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| HEALTH TRIBUNE | Wednesday, April 9, 2003, Chandigarh, India |
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SARS — the mysterious killer & preventive measures Shielding children from injuries AYURVEDA & YOU INFO CAPSULE |
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SARS — the mysterious killer & preventive measures The whole world is stunned to see two tragedies going parallel in Asia, one man-made in the form of killing thousands of innocent people at the hands of oil-thirsty, war-mongers and the other owing to a mysterious infection. The outbreak of the new disease — Severe Acute Respiratory Syndrome or SARS — reminds us of the dreadful epidemics of plague and influenza stirring the previous centuries engulfing millions, in the era when no antimicrobial agents were available. SARS is believed to have begun in Guangdong province in China in November, 2002, spreading to Hong Kong in February, 2003, and from there to other countries through airline/ship passengers. Therefore the counting of SARS cases is being done from November 1. Due to apprehension and panic the triage of the cases was so heavy that it flooded the hospitals of the affected areas. However, most of these patients were personnel working in hospitals. By April 7, 2003, World Health Day, the infection affected 2601 people spreading over 19 countries. It has killed 98 persons and hence also called killer pneumonia. It has mainly involved the countries of Southeast Asia like China, Hong Kong, Singapore, Vietnam and Thailand. However, it has not spared far away countries like Canada, Brazil and Australia. The maximum number of patients have died in southern China, particularly involving Guangdong province, where the infection was first reported in November, 2002. In Hong Kong, of the 883 people infected, 213 are from a housing estate. Of these, 107 are from a single block. It has killed nine persons in Canada and sent thousands into quarantine, stretching the country’s health care delivery system as it struggles to contain the deadly outbreak. Now, Brazil and Malaysia have also reported their first suspected cases. With the virus word spreading, air travellers are said to be one of the main carriers of SARS. The panic-stricken passengers are cancelling their tickets and rescheduling travel plans, especially to Southeast Asia. Business and socio-cultural activities have already come to a standstill in the affected areas. In Singapore and Hong Kong, all the schools are closed and the quarantine law has been imposed.
Causative organism
By the last week of March — 27.03.2003 — the Hong Kong scientists had identified the causative organism as a mutated strain of Coronavirus. The finding is said to have been ratified by the Centre for Diseases Control and Prevention. As such, this virus is the second leading cause of common cold after the rhinoviruses. It is speculated that other organisms like Chlamydia species may also be involved in the outbreak. Southern China, livestock and historically a source of new virus strains, has been recognised as the most likely source of the disease. The diagnosis is clinically ascertained with the help of laboratory feedback by demonstrating either the organism or the antibodies to it. The molecular technique-based tests like polymerase chain reaction using different primers have also been utilised to ascertain the suspected cases. The illness generally begins with flu-like symptoms — high-grade fever, dry, and non-productive cough accompanied by breathlessness, rapidly developing into acute pneumonia of atypical type. The other associated symptoms may be headache, muscular stiffness, loss of appetite, confusion, rash and rarely diarrhoea. The incubation period is generally taken as two to seven days. A close contact with an infected person is needed for the organism to spread from one person to another, such as aerosolised droplets and bodily secretions from an infected person. The SARS figure is amazing as it carries a mortality rate of over 5 per cent, which is much higher than any other respiratory infection.
Treatment
The treatment generally includes supportive therapy along with antiviral agents such as ribavirin or oseltamivir. Steroids have also been administered to patients in combination with ribavirin and other antimicrobials. Routinely used antibiotics have no role to play, except to prevent secondary bacterial infections. As such, the recovery of the patients depends on the ability of the immune system to produce antibodies. The surgical masks are very helpful to curtail the infection in the affected areas.
Prevention & control
The WHO has declared the outbreak as a worldwide health threat and is actively pursuing the cases through global surveillance. It issued an emergency travel advisory on March 15, 2003, in response to the outbreak. This is the first time that the WHO has issued a travel advisory “about a specific region in response to a communicable disease” since it was founded 55 years ago. Subsequent recommendations for travel update on March 27 and April 2, 2003, for the screening of all the passengers coming from the affected countries have also been issued. All these measures involve interviews with passengers, advising travellers with fever and suggesting the postponement of travel to the affected areas. Air travel guidelines also included a step-by-step procedure to follow up fellow passengers who may have had close contact with possible cases. As the knowledge of the disease is evolving the definition of suspected and probable cases has been revised for the surveillance of SARS. India has not reported any case related to the disease. However, that should not be the reason to be complacent. As the pathogens cannot be made to respect the regional and national boundaries, and the neighbouring countries are limping with SARS, there is an apprehension of spread of the disease in this country as well. That is why the Union Ministry of Health and Family Welfare has taken it seriously as it has given high alert to control the mysterious killer. The suspected cases are to be reported to the National Institute of Communicable Diseases (NICD), Delhi. The Ministry of Health has also designed a proforma, which the passengers, arriving from the affected countries are being requested to fill in when they disembark. It has also requested the Ministry of Civil Aviation/Airport Authority of India to refer the suspected cases to the nodal health centres for their proper management. The doubtful cases from Bhopal have been cleared after preliminary investigations. However, the case reported from Mumbai is under investigation as the woman concerned has a strong history of travel to the affected areas. On the instructions of the Union Health Ministry, the Union Territory of Chandigarh the states of Punjab, Haryana and Himachal Pradesh have designated their nodal officers, and all the preventive measures are to be taken promptly in the northern belt. A proforma has also been circulated as a surveillance measure for SARS. Meanwhile, the public has been requested to immediately contact Health Department officials in the case of getting in contact with patients with suspected symptoms. As such, there is nothing to be panicky as the outbreak of SARS can easily be controlled by these timely efforts. The writer is Reader in Microbiology, Govt. Medical College Hospital, Sector 32, Chandigarh.
