SLMA Appeals for more professionalism

Prof. Rezvi Sheriff President SLMA, last week appealed to the professionals in the health sector to shed their differences and march forward together to stem the NCD non-communicable disease burden in the society.

He was making the Presidential address at the annual scientific sessions of the Sri Lanka Medical Association held in Colombo.

He said:

1. At this moment I make a fervent appeal to all doctors to work closely with other members of the healthcare team be it doctors in government, university or private sector settings, be it our sisters, nurses, pharmacists, physiotherapists, medical lab technologists etc - we need to work together in harmony if we are to serve our people well in the face of this chronic illness epidemic. Lets shed our differences and march forward together.

Thank you for your patient listening and I hope you will all join in the efforts to stem NCD incidence and its unacceptable and ugly burden on the Sri Lankan society.

2. Health Equity is of great concern to the SLMA. As individual doctor action and as an apex organization SLMA acts as advocates and agents of change which is of great importance especially in chronic disease.

I feel the enormity of the task in view of the numbers and it will become necessary to use community leaders and indeed the patients and close relatives in screening the community immediately around him or her in order to reach out by whatever means available to make a dent on the frightening situation this country will face from Epidemic Chronic Diseases in the coming decades.

I renew a Call for Action from all stakeholders on behalf of the new generation yet to be born.

War on MCD

I cannot but overemphasize the importance of the take home message to our population to

* Stop smoking,
* Reduce salt intake
* Reduce sugar intake
*Reduce stress level
* Reduce weight
* Modify diet... reduce

carbohydrate and saturated fats

* Increase exercise

* Reduce alcohol intake

These are low cost measures but effective and it is important to apply social marketing techniques if we are to win this War On NCD like the War On Terror going on all around us.

Chronic Kidney Disease

Acute illness		Chronic illness

Renal Colic		Diabetic nephropathy
Acute Pyelnephritis	Hypertensive
Acute Renal Failure	Nephrosclerosis
Acute Nephritis		Obstructive
Surgical Trauma		Nephropathy
Acute Tubular		Interstitial Nephritis
Necrosis		Infective/ Renal TB
Snake Bites		Drug Induced
Post Partum		Congenital
Trauma			Polycystic Kidneys
Drug Induced		Cancer of the Kidneys

The final part of my address is on Chronic Kidney Disease. Although on our list of Hospital mortality it does not appear in the top 10, the Hypertension associated contributes to deaths recorded as cardiovascular and cerebrovascular deaths. It is now being recognized as an additional risk factor for CVD.

Nephology is my field of specialty and I have a long dialysis and transplant experience in this country. I can unreservedly say that Diabetes and Hypertension causing ESRF accounts for over 90% of our uraemics entering Chronic Dialysis programmes today. 30 years ago in 1978 it was less than 30% taken together.

The increasing trends of CKD in the world, in South Asia and in Sri Lanka are now noticeable as increasing numbers are seeking dialysis and transplantation. The sheer high cost of care has made the Ministry of Health take notice of renal disease in Sri Lanka.

This slide lists acute and chronic kidney diseases in Sri Lankan Community.

A new entity

A new entity of Chronic Kidney Disease of Unknown cause was emerging. In the last 10 years, practising physicians and nephologists have noticed the increasing morbidity and mortality attributable to CKD. No evidence of the cause was evident in the History, Examination or Investigation.

This illness was first noticed in Anuradhapura in the NWP and is now seen in NCP and Uva. Who has named it CKDu. The Ministry of Health?s first reaction was to setup special renal clinics in several areas. Doctors from Kandy and University of Peradeniya worked in these clinics.

In some areas like Padaviya CKDu was more prevalent. These areas also had CKD associated with Diabetes, Hypertension and Urological disease but the CKDu was clearly different. It was reported that Anuradhapura medical ward mortality pattern was changing fast and cardiac deaths were less than renal deaths.

It was a disease starting in the young adult and slowly progressing to ESRF in 10-15 years. There was little anaemia or HPT.

Kidneys were stunted on Ultrasound Scan. Chronic Interstitial Nephritis was the predominant pathology in the few cases renal biopsy was undertaken Dr. Tilak Abeysekare and Dr. Nimmi Athureliya gave leadership to these early studies and served to create the needed awareness.

****

Anger, depression and anxiety in Cardiac patients

D.P. Atukorale

Since antiquity, people have been intuitively aware of a harmful association of anger with health. Buddhism actually refers to this as one of the Three Poisons of the Mind (i.e. greed, anger and foolishness).

There is scientific evidence to show that anger and hostility are significantly associated not only with increased coronary heart disease events in initially healthy people, but also with poor prognosis in the patients with existing heart disease. Anger and hostility can precipitate heart attacks in patients who already had suffered from heart attacks earlier.

