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| HEALTH & FITNESS |
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A self-limiting illness
Tackling knee arthritis
Exchange blood transfusion in new-born Rh babies
Pudgy toddlers don’t always outgrow chubbiness
Health Notes
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A self-limiting illness India is in the grip of vector-borne viral fever. Earlier it used to be Japanese encephalitis and dengue fever, which have been coming from time to time. Now it is chikungunya fever, which has re-emerged after a gap of more than three decades. These diseases used to present as isolated cases in the past, but now they are regularly seen as epidemics involving thousands of people. These are being transmitted through the bite of infected mosquitoes. Chikungunya (chik-en-gun-yah) is also called chikungunya virus disease or chikungunya fever. It is a viral infection, which is spread by the bite of infected female mosquitoes of genus Aedes. Apparently, the illness resembles dengue fever and is characterised by fever, severe joint pains as well as skin rash, resulting in a large number of cases but death is very rarely encountered. As chikungunya epidemics are also sustained by the human-mosquito-human transmission, the epidemic cycle is similar to those of dengue and yellow fevers, as the principal vector is the same — Aedes aegypti. Chikungunya is a RNA virus and is grouped as arbovirus i.e. alphavirus, which is indigenous to tropical Africa and Asia, where it is transmitted to humans by the bite of infected mosquitoes, usually of the genus Aedes. The disease was first recognised in its epidemic form in Newala district of an east African country, Tanzania, during 1952-1953. The word “Chikungunya” is thought to be derived from the description in the local dialect of the Swahili, meaning “that which bends up” — the posture of patients afflicted with severe joint pains. In India, the virus was isolated for the first time from Kolkata in 1963. The vector: The vector in this case is tiger mosquito, which is the same as transmitting dengue fever i.e. Aedes aegypti and Aedes albopictus. It is a daytime biting mosquito and has the maximum density after rainfall and wherever there is a small collection of fresh water. Clinical features: Most often chikungunya fever is a self-limiting illness. It is not a contagious disease as it is spread by the bite of Aedes mosquito and incubation period is three to seven days. The typical illness is characterised by sudden onset of flu-like symptoms — fever, headache, malaise, arthralgias due to arthritis, myalgias and low backache. There is skin rash in approximately half of the cases, which is most intense on trunk and limbs and may even desquamate. The arthritis may be severe and involve small as well as large joints. The disease typically lasts for three to seven days and full recovery is the usual outcome. Sometimes, certain patients may experience persistent joint pains for weeks or months and occasionally years after the onset of illness, which is not seen in dengue fever. Moreover, haemorrhagic manifestations are relatively rare and as a rule shock is not observed in chikungunya fever. However, severe cases of chikungunya may occur in the elderly, in the very young i.e. newborns and in those who are immunocompromised. Serious complications like neuro-invasive disease are rare and fatal cases have not been conclusively documented. There are case reports of trans-placental transmission and severe congenital disease. The infection is believed to confer a life-long immunity. Laboratory diagnosis: As such, chikungunya fever should be suspected when the epidemic occurs with the characteristic triad of fever, skin rash and joint pains. The laboratory diagnosis can be established by testing blood for IgM antibodies by ELISA after a week of the onset of illness. The virus-specific nucleic acid sequences can be detected with Polymerase Chain Reaction (PCR). At present, these facilities are only available at reference centres like the National Institute of Virology (NIV), Pune, and the National Institute of Communicable Diseases (NICD), Delhi. Prevention and treatment: The control of chikungunya includes anti-mosquitoe and anti-larval measures. The vector mainly breeds over stagnate artificial water collection sites in a household atmosphere and hence preventive and control measures are to be taken in this direction. However, for personal protection, individuals should take measures against the bites of the mosquitoes. There is no specific drug therapy available. The writer is Professor & Head, Department of Microbiology, Government Medical College and Hospital, Sector 32, Chandigarh.
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Tackling knee arthritis Osteoarthritis of the knee is a major cause of pain and disability. Often these patients face predicament while deciding knee replacement surgery. Such patients tend to remain on conservative treatment for prolonged periods of time vis-à-vis analgesics and cartilage building drugs (Glucosamine). The basic pathology is damage to the cartilage i.e. synovium that covers the joint surface. The damaged cartilage lacks the ability to produce the lubricating fluid rendering the joint dry, stiff and painful. Hyaluronic acid injections dramatically alleviate the symptoms of pain, stiffness, etc. Mechanism of action is by cushioning of the knee joints, anti-inflammatory role and stimulation of the production of hyaluronic acid in the body. These injections are available in pre-filled syringes and the recommended dose is one injection per week for three or five injections. Hyaluronic acid is not a drug in the real sense. It does not entail the same concerns or risk of certain other joint injections (e.g. steroids) but only individuals experienced in giving joint injections should administer these. The only adverse reaction is temporary localised pain or swelling for 24-48 hours. Most of the patients notice improvement in pain and stiffness after the course of injections. Therefore, the indications for usage are:
Physical therapy is also of immense importance. As the knee joint becomes unstable due to thickening of ligaments and muscle wasting, strengthening of these muscles also helps relieve symptoms of pain and stiffness. The following exercises will improve muscle strength:
The writer is a former Doctor/Physiotherapist, Indian cricket team
