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| HEALTH TRIBUNE |
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Most diseases don’t strike suddenly
AIDS: cure lies in preventive knowledge
Thyroid disorder during pregnancy
Pioneer of holistic medical treatment
Researchers determine genes that inherit obesity
Tougher rules for food supplements
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Most diseases don’t strike suddenly Regular preventive check-up of the vehicles we drive, the railway tracks over which trains move on and the aeroplanes we fly, and paying timely attention to the minor noises and creaking sound of the gadgets and machines of daily use will help remove the defect at the beginning. By taking adequate remedial measures through stringent preventive maintenance of these machines, serious and often fatal “sudden” accidents can be prevented. Huge expenditures on the subsequent restorative work and the men and material lost in such accidents can thus be avoided. Even if a vehicular accident does occur, use of head covers and safety helmets by two-wheeler riders and use of seat of belts in the cars can help the victims to avoid serious injuries — specially head injuries and chest trauma which are often fatal. Now let us talk of several diseases of our times which have turned out to be the biggest killers and have a great preventive potential. Heart attacks, high blood pressure, diabetes and cancer are the main diseases responsible for the maximum mortality and morbidity both in the developed and developing countries. India has the dual burden of still facing major challenges from diseases due to infections and under-nutrition where preventive measures through food hygiene, clean environment, proper nutrition and immunization can help in the control of many such problems such diarrhoea, dysentery, typhoid, malaria, tuberculosis and polio. Heart attacks, high blood pressure and stroke: Without going into the details of how these diseases occur, we know enough about some of the risk factors, mostly related to our life-styles, which either start the basic disease process or aggravate the problem. These risk factors are common for heart attacks, stroke and high blood pressure and so can be discussed together: (1) Lack of physical exercise; (2) Diet, high in refined carbohydrates such as white sugar, dairy products, excess of soft drinks (they contain 70-80 calories each medium size bottle) and highly spiced and fat-fried items which often have excess salt too. (3) Alcohol consumption beyond two ounces of whisky or equivalent of two glasses of beer or wine. Excess alcohol use results in high blood cholesterol, triglyceride and high blood pressure, all major risk factors for heart attack. (4) Smoking causes the narrowing of blood vessels which results in a decreased blood supply to the brain, heart, and other vital organs of our body. Apart from these cardiovascular diseases, smoking is responsible for chronic bronchitis, lung cancer and cancer of the voice box and cervix. (5) High blood levels of harmful lipids like cholesterol, LDL (low density lipoprotein) and triglycerides and low level of the protective or friendly cholesterol called HDL (high density lipoprotein) are also one of the major risk factors for heart attacks and stroke. These metabolic risk parameters are generally the consequences of faulty eating habits and lack of physical exercise. If these are the major risk factors for heart attacks, stroke and high blood pressure, then obviously their prevention will be possible to a large extent. This can be done in the following way: (1) Increasing the extent of physical activity through regular exercise and avoiding sedentary living. (2) Avoiding smoking. (3) Restricting alcohol intake to two drinks. (4) Avoiding over-indulgence in food intake, specially sugar and fried things, and eating more fresh fruit, nuts and vegetables. Diabetes:
Diabetes is appearing in almost an epidemic form in most of the developed and developing countries, including India. Being over-weight and lack of physical exercise are considered the two main risk factors for diabetes among adults. By virtue of the fact that this disease adversely affects the blood vessels of the heart, brain, kidneys and other organs of the body, diabetes is now being categorised as a cardiovascular disease. Uncontrolled diabetes results in heart attacks, stroke and kidney failure. Prevention of adulthood diabetes, therefore, lies in avoiding being overweight by diet control and doing regular physical exercise. Periodic blood sugar tests in the case of those with a family history of diabetes will help in the early detection of diabetes and its timely treatment. Cancer: In most of the cancers, risk factors are not known. Smoking, however, is one single risk factor well recognised for its close relation with the cancer of the lung, voice box and urinary bladder. As there is enough evidence of smoking being a major risk factor for several types of cancer, by avoiding smoking and stopping it by those who are already smokers will help in the prevention of many cancers. Other diseases:
Many orodental diseases like that of gums and teeth and dental caries are the result of lack of proper oral hygiene and can, therefore, be prevented by health awareness techniques introduced in the school curriculum and the training of children by parents. Some of the skin problems may be prevented by avoiding synthetic fabrics, tight clothing and taking daily baths. Role of preventive health check-up
Diseases like high blood pressure, initial stages of heart diseases and diabetes continue to be in a “silent” phase for a variable length of time till they suddenly show up with some complication. A small nodule in the breast which may be a harbinger of breast cancer may go unnoticed for quite some time unless a routine palpation of the breast helps in its early detection. There is, therefore, a great role of periodic health check-up in the so-called normal individuals for early detection of diseases like high blood pressure, heart disease, obesity, diabetes and some cancers such as that of breast by physical examination and mammography, of lungs by chest X-ray and bronchoscopy, and cancer of uterus by pap smear. Early detection of high blood pressure is easily done by simply measuring the blood pressure with sphygmomanometer, that of obesity by asking the person to stand on the weighing machine and recording the weight and that of diabetes by routine blood sugar testing. Early detection of heart disease is possible by a detailed history-taking, physical examination, ECG, and tread-mil test (TMT) if resting ECG is normal, a 24-hour ECG (Holter study), echocardiography, stress thallium and contrast enhanced CT scan of the heart may help in some others for an early diagnosis of serious underlying heart problem. The writer is Chief Cardiologist and Medical Adviser, Batra Hospital and Medical Research Centre, New Delhi.
