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| Sunday, 20 July 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Filariasis - still a major health risk Filariasis is a mosquito transmitted disease confined to the Western,
Southwestern and the Southern coastal belt of the Island with a few
pockets inland. Man is primarily responsible for the high prevalence of The causative organism is a thin thread-like worm, called Wuchereria brancofti the young ones (larvae) of which are transmitted by the mosquitoes. The adult worms live in tiny channels in the body, called lymph vessels. (4) The female lays larvae, which circulate in the blood stream. When the mosquito bites and sucks blood from a patient the larvae, which usually enter the blood at night, are conveyed into the body of the mosquito, and there develop into an infective stage. When an infected mosquito sucks the blood later, these larvae make their way into the body of that person. These travel to the lymph vessels and grow into adult worms. Many of those who get the infection may not show any symptoms. Some may develop fever with chills or recurrent swelling, usually in the limbs or scrotum; this is called lymphangitis. In fair skinned persons red streaks may be visible in the affected area. These episodes disappear after sometime even without treatment. In the later stage of the illness, the patients may get swellings of the arms and legs, which usually persist. Very rarely, in poorly treated or untreated patients, the legs may become so swollen that they resemble the legs of an elephant, and it is then called Elephantiasis. When the larvae travel into the lungs, they cause cough and wheezing, as in asthma. This is called Tropical Pulmonary Eosinophilia or Eosinophilic Bronchitis, as the eosinophils (a type of white blood cells) are very much increased in this condition. The disease is confirmed by a microscopic examination of a few drops of blood taken at night. In areas where the disease is marked, the National Filariasis Control Programme provides facilities for this blood investigation. Other more sophisticated tests are nuclepore filtration test and the filariasis antibody test (FAT). Treatment and Prevention Trematment is with the drug diethylcarbamazine (brand names: Hetrazan, Banocide) Side effects such as fever, nausea and vomitting may occur in the first 2 or 3 days of treatment. It is preferable to take the drug soon after meals in order to reduce these side affects. Drug treatment has little effect on Elephantiasis; the current theory is that secondary bacterial and fungal infections aggravate this condition; therefore, a doctor may prescribe antibiotic or antifungal treatment. Keeping the affected area clean and dry would prevent or minimise it. If these measures fail, surgery is indicated for Elephantiasis. Preventive measures: Breeding of the filariasis transmitting mosquito could be controlled by keeping drains and gutters clean and flowing. Converting bucket latrines into water seal ones would eliminate catch pits. The Anti Filariasis Campaign has a programme of spraying blocked drains and catch pits with an insecticide (such as Baytex) to control mosquito breeding. - from 'Your Child, Your Family' by Dr. H. A. Aponso et al. ########### Does HRT prevent heart
attacks in by Dr. D.P. Atukorale There are several studies which suggest that hormone (oestrogen + progestogen) replacement therapy (HRT) could prevent coronary heart disease (C.H.D.) in post-menopausal women. But according to randomised trials (HERS study and WHI study) HRT does not lower the risk of C.H.D. (Heart attacks) in women who used HRT (i.e. oestrogen and progestogen). HERS (Heart and Oestrogen, Progestogen Replacement Study) study investigated the risk of cardiac events (eg cardiac death and new heart attacks) among 2763 post-menopausal women with documented coronary heart disease (C.H.D.) and showed that the risk of heart attacks (C.H.D.) increased by 29 per cent after administration of HRT. When HRT (combination of oestrogen and progestogen) was given it had been shown that progestogen has been shown to adversely affect serum lipid profile (i.e. caused elevation of bad cholesterol). In WMI Study (Women's Health Initiation Study) HRT was used in 16608 healthy post menopausal women who were taking HRT. This study showed a significant higher incidence of heart attacks but this study had to be abandoned because of a high incidence of invasive breast cancer. So in both above studies the cardiac events (heart attacks and cardiac death) increased when a combination of oestrogen and progestogen (HRT) was used. Dr. Nicole Cherry of University of Alberta, Edmonton, Canada carried out a study using only oestrogen to find out whether oestrogen alone is helpful in the prevention of heart attacks in case of post-menopausal women. The above trial was carried blinded, placebo controlled and randomised using only oestrogen (without progestogen) and 1017 post - menopausal women aged 50-69 years who have survived a first myocardial infarction (heart attack) were used. Patients were recruited from 35 hospitals in England and Wales. As mentioned earlier the purpose of the trial was to find whether oestrogen therapy helps these females to prevent (a) a second heart attack (b) cardiac deaths and (c) all - cause mortality. It was found that oestradiol valerate does not reduce the overall risk of further cardiac events such as re-infarction and cardiac deaths (secondary prevention) in post-menopausal women who have just survived a heart attack. ########### Managing eating disorders by Dr. R. A. R. Perera The main features of people with eating disorders are an exaggerated desire for thinness and an intense fear of being fat. They believe that their body is too large, regardless of their weight. These people generally offer no explanation for this phobia, stating merely that the thinner they are, better they feel. In these situations, their self-esteem is unduly governed by weight and appearance.
