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Sunday, 10 November 2013





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World Pneumonia Day on November 12 :

Watch out for pneumonia's symptoms and causes

Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.2 million children under the age of five years, accounting for 18 percent of all deaths of children under five years old worldwide. In Sri Lanka, it remains a leading killer disease for the elderly and the very young. Spread by viruses and bacteria commonly found in nose or throat, it can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze.

An eminent authority on the subject, Consultant Respiratory Physician, National Hospital for Respiratory diseases Welisara, Dr Saman Kularatne discusses how this disease spreads and how it can be prevented in the following interview with the Sunday Observer.


Question: World Pneumonia Day falls on November 12. What is the theme for this year?

Answer: This year’s theme is: Innovate to End Child Pneumonia.

Q. Pneumonia is often confused with similar or related illnesses. What exactly is pneumonia? Is it a disease?

A. Pneumonia is an infection of the lungs. Various other lung conditions can have symptoms and Chest X-ray changes suggestive of pneumonia.

Q. How is it caused? By a bacteria or virus?

A. Pneumonia is usually caused by bacteria or viruses. Rarely fungi and other parasites can cause Pneumonia in susceptible individuals.

Q. Is it infectious?

A. Yes, Pneumonia caused by some viruses such as influenza viruses (Swine flu) and bacterial pneumonias such as Tuberculosis are highly infectious.

Q. How is it transmitted? From human to human? Can animals/birds get it?

A. Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. The best example for human to human transmission is Tuberculosis. Animals / birds are also known to be the source. (ex. Swine flu, SARS,Psittacosis ).

Q. Can dust or heavy rains facilitate conditions for getting the disease? I read that in a study in UK it was found that pneumonia and Bronchitis as well as asthma increase when a lot of pollen is released to the air as in summer. Your comments in relation to Sri Lanka?

A. Certain viruses such as influenza are more common in certain months of the year and may also be common in rainy seasons. These viruses can lead to secondary bacterial pneumonias especially in elderly people. Pollen and dust are associated with exacerbation of Bronchial asthma but not with Pneumonia.

Q. What are the symptoms of the disease? How long do they take to manifest?

A. Symptoms of pneumonia include fever, cough, chest pain, difficulty in breathing, chills and some especially elderly people may be confused. Most of the patients with pneumonia present acutely with few days history but some pneumonias, for example Tuberculous pneumonia usually presents with less severe symptoms of few weeks duration.

Q. Who are most at risk of the disease?

A. Infants and elderly people are more prone to develop pneumonia. Pneumonia is common in smokers, alcoholics, people with low immunity (Diabetics, HIV infected, cancer patients, those who are on regular immune suppressive medicines).

Malnutrition is another common cause in the world. Pneumonia is also common in people who are suffering from chronic illnesses, (patients who are paralysed, having cancers) and also who have chronic lung diseases. Unconscious patients and patients who have problems with swallowing can develop pneumonia due to aspiration.

Q. How are they diagnosed?

A. Pneumonia is clinically diagnosed on symptoms and physical signs on chest examination. This is confirmed by a chest X-ray. Chest X-ray also gives some idea about the extent of the disease. Blood tests are important in different ways.

Doctors perform blood tests to find out underlying predisposing conditions, few examples are, Diabetes, blood cancers (leukemia), HIV, kidney and liver diseases. Blood cultures and some other blood tests are helpful in detecting the causative organism in some patients. Blood tests are also important in assessing the patient’s severity of the illness.

Q. What parts of the body are most affected by pneumonia?

A. Pneumonia is an infection in the lungs but when complications set in this can spread into the chest cavity causing an accumulation of pus in the chest cavity (Empyema). Infection can also spread through the blood causing a very serious complication known as septicemia.

Q. How is it treated? With antibiotics? Or any other technique?

A. Antibiotics are the main treatment in bacterial pneumonia and these should be started as early as possible. Some viral pneumonias responds to anti viral treatment. Oxygen therapy, nutrition and the management of fluid and electrolytes are also important in ill patients.

