Wednesday,
September 23, 1998
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Dropsy-dead
cry for justice Brain surgery now easier Tension and headache Asthma: Chinese experience
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Dropsy-dead cry for justice Concern for sinking public morality in our country has been expressed by a number of right-thinking people from time to time. The recent epidemic of dropsy has brought into sharp focus yet again the precipitous downslide in our sensitivity to the welfare of fellow citizens. The fact of the tragedy itself is bad enough; the unprecedented scale of the event is indeed heart-rending. Epidemic dropsy has been reported from different parts of North India many times in the past but never in such numbers with over 60 deaths so far and more being reported every day! Considering that diagnosis is largely by clinical examination and suspicion aroused only by circumstantial evidence, one wonders as to how many cases have remained unrecognised and unreported in the recent past in Delhi and elsewhere before the attention of doctors was drawn to the condition; and even after that. Rustic village wisdom has for long recognised the toxic nature of the products of the plant as is apparent from the colloquial names given to it: Sialkantha in Bengal, Satyanashi in Punjab and Haryana, Darudi in Gujarat, and Bharamdandi in Maharashtra. Although the plant itself is easily identified especially from its prickly stem, the seed bears a remarkable resemblance to mustard seed or “rye”. Most previous reports have attributed the epidemic to accidental adulteration of mustard oil as a result of failure to distinguish the poisonous argemone seeds from the seeds of mustard. However, argemone seeds are indeed picked by some farmers, in spite of the prickly nature of the plant, and argemone oil is extracted for specific use in the jute industry, as an industrial oil, and sometimes for domestic use as a cheap fuel for lighting “divas” by the village folk. Any one of these could provide a source for accidental poisoning. It is only occasionally in the past that poisoning has been attributable to the deliberate efforts, usually of a small-time trader. Never before has adulteration been reported on such a large scale through the organised machinations of some unscrupulous people under the very noses of the persons who are supposed to be the guardians of people’s health. Who would think that adulteration could occur even where the state itself is the production and distribution agency? The process has obviously been going on for considerable time or else how could adulteration have been detected in so many brands of oils, even vanaspati, sold in the market? According to experts, adulteration amounting to only one per cent is enough to cause toxicity. Clearly there is very little profit in an admixture of such a small amount of the adulterating oil. It is in this context that the news that used mobil oil is another adulterant which has been found in samples of the oil being sold for human consumption assumes added significance! Insiders dealing with oil trade say that adulteration of mustard oil with argemone oil has been going on for quite some time. It is stated that argemone oil, being somewhat pungent, is being regularly added to mustard oil so as to enhance the smell and taste of the oil and, therefore, the market value! It is likely that poor-quality of mustard oil is first adulterated with mobil oil which is a waste product from the motor trade. Later, argemone oil is added to mask or enhance the fragrance of the mixture thus duping the public twice over! What is worse is that the trade appears to have been aware of this practice for quite some time. Even while greed and the desire to attain riches rapidly at all costs is a universal driving force for the perpetrators of such crimes, it requires much more than greed to execute such diabolical programs. The most outstanding is utter insensitivity towards fellow human beings. It is the height of egocentricity to attempt to gain riches at the expense of other people’s lives. Yet, that is precisely what has happened in this instance. Although failure of the executive and their political bosses is writ large on the face of every corpse that has fallen to this man-made disaster, as well as the survivors, who may have to suffer for God knows how long, corrective action has been tardy and the attempt at a cover-up blatant. While bureaucrats will predictably try to shift responsibility, industrialists are apparently pleading ignorance. Industry is clearly guilty of failure to maintain even elementary quality control and must be held accountable for such horrendous disregard for human life in this country. There cannot be any mitigating circumstances for such heinous crimes; the dead are crying for justice. A calamity of this magnitude would have raised hell in many other democratic societies; many elected governments have fallen for lesser sins. Our response has been remarkably muted. There cannot be a greater self-evident indictment of the governmental machinery responsible for ensuring the quality of foodstuff sold for public consumption. The entire staff of the department concerned of the government has failed in its statutory duty and so has the industry. Yet the concerned minister of the government has not owned responsibility so far. In any other country the minister would have resigned or would have been sacked; not so in our country. Likewise, the heads of the statutory monitoring agencies of the government as well as those of the agencies responsible for manufacturing and retailing the oil