It has been shown that heart attacks precipitated by anger are more common in men than women showing that men are more responsive to anger and hostility factors in relation to coronary heart disease than women.

Anxiety is common among heart patients and it is common knowledge that anxiety and stress increase the risk of angina and heart attacks.

Depression has been identified as a possible risk factor for the adverse prognosis and reduced survival after a heart attack and it has been shown that this poor prognosis might be due to rhythm disturbances.

The rhythm disturbances can be due to (a) some of the psychiatric drugs depression patients may be using and to (b) certain hormones such as cortisol Adrenaline and nor-Adrenaline secreted into the circulation during stress and anger. Adrenalin and nor-Adrenaline are known to raise the blood pressure and increase the heart rate (pulse rate) during attacks of anger.

Reference: Journal of the American , College of Cardiology , March 17, 2009

World Hepatitis Day falls tomorrow :

Mind your liver

Sachitra Mahendra

Hepatitis B has made many in regions of Asia and Africa panicked. Dr Desmond Wai, whose expertise is liver cancer treatment, shared his opinion on the epidemic at a congregation recently held at ParkwayHealth, Singapore.

Commonly known as HBV, Hepatitis B infects the liver by way of inflammation. Dr Wai does not observe chemotherapy as a complete retaliation.

"Chemotherapy only cools down it. The practical solution is out in the open, it is liver transplant of which I am specializing. This is quite worse in China. You get 10 percent out of the whole population getting infected!"

Hepatitis B results in symptoms such as nausea, vomiting and skin jaundice. However fatal it may look at times, the disease rarely causes death. The symptoms go through the roof over the weeks on most patients. Patients at early level of liver cancer are always advised not to consume alcohol, because it may result in chronic conditions such as cirrhosis over the years.

This is identified as hepadnavirus too, since it infects with liver specifically dealing with DNA sometimes. Since both Hepatitis A and Hepatitis B begin with the same terms, many take it as the same disease.

"You don't get Hepatitis B through water and food as in Hepatitis A. You get it through body fluids such as oral contact, unprotected sexual contacts and reused syringes."

Hepatitis can be asymptomatic too. The symptoms would not be physically visible over years, though early diagnose and treatment are quite essential in recovery process.

The worst still is that a mother positive with Hepatitis B has the chances of passing it on to her child too. A child should be vaccinated within the very first 12 hours to ensure safe breastfeeding. One vaccination lasts over 20 years.

Hepatitis B can be categorized into two: self limiting and long standing. People with self-limiting Hepatitis B can get rid of the menace over a few weeks. Upon the full recovery an average individual becomes immune to another attack in most instances.

For those who suffered it enough, Dr Wai still has a warning:

"If your immunity is not strong enough, then you have to be extra careful. You are still volatile for a second attack."

He took this opportunity to expose some of his experiences in Sri Lanka too.

"I must say Hepatitis B is almost zero in Colombo. This is because they follow a good health procedure. I have seen people walking along beaches, people constantly getting their medical check-ups done. More importantly Sri Lankans are very hygienic which is essential in prevention of Hepatitis B."

Dr. Wai recalled an encounter with a Sri Lankan University medical doctor.

"It was very easy to work with him. He was well trained. I have met many Sri Lankan doctors. They are all well trained as well as qualified in UK and USA. But the problem is most of them do not have enough time to spare for more patients, as they are occupied with clinics. Anyway I am sure Sri Lanka will soon catch up Singapore in health system."

Cost of Obesity

Statistics show the evidence of obesity and related cost associated with it frequently.

You can always think about the direct cost you bear, because of obesity related diseases. As a country, the cost of obesity is still not being calculated in Sri Lanka. This overall cost bearable to a particular nation comes as a hidden cost. This is because, the loss of productivity due to obesity is any way hard to calculate. In some of the other countries, this estimation is roughly done.

In US, healthcare costs associated with obesity related medical expenses are approximately $100 billion per year. Obesity adds an incremental $395 per person per year to the cost of US national healthcare expense.

Obesity related disability costs employers an average $8,720 per employee per year-in addition to the $12 billion annual expenses from increased healthcare costs, lower productivity, and increased loss of work.. protection against employment discrimination. Under both acts, a person must establish that he or she is an individual with a disability within the meaning of the acts.

This includes anyone who has a physical or mental disability that substantially limits one or more major life activities of the individual, a record of such impairment or who is regarded as having such impairment.

Equal Employment Opportunities Commission (EEOC)

EEOC regulations define "major life activities" as "functions such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working.

The regulations require that the 'working" limitation requires evidence of being significantly restricted in the ability to perform either a class of jobs or a broad range of jobs in various classes as compared to the average person having comparable training, skills and abilities.

The inability to perform a specific job does not constitute a substantial limitation in the major life activity of working. The EEOC regulations implementing the ADA explicitly excludes height or weight within normal ranges and are not the result of a physiological disorder.

