Security News | Sundayobserver.lk

Compared to other years it would seem that this year, deadly dengue has already reached epidemic proportions. Dengue or any other similar disease can reach epidemic level every three to four years, which could be prolonged by precautionary measures said Dr. Paba Palihawadana, Director Epidemiology Unit, Ministry of Health. "This time, fortunately, we have been able to prolong the period up to five years."

As Dr. Palihawadana explained one prominent feature of this particular wave of dengue is that there are three types of the virus circulating now instead of the usual two; with the addition of dengue type one, although Dr. Palihawadana said that all four types are equally dangerous.

However determining whether this particular outbreak is due to a new strand of the dengue virus - which is unlikely - would take a detailed study, for which we have neither the equipment nor expertise.

Dengue can lead from Dengue fever to Dengue Haemorrhagic fever to Dengue Shock. Because there are four types of Dengue, although a person contracts it once, he or she can develop dengue again. A drastic drop in a person's platelet count is often indicative of Dengue, while general symptoms range from high fever, headache, rash on face, trunk and extremities, muscle and joint pain, nausea and vomiting. Dr. Palihawadana advised that a fever persists for more than three days the patient should immediately consult a physician.

Dr. Palihawadana explained that the severity of this wave of dengue owes to the higher density of mosquitoes. Climate change and variations in temperature and rainfall has contributed to a higher density of mosquitoes.

Changing lifestyle is another cause according to Dr. Palihawadana. Busy schedules of people prevent themselves from engaging in such activities as gardening, added to that the problem of managing solid waste, allows mosquito breeding sites to go unnoticed.

But as Dr. Palihawadana pointed out the major problem that, areas hard hit with dengue is struggling to deal with is, unplanned landscaping and interior decorating. She explained that birdbaths and wild plants like bromeliads make ideal breeding sites for mosquitoes. Plants like bromeliads are designed to operate as mosquito breeding sites in the wild, because mosquitoes are also a component in wild ecosystem.

But, as Dr. Palihawadana explains we have unwittingly created new breeding sites in our own homes by bringing these wild plants to our homes. "These are sloppy mistakes we should always attempt to overcome."

Areas that have been identified as particularly vulnerable to the virus recently are areas subject to unchecked and uncontrolled urbanization such as Tangalle and Batticaloa, with the highest percentage of cases reported from Kandy.

Vectors of dengue breed in discarded trash like tyres, plastic bottles, packaging and containers and birdbaths as well as natural water bodies.

Aedes Aegipti has been found to live mostly indoors. This vector is also perfectly adapted to the urban setting in the sense that it feeds only on human blood and therefore virus is not diluted.

Although higher percentages of cases were initially reported from cities and suburbs, latest observations prove that the virus is rapidly spreading to rural areas.

She further explained that there is no point in attempting to eradicate the whole mosquito population. She explained that a major reason for the high density of mosquitoes is the lack of predators. Predators of mosquitoes like frogs are under constant threat from pesticide and global warming.

"Mosquitoes are also a part of the biosphere," therefore she stressed the importance of striking an eco-balance.

The Director said that the Mosquito Borne Diseases Prevention Act is now in force and the power is vested to the Director General of Health Services to prosecute any citizen for having mosquito breeding sites in their residences with a fine of Rs. 25,000 to 50,000 or a six month jail term.

The Ministry of Health is on a joint venture with the local government bodies, Ministry of Education, Department of Police, Civil Security Force and the Ministry of Environment - training hospital staff, conducting death reviews and awareness programs, cleaning and monitoring at household level - to cope with this wave of dengue, but reiterated that the support of the community is vital.

DF/DHF cases and deaths

by month 2009

January 	1,279
February 	  948
March 		  868
April 		1,056
May 		4,064
June 		  432
TOTAL 		8,647