should have faced censure and been sacked from their positions for a clear failure in discharging their responsibilities. Even the press has given it a go-by, the subject has been relegated to a brief head count on the inside pages of the newspapers. What a distortion of our priorities? Mr Bill Clinton’s escapades and Mr Laloo Yadav’s antiques are more important than such premeditated homicide in our midst. The response of the government, industry and the media shows a pathetic disregard for the right to life that the Constitution bestows on every single individual in this country. It is a sad commentary on public perception that the death of people in such large numbers does not evoke the revulsion that it should, perhaps because most of the dead have been poor people. Unlike floods and earthquakes these deaths were wholly and completely avoidable and, therefore, must draw severe public censure. The apathy and cynicism of the public at large who submit to such atrocious and blatant violation of their elementary rights is as severe an indictment of our democratic institutions as can ever be. Democracy that remains restricted to pompous elections is hollow unless it can reach out to all the people, all the time and in equal measure. Sadly democracy has not come to maturity in this country; far from it, it has still to wake up! Dr
Sapru, who has retired as the Head of the Cardiology
Department, PGI, is a practising cardiologist and medical
thinker. |
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Brain surgery now easier THE human brain is one of the most difficult organs to operate upon and surgery in this area involves the risk of leaving the patient impaired in some way. One of the common problems for which brain surgery is resorted to is aneurysms — blisters that form at a weak spot at the junction of two arteries in the brain. The blister usually gets enlarged over a period of time but its maturity is difficult to determine. The ruptured aneurysm results in a haemorrhage, leaving the patient either dead or severely handicapped. An engineer was recently admitted to the Indraprastha Apollo Hospital, New Delhi, complaining of a severe headache, frequent bouts of vomiting and transient loss of consciousness. He was operated upon successfully without cutting the skull. A CT scan in the Interventional Neuro-radiology Department revealed that the patient had suffered massive bleeding on the surface of his brain. A team of doctors headed by Dr Anil Karapurkar and Dr Harsh Rastogi used the endovascular technique to treat the engineer. Rotational angiography was performed to assess the exact location and the size of the blister. Using this road mapping technique on two planes, under vision, a guidewire was delicately inserted into the aneurysm and a micro-catheter was threaded over it so that it is within the aneurysm. Again, under vision, by the road-mapping technique, special coils made of platinum were deployed in such a manner that the first turns of the coil were placed on the wall of the aneurysm. More coils were subsequently deployed until the blister was tightly packed and completely obliterated. Throughout the procedure, contrast fluid was injected intermittently to confirm the positioning of the coil as well as to ensure the potency of the neighbouring arteries. This procedure was possible due to the availability of the sophisticated Digital Subtraction Angiography machines at the Hospital. It took more than three hours to pack the entire blister. According to Dr Karapurkar, this technique offers excellent control over the deployment of the coils. In the endovascular treatment, through a small hole in the groin, a special catheter and coils are placed within the aneurysm. No cuts or incisions are made and the skull is not opened. There is no pain or loss of blood. At least 14 patients have been cured with this mode of treatment. The cost of the treatment varies between Rs 1 lakh and Rs 1.5 lakh. The recovery period is much shorter than that in conventional surgery (it often takes months). Another technique developed by the doctors concerns the use of the nose to insert thin tubes or endoscopes and operate on tumours located in deep, impenetrable parts of the brain that are difficult to reach through conventional surgery. Dr Vijaysheel Kumar, senior consultant in neurosurgery at Apollo Hospital said conventional surgery to treat tumours deep inside tiny, critical parts of the brain was difficult and might prove fatal. Endoscopy, a technique in which thin tubes equipped with magnifying lenses and cutting instruments are inserted through a hole or a cut to operate upon the interior organs in the body, is gaining ground in brain surgery. “Inserting endoscopes through the nose to reach parts deep inside the brain is proving useful in treating tumours of the pituitary gland which is responsible for the production of several key hormones in the body,” Dr Kumar said. Pituitary tumours affect about two per cent of Indians — usually between 25 and 50 years of age — causing headache, loss of vision, dizziness, abnormal growth in various parts of the body and hormonal disturbances. By the new method, surgery can be performed
quickly without the loss of blood and the patient can
recover within three days.— TNS |
