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| HEALTH & FITNESS |
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Alarming rise in
TB cases: It kills and blinds with impunity How to treat
tailbone pain Why our body needs
vitamins, minerals Health Notes
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Alarming rise in TB cases: It kills and TB (tuberculosis) kills more people than any other infectious disease in India. The country has the largest number of TB patients in the world with an estimated 2 million new cases reported every year. The disease kills nearly five lakh of Indians every year. Several TB cases develop eye complications. The majority of the victims are migrant labourers, slum-dwellers, residents of backward areas and tribal people. Not all cases belong to the poor segments of the population.
Risk factors
There are a number of known factors that make people more susceptible to a TB infection. An untreated TB case is a major source of infection. Worldwide the most important of these is smoking. HIV increases the risk of TB. Diabetes mellitus is also an important risk factor. Among the other factors that increase the risk of developing TB are Hodgkin lymphoma, renal disease, chronic lung disease, malnutrition and alcoholism. A particularly dangerous form of drug-resistant TB (MDR-TB) can kill and blind a person with impunity. While the lethal nature of TB is well known many people are not aware that TB patients can go blind due to the spread of the infection or the immune reaction of the disease in the eye.
Why eye involvement
The spread of the infection to the eye occurs through the blood from the lungs or other organs, or it may be due to the immune reaction to tuberculosis antigens. An increasing number of TB patients in India stand the risk of losing their vision as a result of the infection spreading to the eye. In the Indian setting, the moment a patient complains of blurred vision, redness and other signs, he must be examined for tuberculosis. Unfortunately, the regions most affected by TB are also the least equipped to screen patients thoroughly for eye infection, potentially resulting in under-detection of eye problems and consequent blindness. Patients receiving systemic steroids and other immuno-suppressive drugs are particularly at risk for the reactivation of latent TB in the eye and elsewhere. Though only 2 per cent cases of TB develop eye complications, the number of eye-TB cases is large. Nevertheless, TB is not a common cause of blindness. Common causes are cataract, glaucoma, age-related macular degeneration, diabetes, etc. The most common sign of ocular TB is a choroidal mass — involvement of the layer present in the back part of the eye, also called posterior uveitis. Uveitis is a serious eye condition that may cause permanent scars. Subsequent calcification of granulomas can impede vision, and inflammation can cause irreversible damage to the eyes. Uveitis is underestimated as a cause for blindness in most surveys.
Diagnosis and treatment
Several laboratory tests may be required for diagnosis and treatment. The Mantoux Tuberculin Skin Test (MTST) is the most common test. The other is the interferon gamma release assay test (IGRAs). These are blood tests that measure how the patient’s immune system reacts to M. tuberculosis. The QuantiFERON-TB Gold Test (QFT-G) is an IGRA, which is approved for diagnosis. PCR is another test that has been used and shown good sensitivity in various studies to detect latent TB. Treatment with steroids and pupil-dilating eye drops, with specific anti-tubercular medications is necessary in most cases. The writer, a Chandigarh-based senior eye specialist, is the author of many medical books.
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How to treat tailbone pain Pain in the rear pertains to discomfort in the lower part of the sacrum, coccyx and anus. Pain in or around the coccyx is called coccydynia/coccygodynia or tailbone pain. Coccyx is, in fact, the remnant of the tail, from the time when man came into existence, and has not been fully lost during evolution. Patients are often uncertain to call it tailbone, hip or back pain. It frequently affects women more than men because the coccyx is more exposed and prominent in women.
Causes
Pain after a fall onto the buttocks or being hit directly. This could cause a fracture in the coccyx or strain on the sacrococcygeal joint. Injury to the ligaments during pregnancy, delivery etc. At the end of the third trimester, certain hormonal changes increase the mobility of the coccyx which may result in the stretching of the ligaments and muscles that surround the coccyx. Repetitive strain from cycling causes neuropathic pain. Prolonged sitting in a slouched position is responsible for pain in the tail bone. Repeated pressure on the coccyx when sitting can arise in slim patients who have small buttocks with little fat padding. Obesity can cause muscle strain, pinching of nerves or dislocation of the coccyx, leading to pain in the region of coccyx. Congenital — an individual being born with unfused coccyx. Individuals with unfused coccyx suffer from pain during pregnancy or post-delivery as the stress of vaginal delivery inflicts extra pressure, irritating the unfused coccyx. Disc herniation can also radiate pain to the tailbone. Chronic haemorrhoids can aggravate pain.
Symptoms l
The main complaint is the experience of discomfort/pain while sitting or lying down flat on the back which is probably due to the pressure being exerted on the tailbone. Lying on one side or on the stomach helps relieve pain. Standing or walking gives comfort to the individual as this position exerts less pressure on the tailbone. l
Painful bowel movements. l Pain starts during late in pregnancy. l
In women, pain is experienced due to dyspareunia. l
Sometimes the pelvic floor muscles refer the pain to the genital structures — vagina and base of the penis. Some patients may feel pain and have fullness in the rectum.
