TB: Avoidable panic 
Dr S.K. Jindal

The panic caused by a disease in a population is directly proportional to the fear of its transmission and spread among the masses. It was somewhat natural that the report of a few cases of “total drug-resistant tuberculosis” from Mumbai caused a national uproar. People living in and travelling to Mumbai had developed a morbid concern about contracting a similar illness. In the recent past, this had happened with plague, anthrax, bird flu infection and then the H1N1 viral epidemic. One could not imagine if this might happen with tuberculosis, which, in any case, has been there with us for several centuries. The menace of tuberculosis has continued to be there, rather it has increased the world over, particularly in India. Why then bother about the recent reports?

It all started with a paper published in Clinical Infectious Diseases Journal’s December 2011 issue, with reference to Hinduja Hospital in Mumbai, about the occurrence of four cases of advanced tuberculosis whose sputa were resistant to all the 12 drugs for which the sensitivity was tested. Eight more patients were seen thereafter. The outrage necessitated an investigation into the incidence for the adoption of measures to control the spread of the disease and contain the damage. I also had the opportunity to join the Central team.

Undoubtedly, the panic of spread was an over-reaction and totally out of place. Unlike the viruses, the tubercle bacilli, even if resistant to many or all the possible drugs, are neither virulent nor aggressive. They do not affect a large number of people in an epidemic fashion. Those who have close physical contacts with a patient of tuberculosis do face an increased risk of contracting the disease, but not within a period of hours or days. It is a relatively chronic or sub-acute disease in most instances.

The fact remains that tuberculosis is going to stay with us for a few more decades. It is common among the dwellers of slums and crowded colonies. But it does not spare the well-to-do people either. It is not entirely uncommon to find tuberculosis in the rich, including in the highly educated and well-to-do families. Alcoholics, smokers and people with Human Immunodeficiency Virus (HIV) infection are particularly susceptible to get infected and develop very severe forms of tuberculosis.

In principle, tuberculosis is a relatively easily diagnosed disease which can be completely treated, provided the treatment is adequate and standard. It requires confirmation of diagnosis on sputum smear examination and treatment with standard drugs administered for a total period of six months. Unfortunately, tuberculosis is treated in a most erratic, irregular, interrupted and unregulated fashion. In several studies for an audit of tuberculosis treatment, irregularities and errors were detected in over 80 per cent of prescriptions which were analysed. This also remains the most important cause for the development of drug-resistance.

It is, therefore, not at all surprising to find a high prevalence of drug resistance in India. One may not agree with the terminology of “total drug resistance”, but the fact of resistance to a large number of drugs, which are otherwise more effective, is undeniable. We can call it an “extensive drug resistance (XDR)”, “extra XDR” or “multiple drug resistance (MDR)”. Nonetheless, the issue remains a cause for grave concern. Unfortunately, as we move to make a choice from the second, third or fourth line of drugs, we multiply the costs and the toxicity, but reduce the efficacy and the chances of a successful outcome.

Drug resistance is a serious problem associated with not only anti-tubercular drugs, but also with most of the antibiotics used for the treatment of infections. It should also be clearly understood that resistance is actually a phenomenon of micro-organisms and not of the drug (such as an antibiotic). The same drug may continue to remain effective against other organisms as well as other strains of the same organism. Moreover, the organism resistant to a drug at a particular place are not necessarily resistant at other places.

The above stated issue is particularly relevant to the recent report of drug-resistant tuberculosis in Mumbai, mostly limited to the patients from the slums of Dharavi. Patients from other parts of Mumbai or even the residents of Dharavi are not going to contract drug-resistant tuberculosis as was generally feared. Essentially speaking, drug resistance in the affected patients developed due to previous mismanagement through multiple hands.

It is not the fear of transmission of drug-resistant tuberculosis which should cause concern, but the issue of inappropriate treatment and misuse of drugs — the crux of the problem. The sooner we are able to handle the subject, the better it will be.

The writer is Chairman, National DOTS-Plus Committee for MDR-TB, and Professor & Head, Department of Pulmonary Medicine, PGI, Chandigarh.

Myths about homoeopathy
Dr Vikas Sharma

Homoeopathy for long has been associated with many myths that have paralysed its growth and made this wonderful healing science look like quackery. Among the many myths, the biggest is that homoeopathic treatment is slow in its effect. Is it really slow? How slow? The answer is that it is as slow or as fast as the nature gets. To understand this, one has to look at the basic principle underlying homoeopathy. Homoeopathic medicines work on the principle of “like cures like”. This means that a similar impression like that of the disease is given to the body in the from of a medicine. This in turn incites a small reaction in the body which fights the disease. In simpler terms, it means that homoeopathic medicines stimulate our body’s own healing processes.

This is the basic principle --- the speed at which homoeopathic medicines cure a disease is largely governed by the way our natural restorative process responds. Thus, homoeopathic medicines are not slow in action; they are as slow or as fast as our body’s healing system reacts.

