Wednesday, December 1, 1999

How to detect drug addicts
By Dr. Rajeev Gupta
Drug abuse has assumed alarming proportions in Punjab. Here are more questions and answers on the topic.

What AIDS does to man
Five-year-old Lukman Ibrahim and his father Umar came to the synagogue of all nations in the hope of a cure for AIDS.

A miracle of surgical skill
Mr Makhan Singh of Sohal Jagir village, Nakodar, was in a desperate state. His only son — Davinder Singh (aged seven years) — sustained a fracture in his left arm after a 10-foot fall from a jamun tree. The major artery of his arm — the brachial artery — got crushed by the fractured bone.

Food: the uninvited guests

OUR eating habits have changed over the years. We eat out more often than earlier, use more processed foods and most of the time are in a tearing hurry even while cooking food at home. Consequence? Hygiene suffers. And results in unwanted guests like bacteria and viruses landing in our food.

Bacteria, viruses and other microbes are found widely in our environment. An average person carries more than 150 types of bacteria inside and outside the body, informs the Food Safety and Inspection Service (FSIS), a public health agency under the U.S. Department of Agriculture. Generally the bacteria can spread easily and rapidly, requiring just food, moisture, a favourable temperature and time to multiply. This makes meat, eggs, poultry, dairy products and fish common hosts of food-borne bacteria. They can also thrive on knives, crates, cutting boards, sponges, dish towels, sinks, counter tops or even human hands and then pass on to food.

So what are these major food-borne illness, their symptoms and methods of prevention?

Botulism:The dangerous toxins produced by the bacteria, Clostridium botulinum, cause this illness. The bacteria’s natural habitat is soil. Cases of botulism are rare, but very dangerous.

Sources: Low — acid canned foods, such as meats and vegetables that are improperly processed or stored, sausages and fermented food.

Symptoms: Vomiting, diarrhoea, fatigue and blurred vision. These usually occur between 8 and 72 hours after eating the contaminated food. More serious symptoms like muscular paralysis and death due to respiratory failure may follow.

Prevention: Don’t buy cans or glass jars with dents, cracks or bulging lids. Check for a proper seal. And boil the food in the preserving liquid for at least 10 minutes before you serve, or even taste it.

Clostridium perfringens are found in raw milk, foods in buffets and casseroles, stews and gravies kept below 140°F. They may cause nausea, abdominal pains, diarrhoea and gas formation.

Brucellosis: Also called ‘undulant fever’, you get it from milk or direct contact with infected cattle, sheep, swine, goats and dogs.

Sources: Unpasteurised milk from infected animals, usually cows.

Symptoms: Fever accompanied by profuse sweating, headache, weakness, body and joint aches, depression and weight loss. The symptoms usually begin one to two months after exposure to the bacteria, but the onset ranges from 5 to 60 days.

At risk: People who drink unpasteurised milk, as well as slaughterhouse workers, farm workers and veterinarians.

Prevention: Don’y drink unpasteurised (raw) milk or eat dairy products (including cheese) made from unpasteurised milk. Avoid contact with infected animals.

Campylobacteriosis: Caused by Campylobacter bacteria, a common food poisoning agent. Mostly found in the intestinal tracts of cats, dogs, poultry, cattle, swine, rodents, monkeys, wild birds and some humans. Even a small dose may make one fall ill, and most cases are individual rather than outbreaks.

Sources: Poultry, meat, raw milk, untreated water and household pets. Cats and dogs excrete the bacteria in faeces which contaminates their coats. These are transmitted to human hands while petting.

Symptoms: Fever, headache, muscle pain, followed by diarrhoea, stomach pain and nausea. The average onset time is 2 to 10 days. It may be mistaken for appendicitis because of severe pain and fever. Blood and mucus may be excreted. Illness usually lasts between two days and a week, but full recovery may take as long as four weeks. Complications may include meningitis, urinary tract infections, etc.

At risk: Children and adults who stroke or fondle their pets may get the infection. People, especially the elderly, with underdeveloped immune systems are more susceptible.

Prevention: Wash hands properly after playing with pets and using the bathroom. Don’t drink untreated water from purelooking mountain streams or lakes. Don’t drink unpasteurised raw milk from farms or other sources. And follow the principles of safe food handling by thorough cooking and avoiding cross-contamination between raw and cooked food.