Treatment
A pillow or donut cushion is ideally suited to relieve pressure on the area. The donut cushion has a hole in the middle so that no pressure is exerted on the tailbone when the patient sits on the donut. Massage of the pelvic floor muscles, especially levator ani, facilitates a reduction of pain instantly. Massage can be repeated daily for five to six days. It is extremely effective. Manipulation by an expert either externally or internally to mobilise the coccyx is very effective in relieving pain in the tailbone. In this technique, the coccyx is moved in the required direction in the side lying or prone position. It takes only 30 to 50 seconds for the correction and the whole procedure takes 1 to 4 minutes. In a few cases steroid injection can be given in the coccyx to alleviate pain and inflammation
Relaxation exercise
Lying down on the floor with face downwards, the patient is instructed to squeeze the buttocks and relax. Repetitions are advised. Sitting up straight helps relieve pain. Slumped posture acts as a great hurdle as it puts undue load on the angulations of the tailbone, leading to discomfort/pain. If a patient experiences pain over an extended period of time in spite of undergoing the above mentioned treatment, surgery is recommended wherein the fractured coccyx or non-united coccygeal fragment is removed. Conventional medical treatment may help relieve the symptoms of coccygodynia, but it does not address the root of the problem. Proper manipulation and massage bring instant relief in most cases. The writer is a former doctor/physiotherapist, Indian cricket team.
E-mail chadha_r 2003@yahoo.co.in
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Why our body needs vitamins, minerals
They are important for our well-being and helping our immune system to function properly. Both are essential for growth, energy and in protecting our body's cells from damage. The best way to ensure an adequate supply of vitamins and minerals is to eat a varied, balanced diet with plenty of fruit and vegetables. However, most of us don't eat well all the time, plus other factors like stress, being run down or taking the contraceptive pill, may lead to deficiencies in some nutrients. Modern processing, cooking methods and storage can also deplete the vitamin and mineral content of our food before we've even eaten it. For example, boiling broccoli for just 10 minutes will destroy over two thirds of its vitamin C content. So sometimes we may benefit from taking a multivitamin and mineral supplement. — The Independent
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Health Notes Washington: Scientists have revealed that primary school children who don’t like eating fruit and vegetables are 13 times more likely to develop functional constipation than children who do. Drinking less than 400ml of fluid a day also significantly increases the risk, according to the study. Moon Fai Chan, assistant professor at the National University of Singapore, teamed up with Yuk Ling Chan, from the Hong Kong Polytechnic University, to study the diet and toileting habits of 383 children aged from 8 to 10 from a school in Hong Kong. As many as 51 per cent were boys and children who were on regular medication or who paid regular hospital or clinic visits were excluded. Seventy per cent of the children who took part in the study were 10-year-olds, 22 per cent were 9 and eight per cent were 8. “A number of studies have suggested that functional constipation — which is due to dietary habits, environmental habits and psycho-social factors rather than a particular health problem — is getting worse among school-age children,” Chan said.
— ANI
Smoking accounts for more than a third of severe rheumatoid arthritis cases
Washington: A new research has found that smoking accounts for more than a third of cases of the most severe and common form of rheumatoid arthritis. The study has also found that it accounts for more than half of cases in people who are genetically susceptible to the development of the disease. The researchers conducted their research on more than 1,200 people with rheumatoid arthritis and 871 people matched for age and sex, but free of the disease. The patients came from 19 health clinics in south and central Sweden, while their healthy peers were randomly selected from the population register. All the participants were aged between 18 and 70.
— ANI
Flat-dwelling kids ‘more likely to be exposed to tobacco smoke’
London: A US study has shown that kids living in flats have 45 per cent more exposure to tobacco smoke than those in detached houses. According to researchers from Harvard and Rochester Universities, the exposure in flats is due to the smoke seeping in through walls and shared ventilation systems. Researchers took samples only from children who live in a household where nobody smokes, and they looked for cotinine — a product of nicotine and a highly sensitive marker for tobacco — in their subject’s blood. The study found that 73 per cent of the 5,000 children analysed were exposed to second-hand tobacco smoke.
— ANI
Compound extracted from tree ‘can help fight leukaemia’
Kuala Lumpur: A new compound is showing promise against some forms of cancer like leukaemia. The compound comes from the Aglaia foveolata tree, found in Sarawak’s highlands, and has entered pre-clinical trials. Scientists at the Sarawak Biodiversity Centre (SBC), which owns the intellectual property rights to the plant, say that the experiments found that an extracted compound called Silvestrol offered benefits not found in other cancer-fighting drugs. “First, it seems to inhibit leukaemia growth compared with controlled tests performed on mice. Second, the tests show that it seems to bypass drug resistance,” the Star Online quoted Dr Yeo Tiong Chia, senior research officer at the center, as saying.
— ANI
We spend more time as sick now than 10 years ago
Washington: A new study has shown that average “morbidity” or the period of life spend with serious disease or loss of functional mobility has actually increased in the last few decades. The research was carried by Eileen Crimmins, AARP Chair in Gerontology at the University of Southern California (USC), and Hiram Beltran-Sanchez, a postdoctoral fellow at the Andrus Gerontology Center at USC. “We have always assumed that each generation will be healthier and longer lived than the prior one,” Crimmins explained. “However, the compression of morbidity may be as illusory as immortality.” While people might be expected to live more years with disease simply as a function of living longer in general, the researchers show that the average number of healthy years has decreased since 1998. We spend fewer years of our lives without disease, even though we live longer.
— ANI
High intake of folic acid may be linked to cancer
Washington: A new study has suggested that increased consumption of folic acid can reduce birth defects, including neural tube defects, congenital heart disease and oral clefts. But a high intake of folic acid may be linked to adverse events such as colorectal cancer. Researchers at Children’s Hospital of Eastern Ontario Research Institute and The Hospital for Sick Children conducted the study. For the study, red blood cell folate concentrations were examined in 5,248 Canadians aged 6 to 79 years. The study found that less than 1 per cent of Canadians showed folate deficiencies and 40 per cent showed high folate concentrations. However, in the subset of women of childbearing age, 22 per cent were below the concentration considered safe to guard against neural tube defects.
— ANI
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