118 years of trust

Wednesday, August 12, 1998


Eyes are forever, donate them
By Jagjit S. Saini
GIVING and receiving a gift is an immense joy to any one. There is a special sentimental role and added value for a gift desperately needed.

Albumin may have killed burn victims
By Tim Radford
THOUSANDS of burn victims may have died because they were given albumin – a blood product – instead of a simple saline drip, doctors say.

Can we prevent oral cancer?
By Vimal and Poonam Sikri
CANCER literaly means overgrowth of the tissues. Cancer can arise anywhere in the body. It may involve oral tissues directly or indirectly. The simplest cause of cancer is biological alternations in tissues which may be due to chemical or surgical exposure leading to environment conducive to cancer.




Eyes are forever, donate them
By Jagjit S. Saini

GIVING and receiving a gift is an immense joy to any one. There is a special sentimental role and added value for a gift desperately needed. Our religious saints and elders have recommended donation of eyes after death as a perfect gift for the posterity. Just think of the immense sense of satisfaction of giving back a life of sight to a fellow human. Eye donations is a perfect gift given when you do not need eyes any more and your gift earns the gratitude of some one who desperately needs them.

Scientific rationale for eye donation rests on the discovery that eyes remain viable for several hours after death, and if properly harvested, surgical marvels can help millions see again. Eye donations can be made by any person of any age, spectacle wearers, hypertensives, diabetics etc. An eye donation can not be accepted from deceased known to have died of AIDS, hepatitis, rabies and syphilis as there are chances of the decease being transmitted. Eye donation is a very simple procedure which takes 10-15 minutes and does not cause disfigurement, or delays the funeral arrangements.

The eye bank team is willing to recover eyes from wherever the donor is, be it the residence, hospital, mortuary or even the burial ground. The identity of the donor and the recipient are kept confidential. In our country it is illegal to buy or sell donor eyes.

In India 1 million persons have corneal disease and at least 2.5 lakh can be easily cured through cornea transplantation only if quality donor eyes were available. As much as 60 per cent of those awaiting cure through cornea transplantation are children in this country.

Cornea transplantation involves replacement of the front diseased part of the eye with a healthy donated cornea from a donor eye made available to the eye bank after death. In our country in 1996 only 15000 eyes were donated out of which about 7000 could be transplanted because of quality constrains. A huge number are, therefore, needlessly blind for lack of donor eyes.

Eye donation is a simple procedure. The first obstacle, however is, the emotional upset in the family at the time of death. A good effort by a concerned neighbour at grief counselling and at the same time motivating the family of the deceased to agree to donate eyes, is often effective. Once the potential of eye donation has been identified, you need to call the local eye bank.

The eye bank team will try and reach shortly thereafter to remove the donated eye. All this procedure has to be preferably done within six to eight hours of death. Because of the time constrains in which the eyes should preferably be removed from the cadaver, eye banks often operate under severe pressure of time constrains in which they have to reach the deceased, obtain consent for eye donation, harvest the donated eye, bring it to the eye bank and processes it, evaluate it for viability, arrange for serology screening and preserve it before finally distributing it for safe surgical use. Operational efficiency of the eye banks sometimes becomes a constrain due to lack of adequate communication and transport. In the interval that the team from the eye bank arrives, it helps retain eye viability to close the lids, turn off fans, place a handkerchief with ice cubes on both eye lids, raise the head on pillows and keep the death certificate ready. On arrival eye bank team will need to obtain additional consent to donation of eyes from the family.

In the hospitals eye bank personnel often request the family for eye donation. In the PGI Chandigarh, only about 8 per cent of those requested agree to eye donation. This is a very low rate of eye donations. In non-hospital deaths 0.15 per cent of people seek eye donation on their own. This is a dismal contribution. Part of solution lies in more intensive publicity to raise the level of public awareness and setting up neighbourhood eye donation information and grief-counselling centres in the community from where motivated volunteers will provide help for eye donation in the event of neighbourhood death. Placing more grief counsellors in the hospitals will be of additional value too. In Chandigarh where almost 14000 deaths occurred in 1995 and 1996, eyes received in the eye bank were from 1 per cent of the deceased.

