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| Sunday, 12 January 2003 |
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| News Business Features Editorial
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The global epidemic of TB TB is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with pulmonary TB are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. Left untreated, each person with active TB will infect on average between 10 and 15 people every year. But people infected with TB will not necessarily get sick with the disease. The immune system 'walls off' the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of getting sick are greater. Why TB is spreading HIV is accelerating the spread of TB. HIV and TB form a lethal combination, each speeding the other's progress. HIV weakens the immune system. Someone who is HIV-positive and infected with TB is many times more likely to become sick with TB than someone infected with TB who is HIV-negative. TB is the leading cause of death among people who are HIV-positive. It accounts for almost one-third of AIDS deaths worldwide. Drug resistant TB Until 50 years ago, there were no drugs to cure TB. Now, strains that are resistant to a single drug have been documented in every country surveyed and, what is more, strains of TB resistant to all major anti-TB drugs have emerged. Drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their drugs regularly for the required period because they start to feel better, doctors and health workers prescribe the wrong treatment regimens or the drug supply is unreliable. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB), which is defined as the disease due to TB bacilli resistant to at least isoniazid and rifampicin - the two more powerful anti-TB drugs. MDR-TB is rising at alarming rates in some countries, especially in the former Soviet Union, and threatens global TB control efforts. From a public health perspective, poorly supervised or incomplete treatment of TB is worse than no treatment at all. When people fail to complete standard treatment regimens, or are given the wrong treatment regimen, they may remain infectious. The bacilli in their lungs may develop resistance to anti-TB drugs. People they infect will have the same drug-resistant strain. While drug-resistant TB is treatable, it requires extensive chemotherapy (up to two years of treatment) that is often prohibitively expensive (often more than 100 times more expensive than treatment of drug-susceptible TB), and is also more toxic to patients. Effective TB Control The WHO-recommended treatment strategy for detection and cure of TB is DOTS/DOTS combines five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems and use of highly efficacious regimes with direct observation of treatment. Once patients with infectious TB (bacilli visible in a sputum smear) have been identified using microscopy services, health and community workers and trained volunteers observe and record patients swallowing the full course of the correct dosage of anti-TB medicines (treatment lasts six to eight months). The most common anti-TB drugs are isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol. Sputum smear testing is repeated after two months, to check progress, and again at the end of treatment. A recording and reporting system documents patients' progress throughout, and the final outcome of treatment. . DOTS produces cure rates of up to 95 per cent even in the poorest countries. . DOTS prevents new infections by curing infectious patients. . DOTS prevents the development of MDR-TB by ensuring the full course of treatment is followed. Since DOTS was introduced on a global scale, millions of infectious patients have received effective DOTS treatment. The World Bank has rated the DOTS strategy as one of the "most cost effective of all health interventions." Courtesy: WHO ***** The discovery of 195 patients with TB at the Polonnaruwa chest clinic recently has raised concerns among health authorities. Reports from other parts of the island also indicate a rise in the number of TB cases. Undertreatment and late reporting have been cited as some of the causes of this increase in the number of TB patients. Health sources have cautioned the public to seek medical attention immediately if they have had a cough for over three weeks which has been resistant to all medications. It could be the first symptoms of TB. **** TB Update The (WHO) and the global partnership to Stop TB have introduced a new initiative to increase access to tuberculosis (TB) drugs for ten million patients over the next five years. The Global TB Drug Facility, which is housed by WHO and managed by the Stop TB partnership, aims to significantly increase access to high quality TB drugs. WHO called for a commitment of at least US$ 50 million per year for the next five years to the Global TB Drug Facility. The Global TB Drug Facility was launched in Washington DC on March 21 2001, and will finance procurement of quality TB drugs for countries with a high burden of TB. The aim of the Global TB Drug Facility is to provide TB drugs for ten million patients over the next five years and 45 million patients over a 10 year period. **** How TB spreads 1. Tuberculosis can be cured. With modern drugs and methods of treatment early cases recover quickly and become fit for work. 2. Early diagnosis is important. Watch for danger signs such as easily being tired, loss of weight, cough or fever that hangs on, pain in the chest, blood-stained sputum. 