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| Friday, 29 March 2002 |
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Dr. Mahen Wijesuriya, president of the Sri Lanka Diabetic Association stressing this point at a recent conference on diabetes blamed the parents for this sad debacle into which they are pushing their children, by deciding for them what careers they should pursue, disregarding their inner talents and career preferences which are not always in the high fields of medicine, engineering or law. Dr. Wijesuriya warned parents to refrain from doing this disservice to their children and thereby making them sick for life. Dr. Wijesuriya recalling his school days said during their time, they were not so much overburdened with school work, private tuition as it is today. He said it is a pity that today's children have hardly any time for leisure and play. It is a pity to see today's schoolchildren carrying such a heavy load of books on their backs, which in itself shows how overburdened they are with the present educational system. Dr. Wijesuriya said that at the July international conference on diabetes to be held in Colombo among other matters, this aspect of diabetes in the young will be dealt with and the necessary changes to be done in education will be suggested in a report to the appropriate authorities. According to university sources there have been several incidents of the undergraduates even taking their life for being unable to cope with the load of studies they had to shoulder. So far the youngest diabetic detected in Sri Lanka is a 7-year-old girl. Dr. Wijesuriya said, and percentage wise the incidence wise the increase in the young diabetic for the last 10 years is 1990 - 0 per cent 2000 - 8.7 per cent
Inaccurate data in the Annual Health Bulletin A study done by the Colombo Medical Faculty recently has revealed that some of the data on health published in the Annual Health Bulletin published by the Health Ministry is inaccurate. The five-member team headed by Dr. Saroj Jayasinghe who have done the study, in a report published on the study in the SLMA academic sessions programme dated March 2002 state - "There are differences between data from the Annual Health Bulletin (AHB) and the study. The AHB uses secondary data from all hospitals, often retrospectively and has been found to be inaccurate. Though cross sectional, the data from the present study is more valid and specially relevant to develop objectives for purposes of training medical graduates to be effective intern medical officers. The reference here is to the AHB of 1999, the last AHB issued.
Prof. H. A. Aponso explains Hole-in-the heart condition in children Most people have heard the term "hole-in-the heart". This is one form of CHD. These are defects that have occurred when the heart is being formed before the baby is born. In other words, CHD is a condition where a baby is born with a defective heart. However, unless the abnormalities are very severe, it may not manifest soon after birth. The severity of CHD varies a lot. The most severely affected may be aborted, stillborn, or die within a few days or weeks after birth. On the other hand, mild cases may not have any symptoms, and the child may have a normal life-span. The majority of cases belong to the intermediate group where problems arise during infancy or childhood. One of the well-known causes of CHD is German measles (rubella) in the mother during the first three months of pregnancy. What is meant by a "hole-in-the-heart" is that there is a defect either in the wall separating the left and right atrium, or in the wall between the two ventricles (Sec.3), or rarely in both. If blood flows from right to left through the hole unlike in the normal heart where it flows from left to right, the baby appears blue (cyanosed). These holes may be associated with defects in the heart valves, abnormalities of the ventricles or atria or defects in the large blood vessels. In more complicated cases multiple defects are found. Manifestations of CHD in more severe cases, the mother would notice that the baby is very breathless, especially during feeding; this is associated with widening of the ribs during respiration. He may develop bluish discolouration of the lips, tongue, fingers and toes. This discolouration, which is called cyanosis, becomes more marked during crying or coughing. Some babies develop repeated chest infections. Severely affected infants would fail to thrive. Sometimes, a doctor may detect an unusual sound (called a murmur) in the chest, during a routine examination. These children require management by a specialist. It is important to remember that every child with a heart murmur does not have CHD or a heart disease. There is a category of normal children who have such murmurs, which may eventually disappear as the child grows up. These murmurs are called innocent or benign murmurs. After proper evaluation, parents of such children could be reassured and