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| Sunday, 27 October 2002 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Malaria : When you begin to shiver... Malaria is one of the oldest and commonest human afflictions. It accounts for half of the premature deaths, killing mostly children and young adults. Transmission of Malaria in Sri Lanka usually occurs in the Dry zone and a considerable part of the intermediate zone. A major peak of transmission is seen during the latter part of November to February following the N. East monsoonal rains. The vector that is chiefly responsible for transmitting the disease in Sri Lanka is the Anopheles Culcifacies. Currently the Health Ministry is directing its efforts at malaria control with special emphasis on prevention of mortality, minimising P. falciparum infections and prevention of malaria in pregnant women who live in endemic areas. by Dr. Anula Wijesundera Clinical Features Plasmodium vivax Malaria . This is usually a benign illness . The incubation period is 14 days (8-17 days) . The fever is classically intermittent and shows a typical periodicity. The fever peaks every 48 hours and coincides with the release of successive broods of merozoites into circulation. The typical attack has three distinctive phases: The cold stage; 2. The hot stage; and 3. The sweating stage. 1. The cold stage The cold stage is preceded by headache, nausea, backache and followed by rigors lasting 1/2-2 hours. 2. The hot stage . Fever rises rapidly to 39-41 degrees C; . There is a severe, throbbing headache; . Vomiting occurs at the height of temperature. This stage lasts for 1/2-4 hrs. 3. The sweating stage . Profuse drenching sweats follow the hot stage; the temperature drops rapidly to normal; patients feels greatly relieved and sleep thereafter. The primary attack of fever is followed by an afebrile period of 48 hours during which the patient feels well and may even attend to normal work until the next paroxysm of fever occurs. The typical fever is seen in people in non-endemic areas who have recently visited malaria endemic areas. Plasmodium falciparum malaria . Incubation period - 12 days (7 to 14 days). . Prodromal features - headache, myalgia, vomiting, backache (more marked than in vivax malaria) . Fever is intermittent, but may be irregular and high . The three stages - cold, hot and sweating stages - are less clearly defined from one another. Malaria tends to run a more acute course in pregnant women and children. Pregnant women are more liable to develop recurrent malaria due to lowering of immunity to malaria during pregnancy. Physical examination . The patient is often anaemic and may be mildly jaundiced; . The liver and spleen are enlarged; . The clinical features are modified if complications of falciparum malaria occur. Diagnosis The detection of malarial parasites in the blood and their identification is essential for confirming the diagnosis of malaria. Ideally, both thin and thick blood films must be examined for the parasite. The ideal time to examine blood for the malaria parasite is when the temperature has begun to rise before the rigor occurs. Complications of falciparum malaria Complications of falciparum malaria occur particularly when non-immune patients have remained untreated for more than one week after the onset of fever. They include: 1. Cerebral malaria, 2. Acute pulmonary oedema, 3. Hypoglycaemia, 4. Peripheral circulatory failure (algid malaria), 5. Acute liver failure (bilious remittent fever), 6. Acute severe anaemia, 7. Intravascular haemolysis with haemoglobinuria, 8. Disseminated intravascular coagulation, 9. Diarrhoea, 10. Hyperpyrexia, 11. Hyperparasitaemia, 12. Hyperparasitaemia. Cerebral Malaria The criteria for diagnosis cerebral malaria are: a. Profound coma, b. Generalized or focal convulsions Patients with cerebral malaria may have a variety of neurological manifestations such as spasticity, clonus, cranial nerve palsies and neck rigidity. Acute pulmonary oedema This may be precipitated by fluid overload, renal failure, pregnancy and after child birth. Hypoglycaemia Blood glucose levels below 2.2 mmol/L may complicate quinine therapy. Hypoglycaemia may be seen rarely in young children with severe falciparum malaria and in pregnant women. Diarrhoea in falciparum malaria Dysenteric malaria This is characterised by the passage of small frequent stools, with blood and mucus, resembling stools of bacillary dysentery. Choleric malaria This is characterised by the painless passage of large volumes of pale fluid resembling stools of cholera. Severe Anaemia This is the invariable result of recurrent attacks of malaria producing haemolysis of red cells after schizogony and dyshaemopoeisis due to anorexia following chronic malaria. Intervascular haemolysis with haemoglobinuria This complication of malaria follows glucose-6 phosphate dehydrogenase (G6PD) deficiency and is induced by primaquine therapy. 2. An immune sensitivity phenomenon following recurrent P. falciparum infections. 3. Previous quinine therapy (blackwater fever) Clinically, the patient is anaemic, jaundiced and passes black urine. Treatment 1. Uncomplicated attack of P. vivax malaria Chloroquine - 600 mg (4 tabs 150 mg base) on day 1 Primaquine is given in vivax malaria to prevent infection which are due to delayed release of hepatic schizonts (hypnozoites). (Courtesy: Health Education Bureau) *************************** Before you talk to a doctor... by Dr. R. A. R. Perera A doctor cannot be fully competent if he does not communicate effectively with their patients. Far too often the 'first wake-up call' comes from a patient who complains about the medical care he has received. In fact, underlying many, and perhaps most complaints, is the fact the doctor-patient communication has broken down. Numerous surveys show the need for more effective doctor-patient communication. Patients are becoming more educated about health issues. They are