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| Sunday, 25 January 2004 |
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Features |  |
| News Business Features Editorial
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How diabetes affects the eye Diabetes can cause complications which can affect different parts of the body, the eye being one of them, says Dr. R. Prema.
Diabetes can affect the eyes and vision in a number of ways, such as abnormal visual symptoms - fluctuating or blurring of vision, occasional double vision, loss of visual field, flashes, floaters and Early onset of presbyopia - the inability to focus on close objects. Symptoms are: * Cataracts Temporary blurring This may occur as one of the first symptoms of diabetes although it may also occur at any time when your diabetes is not well controlled. It is due to a swelling of the lens of the eye and will clear without treatment soon after the diabetes is brought under control again. Diabetic retinopathy The retina is the layer at the back of the eye that is sensitive to light. diabetes affects the small vessels of the retina in the eye. There are various stages of diabetic retinopathy. Non-proliferative or background diabetic retinopathy: When blood vessels in the retina are damaged, they can leak fluid or bleed. This causes the retina to swell and form deposits called exudate. This is an early form of diabetic retinopathy and may not lead to any decrease in vision, but it can lead to other more serious forms of retinopathy that affect the vision. Proliferative diabetic retinopathy Sometimes, diabetes can cause the blood vessels in the retina to become blocked. If this happens, then new blood vessels form in the eye. This is nature's way of trying to repair the damage so that the retina has a new blood supply. Unfortunately, these new blood vessels are weak. They are also in the wrong place - growing on the surface of the retina and into the vitreous jelly. As a result these blood vessels can bleed very easily and cause scar tissue to form in the eye. The scarring pulls and distorts the retina. When the retina is pulled out of position this is called retinal detachment. This condition is rarer than background retinopathy and is more often found in people who have been insulin dependent for many years. The new blood vessels will rarely affect your vision, but their consequences, such as bleeding or retinal detachment can cause your vision to get worse suddenly. Your eyesight may become blurred and patchy as the bleeding obscures part of your vision. Without treatment, total loss of vision can happen in proliferative retinopathy. With treatment, most sight-threatening diabetic problems can be prevented if caught early enough. The importance of early treatment Although your vision may be good, changes can be taking place to your retina that need treatment. Because most sight loss in diabetes is preventable. Do not wait until your vision has deteriorated to have an eye test. Your family doctor, diabetologist or ophthalmologist can examine for diabetic retinopathy. Remember, however, that if your vision is getting worse, this does not necessarily mean you have diabetic retinopathy. It may simply be a problem that can be corrected by glasses. You might not know that you are having diabetic retinopathy, as there are no symptoms in the earlier stages of the disease. To detect retinopathy, your vision is assessed by the usual charts. The back of your eye examined after dilating your pupils using an instrument called an ophthalmoscope. Sometimes your ophthalmologist may advise a special test called Fundus Fluorescein Angiography. Laser treatment Most sight threatening diabetic problems can be prevented by laser treatment if given early. The laser treatment is to save your sight not to make it better. The laser, a beam of high intensity light can be focused with extreme precision. So the blood vessels that are leaking fluid into the retina can be sealed. If new blood vessels are growing, more extensive laser treatment has to be carried out. In eight out of 10 cases, laser treatment causes the new blood vessels to disappear. All treatment is carried out in an outpatient clinic and you will not have to stay in hospital. Eye drops are used to enlarge the pupils so that the doctor can look into your eye. The eye is then numbed with drops and a small contact lens is put onto your eye to stop it from blinking. The eyes need to be moved in certain directions but this can easily be done with the contact lens in place. The treatment for sealing blood vessels doesn't usually cause any discomfort. However the treatment to remove new blood vessels can be a bit uncomfortable so you may be given a pain-relieving tablet at the same time as the eye drops. If the treatment does become painful, then it is possible to have an injection around the eye to numb the pain. Don't be afraid to have this injection, especially if you have found a previous session of laser treatment distressing. The treatment for sealing blood vessels has few side-effects, although you may have a little central vision loss or notice the laser burns as small blank spots. The laser treatment to remove new blood vessels is more complicated and there may be more side effects. It is quite common to lose some vision to the sides (peripheral vision), and this may mean that you will not be able to drive in future. Night and colour vision may also be reduced. Occasionally your central vision may not be as good as before so that print isn't as easy to see. This is usually temporary, but sometimes this doesn't improve. No treatment is possible without some side-effects. But the risks of laser treatment are far less than the risks of not having treatment. The laser is very bright and causes a temporary reduction of sight which may last an hour or two after treatment. Most people have a headache after the more lengthy treatment and you can take a headache tablet for this. However if the pain is severe, or if your eyesight gets worse, you should contact your consultant straight away. If your eye condition becomes more severe, causing retinal detachment and scar tissue, it may be possible to perform vitreous surgery. This is highly