Your heart condition monitored while at home or holidaying in Yala...
Can you believe it? It is true. Some of us have heard of the "so
called" Telemedicine technology. Using this new medical technology one
can carry out an ECG (electrocardiograph) examination, if one
experiences a mild or severe chest pain, while watching the tele at home
or while relaxing at the Buthuwa bungalow in Yala.
This is just one type. Telemedicine (also referred to as "telehealth"
or "e-health") allows health care professionals, and now, even, non
health persons to use "connected" medical devices in the evaluation,
diagnosis and treatment of patients in other (remote) locations; this
could be land, remote situations in the sea or even in air (many
airlines use Telemedicine now).
Tele-technology is so advanced that more disease diagnosing
information can be transferred from the remotest places in the world
(author had designed the data transferring format from European Union
flagged ships to Telemedicine centres ashore) to Telemedicine Centres in
hospitals and big cities.
For example, technology can be used to transfer lung function status
information in case of acute asthmatic attacks or temperature charts in
case of undiagnosed fever, and more sophisticated formats transfer X'ray
(Teleradiology) and scan images or even microscopic slide pictures (Telepathology).
Many radiologists are installing appropriate computer technology in
their homes, so they can have images sent directly to them for
diagnosis, instead of making an off-hours trip to a hospital or clinic.
Dermatology also uses store and forward technology (although
practitioners are increasingly using interactive technology for
dermatological examinations). General practitioners can take images of
skin conditions, and send them to a dermatologist for diagnosis.
In these advanced settings, patient could also be seen and spoken to
(Teleconferencing function), and in many countries clinics for chronic,
long term illnesses are now conducted via Telemedicine, providing easy
access to health care in remote areas.
As mentioned above, advanced forms of Telemedicine equipment needs a
surgery, the software and equipment, at least a laptop and a
Telemedicine centre, while some user friendly types focusing on some
illnesses per se (heart conditions) need only a laptop and the
In Sri Lanka, with internet facilities being available in most parts
of the country (with the President's "Nanasala concept"), one may only
need the equipment; data can be taken to the nearest Internet cafe,
downloaded and transferred to a centre in Colombo via a computer.
The simplest Heart disease equipment can be as cheap as just over Rs.
5,000 and the slightly sophisticated type, yet, costing under Rs. 50,000
a piece. Thus, with access to internet, these diagnostic cardiac (heart)
equipment can be used at home or, even if one is holidaying in remote
places like Yala or Wilpattu.
A slightly advanced, but yet simple, form has facility to measure
lung function; this could be used in case of asthmatics or in those who
have a cardiac (heart) condition complicating the lung function.
The devices are enhanced through the use of telecommunications
technology along with computing, network technology; video and video
The use of specialized application software, data storage devices,
database management software, and medical devices capable of electronic
data collection, storage and transmission are all key components of
Telemedicine infrastructure. Today, with the further advanced
technological marvel some of the facilities can be used from home and
without the presence of a healthcare professional.
Telemedicine customarily uses two methods to transmit images, data
and sound - either "live", real-time transmission where the consulting
professional participates in the examination of the patient while
diagnostic information is collected and transmitted, or "store and
forward" transmission, where the consulting professional reviews data
asynchronous with its collection.
"Store and forward" technology is used for transferring digital
images from one location to another. A digital image is taken using a
digital camera, ('stored') and then sent ('forwarded') by computer to
This is typically used for non-emergency situations, when a diagnosis
or consultation may be made in the next 24 - 48 hours and sent back.
Some other investigations (e.g. ECG recordings) can be downloaded to a
computer and sent to another computer elsewhere immediately. ECG
tracings and lung function readings are more needed in emergency
The other widely used technology, two-way interactive television (IATV),
is used when a 'face-to-face' consultation is necessary. The patient and
sometimes their provider, or more commonly a nurse practitioner or
telemedicine coordinator (or any combination of the three), are at the
originating site; medical assistants in ships and some airline staff are
now trained to carry out this function.
The specialist is at the referral site, most often at an urban
Tele-medical centre. Videoconferencing equipment at both locations
allows a 'real-time' consultation to take place. The technology has
decreased in price and complexity over the past five years, and many
programs now use desktop videoconferencing systems.