demanding better communication between themselves and their physicians and others in the health-care industry. Thus the need for better doctor-patient communication has become a crucial issue. Generally, most patients are pretty efficient at telling their own stories. A doctor being on time to see patients is probably the best way to keep them happy although this is difficult with urgent calls and hospital and other commitments. A physician may miss some critical information if the patient is nervous and does not disclose everything he needs to tell the doctor about his illness. Here are few tips on how to get the best from a consultation with your physician. . Think about what seems to be wrong. When did it start? What are the symptoms? How bad is the pain on a scale 1-10. . Write down brief details on a single page along with medical history, any medications being taken the dosage and frequency. Give the page to the doctor and keep a copy for yourself. . List questions to ask before you arrive for your appointment. Describe your problem verbally and concisely. If you are too embarrassed to talk, write it down or hand over a relevant page from a magazine. . Take someone with you if you feel that's useful. Write down what you have been told by your physician as soon as you go home. . Speak up if there is any examination, procedure or medical jargon that you do not understand. It's the doctor's duty to explain to you in simple language, the problems you have and what he is going to do about it. In Sri Lanka some doctors due to lack of time do not do this. But lack of time is not an excuse. In countries like England, United States and in Canada a doctor can be sued for not letting the patient know his or her problem in simple language so that the patient can understand his or her medical condition. . If you are sick, or need to talk over something, visit your family doctor first and get a referral letter, without straight going to a specialist. . Make sure that you are informed of the results of any tests, scans or X-rays, which are done, in your subsequent visit. . Don't waste the doctor's time by telling unnecessary things if you think it is not relevant to your present medical or psychological problem, unless the doctor ask about it. The number I thing is that a doctor should treat his patient the way he (the doctor) liked to be treated if he goes to a physician. A doctor should be straightforward and clear in discussing a medical situation and has to show genuine interest in the patient and his family, even when very busy. One thing medical schools are stressing more than ever is the need for doctors to refrain from using medical jargon that patients might not understand. After medical credentials a patient likes his or her doctor to have a sense of humour, the ability and desire to listen, professionalism, a friendly staff and well-kept waiting room, clean fingernails and ability to apologize for running late and if possible call and tell patients that their appointments will be delayed. *************************** Do's and dont's for feeding pre-schoolers
Protein from animal sources is very expensive. Foods from plant sources which are rich in protein, like dried beans or legumes, can be prepared. Soybean products are inexpensive substitutes for meat protein. Watch against disorders like upper respiratory infection, diarrhoeal enteritis, tuberculosis, bronchitis, and pneumonia, common among children. These diseases affect their appetite and intake of essential nutrients. Food allergy causes loss of appetite and diarrhoea. All these factors affect the child's eating habits. Below are a few common parental faults to be avoided. While such practices provide temporary stimuli they encourage harmful eating habits and attitudes. 1. Scolding the child if he does not eat well. This act only leads to tension and frustration. 2. Bribing the child by promising him a toy or the like if he eats. 3. Encouraging competition among siblings. Many parents will hold a brother or sister as an example and say, "See, Mary is eating all her food. Why can't you eat yours?" 4. Hurrying children to eat. Instead, parents should be extremely patient, providing the best eating environment for the child. 5. Begging children to eat. This is not a good practice. The child will realize that not eating can be an attention-getting device. He will concentrate on that rather than on the eating. 6. Threatening the child with a punishment if he does not eat. Any of these practices lead to unwholesome eating habits. Remember, the future health of your child, even the length of his life, depends largely on his nutrition during these foundation years. Courtesy Herald of Health *************************** You & Your Doctor Falling hair by Dr. Sampath R. Nanayakkara Q: I am a 26-year- old working girl. Recently my hair has started falling. I also noticed that there is some powder like substance on my head even after washing my hair. I have also found one or two grey hairs. I have a fear in my mind that one day my head may go bald. Please tell me what should I do to overcome my problem. I shall be thankful if you could give a brief account on normal hair growth and hair care, for the benefit of others who suffer from this same condition. - Worried - A: Your body is covered by some half a million hairs. The only areas that are hairless are your palms and soles. Hair grows about three fourth (3/4") of an inch a month - faster on warm days than cold days, and during the day than at night. The hair we see on the surface of our body is 'dead'. That is why cutting it does not hurt. Falling hair is one of the most stressful problems among young people. Individual hairs live only two to five years. Then the root of the hair organ shrinks and goes into a resting phase and the hair drops out. Therefore a certain amount of hair fall is normal' usually upto about eighty hairs per day. When the root of the hair organ becomes active a