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| Sunday, 29 June 2003 |
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Compiled by Carol Aloysius Heart attacks in the young by Dr. D. P. Atukorale Heart attacks or coronary heart disease (CHD) appear to have become a serious problem in developed and developing countries and is the number one killer in Sri Lanka. For many years it was considered a disease of the people of middle and old age. More recently there appears to be an increasing incidence of heart attacks in young individuals (those below the age of 40 years). More and more young patients with heart attacks have been reported in the Asian countries. Heart attacks (CHD) is a devastating disease. It kills healthy persons in the prime of life or makes them disabled without any warning. If the affected person is a very young individual the tragic consequences for the family, friends and occupation are particularly catastrophic and unexpected. Although the incidence of heart attacks (myocardial infarction) in those below 40 years is low (about 3 per cent) the experience of Sri Lankan physicians is quite different. There is a high incidence of young infarcts (young heart attack patients) in Sri Lanka as compared to the more developed countries. This subgroup of young heart attack patients has a rapidly progressive form of the disease. Unlike the middle aged and elderly heart attack patients, the young infarcts are mainly male patients. According to data available in the Institute of Cardiology, the male/female ratio is 9:1 and is same as that in the West. In the group we studied in the Institute of Cardiology 2.5 per cent of the patients were below 25 years, 5 per cent between 25-29 years, 27.5 per cent between 30-34 years and 57.5 per cent between 35 and 39 years giving a mean age of 34 +or- 4.89. Risk factors The WHO, according to the investigations done in the Institute of Cardiology, the commonest risk factor for heart attacks in the young Sri Lankans is heavy cigarette smoking and resulting frequent catacholamine surges damage endothelial cells leading to dysfunction and injury of the vascular intima. According to our Sri Lankan experience, 30 per cent had hypercholesterolaemia and 30 per cent had hypertriglyceridaemia; The cholesterol values of young infarcts were observed to be significantly higher than those of the controls. The estimation of lipoprotein profile of young infarcts showed that the VLDL (very low density lipoprotein) fraction was higher than that of the controls. In all the cases the lipoprotein estimation was done three months after the heart attack. Elevated VLDL may be a risk factor for heart attacks for Sri Lankans. Another interesting feature in our series is that the serum triglyceride fraction and the serum VLDL fraction of the relatives of young infarcts was significantly higher than those of the controls. Type IV (WHO) hyperlipoproteinaemia appears to be the commonest lipoprotein abnormality (45%) in our series. In Sri Lanka, as in many other Asian countries low serum HDL (good cholesterol) with or without high levels of serum triglycerides is a risk factor for the high incidence of heart attacks in the young. Diabetes mellitus In the Sri Lankan series the incidence of diabetes was rare (5 per cent) and those few patients were diet - controlled diabetics. Thus diabetes appears to be an uncommon risk factor for heart attacks in the young. Hypertension Hypertension is a well-known risk factor for heart attacks in the middle-aged and the elderly patients and not so much for the young. Obesity In the Sri Lankan series reported by Walloopillai and Atukorale 22.5 per cent of the patients had obesity. Authors of the Framingham study predict that, for each 10 per cent increase in weight, there is a 30 per cent increase in the incidence of CHD. Family history In the series reported by Cole et al, 58 per cent of the young infarcts had a family history of heart attacks. A body of evidence shows that certain disorders of cholesterol metabolism may be genetically transmitted to the off-springs of patients with severe CHD. Cocaine Cocaine especially taken in combination with tobacco or a concentrated cocaine hydrochloride ("crack") is another risk factor for heart attacks in the young. Cocaine is known to produce spasm, plaque, rupture and thrombosis resulting in heart attacks. As far as I am aware, no heart attacks due to use of cocaine has been reported in Sri Lanka. Ethanol (alcohol) intoxication This has been responsible for causation of heart attacks in the young, in the presence of normal coronary arteries and in the absence of stimulants, coronary vasospasm is strongly suspected (Williams et al, Heart, 1998, 79, 191 - 4). As far as I am aware no cases of young infarcts following acute alcoholic intoxication has been reported in Sri Lanka. Other risk factors Hyperhomocysteinaemia (high serum levels of homocystein), elevated serum levels of fibrinogen and abnormal blood viscosity are other known risk factors for heart attacks in the young. Other rare causes of heart attacks in the