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Exchange blood transfusion in new-born Rh babies When a baby is born to an Rh negative mother and Rh positive father, it may inherit the Rh factor from the father and become Rh positive. During pregnancy and at the time of delivery some of the foetal Rh positive cells get into the mother’s blood stream. This leads to the formation of Rh antibodies in the mother’s blood which act against the Rh positive cells of the foetus. These antibodies can in turn enter the blood stream of the foetus and destroy its red cells leading to severe anaemia and jaundice. To overcome the shortage of red blood cells as a result of their breakdown, the red cell factories in the bonemarrow, liver and spleen undertake the extra load of producing more and more red cells. Invariably, the emergency is so great that the red cells-producing factories pour out into the circulation many red cells that are still immature and simulate the parent red cells to erythroblast. Hence the term erythroblastosis. Exchanging blood of the baby: Exchange transfusion involves taking out most of the baby’s Rh positive blood, together with most of the maternal antibodies in the babies plasma and replacing these by Rh negative blood from a suitable donor. Obviously, this can not be done all at once: if the entire blood of the baby is let out it will die. So the baby’s blood is exchanged bit by bit with the donors. This is done by introducing a plastic tube into the baby’s umbilical cord attached to a two-way syringe that helps in alternate suction of destroyed blood and replacement by Rh negative blood. To save Rh babies exchange transfusion is still considered to be the most valuable technique but during the last few years there have been some new and dramatic developments. These have helped to attempt in saving even such babies that are not likely to survive and due to the dangerous proportions of the Rh antibodies formed in the mother’s blood. Protective Rh immuno-globulin: Researchers during the last few years have been trying to find means to prevent Rh negative mothers from making Rh antibodies— the principle factor destroying the baby’s red cells as soon as they enter the mother’s blood circulation well before they can stimulate her to make antibodies. Thanks to the untiring efforts of those scientists who have been able to discover the use of Anti-D immunoglobulin it has become possible to check the formation of Rh antibodies in the mother and thus help in saving thousands of neonates from the intricacies of Rh complications. Ironically, whereas about 5 per cent of our population is Rh negative and is likely to have the risk of developing Rh antibodies, very little significance is being attached to this factor either by the transfusion experts or by the obstetrians in our country. A recent survey has shown that some of the blood centres in the country are not performing this test either on the blood donors or on the recipients of blood and thereby subjecting patients to the avoidable hazard of Rh immunisation and their exposure to the danger of transfusion reactions or associated dangers to the new-born babies. Role of Rh clinics: To minimise the avoidable risk of immunisation among Rh negative patients requiring blood transfusion and pregnant mothers all blood centres and maternity organisations should follow the practice of performing Rh test routinely. Ready availability of Rh negative blood for routine transfusions and exchange transfusion in Rh babies can be ensured by maintaining a panel or Rh negative donors. The writer is Emeritus Professor, Transfusion Medicine, PGI, Chandigarh
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Pudgy toddlers don’t always outgrow chubbiness Chicago: Pudgy toddlers face a good chance of becoming overweight 12-year-olds, according to government research that shoots down the notion that kids just naturally outgrow early chubbiness. Children who were overweight at age 2 or later during their preschool years faced a five times higher risk of being overweight at age 12 than youngsters who were not overweight early on, the study found. Sixty per cent of the children who were overweight at any time during the preschool period were overweight at age 12. Children were considered overweight if their body-mass index was in the 85th percentile or higher for their gender and age. That means they were heavier than at least 85 per cent of children their same age and sex. “These results suggest that any time a child reaches the 85th percentile for BMI may be an appropriate time for intervention,” the researchers wrote. “These findings underscore the need to maintain a healthyweight beginning in early childhood. Contrary to popular belief, young children who are overweight or obese typically won’t lose the extra weight simply as a result of getting older,” said Dr Duane Alexander, director of the National Institute of Child Health and Human
Development, which funded the study. The researchers also found that 40 per cent of children whose BMIs were between the 50th and 84th percentiles by age 3 or in the normal to high-normal range — were overweight at age 12.
— AP |
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Health Notes Washington: A researcher from the University of Bristol claims that soaring levels of obesity in children may be linked to improper night sleep. Dr Shahrad Taheri says that increased availability of computers, mobile phones, TVs and other gadgets causes decline in nightly quota of sleep, which may lead to obesity. In an article published in the Archives of Disease in Childhood, he has suggested that these devices should be banned from children’s bedrooms to prevent them from unwanted health problems. Dr Taheri says that “Good sleep could be promoted by removal of gadget distractions from bedrooms and restricting their use.”
— ANI
Grape seed halts colorectal cancer spread
Washington: Chemicals found in grape seeds significantly inhibited growth of colorectal tumours in mice, according to researchers who have already demonstrated the extract’s anti-cancer effects in other tumour types. Their study, published in the October 18 issue of Clinical Cancer Research, documented a 44 per cent reduction of advanced colorectal tumours in the animals, and also revealed, for the first time, the molecular mechanism by which grape seed extract works to inhibit cancer growth. Rajesh Agarwal, professor in the Department of Pharmaceutical Sciences at the University of Colorado Health Sciences Center in Denver, says: “The value of this preclinical study shows grape seed extract can attack cancer, and how it works, but much more investigation will be needed before these chemicals can be tested as a human cancer treatment and preventive.”
— ANI
Hourly breaks can prevent
vision changes
Washington: A researcher from the Queensland University of Technology says people should take a short break from reading or close work at least every hour, as exposing eyes to continuous stress may lead to change in their shape. Dr Scott Read says that the upper eyelid’s pressure and its opening keep changing the shape of human
eyes throughout the day. The biggest changes happen among the people who maintain a downward gaze for a long time while reading or doing close work. He derived these conclusions from the two studies he conducted. Dr Read said that the first study was conducted for over three days, and each day human eyes were observed at 9am, 1pm and 5pm. He said that they saw highly significant changes to the contours of the cornea throughout the day. Such changes were related to forces from the eyelids, and were more marked in people who spent a lot of time reading in downward gaze.
— ANI
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