|
|
 |
 |
| Sunday, 25 July 2004 |
 |
|
 |
Features |  |
| News Business Features Editorial
|
Compiled by Carol Aloysius How biochemical tests can diagnose heart attacks by Dr. D.P. Atukorale Diagnosis of MI or heart attacks is based on the history, clinical
findings, electrocardiogram (ECG) findings and certain biochemical tests.
E.C.G. is the most useful test employed by the physicians for Rarely, in some MI patients, first E C G done in the out patients department (OPD) or in the medical ward is normal. In these cases, if the E C G is repeated in a few hours, E C G shows abnormal changes characteristic of MI. However rarely, there are some patients with MI in whom repeated E C G's are normal and may become positive in a few days. That is why physicians always order a second or third E C G for patients with typical heart attack pain if the first E C G is normal. On the other hand in patients with unstable angina (very severe angina) E C G is normal in a significant number of patients. Even if the E C G is normal, if the clinical features are suggestive of severe angina patient should be subjected to certain biochemical tests such as cardiac enzymes and troponin test before discharge and if the biochemical tests are negative a date for exercise E C G should be given on discharge of the patient from the hospital. Biochemical tests Certain laboratory tests such as estimation of troponins and cardiac enzymes are very useful in the diagnosis of MI (heart attacks) especially if the first E C G is normal. These biochemical tests help the physician to assess the prognosis of the MI patient and those with unstable angina. In hospital with limited number of I.C.U.beds, the physician should admit those with abnormal cardiac enzymes and positive troponin T test to ICU for monitoring and treatment of complications if and when these occur. The biochemical tests are also very useful in diagnosis of MI even if the first E C G is normal. Estimation of biochemical tests also helps the physician to arrange for early administration of lifesaving thrombolytic (clot dissolving) drugs such as streptokinase which have to be administered during the first 12 hours of the heart attack. If thrombolytic drugs are given within the first few hours of the heart attack, the damage to heart muscle can be reduced thus improving the prognosis (prospect of recovery) of the heart attack patient. Cardiac enzymes tests: The commonest biochemical test done for heart attack patients and for patients with unstable angina is estimated of cardiac enzymes such as creative kinase. When there is myocardial necrosis (death of heart muscle cells) following a heart attack, certain proteins released from damaged myocytes (heart muscle cells), can be detected in the blood stream and if cretinine kinase (CK) levels due to damaged myocytes in the blood increase more than twice the upper limit of normal and if the C.K. (MB) is also high, it is very helpful to the clinician to confirm the diagnosis of MI. CK levels and CK (MB) levels go up in a few hours after the onset of MI. If the CK and CK (MB) are normal on admission of chest pain patient to hospital, the test should be repeated in 6 to 8 hours when the test is usually positive in majority of patients with MI. This cardiac enzyme test is available to patients in National Hospital of Sri Lanka and most of the private laboratories in Colombo. The report of the test can be obtained in about 1 to 2 hours when it is done in the private sector. Troponin test Troponins are more sensitive markers of MI and this test is more useful than cardiac enzyme test. Positive troponin T provides evidence of heart muscle injury and should be done in all patients with suspected MI and those with unstable angina. Troponins are usually detected 3 - 4 hours after the onset of chest pain in heart attack patients. In these heart attack patients troponin T is positive for up to two weeks after the infarct. Because of the high sensitivity and specificity, troponin test should be done in all patients with suspected heart attacks. Facilities for estimation of troponin T are available in a number of private labs in Colombo. But unfortunately this very important test cannot be performed in our government hospitals at present. It is high time that facilities for doing this test are introduced in to our government hospitals (at least in the teaching hospitals) as early as possible. Patients with acute MI and unstable angina with positive troponin T have worse prognosis than those with negative troponin T. Patients with severe angina and positive troponin-T test on admission to hospital are highly prone to subsequent heart attacks and should ideally be managed in an I.C.U. If the troponin T is negative, a date for an exercise E C G should be given to the patientt on discharge from hospital and if the exercise E C G is strongly positive the cardiologist will arrange for a coronary angiogram with a view to angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) or medical treatment depending on the results of the angiogram. ************** Hypnosis: magic or a therapeutic tool? Although proven as an effective treatment tool for several diseases, hypnotherapy continues to be side-lined by most psychiatrists, says Dr. Kapila Ranasinghe, Senior Registrar in Psychiatry, Teaching Hospital, Peradeniya.
