Healthwatch
Kidney diseases on the rise in NCP
Nadira Gunatilleke
Director, Anuradhapura Hospital, Dr. W. M. T. B. Wijekoon
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Several areas in Sri Lanka have been severely affected by kidney
diseases since mid nineties. The badly affected areas are located in
North Central, North Western, Uva and Sabaragamuwa Provinces. The
affected areas are Anuradhapura, Padaviya, Medavachchiya, Mahiyanganaya,
Nikawewa, Girandurukotte, Medirigiriya and Polonnaruwa.
Affected areas
According to Anuradhapura Hospital Director Dr. W. M. T. B.Wijekoon
nearly15,000 kidney patients have been detected from the affected areas
since mid nineties. One fourth of kidney patients reported in Sri Lanka
belong to the NCP. In 2008 there were 305 hospital admissions of kidney
patients and 130 of them died. In 2007, 834 kidney patients were
admitted to the hospital and 208 of them died. The number of kidney
related deaths in 2006 was 181.
Dr. Wijekoon said diabetes, high blood pressure, snake bites are some
of the common reasons that cause kidney diseases. But apart from that,
contaminated water is another main reason. In the NCP, water is
contaminated with pesticides and insecticides used for agricultural
activities. Such chemicals contain heavy metals such as cadmium and
sometimes there is a possibility that cadmium can deposit on fish skin
and green leaves grown on river banks. Eating such food can cause kidney
diseases. Another reason is the high fluoride percentage in the water in
this region. When such water is boiled in aluminium pots, both chemicals
get mixed up and become toxic in the human body. Drinking such water can
cause kidney diseases.
Renal Care and Renal Research Centre, Anuradhapura |
Unlike in the past, many people now volunteer to come for screening
for kidney diseases. But Anuradhapura Hospital needs more facilities to
cater to these kidney patients. “We urgently need a generator of 500 kW.
There are 18 used dialysis machines received by the hospital as a
donation. We require around Rs.10 million to repair them.
We have to replace certain parts of those machines and those parts
cost around Rs.10 million. It will take another two to three years to
start kidney transplanting in this hospital because we have to train
staff and obtain other requirements,” he added.
Most affected
Meanwhile, the Medical Officer attached to the Renal Care and Renal
Transplant Centre, Anuradhapura said that around 40 new kidney patients
register with the centre every week and 2,000 kidney patients have
already been registered with the centre. There are many young kidney
patients and some of them are in the later stages of the disease.
According to Dr. Sampath, usually the centre offers free dialysis
only to patients below 40 years and to patients who are about to undergo
a kidney transplant. The patients above 40 are the most affected because
they have to pay for dialysis and they are the breadwinners of their
families. Sometimes more than one of the same family suffer from the
kidney disease and then it become more difficult for the family. The
centre is compelled to look after both patients and their families.
Healthcare and Nutrition Minister inspects the Renal Care and
Renal Transplant Centre, Anuradhapura |
The Healthcare and Nutrition Ministry has issued statistics in
connection with the number of kidney patients reported from certain
areas in 2008 and according to the statistics, 200 persons in every one
million suffer from kidney diseases and annually the Government spends
over Rs. 3,500 million to treat kidney patients. Cost of dialysis for
one patient is around Rs. 8,000 and one kidney transplant costs around
Rs. 800,000 locally.
Earlier, kidney disease was the third top reason for the deaths in
the affected region and snake bites and suicides are the first and
second causes of the deaths but now kidney diseases have come to the
top.
Last year the Ministry arranged free screening for the people in
affected areas for kidney diseases as part of the solution.
Tug-of-war
According to Healthcare and Nutrition Ministry sources, a state of
the art renal hospital built in Colombo at a cost of Rs. 3,500 million
is remain closed because of a tug-of-war between the GMOA and some other
groups. There are 17 dialysis machines installed in this hospital which
has five floors but still the needy patients have no access to its
services because of bureaucratic red tape.
The sources said a special team from World Health Organisation (WHO)
visited Sri Lanka in May last year to find out the real reason behind
this rapidly rising kidney diseases in those areas. Prof. Neil Reginald
Poulter, International Centre for Circulatory Health, U.K and Dr.
Sansdeep Mahajan, Associated Professor, All India Institute of Medical
Science and Dr. Saiyed Habibullah, Regional Advisor, Occupational
Health, WHO South Asia Region were among the members of the team of
specialists, the sources said. The team did not find a specific or
special reason for the problem and the report produced by the team
stated that the reasons detected by local experts have a connection with
the problem and more research needed to come to a conclusion.
The team is scheduled to re-visit Sri Lanka soon. During the first
visit, they stated that similar situation has arisen in certain Baltic
countries where there is a rapid increase in kidney diseases and it
could be due to cold climate.
Same problem
Sri Lanka has the same problem in the dry zone where there is a
tropical climate. Many research had been conducted by various scholars
and organizations on the problem in Sri Lanka but non of them discovered
the exact reason, the sources added.