young are coronary dissection, hypercoagulable states and certain connective tissue diseases (collagen vascular disorders). Other risk factors which may be important in case of young infarcts are emotional disorders, anger and sudden extreme physical exertion. Another important risk factor in case of young infarcts is inflammation (vasculitis) either measured by systemic inflammatory markers such as high sensitively C-reactive protein. Clamydia, mycoplasma and H-pylori are often thought of as having a pathogenetic risk in CHD in the young. Young women with heart attacks Young females with heart attacks comprise an interesting group. It is common knowledge that females are less liable to get heart attacks before menopause because of the protective action of oestrogens. In the groups of 843 patients below the age of 40 years reported by Cole et al, there were 94 females ( 10 per cent). In the above series there were 66 female smokers. In the series reported by Walloopillai and Atukorale there were no smokers. Smoking is very rare among Sri Lankan females. Use of contraceptive pill is a rare risk factor for heart attacks in females. Truncal obesity and increased body mass index (BMI) are other risk factors for heart attacks in the young females. Prognosis of young infarcts Compared to the middle-aged and elderly heart attack patients, prognosis (prospect of recovery) of young infarct patients is very much better as majority of them have less extensive atherosclerosis (irregular deposition of substances such as cholesterol and triglycerides on the inner wall of arteries and arterioles causing narrowing of affected blood vessels) as compared to the elderly heart attack patients. Majority of young infarct patients who survive the heart attack have less damage to the heart muscle and as such their left ventricular function is better than that of older patients. The percentage of young infarct patients having blockage of only one coronary artery is higher than older heart attack patients who frequently have blockage of more than one coronary artery. The group of young infarcts has a substantial vasospastic component superimposed in a genetic predisposition to vulnerable plaque production. Conversely a second group comprised those with diabetes and those with multivessel disease (including those related to high cholesterol states) and these patients have a bad prognosis in spite of bypass surgery. ########## That uncontrollable itching could be the start of... The seven-year itch by Dr. A. M. Aboobucker Scabies which is also referred to as the 'seven-year itch' among other names, is a common, infectious, animal parasitic disease of the skin in Sri Lanka caused by the itch-mite called Sarcoptus (Acarus) scabiei, where the female burrows just under the surface of the skin to lay her eggs. This disease is transmitted by direct intimate skin contact and by contact with an infected person's clothing, bedding or linen. It may rarely spread by more casual contacts, as in the handling of an infected patient by a nurse. The main symptoms of this distressing, highly infectious skin disease are intense itching and linear burrows on the skin produced by the boring mite. Often the burrows are inconspicuous, because of scratches resulting from itching. The scratching also causes the formation of myriad of minute scabs (from which the name 'scabies' is derived). The sites of the body commonly attacked by the mite are the thin-skinned areas below the collar line such as the axillary folds, the flexor surfaces of the elbows, wrists and arms, the sides of the fingers, and interdigital folds. On the trunk the sites most affected are the female breasts, the abdomen, the male external genitals and the buttocks, and on the lower limbs the thighs, behind the knees, ankles and feet. In infants, palms and soles (including toes) are characteristically affected. Only in breast-fed infants scabies has been found on the face. If untreated the scabbing and itching covers the whole body. Secondary infection, with impetigo-like lesions, may occur from scratching in unhygienic surroundings. Itching usually begins about two to three weeks after the infection, apparently due to the development of allergic hypersensitivity, and it is always worse at night, when the warmth of the bed stimulates the activity of the mite. The mite Sarcoptes (Acarus) scabiei is about 0.4mm long, barely visible to the naked eyes. The pregnant female mite burrows into the horny layer of the skin, where she leaves eggs and faecal matter. In about ten days the deposited eggs are usually hatched, and after passing through the larval and nymphal stages the mature mites emerge about six weeks later. The larvae come through the old burrow to the surface of the skin or bore new burrows. It is due to this boring of the burrows by the pregnant mite or the larvae that intolerable itching occurs. The female dies two to three weeks after laying her eggs. Treatment According to the philosophy of Homoeopathy, scabies is an internal disease occurring due to the chronic psora miasm. Itch and other