug to treat TB because it might affect patent sales where people in the third world buy these five drugs as a last resort to life.


"It is unfortunate to see the developed countries making money out of developing countries who suffer from this disease," said Dr. Gunasena.

The good news is that because of Sri Lanka's comprehensive health system, TB drugs are completely free.

The treatment duration for a new case can be done within a time span of six months with four drugs being administered during an intensive phase and two days during the contamintation phase.

"If there is a relapse, in eight months, five days is allocated for intensive treatment and three days doe contamination phase," said Dr. Gunasena. However, TB can't just be miraculously solved unless the patient takes the medication on time and during the mentioned days advised by a doctor. "Drug resistance occurs when medication is taken irregularly.It also causes isoniazid rifampicin resistance which makes it resistance to other antibiotics too," said the doctor.

To prevent MDR/XDR (multidrug-resistant TB/Extensive Drug Resistant TB), an improved case finding sputum microscopy needs to be done.

"We need to achieve global targets since we have already started campaigning to eradicating TB but we still need everyone to check for TB and if they have a cough that persists for more than two weeks with spitting blood, then they might have been affected by TB," said the doctor.

Consultant Community Physician at the Ministry of Health Dr. Sudath Samaraweera said, "Last year, we had 10,320 cases of TB in Sri Lanka where two out of three cases were men who were affected." Unless Sri Lanka stops the spread and controls TB, there might be 50,000 new cases of TB in the next five years.


"In 2010, Colombo posted 81.8, Jaffna 76.4, Kandy 61.1, Kalutara 55.9 and Ratnapura 50.2 for the proportion per 100, 000 in Sri Lanka's population," said Dr. Samaraweera.

The NPTCCD network under the directorate oversees the Chest Hospital in Welisara, the National TB Reference Lab, the Central Drug Stores, 26 district clinics and 174 microscopy centres.

Dr.Samaraweera said, "Our achievements have been prevention, diagnosis and treatment of TB in the IDP camps, by checking district reviews, death reviews, MDR-TB wards, offering services through central drug stores and checking samples at culture laboratories."

However, from the year 2000, Sri Lanka's TB percentage has dropped from 14 percent to 4 percent in 2009 which is a remarkable progress and eradication of TB is well and truly a dream that can be fulfilled.


He said global TB indicators should be lessons that Sri Lanka will learn from. He said, "TB affects one-third of the world's population, eight million new cases are reported every year, every four seconds a person contracts TB and every 15 seconds a patient dies of TB."

According to the doctor, statistics show that the highest per capita cases are reported in the African continent and in Asia, TB primarily affects six countries - India, China, Philippines, Bangladesh, Indonesia and Pakistan.

Dr. P.G. Maheepala, Additional Secretary at the Health Ministry who was optimistic about Sri Lanka's TB goals. He said, "We are confident that Sri Lanka will eradicate tuberculosis in 2020 which is ahead of the target set by the WHO in 2050."

Potential link between antidepressant use during pregnancy and hypertension

Use of selective serotonin re-uptake inhibitor (SSRI) antidepressants during pregnancy appears to be linked with increased risk of pregnancy induced high blood pressure, hypertension, but a causal link has not been established.

Pregnancy hypertension is sometimes linked with pre-eclampsia, a serious condition that can harm pregnant women and their unborn babies.

But the authors stress that pregnant women should not stop taking their prescribed medication; instead they should seek a consultation with their doctor if they are concerned.

Out of 1,216 women, the overall incidence of hypertension in women taking SSRIs appeared to increase from about 2p.c. to about 3.2p.c. (a relative risk increase of 60p.c.). One specific SSRI, paroxetine, was associated with an increase in incidence of hypertension to about 3.6p.c. (an 81p.c. increase).

"These results are an early indicator of risk attributable to antidepressant drug treatment above that which may be attributed to depression or anxiety disorders in the absence of drug treatment," said senior researcher, Dr Anick Bérard who is Director of the research unit of medications and pregnancy at CHU Ste-Justine's Research Centre, The research has been published in the British Journal of Clinical Pharmacology. The issue is particularly important given that antidepressants are one of the most commonly used medications during pregnancy. Up to 20p.c. of pregnant women are affected by depression and anywhere between 4p.c. and 14p.c. of pregnant women frequently use anti-depressants.

The study drew data from the Quebec Pregnancy Registry and compared 1,216 women who had been diagnosed with pregnancy-induced hypertension with or without pre-eclampsia and with no history of hypertension before pregnancy, with 12,160 matched controls.

"Pregnancy induced hypertension is a serious condition that can directly affect the mother and her unborn baby.