The second eating disorder is named as bulimia or binge eating. This is characterized by episodes of binge eating and vomiting or laxative misuse. It is accompanied by a sense of loss of control and a strong desire for a thinner body. They may show little weight loss, or may even be fat. The intense drive for thinness generates an unusual eating behaviours, such as avoiding or toying with food rather than eating it, or secretly disposing of food. They give a variety of excuses for missing meals and often develop a complex set of rules regarding foods and their manner of consumption. They have a seemingly encyclopedic awareness of caloric content, magical beliefs about different food groups and a long list of forbidden foods. Diminishing consumption of food is commonly accompanied by an increasing preoccupation with it. They may compulsively collect recipes or food related careers. Characteristic thinking styles are evident, including a black and white pattern of reasoning. In this type of thinking, a pound gained is perceived as an inevitable trajectory towards obesity. Similarly, they may believe that if they have eaten one biscuit, they might as well eat the entire packet, because there are no in-between states. The fundamental problem in the eating disorders relates to the individual's intense need to maintain a sense of self-worth through undue self-control of weight. This fear of loss of personal control has been linked to underlying feelings of helplessness and to a sense of personal mistrust. Not surprisingly, these people have extremely low opinions of their self-worth. They are extremely eager to conform to external standards and, for this reason, they can carry a particular cultural look or an image to an extreme. Rather than experiencing pleasure from their bodies, anorexic women fear the body as if it were something that must be artificially, rather than naturally, controlled. Risk factors for eating disorders . Idealization of thin female form/Magnification of cultural attitudes Generally, people with eating disorders have commonly been obese. They also come from families in which obesity is more common. Recognizing the early signs of a developing eating disorder may allow prompt treatment. These patients are commonly brought by their family and may be reluctant to participate in the interview. Usual reasons for consultation are . Extreme weight loss and bloating Anorexic women may present with missing their periods or infertility, painful intercourse or frigidity. These patients should be differentiated from wasting diseases (tuberculosis, cancer), endocrine diseases (diabetes, thyroid), and psychiatric disorders. People with serious eating disorders may be mistrustful of doctors because they feel doctors are interested only in refeeding them or making them lose their will and becoming fat. Treatment: The doctor must encourage normal eating habits and weight without making this the only focus of treatment. These patients benefit from learning about body weight regulation and the effect of starvation. Cognitive therapy is very useful. For example, the doctor should discuss with the patient about how easily people can be manipulated by cultural phenomena. It is also important to discuss issues of self-esteem. Doctor should explain that self-worth does not entirely depend on body size and weight. The use of medication in eating disorders is limited. If the eating disorder is due to depression, cognitive therapy and medication is useful. Patients should be encouraged to throw away their scales, stop weighing themselves, and be weighed regularly by the doctor instead. Exercise should be limited to 30 minutes per day. The patient should recognize that self-esteem could be built up by factors other than weight and appearance. ########### New homoeopathy hospital fills long felt need by P. Krishnaswamy The Homoeopathy system of medicine discovered by German physician Dr. Samuel Hahnemann in the 18th century has gained recognition and popularity the world over as a safe, convenient and inexpensive system of medicine for curing a large number of diseases. Authorities on Homoeopathy claim that it provides cures and prevention for nearly all common diseases as also a large number of chronic ones, such as, fevers, malaria, typhoid, eye, ear and nose problems, respiratory disorders like bronchitis, asthma and TB., heart trouble, blood pressure, digestive disorders and skin diseases. Although in our country, only laymen who studied the system and a very limited number of qualified homoeopathic doctors have been practicing it for some time now, it was only recently that the long felt need for a full-fledged hospital for the purpose was fulfilled. Minister of Health P. Dayaratne declared open the newly constructed indoor unit of the hospital consisting of 20 beds in the same location in Welisara where the homoeopathy hospital for outdoor patients was earlier functioning. Since opening the hospital there has been an increasing number of out patients. Presently the OPD is open from Monday to Friday from 9 a.m. to 3:30 p.m. The indoor unit of the hospital is expected to start shortly. An average of 100 patients are being treated every day. According to hospital