Gastroenteritis: This result from an enterotoxin produced by certain types of ‘staphylococci’ in contaminated food. Staphylococcus aureus is present in the nose, mouth and on the skin of healthy people, and also in large numbers in septic cuts, boils and styes. Most outbreaks are caused by direct contamination of cooked food by food handlers carrying the bacteria, and subsequent storage of food at warm temperatures (8°C-63°C), allowing the bacteria to multiply and produce toxins.

Sources: Dairy foods, custards, cream cakes and trifles, cooked meat and poultry dishes, and seafood such as prawns.

Symptoms: Vomiting and diarrhoea, plus abdominal pain.

Prevention: The bacteria can be carried on skin, which makes personal hygiene vital for those handling foods. Avoid sneezing and coughing over food.

Haemorrhagic colitis: Produced by a rare strain of Escherichia coli (E. coli) called VTEC 0157: H7, i.e. verocytotoxin — producing E. coli. This powerful toxin causes severe damage to the lining of the intestine. Though a less common type of food poisoning, it is more serious. E. coli is found in the intestinal tract of both animals and man, and can be transmitted by numerous routes: from animal to animal, animal to man, on food, and through close contact. Unlike other bacteria, it can survive refrigeration and freezing.

Sources: Outbreaks have been traced to salad bars and daycares. Also from hamburgers, roast beef, dry sausages (salami), raw milk as well as cream and cheese from unpasteurised milk, mayonnaise, contaminated/untreated water, and fruits and vegetables grown in cow manure.

Symptoms: Abdominal cramps, vomiting and mild to severe diarrhoea that may contain blood. Symptoms may appear 12 to 60 hours after contact, but 48 hours is typical.

At risk: Young children, the elderly and people with low immune systems. They may also develop the more serious ‘haemolytic uraemic syndrome’ (HUS) that causes kidney failures, brain damage, strokes and seizures. Five to 10 per cent of HUS attack may prove fatal.

Prevention: The best defence against VTEC is thorough cooking. Thaw food in refrigerator or microwave, and refrigerate leftovers immediately.

Listeriosis:Caused by eating foods contaminated with Listeria monocytogenes, often found in soil and water.

Sources: Unpasteurised milk products including soft-cheeses, meat, ready-to-eat foods, coleslaw and pre-packed salads, salami and continental sausages.

Symptoms: Fever, fatigue, vomiting and diarrhoea. They can range from mild flu-like symptoms to septicemia and meningitis. It takes from one to six weeks for a serious case to develop, although milder symptoms may occur 12 hours after eating .

At risk: Listeria may cause miscarriage, stillbirth or premature labour in pregnant women, and septicemia or meningitis in the new-born. In older children and adults, complications may involve the central nervous system and blood stream.

Prevention: Use only pasteurised dairy products. Cook meat thoroughly. Ready-to-eat meals should be eaten piping hot. Refrigerate leftovers within 2 hours of cooking. Clean hands, kitchen surfaces and equipment with hot, soapy water before and after handling food.

Salmonellosis: The most common bacterial foodborne illness, caused by Salmonella. The salmonella family includes about 2000 different strains of bacteria, but only 10 strains cause most of the reported salmonella infections.

Sources: Any raw food of animal origin — meat, poultry, raw milk, fish and shellfish — may carry salmonella.Inadequately cooked egg products, infected food handlers and household pets may cause cross-contamination.

Symptoms: General tiredness, diarrhoea, high fever, vomiting and severe abdominal pain. In severe cases, septicemia or peritonitis may develop. Symptoms usually appear 12 to 48 hours after eating the contaminated food. The illness can last up to three weeks, but it’s possible to be a carrier for 12 weeks or more after cure.

At risk: Salmonella infections can be life-threatening for the very young, the very old and for persons weakened by diseases like AIDS.

Prevention: Sanitation can make a big difference. Always cook meat and poultry thoroughly, as salmonella is not very resistant to heat. Use only pasteurised dairy products. And refrigerate food containing meat or poultry within 2 hours after cooking.
— Courtesy INSIGHT

How to detect drug addicts
By Dr. Rajeev Gupta

Drug abuse has assumed alarming proportions in Punjab. Here are more questions and answers on the topic. (The first part appeared on November 24).

