Health

Why is TB still a major health risk?

By Carol Aloysius

Over 150 years ago, a mysterious unidentified killer disease stalked the world leaving a trail of deaths in its wake.

Undiagnosed and not properly understood even by the medical fraternity at the time, Tuberculosis ( TB) struck at the heart of the world's most productive persons resulting in the premature deaths of nearly 1/12 million persons each year, the death toll in Europe and the Americas rising to one out of seven people.

It was left to one man with a vision to change that grim tide.

In 1882, Dr Robert Koch announced in Berlin he had finally discovered the cause of tuberculosis; the elusive TB bacillus, paving the path towards diagnosing and curing a disease that for so long had baffled the medical world.

With the medical fraternity collectively working to this end, the death rates slowly but encouragingly dropped. Between 1990-2013, the death rates dropped to a low of 45% . From 2000 – 20013, thirty seven million lives were saved through speedy TB diagnosis and superior treatment.

So why, even after these positive gains, is TB still a major global health risk? Look at the statistics: As recent as 2013, TB was killing 1.5 million people worldwide.

In 2013 over half a million children from (0-14 years) fell ill with TB, and 80,000 HIV negative children died from the disease. TB has also been cited as the top five causes of death for women aged 15-44 struck down in their most productive years of life, according to WHO reports. In addition TB is also a leading killer of HIV positive people causing one fourth of all HIV deaths due to multi drug resistance. In 2013, an estimated 480,000 developed Multi Drug Resistant TB ( MDR-TB) worldwide.

Even Sri Lanka has not escaped from the clutches of this vicious trend despite its negligible incidence of HIV/AIDS. Health Ministry sources recently cited two cases of ‘'TB-HIV co-infection'.

Transmission

How does this deadly disease spread? What causes it?

Director National Program for TB Control and Chest Disease (NPTCCD) Dr Gamini Senevirathne explains:

“TB is caused by a bacteria ( myocobacterium tuberculosis) that often affects the lungs . It is spread from person to person through the air.

When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.

A person needs to inhale only a few of these germs to become infected.” While not everyone exposed to the germ gets TB (90% will never get it as they are non infectious) he warns some persons who may have the germ in their bodies without their knowledge, could develop TB if their immunity was lowered.

Most secondary reactivated TB cases are those that remain dormant in the body and become re-activated once immunity is lowered”.

Lankan situation

While Sri Lanka has moved ahead of most of its neighbours including India, towards achieving the Global TB Elimination goal (the current TB situation as of 2014, was 46.6 patients per 100,000 population, subject to district variations.), health officials however warn these figures should not lull us into a false sense of complacency.

According to them as many as 4,000 patients with TB are currently walking around the streets infecting others they come into close contact.

“These are mostly undiagnosed cases, who have not registered themselves at any of our district clinics, for various reasons. Some are drug addicts, others opt for ayurvedic or spiritual healing, while still others discontinue their treatment when they are jailed for some offense.

Those living in very remote areas are also difficult to locate,” Deputy Director of the NCCTPD Dr Sudath Samaraweera explains.

Yet, from the figures he gives us the highest incidence of TB is not so much in remote areas but in the heart of the metropolis teeming with clinics and specialists.

“One out of ten patients found positive are from overcrowded urban areas,” he says.

“This is because of poor environmental conditions, living in close proximity to each other, and the fact that many don't use our free services, preferring to go to private clinics first and then come to us.

A cough is not always an indicator of TB. But if they come to us after taking medications elsewhere it is difficult to make an accurate diagnosis as the symptoms are suppressed.” Finding time to attend clinics while working is another reason.

Stigma

Health officials are worried that the stigma attached to TB, ignorance of the disease and its consequences on the rest of society, could increase the number of undiagnosed cases, and hasten the re-emergence of an TB epidemic in the future.

“Annually more than 13,900 TB patients should show up at our district clinics. But only ten thousand have registered themselves at these clinics, leaving us with 4,000 undetected cases of TB (the numbers could be higher) who need to be reached if we are to achieve our goal of eliminating TB from this country,” Dr Senevirathne said, adding “If they don't come to us, we need to go after them.”

Unless this is done very soon, in the next five years, there could be a TB epidemic on our hands, his Deputy Dr Samaraweera warns. “Over 50,000 patients will be treated for TB. The majority of them will be in the productive age, and over 2/3 of patients above 15 years will be males,” he predicts.

Some of the biggest challenges they face he says is TB control among IDP re-settled and returning migrant populations. “Around 43% migrant populations return after visiting relatives in India where TB is rampant.

Controlling TB among the estate sector, is also a problem.”

Lack of human resources, including chest physicians, lab technicians, nurses and labourers, PHI's in most hospitals are also challenges that need to be overcome, if solutions are to be found to improving TB case findings, minimising treatment defaulters, and having better control of urban TB and TB among IDP re-settled and returning migrant populations, he says.