In the current treatment settings hypnotisability is assessed before an individual is subject to hypnosis. The measurement of hypnotisability can be effectively used in the clinical setting to assess and initiate hypnotic experience while making clinical decisions about the type and direction of treatment. The degree of hypnotisability provides useful information about the way in which an individual relates to the self and the social environment. Hypnotisability is assessed both clinically and using susceptibility scales. Modern hypnosis does not use authoritative commands but educates the patient and requests him to follow instructions. Indeed, with little training, people can hypnotise themselves. This has made hypnosis more acceptable in the context of modern contractarian healthcare delivery model. Uses of Hypnosis The most celebrated use of hypnosis is that it remains as a treatment tool. When hypnosis is used for treatment of psychiatric disorders it is called hypnotherapy and is quite useful in conditions like conversion Disorders, Dissociative Disorders, Post Traumatic Stress Disorder (PTSD), Dyssomnias, Anxiety Disorders and Eating Disorders. It is extensively used in child psychiatry in some centres for the treatment of Somatoform Disorders, Anxiety Syndromes and Trauma Related Disorders. Psychiatrists treating PTSD and trauma related conditions use hypnosis more than other Psychiatrists as it is useful as an interviewing and therapeutic tool. In PTSD hypnosis is often used to assess the personality and facilitate communication while stabilising and interpreting trauma memories. It is also used to discuss trauma memories and diffuse its impact. Medically trained clinicians as well as Psychiatrists are successfully using hypnosis in the treatment of some psychosomatic disorders as these illnesses have both physical and mental components, usually involving a physical condition caused or aggravated by a mental or emotional problem. Most psychosomatic patients are highly hypnotisable and they learn to master the reactive anxiety that is associated with real physical symptoms as well as conversion symptoms. Today, hypnosis is used in other disciplines of medicine as well. Psychological interventions involving hypnosis have been successful in alleviating symptoms in asthma, allergies, dermatological problems, blood pressure instability, bleeding, burns, wound debridement, warts, gastrointestinal disturbances, impotence, contractures of the hand, migraine and tension headaches, enuresis, and obstetrics. Hypnosis is also useful in rehabilitation after accidents and stroke, as well as with psychogenic symptoms. In diabetes, cancer, heart disease, renal failure, orthopaedics, and somatoform disorders, the use of hypnotic interventions has been associated with better symptom management. Specialised centres are using hypnosis as an adjunctive tool in the management of smoking cessation and weight control in motivated patients. It is successfully used in oncology for the management of pain and alleviation of nausea and vomiting associated with chemotherapy. The technique of 'hypnoanaesthesia', as the name itself suggests, takes a patient into a trance state where pain is not felt. When under hypnoanaesthesia some have even allowed minor surgical procedures to be performed on them. Surgeons and Dentists have made use of this technique in patients who were considered 'high risk' for anaesthesia. Hypnosis is also being used to control gynaecological pains and can be used even in minor interventions done in obstetrics. There are case reports of delivering babies under hypnosis. Recently, low hypnotisability among the psychotically vulnerable individuals was established. Psychotic patients, especially those with schizophrenia, score differently on hypnotisability scales than do non-psychotic individuals. Given these findings, the possibility exists that hypnotisability testing in certain cases can be used to clarify the diagnosis; especially in circumstances where early schizophrenia is difficult to differentiate from neurotic conditions. Dangers of hypnosism There are however many psychiatric disorders where hypnosis has been found to be useless as a treatment method. Depressed patients usually fail to respond to their full capacity until the depression is treated with more-traditional psychotherapy, medication, or both. Patients who are suffering from major psychiatric disorders like schizophrenia shouldn't attempt to be hypnotised since it may worsen the condition. Certain types of patients should be approached with caution. Suspicious or paranoid patients usually avoid or resist efforts at hypnosis. Such patients, in whom unconscious fears and suspicions are evoked, may reduce their anxiety by refusing to cooperate with a hypnotic induction. However, in general, formal hypnosis is remarkably safe when used with sound clinical judgment in a goal-directed setting. From a clinical perspective, hypnosis should not be used in an atmosphere that is threatening or coercive. In Sri Lanka, the practice of healing patients while in a 'trance', is very similar to hypnotherapy, and is acceptable to our patients. It is also worth noting that psychiatrists practising hypnotherapy in our country are well received and popular among the patients and the public. Still, only a few psychiatrists use hypnotherapy today, and this could be due to other constraints associated with their practice. Hypnotherapy and hypnosis used in a scientific context can improve the therapeutic armamentarium available for the doctors to treat their patients. ************** A clean environment can prevent Dengue The outbreak of dengue has now reached epidemic proportions. This
article is for the benefit of all 'at risk' of contracting the disease. The dengue mosquito usually bites during day time, specially in the morning and evening. Therefore you could be bitten while at work place, school or travelling. Symptoms of Dengue fever . High Fever; Headache; . Rash on the face, trunk and extremities; Muscle and joint pains; Nausea and vomiting. The symptoms subside in about 3-4 days and the patients recover. Some may progress to Dengue Haemorrhagic Status. Symptoms of Dengue Haemorrhagic Fever (DHF) Haemorrhagic manifestations; Petechial rash; Bleeding from nose; Bleeding from gums; Brown or black coloured vomitus or faeces; Severe and continuous stomach pain; Enlargement of liver. If these symptoms appear take treatment immediately from a hospital. Dengue shock syndrome Warning . The fever may suddenly go down in a patient with DHF. But if the patient still feels ill, it may be a sign of shock.
