[Health Wise]

Dengue on the rise again

Sajitha PREMATUNGE

Aside from being a nuisance, wailing point at blank rage in your ear, mosquitos are responsible for many illnesses that can reach epidemical proportions, such as Chikungunya and dengue, wreaking havoc in tropical regions the world over. With such epidemics the dangers posed by the mosquito menace is not to be underestimated.

Dr. Paba Palihawadana

Dengue is spread by one of the serotypes of the Dengue virus, carried by the vectors - Aedes Aegipti and Aedes Albopictus. These mosquitos bite during day - when it is least expected and human defences of mosquitos are down.

“Although a person contracts dengue once, because there are four different types of the virus, he or she can develop dengue again, infected with another variant of the virus. Whereas Chickungunya can be contracted only once because there is only one type of the virus” said Dr. Paba Palihawadana, Director Epidemiology Unit, Ministry of Health.

Dengue can lead from Dengue fever to Dengue Haemorrhagic fever to Dengue Shock. The major cause of death due to Dengue is Dengue shock from DHF or Dengue Haemorrhagic Fever.

“Late detection and improper treatment could be fatal” said Dr. Palihawadana. She warned that if dengue fever is suspected the patient should undergo an immediate blood test. A drastic drop in a person’s platelet count is often indicative of Dengue.

This condition could ultimately lead to multiple organ failure, massive bleeding, fluid overload leading to cardiac failure, pulmonary oedema, acute liver failure with encephalopathy, encephalitis and myocarditis.

Dr. Palihawadana explained that the best precaution is to keep the environment clean. Since the eggs of the vector mosquitoes are highly resistant and adaptive to extreme environments and can survive for years.

Consequently the Director reiterated the importance of eliminating all empty receptacles such as containers, tins and tyres by crushing and burring them. “Kids should be advised not to play in the dark” said Dr. Palihawadana.

The universal problem of garbage disposal has made easy breading sites for the vector mosquitoes. “The highest number of recorded cases - 164 - are from the Colombo municipality while 266 have been reported from the suburbs.” pointed out Dr. Palihawadana.

“Aedis Aegipti is mostly responsible for spreading the desease in the Colombo city because it is more fond of empty containers, while Aedes Albopictus lays its eggs mostly in water collected in leaves of plants. Therefore it is responsible for spreading the decease in rural areas.”

Dr. Palihawadana pointed out that improper building practices has facilitated the spread of the desease by creating breeding sites for the vector mosquitoes.

“If a certain building does not adhere to proper standards it should not be approved” emphasised the Director.

According to Mosquito Borne Deseases Prevention Act, any citizen can be prosecuted and for having mosquito breeding sites in their residences with a fine of Rs. 25,000 to 50,000 or six month imprisonment and the power is vested to the Director General of Health Services.

The Director said that prevention of Dengue is not the sole duty of the Ministry of Health. “All government bodies should come together to prevent all mosquito borne deseases.”

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Remedial actions

1. If dengue fever is suspected let the patient bed rest as much as possible.
2. Give plenty of fluids
3. Refrain from giving Aspirin or drugs containing Salicylates, use only Paracetamol, in correct dosage (Do not exceed 4 times a day)
4. If DHF is suspected take immediate treatment from a hospital or qualified doctor
5. Monitor patient for dengue treatment even after treatment
6. Be alert to a sudden drop in temperature in the patient, which is indicative of Dengue shock syndrome

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Symptoms of Dengue fever

High fever
Headache
Rash on face trunk and extremities
Muscle and joint pain
Nausea and vomiting
Symptoms of Dengue Haemorrhagic fever (DHF)
Aside from the symptoms of Dengue fever DHF symptoms include Haemorrhagic manifestations, Petechial rash
Bleeding from nose, gums
Brown or black coloured vomitus or faeces
Severe and continuous stomach pain
Enlargement of lever
Dengue shock syndrome symptoms
If the fever of a person with DHF subsides but the patient still appears sick, it may be a sign of shock. Its symptoms include
Coldness or paleness of body
Restlessness or drowsiness
Acceleration of breathing and increase in pulse rate

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Total number of Dengue cases reported from January to 09 March - 2009

Colombo 430
Kandy 401
Gampaha 232
Kegalle 199
Kurunegala 170
Matara 147
Matale 118
Kalutara 113

Extreme multiple births carry tremendous risks

After the birth of octuplets this week, some doctors are questioning the ethics and medical practice that contribute to extreme multiple births.