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Shielding children from injuries “Child and environment” is the years theme of the World Health Organisation. A child’s first environment is the mother’s womb and the next is home. In the mother’s womb the first four months are very crucial. This is known as the period of “organisers” which means the time when every organ of the body is being formed. During this period a pregnant woman should not take any medicine without prescription, even the vitamins and common cold pills. She should not be exposed to viral illnesses. She should not be subjected to X-rays, etc, as all these exposures can result in serious congenital (birth) problems like heart, brain, kidney, eye, ear, bone and limb defects etc. After birth, children are most vulnerable to injuries at home. Unintentional injury is a major public health problem all over the world resulting in death or disability. Of all the deaths as a result of unintentional injuries, 40 per cent are in children under five. In spite of high mortality, disability and socio-economic impact, a systematic approach towards its prevention is lacking. Prevention is possible if injury is conceptualised as a preventable disease having an interplay of agent, host and environment factors and not merely an accident resulting due to God’s will. Little Parag drowned in the bucket while bathing just in few minutes when his mother left him to pick up his towel. He drowned to be left brain dead. During a housewarming ceremony Rani thought that Honey went out with his father. When Honey was not found anywhere after the function was over, they saw him in the water tank which was created for the construction of a house. Rosy got electrocuted by putting fingers in electric sockets which were at the ground level. Such poor children are most vulnerable to household injuries because of mistakes of adults. Children are curious and keep exploring the environment. They become vulnerable due to various factors like living in houses designed for adults, exploring through objects cultured by adults, or using transport designed for adults. There is a conflict between their developmental ability and adults’ expectations. Medical professionals and public health agencies must make parents aware of the need for injury prevention in the case of children. Parents should know that babies grow up fast. They should realise this before he or she is old enough to crawl around and explore everything within reach! Right from this stage to the school-stage children run the risk of household injuries (accidents). To prevent these it is important to anticipate the child’s milestones and take precautionary steps for making the home a safer place for the baby. Unfortunately, children live in the houses designed principally for adults. However, following are the commonly applicable tips: 1. Never leave the infant unattended to in high places (even the cot!), the bathroom or the kitchen. Its a good idea to have bedding on floor rather than letting the child fall from the cot. The cooking articles should be on a table-level platform. 2. Bath-tubs are risky! Bucket bath is equally risky. 3. Fix a safety socket cover on all electric points. Check all electric wires to ensure that they are not frayed or damaged or hanging. 4. Lock away all needles, buttons, hooks, scissors, match boxes, lighters, knives and other sharp objects and medicines. 5. Keep all pesticides locked. Don’t put kerosene, phenol, etc, in coke bottles . 6. Keep aerosol cans and sprays out of reach of children. Accidental spray can damage eyes. 7. Don’t leave plastic bags lying around as children can get suffocated by them. Health surveillance should include injury prevention counselling. Pediatricians should guide parents about injury prevention. It is their duty to educate parents about developmental milestones and related accident prevention measures. It is every parent’s responsibility to provide a safe home for the child. The writer is a Chandigarh-based pediatrician and allergy specialist. Phones: (M) 892226, 0172-562239
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AYURVEDA & YOU Ravindra Vatsyayan Of the three body humors elicited in ayurveda, ‘kapha’ may be the last one, but it is equally important like the other two discussed earlier. ‘Kapha’, a combination of water and earth elements, governs the somatic stability of the body and holds the structural integrity of all its cellular components. Besides imparting immunity and maintaining cohesion between the organs, it regulates the sense of taste, controls the lymphatic system, nourishes the joints, forms all mucous secretions and maintains the fluid balance of the body. Psychological phenomena of emotional constancy, tolerance and calmness are also governed by this body humor. Acharya Charaka, while discussing the qualities of ‘kapha’ has described it as static, slow, dense, cold, unctuous and heavy. In our day-to-day life it is, not difficult to identify a ‘kapha’ personality. ‘Kapha’ people have a stout, heavy and well-developed physique and their bones and joints are well-covered with muscles and fats. With a thick, cold, moist, soft and smooth skin, they have abundant, wavy and lustrous hair. Their appetite is constant and they are known for their craving for sweet and oily desserts. ‘Kapha’ people are endowed with a voice and speech that is deep, slow and clear. A dominant kapha prakriti also reflects a mental frame of a slow, steady, witty and easy-going