Health Ministry inputs Director General Health Services Dr P. G. Mahipala however argues that concrete initiatives are already in place with 26 chest clinics set up islandwide and 30 specialist doctors trained in the UK and Australia now available to pass on their newly acquired knowledge to others in the field.

“Our target is to reduce the number of TB patients to one per one million by 2050. We have the facilities, and know how to do this,” he says.

Reiterating that TB is both preventable and hundred percent curable with early diagnosis and treatment, he pleads for media support in taking their message of ‘Reach, Treat, Cure’ to the public.

“If every newspaper, radio channel and TV Channel, passes on this message even once a day, Sri Lanka could become a TB free country in the not too distant future,” he says with optimism.

Break that wind habit

...with black pepper :

Did you know that a powerful addition to your healthy weight loss plan is very likely already in your kitchen? No, we’re not talking about coconut oil - although that one is amazing too. Draw your attention to your pepper mill. That’s right, it’s black pepper, the most potent of all peppercorns.

Not only does black pepper play a starring role in seasoning our meals today, it has been prized throughout history and was extensively used to treat many ailments, including those rooted in inflammation, as well as digestive disturbances. It can also be instrumental to healthy weight loss.

So what is the connection between black pepper, soothing digestion and promoting weight loss? As it turns out, the benefits are manifold. A 2001 study published in the journal Planta Medica found that piperine, a compound found in black pepper, could help to soothe diarrhoea symptoms. It has also been found to stimulate the stomach’s secretion of hydrochloric acid, which is necessary for proper digestion. It is likely due to black pepper’s ability to increase hydrochloric acid secretion that makes it known for its ability to quell gas symptoms. This ability also promotes a healthy gut environment, because when digestion is running smoothly, toxins are more easily eliminated from the gut. As far as weight loss, a 2012 study published in the Journal of Agricultural and Food Chemistry found that piperine has the ability to block fat cells from forming, and to promote the breakdown of existing fat cells. On their results, the study authors wrote:

“Overall, these results suggest that piperine, a major component of black pepper, attenuates fat cell differentiation… thus leading to potential treatment for obesity-related diseases.”

According to the researchers, piperine may also have other effects on the metabolism that promote fat loss/lessened accumulation of fat, although more research needs to be done on this. Additionally, black pepper is laden with antioxidants, which along with supporting the overall health of the entire body play an important role in healthy digestion and gut balance.

On top of it’s digestive and weight loss potential, black pepper is highly nutritious - it contains vitamin K, and the minerals calcium, copper, chromium, iron and manganese, along with fibre. Black pepper is also known for its decongestant abilities, and research from the University of Michigan Cancer Centre has linked it with aiding in breast cancer prevention - especially when combined with turmeric.

So, whether you’re trying to amplify your fat loss, want to kickstart your digestive health, or just wish to provide your body with some great minerals and antioxidants - all with great flavour - never underestimate the power of black pepper.

Mechanism to stop ageing !

As medicine has improved, increasing our ability to treat disease, so our longevity. The deterioration of the body with age, though, is a whole other matter.

But apparently, all that might be needed is some “house-keeping” of the brain, according to research just published in an early edition of the journal PNAS by a Portuguese team from the Centre for Neuroscience and Cell Biology (CNC) of the University of Coimbra.

The researchers might have also solved a 70-year old mystery: how can calorie restriction (a diet with low calories without malnutrition) delay ageing and increase longevity in animals from dogs to mice.

In their new study, Claudia Cavadas and her group have discovered that the key to this diet appears to be its ability to increase autophagy - the mechanism that recycles unwanted molecules in the cells, avoiding their “clogging and malfunction - in the hypothalamus (which has just been identified as the “control centre” for ageing). They also have identified the molecule that controls the process - called Neuropeptide Y (NPY) - raising the possibility that NPY could be used to develop ways to control ageing (instead of just treat its consequences, like we now do).

The discovery can prove especially important to stop the emergence of age-related neurodegenerative diseases - such as Alzheimer's and Parkinson's - a huge step forwards considering that so far science has been incapable of treating, stopping or even fully understanding them.

And in a rapidly ageing world a better control of this kind of problems can prove crucial for everyone's survival.

In fact, according to the UN, in less than a decade 1 billion people will be older than 60. In Japan, already more than 30% of the population is older than 60 years old, and in Europe 16% of the population is over 65. So it is clear that our increasingly ageing population needs to be kept as healthy and active as possible, or it will be financially and socially impossible for the world to cope.

It is no surprise then, that research to understand and control the deteriorating effects of ageing is now a priority.

One thing that has been clear for a while now is that autophagy (or better, a reduction of it) is at the centre of the ageing process - low levels of autophagy (so cells with impaired “house-keeping”) are linked to ageing and age-related neurodegenerative disorders, such as Alzheimer's, Parkinson's and Huntington's diseases. This is easily explained as autophagy clears the cells “debris” keeping them in good working order.