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AIDS: cure lies in preventive knowledge THE world is facing an AIDS crisis today with 34.3 million HIV positive cases in 1999. Nearly 18.8 million people, including 3.8 million children died till 1999. As many as 15,000 new cases are occurring every day. However 95 per cent of this global total belongs to developing countries. AIDS is a cluster of diseases where the body’s defence system is weakened by HIV infection. The defence mechanism is made up of white blood cells. The HIV virus directly attacks, enters and stays inside the basic genetic material of these cells. Progress to the full-blown disease, from the onset of infection, may take 5 to 10 years. The immune system being jeopardised, a number of opportunistic infections, e.g. TB, may also take place. Almost 60 per cent of the AIDS cases in India manifest themselves as TB patients. In India, the first AIDS case was detected in 1986. Today, India harbours the second largest population of HIV+ve cases worldwide — 3.7 million — and 1,60,000 of them are children. There are 1,20,000 AIDS orphans. AIDS prevalence in India has doubled in the last four years. Lack of knowledge and awareness is the most devastating factor. At least 90 per cent patients are unaware about their HIV status. The poor person, who cannot buy condoms, who cannot afford to treat his STD, who sees commercial sex as a viable occupation, who has no access to awareness programmes is at the highest risk. Population mobility, rapid urbanization, large slums, child abuse, gender bias, lack of sex education and drug addiction are other causative factors. People with untreated STD are two to nine times more at risk. A study in Maharashtra shows that 92 per cent of women have some form of reproductive tract infection while only 7.8 per cent ever sought treatment. Nearly 22,837 children are born infected every year and 11,434 die of AIDS. There is a 33 per cent risk of mother-to-child transmission. It may occur in the third trimester (10 to 30 per cent), during delivery (40 to 60 per cent) or through breast milk. Focused persuasion to terminate pregnancy is a solution. Promoting institutional deliveries, Vitamin-A supplementation, restriction of invasive obstetric procedures like ARM or episiotomies, treatment of RTI and replacement feeding are the other possibilities. The World Bank estimates that if India continues the current health subsidy at 21 per cent, the AIDS epidemic will increase the government expenditure by $2 million per year by 2010. AIDS has no cure. In Punjab only 43.2 per cent ever-married women and 61.7 per cent never-married women of 15 to 49 years of age are aware of AIDS. Awareness generation and dissemination of preventive knowledge are the only long-term cost-effective remedies. This requires committed volunteers with adequate knowledge and counselling skill. Doorstep education among high-risk groups, awareness campaign among the underprivileged communities and low-cost formal sex education are the possible preventive steps. This is where the medical social worker, the doctor with a social obligation, can play a pivotal role. The writers are associated with the Bengal Institute of Health Sciences, Raikot, Ludhiana.
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Thyroid disorder during pregnancy Management of hyperthyroidism in pregnancy 1. The dose of the anti-thyroid drug has to be decreased. 2.Excessive weight gain must be avoided completely. 3.The patient must not be
anaemic. 4.Protection from all kinds of infections should be ensured. Management of hypothyroidism in pregnancy 1. Consume iodised salt. 2.Take vitamins having an iodine content. 3.Adequate doses of thyroxine need to be taken. SEVERE complications can arise among the pregnant women suffering from a thyroid problem in case they conceive before the disease is effectively treated and under control. “It is not just patients themselves but doctors too suffer at times if they do not have the knowledge that there has to be drug alteration in the case of a pregnant woman, having a thyroid problem,” says Prof Sarla Malhotra of the Department of Obstetrics and Gynaecology at the PGI, Chandigarh. Talking about “Thyroid disorders during pregnancy”, she informed that women stop taking their thyroid drugs, thinking that during pregnancy they must not take any medicine at all, which can actually create a medical problem. “It is for this reason that pre-pregnancy counselling with an endocrinologist is essential for the women who know that they have a thyroid problem and the pregnancy can be monitored properly,” she informed. “There are times when we discover that a women is suffering from a thyroid problem when she comes to us with problems like infertility, repeated miscarriage or still birth and it is then that she is put on treatment,” said Dr Neelam Aggarwal, Associate Professor, PGI. She informed that almost 30 such cases from the region are taken care of at the PGI every year. She said there was one case of hyperthyroidism-related pregnancy in 1,000 cases and one case of hypothyroidism in 500 cases. “In the case of uncontrolled hyperthyroidism, the dose of anti-thyroid drug needs to be decreased, the lack of which can lead to a thyroid crisis situation,” stressed Dr Aggarwal. She says that among the other precautions that a thyroid patient must take when she is pregnant are that anaemia must be avoided, there should be weight control and protection against any kind of infection. While talking about hypothyroidism in pregnant women, she says the guiding principle is iodine supplementation where the problem is due to its deficiency. “The patient should be encouraged to consume iodised salt and vitamins containing iodine, so that the deficiency being created in the body is met,” she says. Dr Aggarwal feels that there are times when inadequate knowledge about thyroid disorder in pregnancy can lead to complications, and in case a specialist is not consulted a general practitioner might not educate the patient about this. “There are times when a woman seeking treatment for infertility or miscarriage from a gynaecologist is diagnosed to be suffering from thyroid which is responsible for these gynaecological problems,” she informs.