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Tension and headache PAIN in any form and of all types is discomforting. Most often pains are protective warnings of impending danger. Pain often helps the doctor reach a correct diagnosis. An inflamed appendix, if not painful, is likely to be ignored and, if allowed to burst, can prove fatal. Headache, by far, is the commonest human malady. The total human working hours wasted because of headaches top the list of all human afflictions. “More time is lost to headaches than all the time lost to heart disease, stroke and cancer”, says Dr. David Coddow, of the Mount Sinai Headache Clinic in New York City. Headache is never a disease but merely a symptom of many unrelated disorders ranging from the trivial to grave afflictions. Usually, headaches are the outcome of a wide variety of disorders primarily affecting the eyes, nose, ears or sinuses in the head region or can emanate from the varied inflammations in the body or accompany fever. If a headache is accompanied by symptoms such as visual disturbance, vomiting confusion, loss of memory, numbness in certain parts, lack of coordination, slurred speech or high fever, it warrants immediate medical attention. Researchers have identified three categories of headaches — (i) tension or stress headaches (ii) cluster headaches and (iii) the dreaded migraine. Stress: These comprise over 70 per cent of the total referrals to the pain clinics but are easily manageable. These basically originate in the tense shoulder and neck muscles which when fatigue trigger contractions in the scalp muscles causing pain in the head. The sufferer feels tightening of muscles in the neck, face or scalp, giving him the feeling that “his head is being squeezed in a vice”. Persons, who need but do not use glasses are specially prone to these headaches. Emotional upsets, a state of depression or episodes of anxiety may lead to recurrent tension headaches. Not surprisingly, therefore, these are related to overwork or to emotional turmoil. Even an angry outburst can trigger a tension headache. Rest or a brief nap, or even a relaxed chat over a cup of tea, eases such headaches. Minor changes in one’s lifestyle like avoiding stress, fatigue or excessive exercisable bouts may prevent recurrent attacks. Recovery in such headaches is quick following the use of the commonly available drug store standbys like paracetamol or aspirin. These also respond to even non-pharmaceutical remedies like biofeedback techniques in which the sufferers are taught to relax and redirect the bloodflow to other parts of the body, thereby reducing the pressure in the head. There is no one who has not experienced tension headaches occasionally. However, these afflict the higher strata more. Whereas 80-90 per cent of the bureaucrats or senior executives suffer from occasional tension headaches, well over 30 per cent of these experience such headaches several times a month. Tension headaches, even if severe, are brief and usually do not last beyond a couple of hours. These rarely are accompanied by nausea or visual discomfort. Vomiting is never or rarely associated with tension headaches. These invariably involve both sides of the head and generally occur more towards the end of the day when the sufferer is tired or under mental stress. Their onset is abrupt and not gradual — as that of migraine. Tension headaches can coexist with migrains — attacks of tension headaches in between two episodes of migraine are not uncommon. (To be concluded) Dr
K.C. Kanwar is an eminent biophysicist and a former
Chairman of the Department of Biophysics, Panjab
University, Chandigarh. |
Asthma: Chinese
experience ON my first visit to Hong Kong I thought it must be a colony of hypochondriacs. Virtually everywhere I came across traditional Chinese medicine shops — tiny pharmacies crammed with strange and surprising concoctions that had me, as doctor, staring wide-eyed and open-mouthed. An unlikely marriage of Queen Victoria’s nation of shopkeepers and the entrepreneurial and energetic sons of the Yellow Emperor, the British colony of Hong Kong lasted for 155 years. Hampered neither by self-serving politicians nor myopic government regulations,Hong Kong was the perfect haven for those with the single-minded purpose of creating wealth for themselves. When the British left last year, the once “barren piece of rock” they returned to China was a thriving territory that had grown into the fourth largest financial centre in the world. But beneath the mercenary-minded exterior of the average Hong Kong person there beats a traditional Asian heart — and nowhere is this more evident than when he or she falls ill. If you happen to feel under the weather in Hong Kong you have a cornucopia of traditional remedies to deal with your symptoms. While traditional medicine shops may seem like nothing more than exotic quackery to some westerners, it must be remembered that not too long ago today’s fashionable forms of therapy like acupuncture, aromatheraphy and naturopathy were all relegated to the realm of sham remedies. Times have changed. The traditional medicine shops are full of exotic wares — quixotic concoctions such as ground gecko and crocodile bile for asthma; even capsules (appropriately enough named Trumpet Band) for the relief of flatulence. With sexual anxiety being as common as anywhere else in the world, a furtive nip over to the local sex shop to pick up lotions and potions to improve your performance in the boudoir is easily made. There, “Great Spray” openly vies for space on the shelves with “Strong Pills.” The second, I was told, includes extracts of the male organs of seals, snakes and stags. My favourite pharmacist, Fung Sam, still has his shop in an alley off Hip Wo street, in the crowded Kwun Tong quarter of Kowloon where a myriad cramped shops spill on to the crowded pavements. Large wicker baskets overflowing with dried herbs greet you as you walk through the entrance. Behind the counters, tiers of unmarked drawers hold the secrets of 50 centuries of Chinese medicine. A couple of ancient functionaries shuffle between the counters to weigh these mysterious substances. As quick-witted octogenarians with minimal signs of senility or deformity, they are walking advertisements for the efficacy of their employer’s remedies. Above the drawers, huge glass jars line the shelves, reminding me of the Colombo sweet shop I used to frequent in my Sri Lankan childhood. Of course, instead of gobstoppers and bull’s eyes these jars contain monkey gallstones for ulcers, seal’s testicles “to replace vital essences” and dried turtle shells for kidney ailments. Much more exciting than a mere course of