3. Facilities are available for diagnosis. Protect yourself, go to the clinic early for advice and get a free X-Ray. 4. No one is born with tuberculosis, and it is not a hereditary disease. 5. The disease is caused by a germ: the tubercle bacillus. 6. It is acquired by the transmission of the tubercle bacillus from the sick to the healthy usually by droplet infection when a patient coughs and also through the dried sputum floating as dust in the air. Others acquire the infection through milk from tuberculosis cows (rare in Sri Lanka). 7. Infection frequently occurs in childhood and adolescence but natural resistance overcomes the infection in many. 60-70 per cent of adults in Sri Lanka have thus had their disease arrested and acquire a certain degree of immunity. 8. There is hardly a family in Sri Lanka without tuberculosis infection. The idea of social stigma should therefore be banished from the minds of the people. 9. TB is a preventible disease. BCG is given to all Newborns at all Government Maternity Hospitals. Have your babies protected. This will also protect them from TB Meningitis which is a common childhood disease. 10. Knowledge of healthy living habits, proper nutrition and "Consideration for others" can prevent TB and many other infectious diseases. Visit the Health Education Centre, 51, Sir Marcus Fernando Road, Colombo 7. For further knowledge or information, write to the Executive Secretary CNAPT Centre, 51, Sir Marcus Fernando Road, Colombo 7. Telephone No. 694583. What you can do 1. Spread knowledge regarding TB, Dispel ignorance and superstitions 2. Help to remove the social stigma. 3. Assist by giving employment to those who recover. We have prevented them dying, let us help them to live. ***************** You & Your Doctor unconsciousness Q: Recently, while crossing the road I saw a person who seemed unconscious lying on the road. Please tell me how I can help an unconsciousness person. A: Many people die needlessly while being unconscious after traffic accidents simply because the blockage of their airways while being transported. When dealing with an unconscious patient the vital thing to remember is that the victim must be able to breathe. So if you find someone unconscious on the roadside, turn him immediately on his side. Using a finger, clean the mouth of any Obstruction (i.e. blood or vomit) and remove dentures if present. Then draw his lower jaw firmly forward and hold it there; this keeps the tongue from falling back and blocking the throat. If (breathing) is very noisy it indicates some obstruction. If pulling the jaw a little further forward does not help the mouth and throat should be checked again for any material blocking the airways. Then the patient should be taken to hospital keeping the head slightly lowered than the rest of the body to prevent aspiration and choking. If there is no breathing, mouth-to-mouth respiration to be attempted. Phobia Please permit me first to applaud this excellent service you are conducting, and thank to the medical officers who are contributing to this informative page of which I am a regular reader. I now wish to submit my problem to your doctor. Q: My eldest daughter, 30 years, married for 5 years with no children yet, is working in the State Sector. She hates to mix with people, even with her close relatives and hates to go for parties and functions. Even in office she talks only with a selected few. I now feel that she has some fear in her mind. On the contrary she is very strict with her younger sisters. She is very intelligent, and does anything properly and correctly. Can you please help me to understand what this condition is. what should I do? who should we consult, will her condition worsen?. Dharmasiri, Kirulapone. A: Your daughter seems to have got a complex of disorders in her MIND. Therefore it is not a physical (Bodily) disease - but more of a Psychological Disturbance which could have gradually and slowly developed to the present status of a type of personality disorder. The 2nd possibility could be a Depressive disorder (Depression) because she does not have a child yet, though married for 5 years. Another possibility could very well be a PHOBIC STATE (i.e. Fear in the mind to face a situation on demand - for example SOCIAL PHOBIA). Whatever the cause she needs to be observed by an experienced doctor for a considerable period of time to surface her hidden mental state. These type of illnesses respond very well to HYPNOTHERAPY given by a Qualified Clinical Hypnotist. Attempting Hypnotherapy by now medical people is very dangerous to the future health of the patient. You can get information about the qualified clinical Hypnotists from the Department of Clinical Hypnosis of the College