sources, a majority of the patients come for ailments like, arthritis, asthma, rheumatism, skin, gastric, goiter and catarrhs. Many patients come from distant parts of the country like Ampara, Anuradhapura, Badulla and Matara. The Ministry of Health, Nutrition and Welfare has plans to upgrade the hospital in the near future, with provision of more facilities such as, a surgical unit, maternity ward and dental unit. Plans are also afoot to establish the first Government Homoeopathic Medical College in the same vicinity after getting assistance from India and Pakistan where the system has been well established, with India having 120 homoeopathic medical colleges and Pakistan having about 50. The first batch of students are expected to be admitted by the middle of this year. The hospital will provide internship to homoeopathic doctors who have completed their studies overseas. ########### Cholesterol homeostasis Homeostasis refers to the state of equilibrium in the body with respect to the chemical composition of fluids and tissues. Here we are concerned with the processes through which equilibrium is maintained in the level of blood cholesterol. Cholesterol is put into the circulation by the small intestine and the liver, as well as tissues that wish to get rid of unwanted cholesterol. The intestine absorbs cholesterol in the diet and uses this to make large particles called chylomicrons which transport triglycerides (TG), cholesterol and fat soluble vitamins to various tissues, after a meal. In the fasting state, the intestine also puts out very low density lipoproteins (VLDL) which perform the same functions. The liver gets rid of excess lipid material by synthesising VLDL particles. Unwanted cholesterol from dead cell membranes are put into the circulation and sent for disposal by the liver, in high density lipoprotein (HDL) particles. Cholesterol is removed from the circulation by cells that need cholesterol for various functions (e.g. all cells for making cell membranes, and steroid-hormone-synthesising organs such as the adrenal glands, the ovaries and the testes). Cholesterol also leaves the circulation in low density lipoprotein particles (LDL), chylomicron remnants and HDL particles, all of which are taken up by the liver. In the liver, cholesterol in used extensively for synthesis of bile salts. Both bile salts and cholesterol are exported by the liver in the bile. The bile salt assist in the digestion and absorption of TG and fat soluble vitamins, plant sterols and carotenes. Part of the bile salts is lost in the faeces (about 500 mg per day). Much of it is reabsorbed, taken to the liver and re exported in the bile. About 50 per cent of the cholesterol absorbed from the diet and made in the body are lost in the faeces, as bile salt. The balance cholesterol in the faeces is derived from cast off intestinal cells. The micro organisms in the large intestine convert cholesterol into coprostanol, the main sterol in the faeces. The body has to deal with about 1g of cholesterol daily, derived from both exogenous sources (food) and endogenous sources (synthesis in intestine, liver and other tissues such as the skin). This quantity in fairly constant. If the dietary intake changes, compensatory changes take place in biosynthesis. Homeostasis is maintained by the loss of cholesterol and its metabolites in the faeces. However, the reduction in biosynthesis in intestine and liver is not proportionate to intake at high levels of intake. For this reason, dietary guidelines of most countries recommend an intake of not more than 300 mg cholesterol per day. Homeostasis can be assisted by: 1. Regular physical activity, which is the main factor known to raise HDL levels. 2. Reducing the absorption of cholesterol in the diet by ensuring an adequate quantity of phytosterols (plant sterols) in the diet by including green leafy vegetables in the meal. 3. Reducing the intake of cholesterol rich foods. 4. Ensuring a regular intake of food rich in the dietary fibre, pectin, which interferes with the reabsorption of bile salts in the large intestine, thus breaking the entero-hepatic circulation of bile salts. This will result in more cholesterol being oxidised to bile salts, thus reducing blood cholesterol. Pectin is found in high concentration in carrots and in fruits. Citrus fruits are rich in pectin. In making marmalades the pectin in the whole fruit, including the skin is extracted. Therefore marmalades should be preferred to jams. (From the Nutrition Society) |
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this disease because the mosquito transmitting the infection breeds
exclusively in man-made sites such as catch pits, cesspools, blocked
drains, etc. Rapid uncontrolled urbanisation without concurrent
improvement in sanitation and waste disposal is a contributing factor.
Eating disorders can be of two types. The first and the commonest one
is anorexia nervosa or self-imposed starvation. These people have a
relentless pursuit of thinness and fear of fatness, which can lead to
varying degrees of emaciation. The person with anorexia nervosa commonly
denies that they are ill, and fails to recognize that their changed body
is no longer attractive or healthy.