Diabetics, high blood pressure, excessive use of certain drugs,
excessive intake of red meat and animal proteins, contaminated drinking
water (contaminated with pesticides and insecticides containing heavy
metals such as cadmium, lead and excessive amount of fluoride), use of
illegal alcohol, eating fish skin and green leaves (in the affected
areas), constant use of aluminium pots for cooking and boiling water are
some of the reasons discovered by local researchers who research on
rapidly increasing kidney diseases in certain parts of the country.
Dr. Sampath pointed out that there are five stages in the kidney
disease and diagnosis should be done as soon as possible to delay the
progress of the disease.
There are three types of treatment - medical treatment, dialysis and
transplant. Only transplanting of a kidney can completely cure a kidney
disease.
According to the Sri Lankan law only a blood relation or a
monk/priest or similar person can donate a kidney for a patient and the
donor can lead a normal life after donating a kidney. A normal human
being needs only one kidney to lead a normal life.
Kidney patients can get help from the National Kidney Foundation
where recipients and donors can get registered, he added.
Giving paracetamol for children, what parents should know
Edward Arambewela
Dr. Maxi Fernandopulle, Consultant Paediatrician speaking to the
Heathwatch on giving paracetamol for children made the following
observations:
A commonly taken pain reliever, paracetamol, has always been a safe
option for mothers. For many Sri Lankans, paracetamol is the easiest,
cheapest option.
Vital areas
Yet, new evidence brought forward suggests that caution be exercised
over the use of this common pain reliever. Correct dosages, correct
information are emerging as vital areas that the average Sri Lankan
needs more information on, as doctors point out.
As a pain reliever, paracetamol can be used effectively to bring down
a fever in a sick child, however, the dosage should never exceed,
according to Dr. Rohini Fernandopulle of the Department of Pharmacology,
Faculty of Medicine. She added that once consumed, paracetamol breakdown
is handled by the liver.
Excess paracetamol
While about five percent of paracetamol consumed can remain in the
body, it must be mentioned that for an adult, 4gms would suffice. It
must be mentioned that excess paracetamol left in the liver can cause
great damage to the liver.
According to Dr. Maxi Fernandopulle, Consultant Paediatrician - Lady
Ridgeway Hospital, paracetamol dosages should never exceed 10-15 mg per
kg of body weight per dose. This is considered a normal dose, which can
be easily handled by the liver.
However, when a child is sick and does not have a normal intake of
food, then the stamina of the child is affected. At such times, the
liver would have trouble breaking down the excess paracetamol, since the
substance that handles the breakdown of paracetamol will be low due to
low nutritional levels in the body. It is very important to ensure that
a sick child is well fed, adds Dr. Fernandopulle.
At Lady Ridgeway Hospital alone, there have been deaths reported of
children who died as a result of an overdose of paracetamol.
While doctors do agree that children can handle paracetamol toxicity
better than adults, this is not possible in a sick child, already
weakened by the fever.
Maternal anxiety
Dr. Fernandopulle cites maternal anxiety over a child’s sickness as
well as wrong advice from doctors, as reasons for possible overdosage.
Mothers must remember that medicine should fight the infection that
is causing the fever and not merely deal with the fever, he adds. To
bring down a fever, mothers can also use other methods such as sponging
the child with rapid water.
He says that paracetamol should not be used as a fever prevention,
four doses a day should be adhered to and mothers must never exceed the
dosage indicated for a particular age group of children.
Breakdown
An average tablet of paracetamol for adults contain 500mg while the
average syrup contains 130mg, 5 ml in a teaspoon. In the instance where
paracetamol levels exceed over 140 mg per kg of body weight, it would be
fatal for the patience since the liver would not be able to breakdown
the amount of paracetamol.
Such overdoses would cause irreparable damage while also inducing
kidney failure. Long-term use of paracetamol can also affect kidneys.
While a viral fever can cause some small amount of damage to the liver,
it would be sorted out by itself in almost 99 percent cases, secondary
damage is caused when paracetamol doses in excess, hit the liver.
Other complications
There would be other complications at this stage, such as bleeding in
the stomach since a damaged liver will not be able to handle the
function of blood clotting.
“Nausea, vomiting, anorexia, pale and lack of activity are signs of
paracetamol overdosage which can be interpreted as early signs of liver
damage. If paracetamol toxicity is present in the body, a sample of
blood will indicate so.
Most of the time however, patients are brought too late to administer
the antidote for paracetamol toxicity,” said Dr. Rohini Fernandopulle.
Newer, better tests for heart attacks
Two new European reports should help doctors decide which tests they
choose to use for diagnosing possible heart attacks in emergency room
patients, cardiologists say.
Both studies, which appear in the Aug. 27 issue of the New England
Journal of Medicine, looked at tests for troponin, a protein released by
damaged heart cells. Standard practice in most hospitals now calls for a
troponin test when a heart attack or other major coronary problem is
suspected, with a variety of tests commercially available for two forms
of the protein, designated troponin I and troponin T.