Q (V) Are there adequate medical services for the addicts?

Ans: Punjab does not have adequate medical facilities for the treatment of these addicts. De-addiction centres, run in various parts of the state are not fully equipped to manage the vast number of drug addicts. There are no rehabilitation centres for drug addicts in the state. In most of the centres, only acute detoxification is done for a week or so, and then the addict is discharged. Most of the addicts again turn to drugs. It is a common complaint of the family that all kinds of addictive drugs find their way even into the de-addiction wards or centres.

Q (VI). How can the family come to know of drug addiction?

Ans: It is observed that parents are the last to learn about the addictive habits of their children. A high degree of suspicion is mandatory to identify drug addiction among growing boys and girls. The common warning signals of drug addiction are the loss of interest in studies, unsatisfactory performance in examinations, unprovoked violence, change in the sleep pattern, diminished appetite, the loss of weight, drowsiness, demands for more money, sadistic behaviour, frozen and fixed looks, sunken eyes, episodes of depression and unreasonable conduct.

Once parents suspect that their child is a victim of drug abuse, they should try to search their rooms to find out if drugs are not secretly kept by them. An enquiry from their friends and classmates is often helpful in getting the right clue to their addictive habits.

Q. (VII) How to confirm drug addiction?

Ans: In highly sophisticated laboratories tests are done to assess drug levels in the urine. These tests provide help in confirming the drug intake. Most of the addicts never tell the truth and deceive family members and health-care professionals about their drug intake, thus leaving everything to the clinical judgement of the doctors and the attending staff.

Another way to confirm the addictive status of a person is to admit him to a hospital and wait for withdrawal symptoms to set in. Within two or three days symptoms like bodyaches, sleep disturbances, pain in the abdomen, the loss of appetite, loose motions, irritability, sneezing and restlessness start appearing. Drug withdrawal is to be done under strict medical supervision.

Smack addicts have stains on their teeth. While heating smack on a silver foil they land up burning their fingers. One should look for injection marks in case of IV addicts. With repeated injections their veins become hard and blocked and can be easily felt by fingers.

Q(VIII): What are the various complications of drug addiction?

Ans: The life of drug addicts is never free from complications. They are sure to develop a number of physical ailments related to the liver, brain, blood, heart, kidneys and other vital organs. They are vulnerable to tuberculosis and other life-threatening infections for drugs affect the entire range of psychophysical organisms. Their lives are also cut short by the regular use of the addictive substances. Most of them covertly or overtly remain psychologically disturbed. They develop phases of depression and excitement. Suspiciousness, paranoid symptoms and hallucinations are quite common in them. They complain of irritability and poor memory. Many addicts suffer from attacks of unconsciousness which clinically appear to be epileptic.

Q. IX): What are the treatment options for drug addiction?

Ans: Patients have to be hospitalised under the care of a psychiatrist having experience in treating addicts. The results of outdoor treatment are not very satisfactory. After acute detoxification, patients need regular maintenance treatment for at least four to six months. Relapses are common. The family should be prepared for them and need not be discouraged by them.

Conclusion: One should realise that one needs patience in treating drug addiction. A half-hearted approach does not give fruitful or satisfactory results. In spite of limitations in treatment, in many cases results are highly satisfying. Continuing education about the harmful effects of these drugs in schools and colleges has proved to be effective in many countries. But without an active full-fledged awareness campaign and active vigilance and intervention of the law-enforcing authorities, no de-addiction programme can be made successful. (Concluded)

— The author is a Ludhiana-based consultant psychiatrist and a de-addiction specialist.

What AIDS does to man

Five-year-old Lukman Ibrahim and his father Umar came to the synagogue of all nations in the hope of a cure for AIDS.

Even among those seeking treatment at Prophet T.B. Joshua’s church in Nigeria’s biggest city, not everyone is convinced by his promise that god removes the HIV virus from all who confess their sins.

But there are few other hopes for the multiplying numbers of victims as the epidemic quietly extends its hold on Africa’s most populous nation.

“I was diagnosed about two weeks ago and so was my son. It is him I’m really worried about,’’ said Umar, a 38-year-old Muslim who works as an oil refinery technician.

“I have already started to notice his loss of weight. I particularly pray that the almighty God cures him,’’ he said.