There is great potential to raise the number of eyes procured through voluntary effort in this city in particular where literacy rates are high at 77 per cent; awareness levels about eye donation is high at 70 per cent and there is high community commitment level to eye donation of 24 pledges per thousand. We need to channel voluntary efforts with the help of experts though a well meaning umbrella body of eye donors forum. In several parts of the world and from parts of this country too there are success stories through dedicated and systemic efforts.

Legal requirements in this country make it mandatory to elicit eye donation consent from the family of the deceased after death even if the eyes have been pledged by the deceased before death. In medico-legal cases there is the additional difficulty of tracing relatively apathetic police and obtain their consent as well. In complying with these requirements often precious time is lost and eyes donated loose there viability for safe transplantation. In many parts of the world, including the USA, China, Russia, Europe facilitator legislation are operative which obligates the hospital staff to request the family of the deceased for the eye donation in the event of death (hospital request law); obligate the state to elicit irrevocable mandated choice pre-mortem consent to donate eyes upon death (mandated choice consent). Both these laws have greatly helped eye donations.

In some countries there is the legal provision to presume consent for eye donation and to do away the provisions for complying with police consents in medico-legal cases for the purpose of eye donation. In the conceivable future of few years under enlighten public pressure and the need of meeting the demand of curing blindness through technology, the government is also likely to enact the laws which will be more sympathetic to the cause of eye donation.

It is important that eye donation activity remains an ethical practise through mandatory compliance with the operational state laws. There is fear however that if our legal system and voluntary public participation are not able to match the huge demands from those in need of cornea transplantation, unethical practices of sale of human tissues will gain roots. Curing corneal blinds is economically beneficial to the nation as the huge cost of maintenance, rehabilitation and loss of productivity is immediately recovered upon cure. Besides there is dramatic change in the quality of life of those cured. Efforts in eye banking are in the national interest.

The governmental efforts will need to be supported by large scale voluntary efforts. Setting up eye donors forum with broader eye care goals and through it supporting several neighbourhood eye donation information and grief-counselling centres in the community, raising publicity campaigns periodically, improving eye donations pledges, supplementing efforts at improving technical inputs, supporting patient care and counselling awaiting cornea transplantation patients, help improve operational constrains of collecting donated eyes, help build public opinion for enacting facilitator legislation at the earliest, raising tax-free donation of funds, participating in national and international liaison and net working for eye donation could be a way out in this part of the world.

There are success stories of working for eye donation even in this country from Ahmedabad and other cities.Top


Albumin may have killed burn victims
By Tim Radford

THOUSANDS of burn victims may have died because they were given albumin – a blood product – instead of a simple saline drip, doctors say.

British government experts began meeting last week to review the evidence of 50 years after a British Medical Journal study said that albumin treatment could have caused six extra deaths of every 100 patients treated.

Dr Ian Roberts, of the Institute of Child Health at University College, London, is one of an international team called the Cochrane Collaboration, which examines trials and treatments to see how effective they really are. He and colleagues took the results of 30 trials, involving 1,400 patients, and re-examined the pattern of evidence.

“A very much clearer picture emerged” he said, “We were quite surprised that albumin was associated with a 6 per cent increase in mortality.” Burns victims are often critically ill, with abnormally low levels of protein in the blood. Albumin, refined from donated blood, was reportedly first used to treat US victims of the Japanese attack on Pearl Harbour in 1941, but the treatment has been controversial.

Some doctors have preferred a simple saline solution, at about a thirtieth of the cost. Dr Roberts says in his report that his results should be treated cautiously: the threat only existed while patients were critically ill — people who had recovered were not affected at all — the trials were small, and so were the number of deaths.

