Common but serious diseases
Dr Ajit S. Puri
In this article, Dr Ajit S. Puri, the author of the book "How to Prevent Common Serious Diseases", sums up his main recommendations and advice on the prevention of some common but fatal diseases for the benefit of The Tribune readers.

HEALTH BULLETIN
Summer eye problems
Dr R. Kumar
Come summer, and your eyes are exposed to dust, wind, heat, dazzling light and the ultraviolet rays of the bright sun. Consequently, the number of cases, reporting to eye specialists with complaints like red eye, dry eye, tired eye, irritated eye, burning eye, eye with foreign body sensation or general discomfort in the eyes, increases manifold. To prevent this problem one has to protect the eyes against the dazzle of bright sunlight, dust, heat, and deep-seated effects of ultraviolet rays.

Schizophrenia: care holds the key 
Dr Rajeev Gupta
Schizophrenics are known to suffer from repeated relapses. During these episodes, they become violent and aggressive. At times it becomes extremely difficult to administer medicine to them. Their symptoms, like hallucination and delusion, become worse. They may become completely unmanageable at home and may need short hospitalisation (for two to three weeks).

Ecological care

Q&A
What you need to know about Hepatitis A

Common but serious diseases
Dr Ajit S. Puri

In this article, Dr Ajit S. Puri, the author of the book "How to Prevent Common Serious Diseases", sums up his main recommendations and advice on the prevention of some common but fatal diseases for the benefit of The Tribune readers.

There are many common but difficult diseases which remain hidden in infancy and appear clinically years later when they reach an advanced stage. Their treatment may not be possible or may become very costly and, therefore, unaffordable by the common man. To prevent such disorders, in our ecologically disturbed world, some hints are given below.

In the case of diabetes, blood sugar must be tested at least once in six-months or yearly, especially when there is a family history of the disease. The same advice applies to the early detection of hypertension. Blood pressure also ought to be measured regularly.

There are many kinds of cancer. By and large, painless swelling anywhere on the body, say on the skin, the breast or the testis, should arouse the suspicion of malignancy. Most leukaemias (blood cancers) are treatable; once these are detected, there should be no undue panic.

For congenital heart disease, all pregnant women should undergo ultrasonography of the abdomen, preferably foetal echocardiography, in their first trimester. For rheumatic heart disease, the prevention of sore throat is a must, and for coronary heart disease the children whose parents have suffered or are suffering from this ailment should be looked up right from their childhood. The control of blood pressure, sugar, cholesterol, uric acid and body weight is essential. Lifestyle plays the key role. The avoidance of smoking or tobacco-chewing is commendable. On similar lines, a stroke can be prevented.

One should bear in mind the fact that tuberculosis is a curable disease. Blood in sputum is an important symptom of the disease though in middle-age people lung cancer should also be suspected. However, for early or hidden cases, miniature mass radiography (MMR) has a key role.

Likewise, epilepsy is treatable. Treatment must be sought from a qualified practitioner or a specialist and should be taken uninterruptedly for a period of three or four years. It should be clear that the disease does not affect the intelligence of the sufferer except in certain cases of the newborn.

Undue lethargy in a person should lead one to the thought of early hypothyroidism (underactivity of the thyroid gland) and on the contrary, overactivity in an individual (a rough guide is increased pulse rate while sleeping) may be considered as hyperactivity of the gland (thyrotoxicosis).

As regards tropical diseases, lockjaw, i.e., difficulty in opening the mouth, especially when there is a clear history of injury, more so in an unvaccinated individual, should make one think of tetanus. In the case of rabies, (a bite by a rabid of "escaped" dog), one needs immediate vaccination. Scorpion-sting is most dangerous and one can die within a few minutes to 24 hours. Therefore, immediate hospitalisation should be the rule. A plague epidemic needs to be prevented promptly as people die en masse. It can be forecast as well. The occurrence of seismic activity or an earthquake is an important warning signal. As regards snake-bite, vaccination is available. The biting snake can be non-poisonous too.

AIDS (Acquired Immuno Deficiency Syndrome) has no early specific symptoms. It may have a longer incubation period — of about eight years. The best thing is prevention. Safe sex, the use of condoms and sterilised needles and HIV-tested blood transfusion are ideal. During the incubation period, the individual needs to be cautious and should not spread the disease among innocent people. He or she can be prosecuted. Health-care workers need to take the necessary precaution.

There is a lack of awareness of hidden cases of kidney diseases. Cases of kidney failure/transplant or the ones undergoing dialysis are not uncommon. Prevention of urinary tract infection (UTI), the care of sore throat (to prevent glomerulonephritis), the control of diabetes and hypertension are some of the ways to avert kidney damage or failure. The indiscriminate use of drugs needs to be curbed.

Bronchial asthma is a controllable condition. The use of steroid inhalers are recommended at the international level. Undoubtedly, these are most safe as the dose of the steroids is too small to cause any adverse side-effect in contrast with the oral steroids previously used for this ailment.

