Wednesday,
July 8, 1998
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| Cough:
to suppress or support it? Atmospheric pollution is an important contributory factor in the spread of serious debilitating respiratory diseases. Coughing is one of the ways in which the body copes with air pollution... New hepatitis B vaccines on cards Medical researchers worldwide are working on new hepatitis B vaccines which can be produced cheaply in large quantities and do not rely on human byproducts... Maternal mortality rate Safe motherhood seems to be a distant dream in Madhya Pradesh with the maternal mortality rate (mmr) remaining as high as 500 to 600 per 100,000 which is far behind the national target of reducing the mmr to 250 maternal deaths by the year 2000... Medical notes Growing organs inside body More people living longer Voluntary agencies’ efforts Rise in malaria deaths |
Cough: to suppress or support it? By Rajinder Singh Bedi Atmospheric pollution is an important contributory factor in the spread of serious debilitating respiratory diseases. Coughing is one of the ways in which the body copes with air pollution. Cough is a defensive mechanism designed to rid the air passages of mucous secretions and foreign material. It is an essential defensive action against aspiration. An act of cough can be visualised as occurring in a step-wise fashion — starting with inspiration, following by closure of the glottis, contraction of expiratory muscles, sudden opening of the glottis and expulsion of air. The expelled air carries with it the offending particulate matter and thus cleanses the airways. Cough is one of the most frequent symptoms of cardiorespiratory diseases. No persistent cough should be ignored. It is a dangerous signal, a symptom which accompanies a long list of disorders ranging from the trivial and transient to the grave and mortal. As with any symptom, cough has to be investigated so that a proper approach to the treatment of underlying disease can be planned. In a majority of cases, a confident diagnosis can be reached from a careful history, examination and chest skiagram only. However, others may require number of supplemental investigations. Cough occurs at all ages and is usually caused by the upper respiratory tract infections and by smoking. Chronic smokers may accept cough as ‘normal’. Mucoid sputum production in a smoker usually indicates chronic bronchitis, but the expectoration of a dark yellow or green sputum may signify serious chest infection. Coughing during night is often due to asthma, heart failure and aspiration of the oesophageal contents. Cough may be the only early symptom of lung cancer and lung shrinkage (interstitial fibrosis). Cough associated with blood streaked sputum requires careful investigations for lung cancer, though most of times, it is due to bronchitis, lung infections or tuberculosis. Besides blood counts, sputum testing and chest radiograph, a number of special investigations like radiographic analysis of paranasal sinuses, lung function tests, CT scan, fiberoptic bronchoscopy may be required in a selected group of patients. The decision to initiate any of these “special” investigations depends upon the clinical impression. Cough is a very peculiar reflex of body. From the clinical point of view, if cough fulfils its function of clearance of the respiratory tract, it is physiological and should be preserved and supported by treatment that makes expectoration easier. If it is excessive, does not fulfils its clearance function and persists, it becomes pathological. In such cases, it may have to be restrained or suppressed. Cough becomes a troublesome symptom when it serves no useful function and causes discomfort, loss of sleep or social embarrassment. In addition, persistent cough may rarely lead to complications such as dizziness and attacks of unconsciousness.  The most important point about the management of cough is to look for the cause and treat it. Treatment may be directed either at suppression of cough or at increasing its effectiveness. It would be entirely appropriate to suppress an irritable and distressing cough of patients with tracheobronchitis or terminal lung cancer. But it is not advisable to use cough suppressants in a patient with asthma or lung infections in whom cough is serving a useful purpose of expelling excessive secretions. Many patients report that oral fluids, inhaled steam and expectorants are helpful in clearing secretions, even though effectiveness of expectorants has not been proven by properly conducted clinical trials. The most effective cough suppressants are morphine and its derivatives like codeine etc, which are very addictive and cause physical dependence with prolonged and overusage. Hundreds of cough syrups are commercially available majority containing large number of ingredients, usually in sub-therapeutic doses. They often contain agents having opposing effects. Majority of such compound mixtures are not helpful and their use should be discouraged. To conclude, cough is a symptom, which must be investigated and a function which must be preserved. Persistent cough should be treated symptomatically when the cause cannot be found or when satisfactory treatment of the cause is not possible. |
| New
hepatitis B