According to the regulation, obesity will considered as a disability except in "rare circumstances." So, the countries of the world are now seeing obesity as a national epidemic.

It is being incorporated in policies and preventive programs. This initiative to see the issue of obesity, as a preventable epidemic has many added benefits. As the golden rule says, prevention is better than cure, the cost of treating other diseases, generated because of obesity is reduced because of preventing obesity.

So it is the right time to see obesity in a cost conscious way. The whatever money you spend to prevent or control obesity will be an investment. It will save a further financial loss in the future.

The present day business plans incorporate "cost management", if you inquire about it from a businessman. This is opposed to the term "cost cutting", which was used earlier. The cost management is cutting down the costs which are obvious and seeing the necessary costs as investments. This theory can be applicable to obesity.

Glass of breakfast

Ingredients
one medium size banana
one medium size mango
30gm Optifast Slim
prepared in
250 ml chilled water
Non fat yoghurt 125 gm
one tbsp oat bran
Method of preparation

Peel the fruits and cut into small pieces and place in a blender. Add a small volume of Optifast Slim milk and process until smooth. Add the remaining milk, non fat yoghurt, bran and run the machine until smooth. Pour into a glass and serve.

Total calories 250
Soup with
garlic bread
Ingredients
Medium size tomato
two tsp low fat butter
two tsp wholemeal flour
30g Optifast Slim in
150ml lukewarm water
(Preferably vanilla flavour)

two slices of garlic bread
Water 125 ml
Sault and pepper
Method of preparation

Peel the tomato. Place in a blender and blend until smooth. Add low fat butter and wholemeal flour to a pan and heat. Add blend tomato and water into it. Add sault and pepper to taste. Boil for 5 minutes. Remove from the pan and place it in a bowl.

Meanwhile cut garlic bread into small pieces and place in a pan, toss until crisp and brown. Add bread on top of the tomato mixture. Beat Optifast slim milk well and pour on top of it. Serve hot.

Total calories 255
Corn salad
Ingredients
Whole corn kernels - two
Capsicum - one medium
Pomegranate - one tbsp
Tomato - one medium
Green chilli - one
Mint leaves - a few
springs
Pepper corns - five
Lime juice - one tsp
Salt - to taste
Methods of preparation

Pressure cook corn kernels (3 whistles) with salt until soft
Wash and deseed tomato and capsicum and cut into small cubes
Wash and chop green chili and mint leaves
Mix corn kernels, capsicum, pomegranate and tomatoes
Toss it with chopped green chili and mint leaves, lime juice, crushed pepper corns and salt
Refrigerate and serve chilled
Nutritive value
Carbohydrate - 0 gm
Protein - 1 gm
Fat -
Total calories - 44 kcal
Courtesy: Slimlife

Insured immigrants spend less on health: study

Insured immigrants have lower medical expenses than U.S.-born citizens, even after accounting for lower levels of insurance coverage, U.S. researchers said on Thursday. They said the findings contradict the popular belief that immigrants are a drain on the U.S. health system.

REUTERS

Laughter the best medicine

The difference:

A fellow had married a society girl who was one of a pair of identical twins. But within a year of his marriage he found himself in a court of law applying to the judge on the bench for a divorce.

"But why do you want a divorce?" asked the judge.

"Well it's this way", explained the guy. "My wife's twin sister lives with us, and I often come home and kiss her by mistake".

But surely there is some difference between the two women", said the judge.

"You bet your life there is", exclaimed the husband and that's why I want divorce.

Sent by: G.A. Seneviratne

Taken from Best Jokers of All Time

Your questions on Re-birth

As we carried on this page last week the Healthwatch associated. SLMA sponsored talk on re-birth made by patients under medical hypnosis will be made by Sri Lanka's leading Consultant Clinical Hypnotist Dr. H.B. Jayasinghe (MBBS Cey. MCGP, MDCH Lond, MBS CH UK cht USA) on May 31st Sunday at the SLMA auditorium at No. 6 Wijerama Mawatha, Colombo 7 at 11 a.m.

The talk will be based on the medical evidence doctors have found in the course of this therapy both here and abroad.

Dr. Jayasinghe will be happy to answer any of the questions you may have on this topic re-birth in the course of his talk. So please send in your questions early to us.

Talk on re-birth by Dr. Jayasinghe C/O Features Editor Daily News, No. 35 D.R. Wijewardena Mawatha, Lake House, Colombo 10.

Focus on children best way to stop flu bugs: study

Travel restrictions and other measures help limit the spread of the new H1N1 virus but officials are largely ignoring the best way to stop the bug: focusing on children’s hygiene, a researcher said on Thursday. Citing a review of 51 studies examining different ways to contain respiratory virus epidemics, Tom Jefferson of the Cochrane Library said encouraging children to do simple things like wash their hands is most effective.

REUTERS