"Although a few other studies on the same topic have been performed before, our study is the only one that looks at the class and type of antidepressant and the risk of pregnancy induced hypertension," said Bérard.

The message, however, is not as simple as telling pregnant women to stop taking antidepressants, because once a woman is using them, discontinuation during pregnancy is associated with an increased risk of depressive relapses and post-partum depression.

"Individual decisions have to be made one woman at a time, and risks and benefits have to be evaluated carefully in consultation with a doctor; there is no 'risk zero'," said Dr Bérard."The research adds another piece of evidence and shows the importance of fully assessing the risks and the benefits of antidepressant use during pregnancy for the mother and child," said Bérard.

Anyone affected by this study should not stop taking their prescribed medication but seek a consultation with their doctor if they are concerned.


Predicting patterns of brain damage in dementia

Two breakthrough studies may explain why we see distinct patterns of brain damage associated with dementias such as Alzheimer's disease and could be useful for predicting future cognitive decline in patients.

These independent studies published by Neuron, one studying how brain circuits wire up structurally and the other studying their functional connections, converged on a remarkably similar model that predicted the landscape of degeneration in various forms of dementia. This is particularly significant because, until now, models for predicting regional neurodegeneration in humans have remained elusive.

Different dementias involve distinct parts of the brain, and previous research has led to the theory that neurodegenerative diseases target specific networks of neurons that are linked by connectivity rather than spatial proximity. This neurodegenerative process is thought to involve the accumulation of abnormal toxic proteins and possibly even the spread of these proteins between neurons, which my travel from neuron to neuron through their synaptic connections.

One study, led by Drs. Juan Zhou and William Seeley, from the University of California, San Francisco, addressed this theory. "We were interested in whether knowing the healthy brain's functional "wiring diagram" would help us predict specific patterns of neurodegeneration seen in patients," said Dr. Seeley. "For each illness we studied, specific regions emerged as critical network 'epicentres,' and functional connectivity to these epicentres predicted each region's vulnerability. The findings best fit a model wherein disease spreads from neuron to neuron along network connections that link brain structures."

In a separate study, led by Dr. Ashish Raj researchers modelled this same kind of "transneuronal" disease transmission by mathematically analysing structural connectivity networks obtained from healthy brain MRIs. Their model predicted spatially distinct "eigenmodes," tightly connected subnetworks in the brain, which mirrored classic patterns of damage seen in dementia.

"Our findings provide the first plausible explanation of why various dementias appear to selectively target distinct regions of the brain - as a simple mechanical consequence of transneuronal spread within the brain networks.

This also suggests that all dementias, previously considered to be pathologically distinct, might share a common progression mechanism," said Dr. Raj. "Importantly, this model of disease progression may be useful clinically for prediction of future cognitive decline in patients, based on their current MRI scans. Knowledge of what the future holds would allow patients to make informed choices regarding their lifestyle and therapeutic interventions."

- topix .com

Cooling hands increase exercise capacity

Cooling the palms of the hands while working out could help you stick with a physical activity program, according to a small study.

In the study, obese women who exercised using a palm cooling device improved their exercise tolerance and cardiovascular fitness.

"Obese women often complain about sweating and getting tired because they're walking around with extra insulation," said Stacy T. Sims, the study's lead researcher and exercise physiologist and nutrition scientist at Stanford University in California.

"If you can slow the rate, internal temperature rises and cool someone who is obese, they don't store as much heat and don't feel as uncomfortable. They can do more work."

The cooling devices cooled the palms of the hand and circulating blood, thus pulling heat off the body.

Sims suggested that holding a bottle of cold water may also cool palms and help exercisers feel cooler, less sweaty and less fatigued - allowing them to work out longer and make them more likely to stick with their exercise regimen. For 12 weeks, researchers studied 24 women, 30-45 years old, who had a body mass index between 30 and 34.9, which is considered obese. Half worked out with their hands in a cylinder containing water at 60.8 degrees Fahrenheit. The other half used the same device with water at 98.6 degrees Fahrenheit. Participants didn't know the difference in their devices and did the same fitness activities, starting with push-ups, lunges and then progressing to using the treadmill, which contained the device.

The goal was to increase exercise duration up to 45-minute stretches at 80 percent of their maximum heart rates.

"The control group dropped out quite early," Sims said.

"The women who had the cooling device continued to participate and didn't have an issue with attrition because they finally didn't feel uncomfortable exercising."

During the three-month study, the control group's data remained almost the same while the cooling group:

* Shaved an average five minutes off the time to walk 1.5 miles.

* Dropped almost three inches off their waists.

* Had lower resting blood pressure and greater exercise heart rate.




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