vaccines on cards Medical researchers worldwide are working on new hepatitis B vaccines which can be produced cheaply in large quantities and do not rely on human byproducts, reports PTI. They are also studying how hepatitis B (HBV) vaccine can be combined with other childhood vaccines such as DPT, according to experts investigating the high incidence hepatitis B infection in the country. Their reports have been included in a new book “Hepatitis B in India: Problems and Prevention.” The book edited by Dr S.K. Sarin from the Department of Gastroenterology at G.B. Pant Hospital and Dr A.K. Singal from the Department of Medicine at Sunderlal Jain Hospital in New Delhi examines in detail various aspects of the silent killer disease that has infected more than two billion people worldwide. India with an estimated 43 million HBV infected persons is the second largest pool of HBV carriers in the world, next only to China. The two types of HBV vaccines currently available are an inactivated vaccine derived from blood plasma and a genetically engineered or recombinant vaccine. Several new vaccines being evaluated at present include polypeptdie vaccines containing a special antigen factor or “epitope” that influences its specific immune response, hybrid virus vaccines and chemically synthesised vaccines. These new vaccines focus on an antigen found on the surface of the HBV, known as the hepatitis B surface antigen or HBSAG. Scientists are conducting clinical trials on a polypeptide vaccine that contains two protein pieces or polypeptides that form part of this surface antigen. There two protein portions have been found to be effective antigens, the book says. Scientists in Singapore have tested a second vaccine that contains all three proteins of the surface antigen, unlike the current plasma-derived and recombinant vaccines that contain only one major protein of the surface antigen. A disadvantage with the current vaccines is that a small portion of those who received the vaccination do not develop immunity. The new preparation that contains all three protein portions proved safe and generated antibodies rapidly in 96 per cent of the recipients. Other new vaccines under study include a “Hybrid virus vaccine” that contains HBV genetic material introduced into a vaccinia virus that causes cowpox. The advantages with a vaccinia virus vaccine are its low cost, ease of administration, vaccine stability and long shelf life. However, the use of vaccinia virus has its risks, including adverse reactions. |
| Maternal mortality rate Chasing a distant dream Safe motherhood seems to be a distant dream in Madhya Pradesh with the maternal mortality rate (mmr) remaining as high as 500 to 600 per 100,000 which is far behind the national target of reducing the mmr to 250 maternal deaths by the year 2000. The high mmr indicates that the state is lacking good delivery system to accommodate every woman at childbirth and most of the rural women continue to be deprived of timely and effective emergency obstetrical care. The Director, Health, Dr P.K. Bajaj said the high mmr figure was because of ignorance, poverty, lack of proper communication and geographical condition of the state where 50 per cent of the villages have less than 500 population rendering difficulties in percolating the healthcare delivery system. Besides, the state continued to reel under backwardness and social taboos proving obstruction in the way of a good health deliverance, he stated. Dr Bajaj said post-partum haemorrhage, ante-partum haemorrhage, obstructed labour, septicaemia, eclampsia and anaemia were among the main causes of maternal deaths. Only 15 to 20 per cent of the deliveries were being held in hospitals under proper medical supervision while a major 80 per cent were domiciliary, he added. A health department spokesman said with over 80 per cent deliveries taking place at home and half of them being conducted by non-medical personnel, the problem assumed a serious proportion. However, full time presence of medical officers at the public health centres (phcs) to view safe pregnancy as a top priority will go a long way in mitigating the problem, he remarked. According to official sources, tetanus toxide coverage for pregnant women has gone up to 83.7 per cent in 1996-97 in the state. However, ante-natal care reached only 33 per cent women and only about half the pregnant women got iron-folic acid (ifa) tablets for prevention of anaemia. The operationalisation of the first referral units have also been unsatisfactory. A sufficient number of such units have been identified in the state while a very small percentage have available trained personnel and specialists. Moreover, human immuno-deficiency virus (hiv) testing facilities are not yet developed at the sub-district level for blood banking services. High maternal mortality ratio is also a major contributing factor towards the high infant mortality rate of the state, the sources said. An abysmally low female literacy rate (28.8 per cent) is co-related with maternal deaths. Besides, child marriages are also rampant in several districts of the state. Wedded at a tender age these young child mothers lack proper nourishment and knowledge to keep themselves fit during pregnancies. According to a study conducted by the Regional Medical Research Centre for Tribals, Jabalpur, on the birth-related practices, the role of traditional birth attendants is significant in both tribal and the rural population as they are the only one to provide material services to the women at the doorstep. The prime reason for the low utilisation of such services is due to the concepts regarding pregnancy, delivery and lactation. The study revealed that practices such as performing heavy work