Q. Are there any new breakthrough’s in treatment anywhere in the world? Are these techniques available in Sri Lanka? Is there a drug or vaccines to prevent pneumonia?

A. There are vaccines to prevent pneumonia due to some organisms and are indicated for vulnerable people.(Pneumococcal vaccine, annual influenza vaccine).

Almost all the drugs to manage pneumonia due to bacteria and most of the viruses are available in Sri Lanka.

Q. Is hospitalisation a must for patients?

A. No. Some can be managed as out patients but you need proper and regular assessment of the patient.

Q. If pneumonia can be treated at home what guidelines should be followed by the carers?

A. The medicine should be given according to the prescribed intervals. Fluid intake and nutrition should be looked after. Temperature can be monitored using a thermometer and documented. The rest is important and bathing is avoided and should meet the doctor regularly or if there is any evidence of deterioration.

Q. Does having TB or HIV complicate treatment in pneumonia ?

A. Tuberculosis mainly affects the lungs causing a chronic pneumonia and is the commonest cause of death in patients infected with HIV virus.

Patients with HIV can develop pneumonia due to vast number of organisms due to their poor immunity. Problem with HIV infection is that they are prone to develop pneumonia due to germs/organisms which do not cause any illness in normal immunologically competent people.

Q. What about lung cancer? Are patients with lung cancer more at risk than others?

A. Any patient with cancer is prone to develop pneumonia due to poor immunity.

On the other hand, patients with lung cancer could present with evidence of poorly resolving pneumonia due to local effects of the cancer in the lungs.

Q. Can NCD’s like diabetes, hypertension etc lower the immunity of a person and expose him to pneumonia?

A. Patients with Diabetes have poor immunity specially when the control is poor and they have a very high risk of infections including pneumonia. High blood pressure is not associated with low immunity.

Q. How does pneumonia affect a pregnant woman? Will it affect her unborn child? If so how?

A. Pregnancy per se is not a risk factor for pneumonia but pneumonia during pregnancy can seriously affect the baby and the mother. Pneumonia during pregnancy is associated with low birth weight, premature delivery and miscarriage. There is also a high risk to the mother.

Q. Pneumonia is said to be the world’s largest cause for child deaths. How does pneumonia impact so much on children ?

What is the survival rate of children under five who get pneumonia? Does it depend on the socio environment conditions? Unhygienic surroundings? Or frequent bouts of diarrhoea that sap their immune systems?

A. Worldwide, malnutrition, poor socio economic problems in developing countries, and prevalence of viral infections (Mumps, Measles), lack of health care facilities in some countries are associated with high incidence of pneumonia and deaths in children.

Q. Can pneumonia occur from cross transmission among patients in hospitals? If so, how can this be prevented?

A. Yes. Serious hospital acquired / ICU associated pneumonias are known to occur in hospitals.

Hand hygiene, proper cleaning of instruments and surroundings, adherence to proper techniques when dealing with patients and proper disposal of infected materials are very important.

Q. Have you any advice on preventing pneumonia?

A. Any patient with symptoms (cough, fever, chest pain, difficulty in breathing) should seek medical attention early. Proper control of diabetes is very important.

Those who have evidence of respiratory tract infections should avoid contact with elderly people, infants and people who have chronic illnesses. Inquire about vaccination for elderly people and those who are suffering from chronic lung diseases.

(These vaccinations are available in the private sector). Hand hygiene, use of masks (TB patients), proper sputum disposal are also important.

Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.2 million children under the age of five years, accounting for 18 percent of all deaths of children under five years old worldwide.

Poor children increasingly susceptible to colds in adulthood

Researchers have found an association between lower socioeconomic status during childhood and adolescence and the length of telomeres, protective cap-like protein complexes at the end of chromosomes, that ultimately affects the susceptibility to colds in middle-aged adults.