Multiples have higher health risks because of their likelihood to be born premature. Many premature babies, such as the new California octuplets, are much smaller and face greater dangers than full-term.

These risks include bleeding in the brain, intestinal problems, developmental delays and learning disabilities that could last throughout their lives. But not all preemies have medical or developmental problems.

Doctors who are caring for the octuplets at Kaiser Permanente hospital in Bellflower, California, caution that it is too soon to tell whether any of the eight premature babies have neurological or medical conditions, such as cerebral palsy or anemia.

Dr. Mandhir Gupta, director of neonatology at the hospital, said Tuesday, “There are no indications so far, but again, it is very, very early. They are not 24 hours old yet.”

Six boys and two girls were born Monday through Caesarean section. Several are getting oxygen assistance but are reported to be “doing very well” after nearly 31 weeks in the womb.

Ten years ago, Nkem Chukwu of Houston, Texas, gave birth to the United States’ first surviving octuplets. The eighth baby, a girl named Odera, weighed only 10.3 ounces and died after suffering heart and lung failure a week after birth. In total, the eight premature babies weighed about 10 pounds.

Septuplets born to Bobbi and Kenny McCaughey of Des Moines, Iowa, in November 1997 all survived, and two of them have cerebral palsy.

The mother of the California octuplets wants to remain anonymous, and the hospital has not answered questions about whether she was using fertility treatments. But medical experts who are not connected with the births say it would be nearly impossible for a woman to naturally conceive eight babies at once.

Dr. Mary Hinckley, a California-based reproductive endocrinologist, said, “most commonly, this happens via fertility-assisted conception.”

A mother with a multiple birth could have used hormones to grow and ovulate multiple eggs at the same time. A patient may have not followed the doctor’s recommendations, or the doctor may not have understood the consequences, allowing the patient to produce too many eggs, which were then fertilized, resulting in a multiple birth. “It’s considered fairly reckless for reproductive endocrinology in the United States,” Hinckley said.

“Through guidelines, we’ve really altered this so [large multiple births] are incredibly uncommon here in the U.S. It’s usually if the doctor is not doing what he was trained to do or the patient is not following the doctor’s advice.”

The more premature the babies are born, the greater risks they have of dying or facing significant lifelong problems, said Dr. Norbert Gleicher, medical director at the Center for Human Reproduction in New York.

“The media should not make this into heroic case,” Gleicher said.

“This is anything but a heroic case. This is very bad medicine.” Twins carry low risk of premature birth. Triplets have higher risk than twins, quadruplets have even higher risks, and so on, he said.

As a result, “octuplets are crazy with tremendous risk,” Gleicher said. “Our function as physicians is to help our patients to have babies, but it is our principle that patients have healthy babies. So we have an absolute responsibility to prevent high or multiple births.” Experts aren’t sure why multiple births tend to occur prematurely.

Some suggest that the uterus can’t handle such a large mass, causing the woman to go into early labour.

During the pregnancy, the fetuses are cramped inside the uterus and compete for the same resources, and some may be weaker or smaller than others. The eight children born this week weighed from 3.4 pounds to 1.8 pounds.

“There was a wide range of weights,” said Dr. Leonard E. Weisman, director of the Perinatal Center at Texas Children’s Hospital. “Some of that might be due to human variation, or some of it might be due to the fact they might have been compressed and not getting enough support from the placenta.” Weisman, who helped deliver the first set of octuplets 10 years ago, said there are health risks to the mother as well.

“There’s a potential that the babies would outstrip the needs of the mother,” Weisman said. “It’s rather remarkable mother could stay with eight fetuses for 31 weeks.

That’s unusual.” Two of the California octuplets were on ventilators, or breathing tubes, in the hours after their birth, but those tubes were removed Monday night, Gupta said. While some of the babies are receiving oxygen through their noses, most are breathing by themselves, he said.

-CNN

Cellular phones can damage heart pacemakers

Dr. D. P. ATUKORALE

Cellular phones (mobile phones) can disrupt implanted cardiac pacemakers (pacesetters) and hand held mobile phones may by electrical interference, prevent cardiac pacemakers from functioning normally and cause rhythm disturbances resulting in giddiness, near-syncope and palpitations.

Research done at Mayo clinic Minnesota (USA) using 980 pacemaker patients, it was proved by a research team led by Dr. David Hays that hand phones could interfere with contractions of the pumping chambers of the heart in permanent pacemakers patients. However there was no interference when the telephone was held in normal position over the ear.