chronic internal ailments appear due to this miasmatic diathesis. In western medical system Sulphur ointment and Benzyl benzoate emulsion have been used as a very effective treatment. Though all these treatments may help in destroying the mite which causes the disease, they cannot eradicate permanently the lesions caused by it and the psoric diathesis which is the latent factor for the disease. There are however some valuable remedies in homeopathy to cure the disease and its latent cause effectively and permanently. One of the anti-psoric remedies such as Arsenicum album, Calc,, Sulph., Merc., Sol., Sepia., Psorin., Sulphur, Silicea, Hep. Sulph, etc, may be given internally according to the symptoms. Treatment should be started with Sulphur. A few doses of Psorinum may be given along with the selected remedy at infrequent intervals. Externally Sulphur ointment, Styrex ointment, Oil of Lavender or Balsam of Peru may be applied for two or three days. However, internal medication is more effective than external one. Hygienic measures are also very important. Not only the patient but also every member of the household should strictly follow these measures. A hot soapy bath should be taken once or twice daily. All bedding and clothing should be carefully boiled or baked before being used. Every article should be exposed to heat in order to destroy the mite as the mite cannot withstand temperatures above 102 degrees Fahrenheit for longer than five minutes. External application of an ointment or oil should be done after a good warm bath. Scratching should be avoided as far as possible in order to prevent a secondary infection. If untreated, scabies infection goes on indefinitely, and if the patient is not properly treated or the cure is incomplete, recurrences are likely resulting in various chronic non venereal diseases. ########## The healing touch By E. Weerapperuma It is not strange to hear today that there are physicians who claim that they have the power to heal using non-conventional yet scientifically proved methods. Touch-Healing Therapy is one such method of treatment. Dr. Shashikant S. Seth, a Gold Medal winner and recipient of several prestigious awards for Natural Healing believes that the Touch Heal method is a simple cost effective, once-and-for-all cure for almost any disease. "This has given my patients positive results in the cure of especially chronic illnesses like arthritis, asthma, spondylitis and even frozen shoulder, says the Mumbai based therapist. He now travels to various parts of the world carrying his message of healing hands. He says that touch healing therapy is part of nature-pathy and a blend of acupuncture and natural elements which exists in the universe. "What I do is to transfer this energy into the body of a patient with positive healing results", he said in a recent interview with The Sunday Observer. The Indian doctor who has received world recognition for his work says that touch healing therapy, which involves placing the hands on the affected area can heal tumours and those who have been advised to undergo by-pass surgery. "It is not spiritualism but a scientific method of healing. It is a transfer of cosmic energy to the patient's nervous system", he said. This method was not developed over night. It has been well researched and scientifically proven, he adds. After careful research he says he had found a herbal medicine - a food supplement, very beneficial to Asthma, Bronchitis, Cough and Colds. "It is my invention. "This herbal powder is to be taken with milk-rice - kiribath on Poya Days before the moon-rise", he said. He has also developed a medicine for malaria prevention and cure. Explaining further Dr. Seth said that the patients could take their usual dinner on Poya day before moonrise. "And not to take any food or liquid till next morning. This treatment has no side effects even though it has to be taken at your own risk," he said. For heart patients he had invented another herbal treatment. The herbal mixture has to be applied over the body for about five days. The paste is prepared using butter, oil and Ulundu powder. He also said that he has invented a herbal powder which is good for diabetic patients and it is to be taken with water. "I have given this treatment to a number of patients in Sri Lanka who are cured now. Dr. Seth has been practising Touch-healing therapy for the past 25 years." When I began acupressure treatment, it was amazing to see that my patients were getting better. I moved from that to Touch and Heal. I use only herbal medicines in place of drugs," he said. He also treats western people suffering from insomnia, stress, back pain, leg, hand, knee pain and many others and also stomach disorders, mental and emotional problems. He says that Healing Touch Magneto therapy, acupressure and naturopathy need no medicine. "The Touch healing therapy removes bad energy from the body of the patient via the therapist's body. The patient will find himself or herself at ease in a very short time", he claimed. "It reaches the root of a disease.By using it your body will