Published in Brain, Behavior and Immunity, the study showed that children and teens with parents of lower socioeconomic status have shorter telomeres as adults. Telomere length is a bio-marker of aging with telomeres shortening with age. As a cell's telomeres shorten, it loses its ability to function normally and eventually dies. Having shorter telomeres is connected to the early onset of illnesses such as cardiovascular disease and cancer, with mortality in older adults and, as CMU's Sheldon Cohen first discovered, predicts susceptibility to acute infectious disease in young to midlife adults.

This new research now links low childhood socioeconomic status to shorter telomeres and an increased susceptibility to the common cold.

“This provides valuable insight into how our childhood environments can influence our adult health,” said Cohen, Professor of Psychology in CMU's Dietrich College of Humanities and Social Sciences.

In the study, Cohen and his team measured the telomere lengths of white blood cells from 152 healthy volunteers between the ages of 18 and 55. To gauge childhood and current socioeconomic status, the participants reported whether they currently own their home and whether their parents owned the family home when they were between the ages of 1 and 18. They were then exposed to a rhinovirus, which causes a common cold, and quarantined for five days to see if they actually developed an upper respiratory infection.

The results showed that participants with lower childhood socioeconomic status - indicated by fewer years that their parents were homeowners - had shorter than average telomere length. Telomere length decreased by five percent for each year the participants’ parents did not own a home.

The researchers also found that parental home-ownership in both early childhood and adolescence were both associated with adult telomere length.

The participants with lower childhood socioeconomic status were also more likely to become infected by the cold virus. Specifically, for each year their parents did not own a home during their childhood years up to age 18, the participants’ odds of developing a cold increased by nine percent.

“We have found initial evidence for a biological explanation of the importance of childhood experiences on adult health,” Cohen said.

“The association we found in young and midlife adults suggests why those raised by parents of relatively low socioeconomic status may be at increased risk for disease throughout adulthood.”


Early bedtime may prevent childhood obesity

Putting children to bed earlier may be a simple way to keep their weight down, research has shown.

Childhood obesity is not only caused by fast food, sugary drinks and lack of exercise, the new findings suggest. Lack of sleep also appears to be an important factor.

Scientists made the discovery after adjusting the sleep patterns of 37 children aged eight to 11, more than a quarter of whom were overweight or obese. For the first week of the study, children were asked to sleep their typical amount.

During the second week the children randomly had their sleep time either reduced or lengthened.

Over the course of the third week, they were given the opposite sleep schedule. When children increased their sleep, they reported consuming an average 134 fewer calories per day and lost half a pound in weight.

Tests showed they had lower fasting levels of the hunger-regulating hormone leptin. “Findings from this study suggest that enhancing school-age children's sleep at night could have important implications for prevention and treatment of obesity,” said Dr Chantelle Hart, from Temple University in Philadelphia. “The potential role of sleep should be further explored.”

Dr Hart is now working on a follow-up study to determine whether increased sleep produces significant changes in eating patterns, activity, and weight. Given all of its documented benefits, in many ways, you can't lose in promoting a good night's sleep,” she said.


Britain’s reliance on foreign health staff blamed for crisis in poor countries

Migration of workers is so great that ‘its impact cancels out the benefits of international aid’

Britain has been guilty of fuelling a “brain drain” of health workers from some of the world’s poorest countries that threaten to reverse gains in global disease control, a leading charity has warned.

Rich countries collectively save billions of pounds every year by taking on doctors, nurses and midwives who were trained overseas, said a report by Health Poverty Action (HPA).

One of the main destinations has been the UK. About a third of doctors registered with the General Medical Council (GMC) were trained abroad, and more than a quarter were trained outside Europe. The charity said that in some cases the impact of migration on health workers’ home countries was so great that it cancelled out the benefits gained from international aid fromwealthier nations.

Africa is hardest hit, with only three percent of the world’s health workforce practising on a continent that carries almost a quarter of the world’s total disease burden, the charity said.

Martin Drewry, the director of the HPA, said: “There is already a global shortage in health workers, and unless we take urgent action, it will get worse.”

The World Health Organisation has estimated there is an international shortage of around four million healthcare workers.

-The Independent


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