of GP's Sri Lanka, No. 6, Wijerama Mawatha, Colombo 7. Your daughter can expect a permanent cure by this therapy. Dr. Sampath Nanayakkara. ***************** Nutrition from the ocean bed Oceanic herbs or sea vegetables contain more of the essential elements of life required for the normal body processes of animals including humans than any other plant or herb that grows on land. Therefore the sea vegetable dulse and Irish moss when taken as part of a macrobiotic diet are extremely nutritious food stuff essential for healthy vitalized metabolism. Irish moss contains vitamins A, C, D, E, B1, B2 and one of the few vegetarian sources of vitamin B12. Irish moss also contains high content of iodine, calcium, manganese, zinc, bromine, iron and protein and appreciable amounts of magnesium and sodium phosphates. Irish moss is low in fat with few calories and therefore ideal for body builders or those who are dieting. Irish moss has long been recognized for its ability to cure and abate the symptoms of colds and flu. Irish moss contains potassium chloride which helps to dissolve cathars which are responsible for congestion associated with chesty coughs. Therefore Irish moss provides a healthy natural alternative to the man-made over-the-counter pharmaceutical cough and flue remedies. Irish moss contains several anti-microbial and anti-viral agents which not only prevent colds and flu but a wide range of other infections as well. Irish moss has been reported to alleviate sore throats, bronchitis and pneumonia. Irish moss contains significant amounts of iodine. Thyroid gland needs iodine for its proper gland function. Iodine plays an important role in our ability to fight disease. Due to the strong alkaline nature of the Irish moss, this sea vegetable has been used in the relief and cure of bunions. Irish moss and dulse have been used to relieve the rigors day after excessive alcohol consumption i.e. hangover. It replaces much of the iron content that is leaked from the body as a consequence of dehydrative effect attributed to the consumption of alcohol. Irish moss is reported to be effective for cancer, and radiation poisoning. It is an anti-tussive, and effective against halitosis, the formation of varicose veins, against dysentery and Irish moss has been applied as an emollient. Sent by Dr. D.P. Atukorale ***************** From our readers... Please help us cure our daughter! Our beloved daughter Harini who is 11-years-old developed a sudden illness and became unconscious after developing frequent violent fits. She was admitted to the Intensive Care Unit of the Lady Ridgeway Hospital, Colombo, Sri Lanka on 26th October 2002. Under Dr. Srilal de Silva, Consultant Paediatrician-in-Charge of the ICU and his dedicated staff, our daughter is receiving the best possible medical attention. She is being treated for Encephalitis, prolonged unconsciousness and intractable seizures. We are informed that there are several varieties of Encephalitis and that our daughter is infected with one such variety for which, unlike the common Japanese Encephalitis, treatment is not commonly available. After receiving treatment for over a period of six weeks, her fits have now apparently subdued but she continues to remain unconscious. We are told that treatment for the variety of Encephalitis that our daughter is suspected to be infected with may be available in other parts of the world. We are determined to provide our daughter with whatever medical attention and care that is required to cure her illness at any medical institution/hospital in any part of the world. We request your kind help to convey our intention to as many people as possible all around the world so that it would reach someone who may be able to give us some information about hospitals/medical institutions that could cure our daughter. Please do us the favour of forwarding this e-mail to all your friends around the world and particularly to those who are connected with the medical profession. Anybody who has any information to give us in this regard may kindly get in touch with us by sending an e-mail to one of the following addresses: mail to: [email protected] ***************** Teen talk Adolescents and the elderly form a significant section of our population. Yet, in spite of this, many of their problems whether physical mental or emotional, have received scant attention. The Health Page of the Sunday Observer has thus decided to give them a special slot with a team of experts to discuss their common problems. This week we focus our attention on two common teenage problems discussed by well-known beautician Sharminie Wijeyesekera from Exclusive Lines. Q: I have dark circles under my eyes. I've had this condition for nearly two years now and have used various gels and cream but yet it is the same. The skin around the eyes is very dry too. Is there a treatment to correct this condition? A: Your condition sounds like - 'Pigmentation' under and around the eyes. There is a special whitening eye contour serm which minimises pigmentation. This is an ultra gentle treatment which also brightens the eye and moisturise the skin to