undue anxiety prevented. It is important to stress that chest pain is not a common symptom of heart disease in children. Management of CHD 1. Some anxious parents tend to overprotect their children when they are detected to have murmurs. But it is extremely unusual for a child with heart disease to die suddenly at home or in school, unlike adults who have heart disease. Therefore medical advice should be sought regarding the degree of exertion that should be permitted. During dental procedures such as extractions & fillings, antibiotics should be used to prevent complications, e.g. subacute bacterial endo carditis. Therefore dental care to prevent tooth cavities dental carries, which should be a concern to all persons, is especially important in children with heart disease. 2. In Sri Lanka, certain types of CHD can be successfully treated surgically. Cardiac surgery for the more complicated types, is bein gradually developed; it is available in the private sector in Sri Lanka. 3. Some cases of CHD could be prevented. Marriages between first cousins should be discouraged as these may result in abnormal babies. If a pregnant mother develops rubella (German measles) during the first three months of her pregnancy the baby may have CHD. There is the possibility of terminating such a pregnancy in some countries, but not yet in Sri Lanka. Rubella can be prevented by vaccination, which is now being given to schoolgirls and non-pregnant women of the childbearing age. Rubella vaccine, along with mumps and measles vaccine (MMR) is given to children as a routine, in most countries; it is available in the private sector. Rheumatic Fever; Arthritis, Chorea and Heart Disease Rheumatic fever occurs in children and young adults, as a complication of a bacterial infection of the throat by an organism called streptococcus. This disease is more prevalent in poor countries and in communities living in overcrowded damp houses with poor ventilation; in such conditions, throat infections tend to spread easily from person to person. The complication referred to above is an "allergic" (immunological) response to the streptococcal infection. A common manifestation of the disease is pain and swelling of large joints such as the knee joints, ankle joints and elbow joints. This is called rheumatic arthritis. The pain and swelling may flit from one joint to another, within a few days. Some children with acute rheumatic fever become jittery and develop abnormal movements. This is called Rheumatic Chorea. In some of these patients the heart is also affected. This is called Rheumatic Carditis. This condition leads to inflammation of all parts of the heart, especially of the heart valves-mitral and aortic. This results in a disorder of the heart function. At this stage a doctor would hear, with a stethoscope, an abnormal heart sound which is called a murmur. Sometimes the rhythm and regularity of the heartbeat becomes abnormal, and this worsens the pumping action of the heart. The heart muscle may also get involved leading to enlargement of the heart. When the heart is seriously affected, the patient would become breathless on exertion, and this may gradually progress to breathlessness at rest. These are the symptoms of heart failure. Prof. Aponso has sent this article to the Health Watch in response to several requests from mothers to get this condition explained by an authoritative source - Health Watch.
Question Box On prebiotics Mrs. R. Kuruneru Katuneriya has asked what prebiotics are as one of the doctors in the government dispensary has prescribed prebiotics for her child. Dr. Viraj Peramuna in the Health Watch Medical Advisory Panel to whom the question was referred has sent the following reply. Non-digestible food supplement Pre-biotics are a non digestible food supplement that have recently been discovered to give children to improve their growth. These are natural food ingredients (mostly carbohydrates) that promotes healthy digestion, and helps in better absorption of nutrients such as proteins, vitamins, iron and calcium all of which help in a healthy physical and mental development of the child. Pre-biotics have also been found to reduce the harmful bacteria in the stomach, risk of infective diarrhoea and likelihood of constipation. Growing children such as toddlers and pre-schoolers require an increased amount of energy and nutrients for their active lifestyle. Since children are generally poor eaters and have very small appetites, ensuring that they get the required nutrients in their food becomes critical. It is important to provide them with the correct nutrient dense foods i.e. those that supply plenty of nutrients in a small volume of food. This will ensure proper growth and development. Recent nutritional breakthroughs have helped in the development of "functional foods" which produce specific health benefits. Functional foods such as Prebiotics can be added as a food supplement to food to give specific, health benefits.