antibiotics. — Gemini |
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New
injection for painful nerves It usually occurs after an attack of Herpes zoster infection or through skin lesions.The affected patients complain of sharp, intermittent pain on one side of the head or face.The new injection therapy, “Jaipur block”, consists of three anaesthetic agents — xylocaine, bupivacaine and dexamethasone solutions — in appropriate concentrations, team leader Rishi Bhargava from the Sawai Mansingh Hospital in Jaipur, who has been working for the last 19 years on the treatment, told PTI. The Jaipur block is given in combination or alone in a scheduled time frame and works by anaesthetising the nerves carrying pain impulses to the brain, he said.About 96 per cent of the patients obtained complete relief after the treatment in his study with 3960 patients.While 28 per cent of patients were relieved of pain after a single dose of injection, 57 responded after two injections and 11 per cent after three injections, Bhargava reported in the International Journal of Dermatalogy. “The trials probably involved the largest group of patients, and some side-effects like giddiness and sweating were observed occasionally in a few patients,” Bhargava said.The new anaesthetic product would come into the market as soon as all the trials are completed, he added. While available therapies for treating herpes infection are based on anti-viral drugs and pain killers, they are usually found ineffective for long term treatment, Bhargava said. Herpes is common in adults with low immunity or malignancy like those infected with human immunodefficiency virus (HIV). It is 50 to 100 times more common in children suffering from blood cancer (leukemia) than healthy ones of the same age, he added.— Yash Goyal Oral
cancer epidemic A recent house-to-house survey in Bhavnagar district of Gujarat shows a high incidence of “oral submucous fibrosis” or OSF — a precancerous condition in the mouth that can lead to oral cancer.The survey by the epidemiology research unit of the Tata Institute of Fundamental Research (TIFR) in Mumbai found an increase in prevalence of OSF — double of that three decades ago. Another disturbing trend was the high prevalence of OSF in the lower age group, with 84 per cent of the OSF patients less than 35 years of age.This could be directly attributed to the use of areca nut products, the TIFR team led by P. C. Gupta reported in the National Medical Journal of India. Both areca nut use and OSF were concentrated in the lower age group below 35 years.The findings on over 11,000 men and 10,500 women point towards an evolving epidemic of OSF in the rural population in Bhavnagar, which could hold true for most of North India. Areca nut is the main constituent of “pan masala”, a product which attracts low government taxes as it contains no tobacco, and is the target of high-profile aggressive advertisement campaigns. The low taxes and wide publicity has led to an enormous increase in the use of all types of areca nut and smokeless tobacco (that is chewed or inhaled as snuff) among Indians, especially North Indians.Areca nut is also mostly used in “mawa”, a mixture of tobacco, lime and areca nut. One-tenth of “mawa” users had OSF, the TIFR survey found. “Thus the perception of a substantial increase in the incidence of OSF in the North Indian population appears to be real”, the report says.The epidemic needs to be stemmed urgently by taking measures to discourage the use of products containing areca nut or tobacco, it warns.OSF, a progressive chronic disease with no known cure, can be detected by the presence of fibrous bands in the mouth that develop as the mucous lining in the mouth becomes less elastic.The patients cannot tolerate spicy food and the opening of the mouth reduces progressively. In extreme cases, it may be difficult for even a straw to pass through the mouth.— T. V. Padma Malaria
vaccine The discovery, which is bad news for the malaria control programme, was made by M. A. Ansari and his colleagues at the Malaria Research Centre and Y. D. Sharma of the All-India Institute of Medical Sciences in New Delhi.“The presence of multiple P. falciparum isolates with different genetic make up will have serious implications for the development of vaccines and drugs,” the scientists said in a report published in Current Science. “Furthermore,
a falciparum malaria vaccine raised elsewhere may not be
effective in India since the Indian isolates seem to be
different, the scientists said.The parasites, genetically
different from each other, were isolated from a total of
101 malaria cases in Rajasthan, Assam, Delhi, Haryana,
Uttar Pradesh, Orissa and Madhya Pradesh. The majority of
Rajasthan isolates were chloroquine resistant.P
falciparum is the most lethal human malaria parasite
causing epidemics and large number of deaths in
India.(PTI)— K. S. Jayaraman |
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