Months 		Jan 	Feb 	Mar 	Apr 	May 	June 	Total 	Deaths

					RDHS
Colombo 	293 	156 	120 	151 	522 	101 	1,343 	  13
Gampaha 	125 	105 	 56 	 90 	549 	 30 	  955 	  20
Kalutara 	 67 	 46 	 42 	 40 	156 	  9 	  360 	   4
Kandy 		232 	166 	124 	174 	577 	 20 	1,293 	  24
Matale 		 73 	 43 	 61 	 62 	 93 	  3 	  335 
N’Eliya 	  8 	  9 	  3 	  8 	 19 	  1 	   48 
Galle 		  8 	 14 	 11 	  6 	 52 	  7 	   98 	   3
Hambantota 	 23 	 13 	  6 	 34 	279 	 33 	  388 	  12
Matara 		106 	 39 	 26 	 17 	184 	 37 	  409 	   5
Jaffna 		  3 	  3 	  2 	  0 	  0 	  0 	    8 
Kilinochchi 	  0 	  0 	  0 	  0 	  0 	  0 	    0
Mannar 		  2 	  1 	  0 	  0 	  1 	  0 	    4
Vavuniya 	  4 	  0 	  0 	  0 	  3 	  0 	    7
Mulaitivu 	  0 	  0 	  0 	  0 	  0 	  0 	    0
Batticaloa 	 12 	 62 	 12	  0 	 45 	 58 	2 299 	   9
Ampara 		  4 	  9 	 11 	 12 	 33 	  0 	   69
Trincomalee 	  8 	 33 	 18 	 81 	 71 	  2 	  213 	   2
Kurunegala 	 96 	 69 	 52 	 63 	361 	 57 	  698	   8
Puttalam 	 14 	 11 	 23 	 12 	 55 	  7 	  122 	   1
A’pura 		  7 	 13 	 79 	 56 	 78 	 14 	  247 	   2
Polonnaruwa 	 10 	  5 	  5 	  8 	 19 	  0 	   47
Badulla 	 11 	  7 	  5 	  8 	 28 	  5 	   64
Moneragala 	  5 	  3 	  2 	  1 	 14 	  9 	   34 	   1
Ratnapura 	 33 	 25 	 16 	 23 	291 	 51 	  439 	   3
Kegalle 	 96 	 95 	 76 	152 	604 	 43 	1,066 	  15
Kalmunai 	 39 	 21 	 10 	 13 	 17 	  1 	  101 	   2
TOTAL 	      1,279   	948 	868   1,056   4,064 	432 	8,647 	 124

					
Table 1.a DHF cases and deaths reported in Colombo district

MC Colombo 	129 	 67 	 26 	 29 	162 	 37 	  450
Other areas
of Colombo 	164 	 89 	 94 	122 	360 	 64 	  893

TOTAL NO.OC
CASES NO 	293 	156 	120 	151 	522 	101 	1,343

c:indi/mydoc/dhf data h3992009

Updated date: 09.06.2009, 0 = Not Received

Common causes of liver diseases and advanced level of treatment

Dr.Desmond Wai ,consultant Transplant Hepatologist and Gastroenterologist of the Asian Centre of Liver Diseases elaborates on the common causes of liver diseases and the advanced level of treatment in a recent interview:

Excerpts:

Common liver diseases in the South Asia region- Hepatitis B is very common in North and south East Asia with prevalence of 10% Hepatitis C common in certain parts of Asia like Myanmar, Cambodia, Vietnam and Mongolia. Though viral hepatitis B and C not common in South

Though a particular cause for this is not known for sure, but some speculate it would be due to genetics. and also could also be due to diet. In Sri Lanka coconut oil is used quite often for cooking purposes, high in saturated fat, which could as a result lead to high cholesterol and fat level in people. This could then lead to fatty liver disease. But these are just speculation which requires further evaluation.

Hepatitis

Viral Hepatitis A is transmitted by consuming contaminated food. Viruses could be found in the stools of patients who suffer from Viral Hepatitis A. If the stools are not well treated and contaminate the food chains, people who consume contaminated food can contract hepatitis A. Hepatitis is E is also transmitted in the same manner.

Viral Hepatitis B is transmitted through childbirth, sexual intercourse or blood. When a Hepatitis B mother gives birth to a child he/she can

Viral Hepatitis C is transmitted through blood. Most Hepatitis C patients in America, Europe and Singapore have history of blood transfusion or are injection drug users.

The virus can infect the liver, cause inflammation and scarring. Eventually that could lead to liver dysfunction and cirrhosis. In patients with viral hepatitis A and E , 99% of patients improve and recover and only 1% would die of acute liver failure. Patients with hepatitis B and C could develop long term problems like cirrhosis or even cancer.

Fortunately all viral Hepatitis varieties are rare in Sri Lanka. Out of the many causes for that I think the most likely cause is Sri lanka has a very effective public health system and a very good hygiene system.

In patients with acute viral hepatitis A and E, 99% of patients improve and recover and only 1% would die from acute liver failure.

Patients with hepatitis B and C could develop longterm problems like cirrhosis or even cancer.

Patient can either take meditation or undergo surgery when they have positive for these types of hepatitis.Nowadays, very effective and safe medications are available to treat viral hepatitis and we expect the morbidity and mortality from these virus to decrease in future.

Liver transplant

Liver transplant is widely done in the world since the 1980s and is considered the standard of care for patients with end stage liver disease like cirrhosis, cancer, or liver failure.