So far rates of HIV infection in Nigeria as a whole are lower than in Southern and Eastern Africa and even some other states on the West African coast.

But medics say that with a general lack of awareness among many of Nigeria’s 108 million people and an ineffective official programme to slow the spread of the deadly virus, Nigeria’s could be a bigger disaster than anywhere else.

“The problem is now getting out of hand because we are seeing more and more people who are infected, more and more people who are desperate to get treatment, to get drugs,’’ said Professor Femi Soyinka, who runs a help project for infected people.

Professor Soyinka said that over the past year the number of those seeking help from his Nigerian network on ethics, law, HIV/AIDS prevention, support and care had tripled.

Projections by the UN AIDS programme on the basis of studies carried out in 1995 to 1996 suggest the infection rate could be more than 6 per cent of the sexually active population, aged between 15 and 49.

If current rates of infection continue unabated, that will rise to nearly 10 per cent by 2005.

“With more than 4.1 million people already infected that is more than the population infected in many Southern African countries,’’ said Mr Kenneth Ofosu-Barko, Adviser to the UN Programme on AIDS.

“If a disease affects predominantly the productive sectors of society you know what that means, the trained sector will be gradually wiped out.

“There will be a shortage of teachers, of farm hands. Now it’s entered the executive class. Boardrooms are going to start dwindling, by implication it will affect the economy,’’ Mr Ofosu-Barko told Reuters.

Democracy offers hope for change.

Fighting the spread of the disease was not a priority for Nigeria’s succession of military rulers, whose rule was characterised by corruption, human rights abuses and general economic decline.

Doctors hope that will change under Mr Olusegun Obasanjo, Nigeria’s first elected President for 15 years, who mentioned the need to battle AIDS as an urgent need in his revised budget.

The AIDS-related death of Afrobeat singer Fela Anikul Apo-Kuti in 1997 temporarily highlighted the disease and figures show signs of increases in condom sales, but awareness outside the urban centres is often minimal.

“I go to the field and when I talk about AIDS, some may know that there is something and they pray they don’t get it but that is all they know about it,’’ said Professor Soyinka.

For those who are infected there is little prospect of anything but an early death, with first signs of the disease usually appearing some two to four years after infection — generally earlier than in the West.

Most patients cannot afford drugs to treat opportunistic infections that take advantage of the weakened immune system let alone dream of expensive multi-drug therapies that can reduce the level of the virus in the body.

The result is that ever more people turning to herbal and spiritual miracle healers, whose claims are spread by word of mouth and in the pages of popular newspapers.

“It’s very dangerous. People believe that they are cured so they continue to infect other people,’’ said Professor Soyinka. “They are doing a lot of harm to the people, but nobody cares.” — Reuters

A miracle of surgical skill

Mr Makhan Singh of Sohal Jagir village, Nakodar, was in a desperate state. His only son — Davinder Singh (aged seven years) — sustained a fracture in his left arm after a 10-foot fall from a jamun tree. The major artery of his arm — the brachial artery — got crushed by the fractured bone. His forearm and hand turned blue and cold and were in imminent danger of a gangrene attack. He was referred to the Tagore Heart Care Centre, Jalandhar. Dr Harinder Singh Bedi, Chairman, Department of Cardiovascular Surgery, realised that the lack of blood supply would not only lead to the loss of the arm but also potentially lead to the poisoning of the body.

Since time was running out, he was immediately taken for surgery. During the operation it was found that the artery was totally crushed and the muscles and tissues had suffered extensively from the lack of blood supply. As a desperate measure to try and save the limb, the artery was replaced by a vein taken from the leg in a major operation.The pulse of the hand returned and there was a dramatic recovery of the arm.

The other members of the team involved in this marathon surgery were Dr A. Suri, Dr M.S. Kalkat, Dr B.S. Sengar, Dr A. Nayyar, Dr R. Chawla and Dr V.P. Sharma. Dr J.S. Dang and Dr P. Lal were the orthopaedic experts present in the operation theatre.

According to Dr Bedi, Davinder Singh has now recovered 85 per cent of the functions of his arm. It is expected that there will be a regular improvement over the next few weeks. It is of paramount importance in any vascular injury to report to a surgical centre as soon as possible so that the limb can be saved — K.P.S.