But albumin is used in Britain on 100,000 patients a year, often as a treatment for shock.

“If you say the results of this review are relevant to say, only 10 per cent of those, then we are talking about 600 unnecessary deaths each year in the UK alone.

“Albumin has been used since the 1950s, so basically the numbers add up to thousands of unnecessary deaths,” he said.

“I think it is bad news that we have been giving a treatment that is harmful. But the good news is that thanks to the Cochrane Collaboration and this programme of work to find out what the evidence shows, we can take action on it now.”

“It is important to point out that it is still uncertain whether albumin is responsible for any extra deaths, or why it might be harmful – and to note that the author himself is advising caution,” the experts say.

— The Guardian, LondonTop


Can we prevent oral cancer?
By Vimal and Poonam Sikri

CANCER literaly means overgrowth of the tissues. Cancer can arise anywhere in the body. It may involve oral tissues directly or indirectly. The simplest cause of cancer is biological alternations in tissues which may be due to chemical or surgical exposure leading to environment conducive to cancer. The occurrence of cancer can be prevented by withdrawing the environment and protecting the individual from its exposure. The probability of cancer is modified by number of factors like genetic background, age, sex, nutritional status, poor oral hygiene, intake of alcohol, tobacco and betel chewing, smoking and even exposure to sun. The mechanical irritation by sharp angles of ill-fitted dentures, sharp edges of the teeth, and projected fillings may also lead to cancer.

Cancer of the oral cavity is relatively curable being a highly accessible area of the body. Most of the oral cancers are of one variety i.e. squamous cell carcinoma. In spite of the fact that the oral cancers can be cured, a number of persons die because of oral cancers in India. Persons of low socio-economic status are at high risk because of certain habits such as tobacco chewing and smoking and also these group of people are found to be least concerned with the oral health.

Certain persons keep concentrated alcohol in their oral cavity for long, may be for fun sake or taste sake, are liable to be caught. Basically combination of alcohol and smoking is more injurious to oral tissues.

The mouth is the most abused part of the body. Dietary staples, culturally indigenous food and beverages may induce oral cancer. The food which contains preservatives and additives is linked with the development of oral cancer. We are also ingesting number of chemicals for medicinal, cosmetic and pleasurable purposes which contribute to oral cancer.

About half of the oral cancer cases occurs in the tongue and the remaining are divided roughly equally in the palate , floor of mouth, gingiva and buccal mucosa. Rarely the lips and salivary glands may also be involved.

Early detection is mandatory in all such lesions. The most promising tests for early detection of oral cancer are given below:

Self examination: The individual should observe any change in colour, contour and texture of the mucous membrane of the oral cavity. All features should be examined by dentists in their routine check up of patients.

Toludene blue test: This is a painless staining test giving quick information to the patients and the dentists. Toludene blue dye is helpful in staining altered oral epithelium in vivid blue colour. However, only surface epithelium picks up the dye and not the underlying tissues, so the extent of the cancer invasion cannot be accurately assessed.

Sialography: The salivary glands are radiographically evaluated by injecting a radiopaque dye.

Oral cytology: The scrapings of the lesions are examined under microscope to note the changes occurring in the cells.

Biopsy: In this technique the deeper tissue is excised or removed with needle or incision and examined under the microscope. This is a better and sure way of diagnosing oral cancers.

Prevention: Oral cancer can be prevented to a large extent. The persons should be educated and motivated regarding the use of alcohol, smoking, tobacco and betel chewing. Persons who are in the habit of keeping tobacco or betel in their buccal vestibule are more liable to have cancer at any stage. Pan masalas are also very dangerous and should be avoided at all costs.

The community should be cautioned against the consequences of the disease and be informed of the danger signals like any persistent scaly white patch, pigmental spot, any non-healing ulcer, puffy bleeding gums, sudden loosening of teeth without the history of trauma, oral numbness, a lump in the oral tissues and altered taste.