Our body’s healing reaction is dependent on many factors. The intensity of the disease, the nature and the time period during which it has been in our system and, to some extent, the overall vitality of the body determine the speed at which our body cures itself. For example, a long-standing (20 years or so) case of eczema would take a coupe of months to be totally cured. On the other hand, an acute case of simple sore throat can respond within hours.

The second myth that plagues homoeopathy is that of “onions and coffee”. Should onions and coffee be avoided with homoeopathic medicines? Can they affect the treatment of a disease? These are myths and do not alter the homoeopathic action in our body. I am a regular onion eater and I have closely monitored myself whenever I am on homoeopathic medication. It does work even while I take onions. I have never advocated the avoidance of onions and coffee to my patients, still it works for them. It is a pure myth. There is no research or clinical trial that indicates that onions and coffee work as an antidote when we take homoeopathic medicines. The founder of homoeopathy, Dr Hahnemann, had cautioned against the overuse of coffee as a stimulant and that has been misread and wrongfully interpreted.

The third myth is that after taking homoeopathic medicines there is always an increase in the existing symptoms. This is very common to hear from patients: “Will my symptoms increase when I start taking homoeopathic medicine?” The answer is, “Not always”; they do but only in certain conditions and are easily avoidable. In certain disease conditions, where symptoms are suppressed by the use of conventional medicines, one might see a slight increase in these symptoms which is usually temporary and followed by major relief even in the previous condition too. The increase in symptoms can easily be avoided by an expert homoeopath with the careful choice of medicine potency.

The writer is a Chandigarh-based homoeopath. vikas@drhomeo.com 

Regular exercises can help prevent arthritis of hands 
Dr Ravinder Chadha

The word “arthritis” denotes inflammation of the joints. Our hands and wrists comprise multiple small bones and, therefore, multiple small joints which work in tandem to produce movements.

Arthritis can occur in multiple areas of the hand and the wrist. Females are more vulnerable after menopause and the problem generally runs in families.

Osteoarthritis and rheumatoid arthritis are the two most common forms of arthritis. The former is more common and affects elderly people. Rheumatoid arthritis is a chronic inflammatory illness which primarily attacks the linings of the joints. The hands and the feet are most often affected. When inflammation in the joints becomes chronic, longstanding cartilage and bone destruction occurs, leading to permanent deformity. Certain individuals suffer from severe pain while others do not. Hardened lumps called “rheumatoid nodules” occur under the skin of fingers.

Osteoarthritis of the hand involves certain spots more frequently. Small, bony nodes called Heber den’s nodes appear on the distal joints of the finger. Similarly, Bouchard’s nodes appear on the middle joints of the fingers.

Symptoms

On movement, there is pain and stiffness which is relieved on rest.

Hand function impairment vis-à-vis difficulty while writing, grasping objects, buttoning up a shirt, etc.

Morning stiffness due to muscle spasm and contraction, resulting in muscle shortening.

Repetitive pinching grip as is seen in the case of painters and mechanics suffer from more severe pain.

The base of the thumb where it meets the wrist is usually affected. Gripping of objects, opening of lids or turning of keys become agonising.

Treatment

The goal of treatment is to alleviate pain and stiffness, facilitate enhanced mobility and postpone the progression of the disease.

n Conservative treatment -— medication to decrease pain and swelling.

n Heat modalities such as paraffin bath and warm wax.

n In chronic cases, turning a finger/wrist sleeve/splint during night is helpful.

n Local application of steroid in the case of thumb arthritis provides instant relief.

Exercises

Excercises increase the lubrication in the cartilage of the joints, thus reducing the symptoms of pain and stiffness. With aging, the muscles and tendons that support the joints tend to get weaker.

The following exercises strengthen the muscles to protect the joints and provide support:

Raising both hands, curling fingers inwards to touch the palm and returning back. Then move your fingers and thumbs simultaneously to make a fist. Repeat several times a day.

Finger flutter exercise: Sitting on a chair, drop your hands on the side of the body. Relax your arms by moving them while shaking hands and fingers. This helps relax muscles and enhance circulation.

Finger extension exercise: The affected hands’ elbow is placed on the side of the chair. The fingers of the affected hand are passively placed into extension with the help of the other hand.

Finger-stretch exercise: Raise both hands with wrists and fingers fully extended. Move the hands like a screw with fingers closed in a smooth continuous movement, starting with the little finger. Finally, the hand is flexed as the fist is closed forcibly with the thumb overlapping the index finger.

Finger extension: Place a rubber band around all five fingertips. Spread fingers till your hands get tired.

Ball squeeze: Place a rubber ball or a tennis ball in the palm of your hand, squeeze it till the hand gets tired several times a day.

Initiating a regular exercise regime at the onset of arthritis is the key to preventing long-term pain and disability.

The writer is a former doctor/ physiotherapist, Indian Cricket Team. Email — chadhar587@gmail.com