The prevention of liver diseases is equally important. Vaccination for hepatitis-B is available but there is no hope for alcoholic cirrhosis of the liver. The ultranosography of the liver can show early or reversible signs of the disease but if the individual is not careful (he or she does not stop or reduce the consumption of alcohol), he or she may even face the cancer of the liver.

It is hoped that the above guidelines will help in preventing the above-mentioned common but fatal diseases. For further details, the book authored by the writer, "How to Prevent Common Serious Diseases", published by Sterling, New Delhi, may be consulted. (A TV talk on the plague epidemic to be telecast by the Doordarshan Kendra, Jalandhar, on May 18 at 4.15 p.m can also be viewed.)

HEALTH BULLETIN
Summer eye problems
Dr R. Kumar

Come summer, and your eyes are exposed to dust, wind, heat, dazzling light and the ultraviolet rays of the bright sun. Consequently, the number of cases, reporting to eye specialists with complaints like red eye, dry eye, tired eye, irritated eye, burning eye, eye with foreign body sensation or general discomfort in the eyes, increases manifold. To prevent this problem one has to protect the eyes against the dazzle of bright sunlight, dust, heat, and deep-seated effects of ultraviolet rays.

Red eye: In our part of the country, the onset of summer brings frequent duststorms and with them come a crop of patients with pink eyes, with or without discharge. The condition is broadly labelled as conjunctivitis.

Conjunctivitis, or pink eye, is the inflammation of the conjunctiva, the clear mucous membrane that covers the white part of the eyeball and the inside of the eyelid. It is the most common eye infection in India— especially in Punjab and Haryana. Cases may vary from mild redness and a watery condition to serious infections where the vision is impaired.

Conjunctivitis happens when the conjunctiva becomes infected, usually by a virus or bacteria. It can also be caused by an allergic reaction or chemical irritations. If you have conjunctivitis, you may wake up with your eye-lashes stuck together with the dried mucous formed during the night. The condition often affects both eyes and causes a gritty feeling. Although the vision is usually not affected, the eyes may become very sensitive to light. The stickiness of the eyelids is quite unpleasant. In severe cases, the eyelids are swollen. Itching is another common symptom.

All cases of redness in the eye may not be due to conjunctival infection; some of them can be due to exposure to heat, dry eye conditions, allergy to environmental pollutants or simply because of fatigue or sleeplessness. Early and correct treatment prevents delay in recovery, complications like ulcers in the eye as well as unnecessary exposure to antibiotic drops.

The foreign body: Getting a particle on the cornea or behind the eyelid during duststorms is fairly common. Washing the affected eye with clean tap water is the best thing you can do. Do not rub the eye in any case. If the foreign body cannot be removed by washing, do not indulge in domestic surgery. Consult an eye-specialist.

Dry eye: Patients reporting with multiple and vague complaints like discomfort, irritation, fatigue, burning, intolerance to contact lens, etc, with apparently normal-looking eyes may give an indication of the underlying dry-eye condition. The incidence and the level of discomfort are generally higher during summer in such cases. Only a clinical examination and certain tests reveal the dry-eye state.

Management: In the case of infection, cleaning the crusting on the eyelids every few hours with a cotton swab soaked in lukewarm water usually helps one feel better. Antibiotics eye drops, ointments or other medications may also be used under the supervision of an eye-specialist. The eye should not be covered by a bandage or an eye-pad as this can make the infection worse.

Prevention: The role of sun glasses is paramount in the prevention of summer-related eye problems. Sun glasses help in reducing the glare, filter out 99 to 100 per cent of the ultraviolet (UV) rays and provide visual protection. One can be comfortable. Distortion of colours is avoided. No one is immune to sunlight-related problems. People who spend long hours in the sun are more prone to UV exposure. Some are more sensitive to UV rays and others who take medication like tetracycline, sulpha, birth control pills, diuretics and tranquillisers become more sensitive to UV rays.

Good sun glasses should be able to protect one against all types of harmful UV rays. However, since 50 per cent of the sun rays enter the eyes from above or around the sun glasses, the shape, size and style of the glasses should be such that all sunlight is cut off from the eyes. The glasses should be impact-resistant and the frames should be bendable but unbreakable.

Washing the eyes and the face as well as the hands with soap and clear tap water repeatedly, soon after the exposure to dust or pollution, is a good preventive measure.

Dr R. Kumar is the President of the Chandigarh Ophthalmological Society. Address for correspondence: 232, Sector 16 A, Chandigarh.

Schizophrenia: care holds the key 
Dr Rajeev Gupta

Schizophrenics are known to suffer from repeated relapses. During these episodes, they become violent and aggressive. At times it becomes extremely difficult to administer medicine to them. Their symptoms, like hallucination and delusion, become worse. They may become completely unmanageable at home and may need short hospitalisation (for two to three weeks).