On experiencing any of the above signs, one must contact the dentists for further diagnosing.

The public must follow the advice of the dentist otherwise prevention of the oral cancer becomes a remote possibility. Other features should also be taken into consideration. The nutritional stability of the patient is of considerable importance. There is no diet that prevents cancer. However, vitamin deficiencies may play a role in oral cancer. Finally it is the duty of the dentist to refer the suspected oral cancer patients to the specialist for proper management and treatment.Top


Neem as anti-diabetic agent
NEEM leaves, grandma’s remedy for all ills, possess anti-fertility properties along with anti-diabetic ones, say scientists exploring the potency of medicinal plants at the Indian Statistical Institute (ISI), reports PTI.

Studies at the biometry unit of the ISI over the past decade showed that rats injected with water soluble alcoholic extracts of Azardiaracta indica (neem) leaves suppressed release of fertility hormones.

Simultaneously, blood tests on diabetic rats fed with excess glucose, induced with the glucose producing hormone (epinephrine) and then treated with the neem extracts revealed no increase in their sugar levels.

“Both properties of the wonder plant are being studied in depth and we hope to standardise a drug on the anti-diabetic property soon,” head of the biometry unit Tapas Basu said.

The extracts have been established for anti-allergenic activity also. Though neem has been in use for this purpose since long, its mechanism of action inside the body was hitherto unknown, he remarked.

“We have proved through animal tests that neem suppresses the activity of allergy causing chemical hystamine once inside the body,” he said.

Similar tests have shown that the medicinal plant has hepato-protective (liver protecting) qualities, he added.

Snoring and heart disorders
Young men who snore and are constantly tired during the day are twice as likely to die of heart diseases, according to a study published recently, says Reuters.

“The combination of snoring and excessive daytime sleepiness (EDS) appear to be associated with an increased mortality rate but the effect seems to be age-dependent,” Dr Eva Lindberg of Uppsala University Hospital in Sweden said in the study in the August issue of the Thorax magazine.

The combination was more deadly in young men and seemed to be associated with cardiovascular disease, but the researchers found the risk decreased with age and had no effect on death rates pass the age of 60.

Snoring alone did not carry any added risk.

“Men below the age of 60 with both snoring and the EDS had an age-adjusted total death rate which was 2.7 times higher than men with no snoring of the EDS,” Lindberg remarked.

The researchers followed 3,100 men (aged 30-69) who responded to a questionnaire about sleeping, snoring and their family history of various diseases. One-thirds of the men said they snored and 11 per cent (351 men) also suffered from sleepiness during the day because of their snoring.

During a 10-year follow-up period 213 men died. The main cause of death for 88 of the men was cardiovascular disease.

Good news for disabled
TWO young students have developed a computerised glove which can convert the deaf-mute alphabet into speech and another has invented a blind person’s stick which can “hear” obstacles, reports DPA.

These and other helpful pieces of apparatus were devised by youthful inventors as part of a special competition held by the Christoffel Mission for the Blind in Bensheim, near Mannheim, on the occasion of its 90th birthday, in conjunction with “Jugend Forscht” a young inventors competition held annually in Germany.

“We are glad that young inventors want to help disabled become accepted by society,” says Guenter Conrad Althans, one of the jury members.

Pets can spread diseases
MANY people who keep cats and dogs as pets hug or kiss them. Some of them put their fingers in the animal’s mouth. But these practices can be dangerous at times. Even if the pets are well looked after, they can pick up and pass on Humana diseases like measles and mumps. Your pets can transmit their skin diseases to your children, reports ANF.

If your dog or cat is allowed to excrete in your backyard where your children play without shoes, intestinal parasites can also pass from pets to children. Untreated pet waste can also damage your kitchen garden.

Sick pets should be isolated as far as possible if the sickness lasts more than two to three days.Top

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