be free of any disease", he said. ########## Glands for Go ! The glands, tiny as they are, provide between them almost all the "go" that's in us. Their products, the hormones, are the stimuli behind the mysterious life processes that go on continuously every second of our lives. Important as the glands are for our well-being, vital as they are to life itself, their total weight is a mere two ounces. The remarkable pituitary One of them, the pituitary, usually no bigger than half an inch across, is the co-ordinator of glandular activity. It has its location in the middle of the head, at the base of the brain. From there it issues directives to every part of the body by way of about 50,000 nerve fibres and its hormones in the bloodstream. Co-ordinating the work of other glands is not the pituitary's only task. The pituitary gland produces a secretion, called prolactin. This causes a healthy mother's breast to be filled with milk to nourish her offspring. Another pituitary-produced hormone closes a mother's womb after birth, reducing the ever-present risk of a haemorrhage at that time. Growth, too, is influenced by pituitary secretion. The adrenal, the thyroid, the sex, and the pancreas glands are certainly organs in their own right, with specific tasks assigned to them. Yet it is believed that it is due to the effects of certain hormones from the pituitary, that they begin functioning when the need arises. Adrenals for defence The adrenal gland is usually referred to in the plural because there are two of them, located near the kidneys. They weigh a mere five grammes, too small a weight to be described in traditional weights and measures. Yet they secrete nearly thirty different chemicals; so great in power and potency that they are thought to be effective against 100 known diseases; so small in quantity that the life-long output of the glands could be stored in the hollow of a bad tooth ! In the centre of the neck, near the voice box, is the thyroid. This weighs less than a tenth of an ounce. Normally, its life output of secretion is as much as will half fill a thimble. With this gland - perhaps more so than with any other - the correct quantity of secretion is of paramount importance, as can be dramatically demonstrated. Over production by the thyroid gland in the person so affected, will cause the heart to palpitate, make breathing difficult, and cause eye balls to protrude. These can become so severe that the sufferer can neither swallow nor breathe. It also causes abnormalities. Both Gull's disease and so-called Cretinism are brought about by hypo - or the subnormal - secretion of thyroid hormones. It is a goitre caused by too little iodine. Paradoxically, toxic goitres are caused by too much - or hyper secretion of the thyroid gland. The over-activity of the thyroid may also be responsible for high blood pressure. This also conditions unusually great appetite, and generally the burning up of food and its change into energy at too great a speed. Sex glands There are, two types of sex glands male and female. The male sex glands or testes produce the hormone testosterone. This chemical, it has been found, has more than the obvious function: it helps to absorb protein. It also is thought to make elderly, people feel better, and helps to stop bleeding in the uterus. This brings us to the female sex glands, situated in the lower abdomen, and producing two distinct hormones - estragon and progesterone. The first is the underlying stimulus for the production each month of an egg cell. As a result of the second hormone, prosterone, the womb prepares for the possibility of the start of a new life. The purpose of all glands is to produce hormones which, in turn, stimulate the life processes. They do it, however, in different ways. Some secrete hormones externally. Among these are the salivary glands that cause our mouths to "water" at the sight of food. We call them exocrine glands. The endocrine or ductless glands, among them the thyroid, secrete internally, directly into the blood-stream. There are others that secrete externally and also into the blood, such as the sex glands and the pancreas. Courtesy - Herald of Health ########## You & Your Doctor by Dr. S. R. Nanayakkara Huntington's disease Could you please give me an answer to the following questions. Q: 1. What is known as Huntington's disease? 2. Is there a cure or, if there is no cure; is there medicine to slow down the progress of this disease. 3. Why is it called Huntington's disease? - Concerned A: 1. This is a hereditary disease, the symptoms of which usually start between 30 and 45 years of age. The patient has involuntary movements of the legs , arms and face. These movements are rapid and jerky. Mental changes too develop, such as, Dementia, Gamma Amino Butyric Acid is reduced in the brain cells of these patients. 2. No effective therapy is still available. But Tetrabenazine (Tetrabenazine) can control the jerky movements. 3. Because it was described by an American Physician G. Huntington (1851-1916). |
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