Many families find it difficult to have access to private psychiatrict treatment. In the absence of adequate state-run medical facilities, a large number of schizophrenics belonging to the poor section of society remain untreated and finally become wandering lunatics. A lack of proper and adequate treatment also drives them to chronicity and poor prognosis.

During the acute phase of the disease, some of these patients may have the tendency to run away from home and it may become difficult to trace them. I advise the worried family members to get the patients' names, addresses and phone numbers tatooed on their forearms. It is of great help in tracing them in unfortunate circumstances.

Drug treatment always remains a source of concern. Many patients just refuse to take the treatment. They often themselves discontinue the drugs or their family members do not understand the need to continue the therapy.

Side-effects of drugs:
Schizophrenic patients are managed with a group of medicines called anti-psychotic drugs. Common antipsychotic drugs being used in clinical practice include: Haloperidol (Serenace), Chlorpromazine (Largactil), Thioridazine (Thioril), Trifluoperazine (Eskazine), Loxapine (Loxapac), Pimozide (Orap) and Clozpine (Lozapin). The latest drug added to the armoury of the psychiatrist is Olanzapine (Olexa). It is showing very good clinical effects and has helped a number of patients who were earlier not responding to any drug. In chronic cases, long-acting depot drugs like Fluphenazine Deconte (Anatensol) and Haloperidol Deconate (Senorm-LA) are suitable. They ensure good treatment compliance and are quite economical in the long run. (Injections, if prescribed, have to be given once in a fortnight or once in a month).

The common side-effects of the antipsychotic drugs are many: constipation, dryness of the mouth, difficulty in passing urine, giddiness, difficulty in reading and postural hypotension, etc. The patients on long-term antipsychotic drugs appear slow and retarded. Their faces lose expression and they have wax-like appearance. Many patients complain of regular tremors of hands or the whole body. Their gait and reflexes become slow. Some of the drugs used for managing schizophrenia induce a clinical picture which is like that of parkinsonism, a disease characterised by slow body movements, rigidity and tremors. Some patients, on long-term management, develop tardive dyskinesia, an irreversible clinical state, when patients develop repetitive movements of the tongue, the facial muscles and other axial parts of the body like upper and lower limbs. Once tardive dyskinesia develops, there is no effective drug for treatment.

Interpersonal problems
Chronic schizophrenics are known to have poor interpersonal relations. Many patients become asocial and withdrawn. They start losing the human touch and bond. They are unable to emphasise with the troubles of others. Emotional blunting and apathy are the common difficulties with chronic schizophrenic patients. Quite commonly, they start experiencing abnormal emotions. They smile and laugh without any apparent reason. So, their friends and colleagues start avoiding their company. Gradually, such patients turn loners.

Conclusion
It is my personal experience that many family members do not accept the fact that their patient is suffering from a chronic mental illness. They waste their precious time in seeking unscientific and unjustifiable treatment. It is important to remember that the acceptance of a problem is the first step in finding its solution.

Once the problem is accepted, one should go in for the best possible treatment. Closing one's eyes to the harsh realities of life only compounds one's sorrows. This is true in the case of all diseases, including schizophrenia. Concluded

The author is a Ludhiana-based psychiatrist. He edits Meditrack, a monthly health magazine. He can be contacted in Tagore Nagar, Ludhiana (phones: 472822 and 472899; Email: meditrak@satyam.net.in).

Ecological care

With the increasing need to dispose of green waste worldwide, GreenMech — the United Kingdom's largest maker of wood chippers and shredders — has set up its own company in Asia. The speed of vegetation growth in the region makes the wood chipper and shredder two essential elements in organic waste management.

Following the forest fires in Indonesia that resulted in smoke pollution in neighbouring countries, many Asian nations have introduced strict "no burning" laws.

The GreenMech company has seen its turnover reach £3 million since it was started five years ago.

Plans have recently been laid to expand its overseas markets and to achieve 50% of its sales overseas by 2005.

With an eye on the European Union's plans to recycle 60% of green waste by 2004, the company is committed to delivering a range of machines to meet all such proposals.

The GreenMech ChipMaster and ShredMaster ranges made at the company's factory in the English Midlands are powerful and reliable machines. Its wood chippers, such as the track-mounted diesel-powered machine (Trak-Chip), can deal with branches up to 250 millimetres (10 inches) in diameter.

Its patented, curved disc-blade chipping technology preserves the cutting edge of the blades up to four times longer than conventional ones. With an emergency reset facility combined with a unique "idle run" mode that reduces noise while promoting economy, it meets all the safety standards proposed by the UK's Health and Safety Executive and present and future European Union safety regulations. Other features include a no-stress power control system and an infeed chute that can be rotated through 360 degrees.

The Trak-Chip has all the standard features of the GreenMech range and a 270-degree turntable that allows material to be loaded from the most convenient direction. Its rubber tracks give a remarkably low ground pressure, enabling the machine to traverse sensitive plant growth areas. BIS

Q&A

What you need to know about Hepatitis A

To be concluded