specialised and you should discuss the various options with a consultant ophthalmologist. The longer the person has diabetes, the greater are his/her chances to develop diabetic retinopathy. Almost 80 per cent of people, who have diabetes for 15 years or more, have some damage to the blood vessels in their retina. There is no treatment that can prevent diabetic retinopathy altogether. But it has been proven that a good control of diabetes can delay and slow down the rate of progress of diabetic retinopathy and its complications. Besides good control of blood sugar, one must exercise regularly, keep blood pressure under control, avoid smoking and not be obese. In diabetic women, who begin a pregnancy without retinopathy, the risk of developing non-proliferative diabetic retinopathy is about 10 per cent. Further those, with non-proliferative diabetic retinopathy at the onset of pregnancy and those who develop systemic hypertension tend to show progression with increased haemorrhage, cotton wool spots and macular oedema and no doubt exists that women who maintain good metabolic control during pregnancy, have fewer spontaneous abortions and fewer children with birth defects. However women who begin pregnancy with poor control but who then are suddenly brought under strict control, frequently have severe rapid worsening of their retinopathy and do not always recover after delivery. All diabetics need to have a thorough eye examination shortly after the diagnosis. Insulin dependent diabetics then require eye exams every two years. By eight years after diagnosis, yearly exams become necessary. Non-insulin dependent diabetics require exams yearly.Women with diabetes who become pregnant need an exam in their first trimester, and likely another one at the start of their third trimester. The presence of proteinuria is cause for immediate assessment. Your doctor may make recommendations that are different from these. (Courtesy: The Hindu) **************** Things to tell your eye doctor * The type of diabetes you have, Type I or Type II **************** Iodine: A little known ally Iodine is a trace element essential for life. It is found in rocks,
minerals, the ground and the atmosphere, and more specifically in
seawater. The oceans are the world's iodine reservoir. With Iodine is present in the human body in very low quantities (15 to 20 milligrams in adults) mainly in the thyroid gland. Iodine is an essential element in the make-up of thyroid hormones. These hormones play a decisive role in the metabolism of all the cells in the body and in the development of organs, notably the brain. This is why deficiency during childhood can lead to irreversible mental issues. By regulating the speed of enzymatic reactions, thyroid hormones speed up substance burning and oxygen consumption; hence it is a good idea to give iodine supplements to people wishing to increase their calorie consumption in order to lose weight. The body gets its iodine essentially from food. Products from the sea are the main source of iodine; fresh fish, langoustines, lobster, shellfish and oyster contain between 500 and 3,000 micrograms of iodine, with excellent bio-availability. To combat iodine deficiency on a worldwide scale, the World Health Organisation has created the principle of iodised salt, which is enriched artificially to combat iodine deficiency. And yet iodine deficiency is still common. It exists in both developing countries and industrialised countries. In developed countries, deficiency risk factors are linked to different factors: eating habits (especially vegetarian diets), the consumption of goitrogenic vegetables (cabbage, cauliflower, turnips and soya), tobacco, selenium deficiency and doing sport in hot weather (perspiration). In Europe, the recommended daily intake of iodine is 150 micrograms per day for adults and 200 micrograms per day for pregnant women and women breastfeeding. The European Commission has set a maximum tolerated amount of 600 micrograms of iodine per day for adults Iodine plays an essential, synergetic role with soya isoflavones and calcium supplements in helping premenopausal and menopausal women to face up to the frequent problem of weight gain during this period. Thalgo Nutrition products have been created to make up for specific iodine deficiency while respecting the recommended daily intake and maximum tolerated standard amounts. They can be divided into three categories according to their iodine content: products rich in iodine, moderately rich in iodine and low in iodine. People suffering from nodular goitres or thyroids problems, should be careful when taking iodine and ask their doctor for advice before taking any products rich in iodine. Iodine allergy The expression "iodine allergy" is often used incorrectly when talking about allergy type reaction phenomena when the iodine is often not to blame: Reactions to x-rays iodised subjective contrast products which is frequent. In this case there is indeed a reaction to iodine but it is an injection, so there is no reason to believe there will be a similar reaction if iodine but it is take orally. An allergy following contact with iodine-base disinfectants, which is very rare and is not related to the previous case. Reactions to seafood, which are relatively frequent: such reactions are due to a real allergy to a mollusc or shellfish protein, in which case the iodine is iodine is not at all to blame. (Courtesy Woman's own ) **************** What is "stress"? by Dr. Sampath R.Nanayakkara Q:Can stress cause diseases? A: Stress is a series of physiological and biochemical changes produced when a living being is acted upon by a stressor. Stressor means a stimulus entering in to the system through eye, ear, nose, tongue, body surface and mind. It is generally believed that biological organisms require a certain amount of stress in order to maintain their well being. The response to the stressor occurs in the following way: 1. Alarm Reaction: the body recognises the stressor which in turn, make the 'Pitutary Gland' of the brain and the 'Adrenal Glands' on the Kidneys to produce a hormone essential to either Flight or Fight. In this stress heart rate increases, blood sugar elevated, pupils dilate and digestion slows down. 2. Adaptive stage in which the body begins to repair the effects of the arousal. The acute stress symptoms diminish or disappear, while maintaining the defense. 3. Exhaustion stage occurs when the body can no longer respond to the stress factor. Several diseases such as emotional disturbances, heart disease, high blood pressures, diabetes, gastritis and ulcers, asthma, diminished community to infective diseases may develop. Stress test is a method to evaluate the fitness of the heart muscles. While exercising, usually on a treadmill the individual is subjected to gradually increasing levels of work. At the time an electrocardiogram (ECG) monitoring changes in the ECG indicates a disease of the heart muscles. **************** How to fight Dengue