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Pioneer of holistic medical treatment Dr Hahnemann was a clinician of international repute, with his patient base spreading all over Europe! In less than two years after doing his M.D., he realised that treating patients by dividing them into water-tight compartments would not help to achieve the desired results. He stated that each individual must be treated as “a complete human being” and must be treated by a single medicine at any one given time. He understood clearly the “mind-body” connection — psycho-neuro-immunology as it is presently understood. This line of thought made him to move away from practising regular medicine. He was even asked to give up his medical degree, but his efforts to formulate a more holistic form of medical treatment remained unaffected. He finally came out with his compilation titled “Organon”. He stated very clearly in it that in order to study and practice homoeopathy, one must be a medical doctor first. He stressed upon the diagnosis of the disease and recognised the importance of diagnostic investigations and the approach of “individualisation”. The world over regular medical doctors are turning towards studying homoeopathy and they are doing so with no regrets. Specialists from different fields of medicine such as E.N.T., dermatology, respiratory medicine, gynaecology, psychiatry, pediatrics and dentistry are using homoeopathy in their practice and with good success. The fact that homoeopathy is a scientific system is being proved by modern research techniques. Respected medical journals are recognising the role of homoeopathy in curing diseases and also improving the health status of the individual. Recently a study was conducted by the Royal Homoeopathic Hospital, London. It concluded that those families which took homoeopathic treatment had their yearly medical bills much less compared to those who took conventional medical treatment. This goes to show that correct homoeopathic treatment not only cures the disease, but also restores health at a lower cost. The approach of treating the patient in a holistic manner allows homoeopathy to treat many diseases where the regular medical treatment does not have much to offer. The writer is a Panchkula-based homoeopath.
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Researchers determine genes that inherit obesity
WASHINGTON: Tulane University researchers have confirmed several genes that determine obesity inheritance. This is the first study of a longitudinal data to link body mass measurements taken over several decades to specific genes located on chromosomes. The researchers analyzed blood and health data from white siblings in 342 families who had been screened several times in a Bogalusa Heart Study over a period of three decades. Although the causes of obesity are complex, researchers estimate that between 40 and 70 per cent of the obesity cases have a genetic component. Over the past 20 years scientists have identified more than 250 genes or chromosome regions that may contribute to obesity. “Obesity in America is a complex trait and its development depends on several genes as well as a person’s interactions with environmental factors such as diet and exercise,” said researcher Wei Chen. “We found evidence of obesity-related genes on chromosomes 1, 5, 7, 12, 13 and 18 that were linked to a long-term trend of obesity from childhood to adulthood, and the gene on chromosome 12 showed the strongest link,” he adds. Chen is an epidemiologist at the Tulane University School of Public Health and Tropical Medicine. A particular gene on chromosome 12 is related to the development of insulin resistance. Insulin resistance is a reduced sensitivity in the tissues of the body to the action of insulin, a hormone that allows blood sugar to enter tissues to be used as a source of energy. It is associated with Type 2 Diabetes, high blood pressure and obesity.
— ANI
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Tougher rules for food supplements THE US food and drug administration has been advised to crack down on unsafe dietary supplements. The FDA is considering suggestions that makers should be forced to tell it if their products cause adverse effects. "It is a breath of air that has long been needed," says pharmacologist Arthur Grollman, of Stony Brook University, New York. About 29,000 dietary supplements are available in US drugstores. Fears about potential risks escalated last year after the death of baseball player Steve Bechler, who was taking the weight loss and energy aid ephedra. While it was unclear whether the supplement caused his death, the FDA banned ephedra. Such supplements are regulated as foods, not drugs. This means manufacturers must ensure their products are safe, but do not have to prove this. Supplements are only banned if the FDA proves that they are unsafe. In 2000, the FDA asked a panel of experts to devise a system to evaluate supplements' safety. The resulting report has now been released by the National Academies' Institute of Medicine. The FDA said it would work out whether the recommendations were feasible.
— The Guardian
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YESTERDAY was the birth anniversary of the founder of homoeopathy, Dr Sameul Hahnemann. Most intelligent critics of all schools who are familiar with his literary works agree that he was one of the most profound thinkers and learned writers of his time. His description of disease, his thorough knowledge of ancient languages and of the medical literature of the past, his wonderful powers of observation, his critical acumen, and, above all, his acknowledged benevolence ad integrity would have secured for him a position among the great men of his century under any circumstances.