new hair starts to grow. Usually at any given time 10% of the hair roots are resting, and 90% are active in your head. Wearing hats and helmets, exposure to sun, too frequent washing, catarrh, breaking sleep at night and some of the causes have been blamed for hair loss. Another cause is dandruff with fungal infection. There are hereditary factors as well. Baldness affects about 43% of men and 8% of women. Your own hormones also have an effect on your hair growth. A notable example is that, during pregnancy, hair grows luxuriantly, but at the termination of pregnancy it drops rapidly. High level of female hormones are secreted during pregnancy. Lack of Thyroid Hormone can lead to hair loss. Most hair dyes are reasonably safe. But the scalp may become allergic to a particular dye, which can lead to severe irritation and loss of hair. The powdery substance you noticed on your head is probably DANDRUFF. This is by far the most common hair problem. Dead cells on the surfaces of your body are continually being shed. When this shedding becomes excessive on the scalp we have dandruff. It is better not to use soap. Your doctor will prescribe a remedy for your dandruff. *************************** Coping with stress by Dr. H. R. S. Keerthisinghe, Consultant Psychologist What is 'Stress?' Stress is a way of preparing for a challenge or challenges. Causes of 'Stress' may be due to the following reasons: 1. Intrinsic factors (within one's own self) 2. Extrinsic factors - a) Psycho-social environmental factors; b) Physical environmental factors. A certain level of 'Stress' is beneficial. 'Stress' beyond a person's ability to cope is harmful. Impact of 'Stress' There are three ways in which stress can affect people. They are: 1. Physiological impact Physiological mechanism of 'stress' symptoms . Pupils of eyes are dilated (nervous system) . Heart rate is increased (cardio-vascular system) . Blood pressure is increased . Respiration is increased (respiratory system) . Muscle tone is increased (musculo-skeletal system) . Less Blood supply to the intestines (digestive system) . Genito-urinary dysfunctions (genito-urinary system) . Disorders of excretory system In short, the whole human system is physically alarmed. Psychological Impact . Changes in the 'cognitive' process - motivations / productivity / poor concentration/ forgetfulness / weak in intellect and learning abilities / etc. . Changes in the 'affect' domain - anger / sadness / hot-tempered / fear / excitement/ mostly negative feelings / intolerance / irritability / impatience / emotional changes etc. . Changes in the 'conative' domain - Results in behavioural changes / addictions / substance dependence / impulsiveness / aggression. Psycho-social Impact Unhealthy Intra-personal and Inter-personal relationship. Often problems with others. Could 'Stress' be scientifically assessed? Yes. These are done in two ways: 1) Physiological examinations 2) Psychological assessments Rating Scales are prepared by Psychologists for assessment of 'Stress'. Physiological effects of 'Stress' . Hypertension (high blood pressure) . Heart diseases . Breathing difficulties . Gastric ulcers (gastritis / epi-gastritis) . Musculo-skeletal aches and pains . Mental Illnesses - nervousness / anxiety / often headaches / sometimes depression . Sexual Dysfunctions . Endocrine Dysfunctions Could 'Stress' be controlled? In modern days, experts suggest that 'Stress' should not be controlled. But 'Healthy Management' of 'Stress' is welcome. Management of 'Stress' could be discussed on two-fold approaches. 1) 'Stress' avoidance measures 2) 'Stress' reduction measures To avoid Stress follow these rules: - Encourage 'time management' Stress reduction measures Learn relaxation techniques EMR - eye movement relaxation The tell tale signs of stress Do you feel guilty when relaxing - uneasy if not 'on the go'? Do you lie awake worrying about tomorrow? Are you tense...does your neck feel 'knotted-up'? Are you impatient or irritable - do you interrupt when others are talking? Do you feel that you have a lot on your mind - have difficulty concentrating? Are you smoking or drinking more - do you eat in a hurry? Does life seem full of crises - are you always having rows? Do you find it difficult to make decisions? Do you feel frustrated when people don't do what you want? Do you frequently experience a butterfly stomach, a dry mouth, sweaty palms or a thumping heart? If you've said yes to some of these, symptoms your are likely to be suffering form stress. Courtesy Flora Stress at work doubles risk of death from heart disease: study According to a study published in Saturday's issue of the weekly British Medical Journal (BMJ), people who suffer from stressful demands at work, poor rewards and scant career opportunities are twice as likely to die from heart disease. Researchers led by Mika Kivimaki, a psychologist at Helsinki University, monitored the health, for an average of 25 years, of more than 800 employees at the Valmet machine tool company, in Jyvaskyla, central Finland. The team regularly recorded the volunteers' blood pressure, levels of cholesterol and body fat, and participants filled out questionnaires about their stress and sense of reward in their job. After the figures were adjusted for age and sex, employees with high job strain, a combination of high demands at work and low levels of control over their jobs had 2.2 times more risk of dying of cardiovascular disease compared with counterparts with low job stress. Highly-stressed employees notably had higher levels of blood cholesterol and put on weight as years went by. "High job strain and effort-reward imbalance seem to increase the risk of cardiovascular mortality," the authors say. "The evidence from industrial employees suggests that attention should be paid to the prevention of work stress." (AFP) |
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Mothers should know how to use cheap sources of nutrients.