Farook on Papaya We have received an e-mail from M. M. M. Farook of 78/16 Liyanage Road, Dehiwela on papaya, as a remedy for the control of diabetes. It will be carried next week. Thank you Mr. Farook for writing to us - Health Watch. More on Papaya by Dr. S. J. Wimalawansa, Dept of Biochemistry Peradeniya University The papaw (Carica papaya) is not indigenous to Sri Lanka. It is probably a native of the western hemisphere, brought here by the Portuguese. Papain is prepared from the juice (latex) of the unripe fruit of the papaw. Papain is more stable than trypsin and pepsin, and has been crystallized from salt solution and from 70% ethanol. As a topical medicament a chemica-combination of papain-urea-chlorophylt lin ointment is believed to be superior to other topical agents. In another study, the same combination, in conjunction with saline irrigation, was successfully used on pressure ulcers. This proteolytic enzyme is believed to be effective in eliminating the cellular components of inflammation. Material and Method Patients with infected wounds mainly of traumatic origin with slough and of more than 5 days' duration were selected for the trial, from those who attended the out-patients' department of the District Hospital, Kaltota. There were 104 patients in the study. Gradation of wounds The wounds were graded into 3 groups according to their size and severity: Group 1 - Mild wounds less than 5 cm in diameter, with slough. Group 2 - Moderately infected wounds 5-10 cm in diameter, with slough. Group 3 - Severe or grossly infected wounds more than 10 cm in diameter or where the bone is exposed and/or there is an offensive discharge, with or without maggots. Method of Treatment The wounds were thoroughly cleansed with soap and water and foreign debris removed. No attempt was made to remove adherent slough. Raw papaw fruit was grounded into a paste and applied evenly on the wounds and bandaged firmly. In all cases the paste was removed after 24 hours of application. Some of the moderate and severe cases were, treated with a second application. Raw papaw paste was followed by application of ripe papaw paste on all wounds for 2-3 days. Method of assessment The response to treatment was assessed by: 1. Time taken for the appearance of healthy granulation tissue. 2. Time taken for the patient to be fit to resume work.
Discussion The mode of action of papaya is not precisely known. Sensitivity studies done by the author on different organisms did not show antibacterial activity in water, ether and alcoholic extracts of papaya. Apart from the fibrinolytic activity which assists in the removal of slough, there may be a direct proteolytic action on bacteria which prevents its colonization and enables the host to destroy them. During inflammatory response a fibrinous coagulum develops covering the surface of the wound and encompassing surface pathogens. Although this coagulum serves to immobilise the organisms and protect the host against bacterial invasion, it substantially limits the ability of antibiotics to gain access to the bacteria. This surface coagulum appears to play an important role in minimising the effectiveness of antibiotics and defence mechanisms in a variety of clinical situations. Topical papain had been used in debridement of burn eschar and necrotic tissues, and in suppurative diseases of soft tissues. This is only a preliminary uncontrolled study and a controlled clinical trial is in progress to establish whether papaya paste is significantly useful in the treatment of chronic infected ulcers. If this is found to be effective it may prove to be more economical and safe, than conventional topical antimicrobial agents, as in the preparation of large infected ulcers prior to skin grafting. Courtesy: Ceylon Medical Journal.
Following Dr. H. B. Jayasinghe's article on hypnotic cure for alcoholism and drug addiction in this page on March 15, we had a number of letters from our readers posing various questions to Dr. Jayasinghe. We have directed all those questions to Dr. Jayasinghe. Please send your questions on Hypnotherapy direct to Dr. Jayasinghe in future to the following address: No. 23/4, Dalada Vidiya, Kandy or No. 59 Peradeniya Road, Kandy. He will reply through this page - Health Watch |
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Produced by Lake House |
The increasing incidence of diabetes among the young in Sri Lanka is
being attributed by the medical profession in the country mainly to the
stresses imposed on the young in trying to reach high educational goals
beyond their personal capabilities.