In general, three types of patients need liver transplant. The first is patients with acute liver failure. These patients have rapidly deteriorating liver function, and are presented with jaundice, confusion, and fever, Common causes of acute liver failure include acute viral hepatitis, drugs, or poisoning. The second type of patients have advanced liver cirrhosis. They present with jaundice, lack of energy, recurrent infection, swelling of abdomen, or vomiting of blood.

The third type of patients have liver cancer. Liver transplant is best for liver cancer patients where the cancer is centrally located so cannot be resected, or those with advanced cirrhosis.

Assessment

The donor must fulfil three basic criteria. First, the donor must be fit and healthy. Secondly, the donor must be purely voluntary. Thirdly, the donor must be either related to the recipient, or know the recipient.We assess the recipient, to determine if he needs a transplant, and if he is medically fit for the transplant.

Someone who is fit and healthy and will be an ideal donor and truly wants to help. A transplant patient will return to normal life. They can get married and have children.

Complications

Approximately 0.5% of donors could die from the surgery so we do take every precaution to ensure donor surgery is safely performed, and the are well taken care of after surgery.

About 5% of donors have serious complications like bile duct injuries Having said that, most donors return to normal work after 2 months, and most live a normal life.

I reviewed one of my transplanted patients last month. The patient had liver cirrhosis and was in a coma state about 4 years ago. Today, he was well and was working as a businessman in Jakarta. His donor was his son, and now 4 years post transplant, the son got married and is now the father of a pair of twins.

We have many happy queries like that donors can still have babies after donating his or her liver? Many of our donors have got married after the donation and have many kids after that.

Prevention

The best ways are to live well, eat well, and do regular exercise. See your doctors regularly for body checkups.

Hormone replacement therapy heightens risk of lung cancer death

Although the onset of menopause brings with it a variety of unsettling symptoms ranging from hot flashes and night sweats to increased anxiety, irritability and more, women may be far better off to suffer these rather than seek the relief brought by hormone replacement therapy. On the heels of news that perimenopause causes temporary memory loss and learning difficulties adding to the list of grievances of the menopausal state, comes a warning that hormone replacement therapy for menopausal symptoms greatly increases the risk of lung cancer death. A new study suggests that women who take estrogen-progestin pills and also develop lung cancer are at a 60 percent greater risk of dying from the disease than women who do not take hormones and develop lung cancer.

Dr. Rowan Chlebowski of Harbor-UCLA Medical Center in Los Angeles, who led the study, said that the findings of the analysis indicate that smokers who receive hormone replacement therapy (HRT) should stop taking the hormones and for those smokers who are contemplating HRT, careful consideration should be given prior to commencing it. Experts have already warned women who take hormones to use the lowest dose for the shortest duration possible, and to this warning Chlebowski added, "Women almost certainly shouldn't be using combined hormone therapy and tobacco at the same time." The results of the study were recently presented at a meeting of the oncology society in Florida.

This latest analysis used data from the Women's Health Initiative study, a federal study in which 16,608 women were given either Prempro, a drug combining estrogen and progestin, or a placebo. The average age of women in the study was 63, and the participants used high doses of Prempro over long periods of time. The study was halted in 2002 after it was discovered that more breast cancers were occurring in those women receiving the Prempro, demonstrating that the HRT increased the risk of breast cancer. The women who participated in the original Health Initiative study continue to be followed.

The current study focused the most common type of lung cancer known as non-small-cell lung cancer. After five and one-half years on HRT and more than two years of follow-up, no significant difference in the number of incidence of lung cancer that developed was noted in hormone users. However, an alarming 46 percent of lung cancer occurrences proved fatal in hormone users compared to only 27 percent of those who received placebo. HRT accounted for one extra death from non-small-cell lung cancer per 100 women in the study. The researchers have not yet studied lung cancer risk in those who took estrogen alone without progestin.

Chlebowski noted that previous research suggests that hormones play a role in non-small cell lung cancer since women tend to have higher survival rates than men and are known to have a more positive response to certain therapies. However, Dr. Len Lichtenfeld of the American Cancer Society said that with only 106 lung cancer deaths occurring in the study to date, that the total deaths are too few to make comprehensive conclusions about risk.

Dr. Joseph Camardo of Wyeth, maker of Prempro, pointed out that women use HRT much differently now than during the period of time the federal study was conducted and that the same risks may not apply with the new patterns of use.

Women now start HRT at the age range of 51 to 54, and take the hormones for an average of two years. During the period of the Women's Health Initiative study, the average age at which women began HRT was 63 with the therapy continuing for more than five years.

Lung cancer is world's leading cause of cancer death. In 2008, there were more than 215,000 new cases of lung cancer diagnosed and almost 162,000 deaths in the United States alone.

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