1. Asymptomatic undifferentiated fever Recognition of Dengue Fever (DF) Dengue fever is an acute febrile illness of two to seven days duration with two or more of the following manifestations (a) Headache More severe form may manifest as:- (a) Bleeding from the mucosa (Bleeding from nose, Bleeding from gum and
at injection sites) Most patients show two distinct phases: (1) Febrile phase lasts 2-7 days (2) Critical phase follows the febrile phase and lasts for 2-3 days. In this phase patient may develop life threatening complications such as Dengue Hemorrhagic fever and Dengue shock syndrome. Patients who get appropriate treatment in the early stages may not go in to the critical phase. Treatment - Patient should rest DF must be examined by a Doctor - Should avoid taking aspirin or other NSAIDS (eg. Brufen) - Patient with signs of abdominal pain, bleeding into the skin and gum, passing black stools, should be taken to a hospital immediately and given plenty of fluids to drink while transferring to the hospital. Courtesy Nawaloka News **************** Facts on Dengue . Spread through the bite of an infected Aedes Aegypti, mosquito. Mosquito gets the virus by biting an infected person. . The mosquito rest indoors in dark places like closets, outside in the cool shade. Female mosquito lays eggs in clear still water, in places like barrels, jars, pots, flower vases, tyres, discarded bottles. It is important to eliminate these sites to control the mosquito. Prevention . Mosquito transmits DF bites during day time . Wear long sleeved clothes and long dresses to cover the limbs . Use repellents (care should be taken in using on children and elderly) . Use mosquito coils and electric vapour mats during the day time . Use mosquito nets to protect babies and people who may rest during the day time . Patients with dengue in hospital or at home should use mosquito nets at all times to prevent the spread **************** Snail venom helps ease cancer pain A synthetic form of sea snail venom can ease pain in cancer and AIDS victims who get no relief from morphine or other conventional painkillers, a study found. Laboratory research has found evidence that the venom that the snails inject to immobilize their prey might have beneficial effects on some heart problems, strokes, central nervous system disorders and other ills. The latest study involved the experimental drug ziconotide, a laboratory-made equivalent of a compound in the venom of the small Conus Magus cone snail, which lives in shallow tropical saltwater. The infusions produced significant relief in patients whose pain did not respond to more conventional drugs such as morphine. Side effects, including dizziness and confusion, were common but can be reduced by fine-tuning the drug dose, said co-author Dr. David Ellis, a medical director of Elan Pharmaceutical, which makes ziconotide and helped fund the study. "This is a new, promising kind of treatment," said Dr. Jerome Yates, vice president for research at the American Cancer Society. Yates, who was not involved in the study, said thousands of cancer patients suffer from intractable pain and might benefit from the new drug. Elan is seeking federal approval for the drug, and one of the researchers said he expects it to become commercially available within the year. Seeking human uses for animals' defense mechanisms is not new. Other recent efforts include an experimental drug derived from snake venom that has shown promise in treating strokes. Colon Cancer Researchers at Israel's Weizmann Institute said Tuesday they have managed for the first time to halt the spread of colon cancer cells in laboratory test. Scientists at the centre near Tel Aviv believe that their breakthrough could help pharmacologists develop drugs to prevent or reverse colon cancer, which is the second most common form of cancer in men and third with women. The researchers found that the metastatic, or migrating nature of colon cancer cells, results from the malfunctioning of "cell-gluing" molecules including beta-catenin, which can lead to cells breaking loose from tissue and migrating to form another tumour in another part of the colon. The malfunctioning can result in rival e-cadherin molecules being overwhelmed by beta-catenin, activating a cancerous gene known as Slug. But the researchers found that by supplementing e-cadherin molecules in parts of the colon they can subsequently reverse the process and make the cells stick together again. |
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Diabetes is a chronic disease that interferes with the body's ability
to use and store sugar and can cause many health problems, including
complications that affect many parts of the eye.
evaporation,
this iodine is spread throughout the atmosphere and falls back onto the
ground as rain. The ground's iodine content varies according to how close
the coast is and according to rock type. In the sea, algae absorb and
increase iodine concentration.
During the last 10 years we have witnessed a dramatic increase in the
global incidence of Dengue and its severe manifestations. Frequent
epidemics in endemic countries put 2.5 billion people at risk of the
infection worldwide. Of the vast majority of cases, nearly 95% are among
children of less than 15 years of age. This infection is the most wide
spread mosquito borne disease in humans of major public health importance.
In the manifestation of Dengue there are four types:-