Many forms of electromagnetic energy can interfere with the function of cardiac pacemakers. Magnetic Resonance Imaging (MRI) Scanning lithotripsy devices, electrocautery devices (during surgery), electronic apex location, and electroanalgesic devices can cause interference with the function of the permanent pacesetters.

Interference may occur with various digital telephones but not with analogue telephones.

It had been shown that interference can cause at the header of the pacemaker and direct incidence of interference occurs when the hand phone is directly over the pacemaker. The researchers say that cellular phone users should not keep the hand phones in their shirt pockets.

If the cellular phone is as far as 10 cm from the pacemaker, it does not cause interference and the incidence may vary according to the model of the pacemaker.

If you are a case of permanent pacemaker and is going to undergo any type of surgery or if you are going to get a MRI Scan you must inform the cardiologist who had inserted the permanent pacemaker and get his or her advice prior to the procedure.

Surgical care for the IDPs and the injured

The College of Surgeons of Sri Lanka being the professional body representing the surgeons of Sri Lanka has been responsive to the surgical needs of the internally displaced persons (IDPs) and the injured in the North and East of the country.

From the very inception of the problem, the College of Surgeons has coordinated an initiative to send surgeons to hospitals in the areas of need to attend to the surgical needs of the IDPs and the injured. These extra surgeons who have been placed in Trincomalee, Vavuniya and Mannar hospitals have gone to these hospitals on a voluntary basis.

These initiatives of the College are complementary to the steps taken by the Department of Health, and other professional associations and trade unions belonging to the health sector.

The situation is being continuously monitored and reviewed by the College.

Lack of sleep could raise risk of diabetes

Allie Montgomery

Did you ever think those late nights during the work week could cause morethan just sleep deprivation? It has been found that people who have sleptfewer than six hours a night were more likely to develop a condition thatprecedes diabetes than those sleeping for longer periods of time.

The researchers said that the study supported mounting evidence that cutting back on your sleep can have a very profound impact on your health. Thissix-year study was presented at a recent conference for the American Heart Association.

Cases of type 2 diabetes, which is often linked to obesity, have been risingall across the world.

This condition develops when the body makes too muchinsulin, but does not use the hormone the hormone efficiently to help breakdown sugar in the blood. It is considered a stepping stone on the way to the condition which is known as impaired fasting glucose, in which the levels of blood sugar are too high, but not high enough to constitute a diagnosis of diabetes.

A research team from the University of Buffalo, in New York, followed a group of volunteers for the study for over a period of six years.

They found out that the people who slept on average for fewer than six hours a night during the work week were approximately 4.56 times more likely to develop impaired fasting glucose than those that were sleeping six to eight hours a night.

The lead researcher of the study, Lisa Rafalson, said, “This study supports growing evidence of the association of inadequate sleep with adverse health issues.

Health News

Asia facing tobacco-related 'epidemic'

Policymakers need to step up efforts to cut smoking rates in Asia to prevent

an "epidemic" of tobacco-related lung disease, a conference here was told Thursday. Many Asian countries have seen a surge in tobacco use in the last decade, particularly among the young and in urban areas as a result of economic growth. A rise in smoking by women has also been noted.

But ignorance of the health risks remain, especially among the rural poor, while overall tobacco use is adding an economic burden to countries in terms of healthcare and insurance costs plus lost productivity through illness.

Matthew Peters, head of thoracic medicine at Sydney's Concord Hospital, told

the 14th World Conference on Tobacco or Health that there were "real and material healthcare benefits" for countries to encourage people to quit.

For tuberculosis, which is increasing in Asia, 20 to 60 percent of cases were caused by smoking, he told a seminar entitled "Tobacco-related lung disease in Asia -- actions to avert the epidemic".

"Stopping smoking is a very simple way" of cutting TB rates, he said, adding that quitting also meant the region's poor, who are most affected by the disease, could use the money that previously went on tobacco for food and clothing.

"These benefits are substantial, they are seen quickly and impact on the most important hea lth risks in this region... and the especially complex issue of economic deprivation and nutrition," he added.

The conference has already heard concern about increases in smoking and tobacco use in Asia, as big tobacco firms look to the region for new markets as more people give up in developed countries.

Health professionals want anti-smoking legislation, including bans on tobacco advertising, tightened up. Some 1.25 billion people worldwide use tobacco in some form every day. China and India account for more than half of that total, according to American Cancer Society and World Lung Foundation statistics presented here.

Source – AFP, SRM