prevent dryness and crows feet.' Q: Time and again my lips chap (crack) especially when exposed to the sun. There are also fine lines that I have noticed around the lip line. How can I prevent this? A: Use a lip balm daily that will moisturise your lips as well as protect from the sun. There is a multi treatment for lips available in the market. As for fine lines - use an Eye Balm around the lip line especially at night. This will not only minimise the line but also prevent any new lines. ***************** Tired, lethargic and breathless? you may be suffering from... Nutritional Anaemia Nutritional anaemia is a major problem in Sri Lanka. Although iron deficiency is the main cause of nutritional anaemia, deficiency of vitamin B12, folic acid, and pyridoxine, may also lead to nutritional anaemia. What is Anaemia? Haemoglobin in red blood cell gives the blood red colour. A sufficient quantity of haemoglobin is essential for the efficient transport of oxygen from the lungs to the various tissues of the body. The deficiency of iron leads to a reduction of this red pigment. This is known as iron deficiency anaemia. The following manifestations may be observed, in a person whose bodily functions are affected as a result of iron deficiency: 1. fatigue Pallor and Glossitis are manifestations of severe chronic iron deficiency. Iron requirements The requirement of iron in growing ages is very high. An iron stone of 4.-4.5g is built during the first 18 years of life and maintained throughout. Iron requirement of a girl who has attained age following adolescence is higher than that of an ordinary person. An amount of iron is lost during menstruation. If the loss is not replenished by diet, iron deficiency may arise. Therefore, such iron deficiencies may be due to: 1. inadequate daily intake of iron through food 2. external loss of blood - acute in cases such as bleeding during accidents or constant loss of blood (e.g. due to haemorrhoids or menstruation) or as a result of an attack of malaria or consequent upon a hookworm infestation. This explains the high prevalence of iron deficiency anaemia among children and women. Moreover, there is a greater risk of women developing iron deficiency anaemia during pregnancy and lactation (than otherwise) because of the increased demand. It is also recognised that in late pregnancy iron needs will rise upto five times the pre-pregnancy requirement. In order to meet this increased iron requirement it is essential to take iron supplements and vitamin C given at the field antenatal clinics. Absorption of iron by the day today consumption of food depends on: total volume of iron found in the meal nature of the iron found in the items of food other food items included in the meal iron requirement of the individual concerned Consumption of food rich in iron increases the proportion of iron absorbed from such food. The absorption of iron from a particular food depends on the nature of iron. Iron is divided into two groups based on the nature of iron in any particular food item. 1. Haem Iron This is found mainly in meat and fish; about 15-20% of the iron available in these food items is absorbed 2. Non-Haem Iron Pulses, legumes, dark green leafy vegetables, eggs and milk contain an appreciable quantity of iron. Since this iron is in the form of non-haem iron, the rate of absorption depends on the other factors in the diet. The Sri Lankan diet mainly consists of non-haem iron and only 5% of the ingested iron is absorbed, therefore,if a greater proportion of the iron available in the food we consume is to be absorbed,with every meal; 1. more iron rich foods should be consumed 2. food items that enhance and facilitate the absorption of iron of the non-haem group should be included in our diet. To enhance the absorption of iron: Consume fresh vegetables and fruits containing vitamin C; Add such acidic food items as lime, tamarind or tomatoes; Citric, malic and titric acid that is found in these food items, increases the absorption of iron in addition to Vitamin C Inhibitory action of food items in relation to iron absorption would be reduced to a great extent by keeping pulses such as gram and greengram in water for 24 hours, thus allowing them to sprout The process of fermentation used in the preparation of Hoppers and Thosai facilitates the absorption of iron At least a small quantity of fish or meat taken with a meal enhances the absorption of iron. Tannin food inhibits the absorption of iron eg: Food containing tannin eg. tea, coffee It is advisable to avoid taking tea or coffee along with or immediately before or after a meal. Free cancer risk assessment The Ceylinco Cancer Detection Centre Colombo will hold a free 'cancer risk assessment' service to mark its first anniversary on January 12. The service will be provided at the Detection Centre at No. 60, Park Street, Colombo 2, commencing from Friday January 10 to 17. Those who wish to avail themselves of this free service are requested to register themselves at this centre. They can either call over personally as telephone 075-374374. |
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