There are many configurations of an interactive consultation, but
most typically it is from an urban-to-rural location. It means that the
patient does not have to travel to an urban area to see a specialist,
and in many cases, provides access to specialty care when none has been
Almost all specialties of medicine have been found to be conducive to
this kind of consultation, including psychiatry, internal medicine,
rehabilitation, cardiology, paediatrics, obstetrics and gynaecology and
There are also many peripheral devices which can be attached to
computers which can aid in an interactive examination. For instance, an
otoscope allows a physician to 'see' inside a patient's ear; a
stethoscope allows the consulting physician to hear the patient's
Many healthcare professionals involved in telemedicine are becoming
increasingly creative with available technology. For instance, it's not
unusual to use store-and-forward, interactive, audio, and video still
images in a variety of combinations and applications. Use of the Web to
transfer clinical information and data is also becoming more prevalent.
Wireless technology is being used for instance, in ambulances
providing mobile telemedicine services, and more and more airlines now
use Telemedicine technology.
(Dr Wickramatillake was the Project Coordinator of the European Union
Telemedicine project NIVEMES, for ships and remote sites, and the
software he had designed is being used in EU ships - [email protected])
Good and bad dietary fats - Part II
by Dr. Nimal Ratnayake, Ph.D. (Head, Metabolism Section, Nutrition
Research Division, Health Canada, Ottawa, Ontario, Canada )
Coronary heart disease (CHD) is the primary cause of death in both
developing and developed countries. It is a complex disorder, several
modifiable and non-modifiable factors contribute to its development.
Among the modifiable factors, high levels of total blood cholesterol
and low density lipoprotein (LDL) cholesterol constitute major risk
factors for CHD. LDL is the major lipoprotein fraction that carries
cholesterol in the blood.
Generally, LDL transports cholesterol from the liver and small
intestine to cells and tissues which are taking up cholesterol. Because
LDL transports cholesterol to the arteries, increased levels are
associated with atherosclerosis, and thus myocardial infractions,
strokes and peripheral vascular disease. This is why LDL cholesterol is
called bad cholesterol.
The American Heart Association recommends that LDL-cholesterol should
be maintained below 100 milligrams per 100 decilitre (mg/dL) of blood to
minimize the risk of coronary heart disease..
In recent years lower levels of high density lipoprotein (HDL)-cholesterol
have also been implicated as risk factors for CHD. HDL is another class
of lipoproteins that remove cholesterol from the body's tissues to the
liver and from which a portion of cholesterol is put back into the
circulation and the remainder is excreted after conversion to bile
Because of this process, in which HDL can remove cholesterol from
atheroma within arteries, and transport it back to the liver for
excretion or re-utilization, they are sometimes called "good
cholesterol". High level of HDL particles serves as protection to the
body's cardiovascular health (in contrast to "bad" LDL cholesterol).
Men tend to have noticeably lower HDL levels than women. Men also
have an increased incidence of atherosclerotic heart disease. High
concentrations of HDL (over 60 mg/dL) have protective value against
cardiovascular diseases whereas low concentrations of HDL (below 40 mg/dL
for men, below 50 mg/dL for women) are a positive risk factor.
From the vast number of human feeding studies conducted over the last
50 years in many parts of the world, in healthy volunteers and people
with heart disease, it is very clear that the type of fat in the diet
plays an important role in heart health.
There is little evidence to suggest that moderate changes in total
fat without a change in the type of fat has any beneficial effects and
might actually produce a more detrimental effect on cardiovascular
disease. From these studies some common conclusions can be drawn.
Saturated fats increase LDL and HDL cholesterol but have their
greatest effect on LDL. Monounsaturated and polyunsaturated fatty acids
both decrease LDL cholesterol. Except at exceptionally high intakes,
polyunsaturated fatty acids does not decrease HDL and monounsaturated
fatty acids may actually increase it.