One of the studies, done primarily in Switzerland, compares the
accuracy of four new tests with that of a widely used older assay. The
other, led by German physicians, compares tests done for the I and T
forms of troponin.
“Both of these studies show that newer assays that are becoming
available have a much better sensitivity, detecting even smaller amounts
of damage,” said Dr. E. Magnus Ohman, director of the program for
advanced coronary disease at Duke University. Ohman, an expert on
coronary diagnosis, was not involved with either study.
But because of the newness of the tests, “most physicians are
uncertain about how they should be used,” Ohman explained. The new tests
will be a matter of intensive discussion by representatives of the
American Heart Association, the American College of Cardiology and the
European Society of Cardiology at a meeting in Barcelona next week, he
added.
The German study compared newer tests of the two forms of the protein
with older tests now widely used in suspected heart attacks. The study
of 1,818 cases found that the newer troponin I test was more sensitive
in detecting heart damage and more specific in determining that the
damage was due to a heart attack.
The troponin I test was better than 90 percent sensitive in detecting
heart damage and 90 percent specific in determining whether it was due
to a heart attack, the study found.
A second study led by Swiss cardiologists reported on the use of
newer tests for both troponin I and troponin T on 718 people who came to
emergency rooms with symptoms indicating possible heart attacks.
“The diagnostic performance of sensitive cardiac troponin assays is
excellent, and these assays can substantially improve the early
diagnosis of acute myocardial infarction [heart attack], particularly in
patients with a recent onset of chest pain,” the researchers wrote.
The choice of a troponin test still might not be easy, Ohman said.
For example, he prefers a test for troponin T. That is a minority choice
in the United States, where about 60 percent of physicians test for
troponin I, Ohman said.
More studies probably are needed to help doctors make a choice, he
said. “We need to assay the sensitivity of tests in a broader range of
patients,” he said of the European studies. “I suspect that they had
many more patients and somehow selected out the more likely cardiac
patients. We need to do many more studies on patients with a lower
chance of cardiac disease.”
The increased sensitivity of the newer tests might pose a problem in
some cases, Ohman said. “Once you are able to detect smaller and smaller
infarcts [damaged heart areas], you can be detecting damage that may not
be a clinical heart attack,” he said, which would complicate the choice
of treatment.
Increased troponin levels can be due to “a whole host of conditions”
other than a heart attack, including inflammation from myocarditis and
even strain on the heart from blood clots in the lung, Ohman said.
HealthDay News
‘Most hearing disabilities can be cured’
Harshini Perera
People with moderate hearing deficiencies can be integrated to the
work force of the country with a little assistance to overcome their
hearing disabilities, said ENT Surgeon, Dr. Ravindra Ruberu.
He
said a survey published in a WHO publication in 2002, showed that eight
percent of Sri Lankans are suffering from deafness due to certain causes
of hearing impairment and it was an area which was given less attention
ten years ago.
The Audiology centre at Ratmalana is open for testing and treating
hearing impaired children and adults in Sri Lanka. It will facilitate
the children in Ceylon School for Deaf and Blind and outsiders with
hearing and speech impairment.
Children born with deafness as a result of genetic defects and
moderate deafness can be treated at this Centre which was donated by
Dialog to “Enrich and empower the nation through Inclusion” in 2007.
Treatment to children in the Deaf and Blind School is provided free
whereas external patients can also get treatment upon payment for
medical tests, he said.
The Audiology Centre at Ratmalana treats those with deafness,
impaired hearing and speech defects. Several tests are conducted before
the treatment at the Centre.
The Centre assists children with autism in improving their hearing
and emotional expressions. Audiologist, Thilini Amarasinghe said due to
increased awareness of parents, more children with autism come to the
Centre for treatment.
Other than treatment, a counselling service for parents and children
is being conducted at the Centre to ward off social stigma attached to
Deafness, Speech and Language, Pathologist Buddhima Samaraweera said.
Rich veggie diet safer than vitamin supplements
A rich diet abundant in fruits and vegetables is much safer and more
effective for human health than vitamin supplements, Dutch scientists
reasserted.
Investigators from the University of Amsterdam assured many of these
vitamin supplements contain complementary products that might be
harmful.
Nutrition expert Martin Kartan said many laboratories producing these
supplements use confusing instruction manuals for patients.
Kartan mentioned a recommendation from a product which is able to
prevent harmful tobacco consumption consequences which became confusing
for its consumers.
Investigators also said that highly concentrated pills of Vitamin B6
might be dangerous.
Kartan suggested people should better invest their money and time
eating fruits and vegetables.
“Everything else is pure business,” he concluded.
Prensa Latina
New Glaucoma - Unit
The new building of Glaucoma Unit and extension of services of the
Lion Gift of Sight Hospital, Panadura at Galgoda Sri Maha Viharaya
premises was opened recently under past international Lion President
(2007/2008) Mahendra Amarasuriya’s patronage. Chief Incumbent of the
Galgoda Sri Maha Viharaya Ven. Pothupitiye Pannasekara Thera and several
others.
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