person. Mostly ‘kapha’ people are thoughtful, compassionate and compromising, but are also unhurried to take initiatives and seem to be calm and content in all circumstances. With a sound and deep sleep pattern, they appear to be more sluggish in the morning. They like warmth, sunshine and comfort, but still are not strongly affected by weather changes. The ‘rajasic’ and ‘tamsic’ tendencies can make them inclined towards a luxurious lifestyle, lethargy and stubbornness, thus making way for insensitivity, stupor, dullness and slowness of comprehension in place of other good qualities of the ‘kapha’ personality. The ‘kapha’ people unlike the ‘vata’ and ‘pitta’ dominated persons have good immunity and endurance. But their disease pattern typically revolves around the qualities of ‘kapha’ as a body humor. They are prone to be phlegmatic and easily catch diseases related to the respiratory tract. Since obesity is their characteristic feature, ‘kapha’ people also face problems with the weight-bearing joints of the body. Their inclination towards inactivity and sedentary lifestyle coupled with the weakness for eating heavy and oily diet give rise to many other health anomalies like a high cholesterol level, fat deposition in arteries, edema and glandular swellings. Ayurveda specifically advises ‘kapha’ people to adopt a diet plan which is conducive to their health. Sweet, sour and salty tastes increase ‘kapha’ by adding to bulk and moisture in the body. It is the pungent, bitter and astringent, tastes which have qualities opposite to those of ‘kapha’ and their use helps to reduce its excessive accumulation. A diet that is warm, light and dry in nature rather than cold, heavy and oily is best suited to such persons. Less of rice, bananas, milk, butter, ghee and desserts and more of green vegetables, lentils other than urad and eatables and spices like clove, black pepper, garlic, turmeric and cumin are recommended to them. The ideal environment for ‘kapha’ people is warm and dry. The best medicine for them is activity and it is worth the effort to persuade them to go out for walks, jogging and other exercises matching their strong endurance capacity. They should also be advised not sleep during the day-time. Regular or intermittent use of one gm powder of black peeper (kali mirch), dry ginger (sonth) and long pepper (magh) all mixed in an equal quantity helps their system to work more efficiently. P.S. Many readers have queried which is good or bad prakriti. Ayurveda believes that all personalities have their pleasant and unpleasant traits. What is important is that to live a healthy and purposeful life one should not only understand one’s body constitution and its appropriateness but should assess mental capabilities also. It is the positive or negative loading of the body and mind which makes any personality good or bad. The writer is an established ayurvedic consultant based at Ludhiana. Phone: (M) 9814033977.
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INFO CAPSULE WASHINGTON: A new study has found that Type 1 diabetes causes a decrease in brain tissue, a loss that might explain why diabetics seem to have higher rates of cognitive impairment throughout life. It's well known that people with juvenile-onset diabetes, or Type 1 diabetes, are more prone to a host of problems, including nerve damage in the extremities, kidney failure and stroke. "Less is understood about diabetes' effect on the brain. In fact, there are a lot of people who believe diabetes does not affect the brain", said study author Dr Richard Chan, an assistant professor of neurology and neurosurgery at the State University of New York at Buffalo, according to a report in News24.com. However, a growing body of research seems to say otherwise. People with Type 1 diabetes do not produce insulin, so they have to take daily insulin shots to stay alive. Studies have shown children and adults with this form of diabetes are prone to subtle cognitive difficulties, including problems with memory, abstract reasoning and attention. Other studies suggest diabetes could be linked to dementia, including Alzheimer's disease.
ANI How to get kids eat healthy vegetables WASHINGTON: "Broccoli, yuk!" That's how kids usually react every time you serve them vegetables like these. While getting kids to eat their veggie can sometimes feel like an exercise in futility, you should not give up. However, if you have run out of ideas on how to get your kids eat these healthy foods, try these tactics suggested by the Hospital for Sick Children in Toronto. Firstly, let your kids help you pick out a vegetable at the farmer's market and let them help you prepare it. Secondly, try serving it a different way — raw if you usually cook it, or lightly steamed if you usually serve it raw. Thirdly, give it a funny name and serve it when your kids are hungry. Lastly, seat your child next to a child who loves vegetables and let peer pressure take over. Furthermore, don't assume your child will never like it. Some children take longer than others to feel comfortable with certain foods.
ANI Boosting “good” cholesterol levels WASHINGTON: Boosting the levels of "good" cholesterol rather than reducing "bad" cholesterol significantly reduces deaths from heart disease. A study has found that when patients are given drugs to increase high-density lipoprotein, (HDL), the healthy fat found in blood, the number of deaths from heart disease falls significantly.
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