Be alert to a sudden drop in temperature in a child having fever. Refrain from giving Aspirin or drugs containing Salicylates to the child. Use only Paracetamol, in correct dosage. Don't exceed 4 times a day. Prevention of Dengue Fever / DHF is only by elimination of breeding places of the mosquito transmitting the Dengue virus. Such mosquitoes breed in containers where there is collection of clean water. These containers lie in and around homes, schools and work places. How to get rid of them Crush and bury empty tins, coconut shells and earthenware during disposal. Add salt to the water in flower vases and ant traps. Change water frequently. Remove leaves and debris blocking drains and gutters. Fill with sand or pierce the tyres on roof-tops to prevent collection of water. Cover all utensils containing water. Change water frequently in containers kept for dogs, birds etc. Avoid throwing Sili Sili (Polythene) bags to the open environment. Keep the surrounding of your house clean. If Dengue fever is suspected... Get the patients with fever to rest in bed. Refrain from sending children with fever to school . Give plenty of fluids to drink . Refrain from giving Aspirin or drug containing Salycilates. If DHF is suspected Take treatment immediately from a hospital, qualified doctor. Don't keep changing doctors. Early treatment of DHF can prevent serious sequelae. Monitor the child/patients for dengue symptoms even after taking treatment. (Courtesy Health Education Bureau) ************** Health update : Breast milk cure for cervical cancer by Linda A. Johnson A compound in breast milk has been found to destroy many skin warts, raising hopes it might also prove effective against cervical cancer and other lethal diseases caused by the same virus.
"Any long-term potential for any devastating diseases is very speculative at this stage but should be followed up". There are 130 known types of the human papilloma virus. Nearly all cases of cervical cancer are caused by two sexually transmitted types. Other types cause skin and genital warts, squamous cell skin cancer and lesions in the throat that are deadly in rare cases. Many people carry the virus in skin cells, but it does not always cause disease. Doctors knew breast milk contained a natural antibiotic. But its potential against viruses and tumours was discovered by accident. Svanborg's team was testing ways to fight what is called bacterial superinfection - bacteria infecting cells already infected by a virus. They applied a protein in mother's milk called alpha-lactalbumin to double-infected lung cancer cells. To the researchers' surprise, the cancer cells as well as the bacteria inside them were killed. That was because the milk protein had changed its configuration, bound to another milk component called oleic acid, and created the more powerful Hamlet compound. The research team then tested the compound against warts on patients' hands and painful ones or their feet, called plantar warts. The warts shrank by at least 75 per cent over the first three weeks the compound was applied to the skin. And at least three-quarters of the warts disappeared after a second treatment. The research was reported in Thursday's New England Journal of Medicine. |
|
News | Business | Features
| Editorial | Security Produced by Lake House |
the
diagnosis of MI and unstable angina (very severe angina). In majority of
heart attack patients the E.C.G. shows abnormalities within the first few
minutes of the heart attack (MI). In majority of these MI patients, the E
C G shows diagnostic features in the first one or two hours depending on
the severity of the heart attack (MI).
Hypnosis is best understood as an altered level of consciousness where
the individual is capable of focusing his or her attention while accepting
some distortion of reality. It is also typified by a feeling of
involuntariness - movements seem automatic, and suggested perceptions can
alter or replace ordinary ones. The hypnotic state can be entered and
exited in a matter of seconds.
Dengue is caused by a virus. It is spread by the bite of the infected
Aedes Aegipti and Aedes Albopictus.
Symptoms of shock; Coldness of body; Paleness of body; Restlessness and
drowsiness; Acceleration of breathing and increase in pulse rate;
Indicates worsening of disease.
Skin warts are caused by the human papilloma virus, which is extremely
widespread. Swedish researchers found that when the breast-milk compound -
since named HAMLET - is applied to the skin, it kills virally infected
cells in warts resistant to conventional treatments. "This may have
relevance for the treatment of cervical cancer because virally infected
and cancer cells are similar,," said lead researcher Dr. Catharina
Svanborg, professor of clinical immunology at Lund University in Lund,
Sweden.
