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Kidney diseases on the rise in NCP



Director, Anuradhapura Hospital, Dr. W. M. T. B. Wijekoon

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

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’

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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