That the process is so important in the brain is no surprise either, since neurons are the cells less able to replenish themselves once one dies/malfunctions.

But about a year ago there was a remarkable discovery that changed the field: hypothalamus, which is a brain area that regulates energy and metabolism, was identified as “the” control centre for the whole-body ageing.

To Cavadas and her group, which have worked on ageing and neurosciences for a long time, this was particularly exciting. Not only they knew that the only proved method to delay ageing and increase longevity - calorie restriction - increased autophagy in the hypothalamus but also that it did the same to NPY and that mice without NPY did not respond to calorie restriction. Furthermore NPY, like autophagy, diminishes with age.

- MNT

Five things not to say to someone:

Living with anxiety

Unless you walk in the shoes of an anxiety sufferer every single day, believe it or not, you’ll never fully relate to the illness. No matter how many articles you read or stories you hear, the firsthand experience is the only way to get it. Lending advice to a loved one isn’t discouraged, but here are a few things that should rarely or never be said to someone with anxiety.

1. “Calm down.”

When a child cries over a lollipop they can’t have, it’s acceptable to tell them to calm down. But when a person is anxious over nothing, telling them to calm down is the worst thing you can say. Being calm is the first thing an anxious person wants to be, but the last thing they can be.

Instead… offer to do an activity with the person. Even though my hand is far from sturdy, I find painting to be a good way to actually calm down.

2. “It’s all in your head.”

Thank you to the Captain Obvious who came up with this response to anxiety. Yes, every part of being anxious is in your head, but the difference between being able to control the worries and not are neurotransmitters in the brain. I know my thoughts are in my head, but so are the person’s

living next door to me and sitting next to me on the subway. I have a hard time getting thoughts out of my head. The other two might take just a second to realize how irrational they might be acting.

Instead… talk it out. Ask what it is the person is thinking about and slowly turn the conversation into a different subject.

3. “I’m stressed out too.”

Although anxiety can work as a stressor, stress is not the same as anxiety. The main difference is that anxiety creates stress over irrational thoughts (most of the time) while stress is created by actual situations. Trying to relate and compare yourself to an anxious person can elevate their feelings and rub them the wrong way. They know you aren’t feeling the way they are, so don’t try to pretend. Instead… try to ignore the situation. Unless the person voices their anxious feelings, don’t bring it up at all or question if you did something to make them feel that way.

4. “Why don’t you just pop a Xanax?”

The misconception about prescribed drugs for mental illness is that they’re easy recreation for patients. But for the patients, that’s the last thing they are. I personally tried to avoid being prescribed anything at all costs. Now, I’ve come to terms with the fact that I’ll probably be taking pills every day for the rest of my life. When someone tells me to “pop a Xanax” or says how much they love taking SSRI’s recreationally, I can’t help but want to flip out. It’s almost offensive when you hear people take a drug for fun when you essentially need to survive.

Instead… ask if they want to watch a movie and chill. Pushing them past their limits is never a good idea.

5. “Others have it way worse than you.”

I never understood why people would tell me how perfect my life is compared to others when I told them I have generalized anxiety disorder. It made me feel as if they thought I was making my mental illness up and have no reason to feel the way I do. On the outside, I don’t have any reason to feel the way I do. I’ve been well raised and educated, constantly surrounded by family and friends.

-Yahoo Health

Health bytes

Aspirin and heart attacks

Dr. Virend Somers, a Cardiologist from the Mayo Clinic, and lead author of a report in the Journal of the American College of Cardiology states that most heart attacks occur in the day, generally between 6 a.m. and noon. Having one during the night, when the heart should be most at rest, means that something unusual happened. Somers and his colleagues have been working for a decade to show that sleep apnea is to blame.

1. If you take an aspirin or a baby aspirin once a day, take it at night. The reason; Aspirin has a 24-hour ‘half-life’ therefore, if most heart attacks happen in the wee hours of the morning, the Aspirin would be strongest in your system.

2. FYI, Aspirin lasts a really long-time in your medicine chest for years, (when it gets old, it smells like vinegar.)

Why keep Aspirin by your bedside?

It's about Heart Attacks – There are other symptoms of a heart attack, besides the pain on the left arm. One must also be aware of an intense pain on the chin, as well as nausea and lots of sweating; however, these symptoms may also occur less frequently.

Note: There may be NO pain in the chest during a heart attack. The majority of people (about 60%) who had a heart attack during their sleep did not wake up. However, if it occurs, the chest pain may wake you up from your deep sleep. If that happens, immediately dissolve two aspirins in your mouth and swallow them with a bit of water.

Afterwards:

Call 119

Phone a neighbour or a family member who lives very close by.

Say “heart attack!”

Say that you have taken 2 Aspirins.

Take a seat on a chair or sofa near the front door, and wait for their arrival and do not lie down!