The net effect is that saturated fatty acids increases the LDL/HDL-cholesterol
ratio whereas monounsaturated and polyunsaturated fats decrease the
Thus, any incremental increase in the intake of saturated fats
increases the risk of coronary heart disease, whereas monounsaturated
and polyunsaturated fats produce a favourable blood lipid profile and
decrease the coronary heart disease risk. Therefore, intakes of
saturated fatty acids should be as low as possible while consuming a
nutritionally adequate diet.
Trans fatty acids also increase LDL cholesterol, similar to that of
saturated fats. However, unlike saturated fats, trans fats decrease HDL
cholesterol and therefore trans fats increase the LDL/HDL cholesterol
ratio to a greater extent than saturated fats.
In other words, trans fats are more dangerous than saturated fats.
Many western countries have taken steps to reduce the trans content in
processed foods and margarines to the lowest level possible.
Tips for consumers
1. Since saturated fatty acids are associated with increased risk of
cardiovascular disease, avoid using oils in cooking that are high in
saturated fats, such as coconut oil, palm oil, palm oil, butter, lard
(pork fat) and other animal fats.
2. Choose vegetable oils with the best nutritional profiles - those
with a healthy amount of monounsaturated fat and the two essential n-6
and n-3 polyunsaturated fats and low in saturated fat.
Of all the vegetable oils, canola, and to some extent soybean, are
the healthiest oils. Use these oils as salad oil, cooking oil and to
stir-fry vegetables or saute foods.
3. Other vegetable oils such as olive oil, sunflower, safflower, and
corn are also low in saturated fats. However, canola and soybean oils
are far superior to other vegetable oils, because they can provide both
n-6 and n-3 polyunsaturated fatty acids.
Other vegetable oils contain primarily n-6 polyunsaturated fatty
acids and almost no n-3 polyunsaturated fatty acids. Excess intakes of
n-6 polyunsaturated fatty acids are not recommended because large levels
of n-6 fatty acids in blood may have some negative effects on heart
On the other hand, the n-3 fatty acids counteract the negative
effects of the n-6 fatty acids and provide protective effects on
cardiovascular risk. They may also improve other cardiovascular risk
factors such as platelet function, blood pressure, blood flow and
Thus, it is imperative to have a good balance of n-6 and n-3 fatty
acids in our diets. In this respect, canola oil is the best vegetable
oil, because it provides n-6 to n-3 in a desirable ratio of 2:1. Soybean
oil can also provide both n-6 and n-3 fatty acids, but the disadvantage
is that it contains too much n-6.
4. Choose soft margarines that are low in saturated and trans fats
instead of butter, hard margarines, lard and shortening.
5. Substitute unsaturated oils (such as liquid oils or soft
margarines low in saturated fats and trans fats) in recipes that call
for shortening, butter, hard margarines, lard or beef fat..
6. Use a small amount of oil to saute or stir fry foods rather than
deep-frying in oil. Deep-frying uses a large amount of oil, which is
soaked up by the foods, thereby increasing the overall caloric content
of those foods.
7. Although deep frying is not a healthy choice, if you have to deep
fry, choose a hard fat such as coconut oil, palm oil are or palm kernel
oil. These oils more stable than unsaturated liquid vegetable oils.
Because of their high saturated fat content, they do not break down
during deep frying.
Although fried foods are more tastier than non-fried foods, because
of the negative effects of saturated fats on CHD, it is best to limit
eating deep fried foods on a regular basis.
8. For pan frying, it is not necessary to have a highly stable oil.
Oils containing high levels of monounsaturated fats have a stability
intermediate to that of saturated oils and polyunsaturated oils and are
healthier than saturated fats.
For pan frying, use any of the very high monounsaturated oils, such
as canola or olive oil. Once you use the oil for frying, do not use it
again for frying or cooking. Polyunsaturated fatty acids tend to break
down when they are exposed to high temperatures for long periods.
Therefore, always use fresh oil for deep frying.
In summary, oils containing large amounts of saturated fats or trans
fats are considered as bad fats. Bad fats include coconut oil, palm oil,
butter, various animal fats and hard margarines prepared using partially
hydrogenated oils. Polyunsaturated fat, along with monounsaturated fats
are good, healthy fats and they can be found in oils such as canola,
soybean and olive.
Polyunsaturated fats are necessary for the body and protects against