till the terminal stage of pregnancy, delay in cutting the umbilical cord, usage of unclean instruments, putting the children in unstitched linen leading to exposure of cold should be prevented to help in improving the health of the mother and child. Referring to these problems, the State Health Director said the state government had taken considerable measures to contain the problem. All pregnant women were being registered and administered tetanus toxide immunisation under the safe motherhood programme. Moreover,iron folic acid tablets were being supplied to them for prevention and correction of anaemia. He said efforts were on to acquaint expectant mothers with the location of the health facility nearest to her. Facilities for ante-natal check-up had also been intensified and steps were being taken to arm the health units with women doctors, he said, adding that reproductive child healthcare had been introduced which emphasised on adolescent girl education. (UNI) |
| Medical
notes Growing organs inside body A bio-engineering company has said that scientists are trying to grow organs like heart or the liver inside the human body using a new tissue replacement technique, reports ANI Gail Naughton, president of the company Advanced Tissue, said the technology has already been used to grow new livers in rats and dogs and to generate new heart muscles in animals with diseased heart. He added that the technique could eventually be used in human beings to alleviate the problem of shortage of human organs. The Massachusetts Institute of Technology and Children’s’ Hospital of Boston were recently granted three patents which cover the growth of new organs and tissues inside the body. The technique uses cells and a dissolvable polymer scaffold to grow the organs. The scaffold is moulded in the shape of the desired organ and cells are attached to it. The cells will then grow in the shape of the moulded scaffold. By the time the cells form the shape of the organ, the scaffold is dissolved and the old organ can be removed. Naughton said the technique has the potential to grow a liver in a new born baby in three to four weeks. He added that the technique can be used in the patients with liver sclerosis and also in the new born babies with enzymatic deficiency. It could also be used to replace pieces of the oesophagus, bones or heart muscles, she remarked. She said in two years human trials for bones is expected to be started and subsequently for heart muscles. Liver trials, she said, might take from five to 10 years. The US food and Drug Administration will take a minimum of three years to approve the technique, if all goes well. More people living longer MORE people are living longer and are expected to continue living longer well into the 21st century, a team of 14 international scientists have said, according to Reuters. “The major take is longevity is going up, more rapidly than we can explain,” said Dr Thomas Johnson, Professor of Behavioral Genetics at University of Colorado, recently. “Humans can’t live forever, but there is no real limit,” he remarked. Dr Johanson is one of the researchers from institutions in Europe, the USA and Mexico who found that 15 per cent of the world population in 2025 will be 60 or older. This figure is up from just 9 per cent in 1997, according to the study published in the journal Science. Led by Dr James Vaupel of Max Plank Institute for Demographic Research in Rostock, Germany, researchers studied life expectancies of people in developed and developing nations by using a technique called biodemographics, a mix of biology, demography and statistics. After gathering data from various countries, they found the countries projected to have the highest per cent of people over 60 will be Japan and Italy, with 33 per cent. By 2025, 32 per cent of Germany’s population will be 60 or older, they predicted, and in Sweden 29 per cent of the population will be 60 plus. The per cent of over-60s in the USA is expected to climb to 25 per cent from 17 per cent in 1997, while developing countries like India and Mexico, would have elderly population of about 12 per cent. Voluntary agencies’ efforts THOUGH the voluntary agencies have played an important role in providing low-cost and effective health services, hardly any efforts have been made to promote and strengthen them to meet the critical needs of the healthcare system in the country. According to Dr Alok Mukhopadhyay, president of the Voluntary Health Association of India (VHAI), more than 7000 voluntary organisations active in the field of healthcare have not only played an important role in developing alternative model ‘which’ gives adequate importance to traditional healers and the Indian system of medicine, but also helped filling the critical gaps that exist in the government health service. Voluntary organisations like the Kerala Sastra Sahitya Parishad and the VHAI through its “Khoj” project are taking up health and development initiatives in remote area by launching special campaigns against drug policy, anti-smoking and amniocentesis and educating people about the modern healthcare system controlled by multinational drug companies. He stressed the need to generate public opinion about rational, holistic and effective health services in the country through mass organisations like trade unions, people’s movement or political parties so that a conducive atmosphere is created for a shift in policy and greater public accountability of the existing government health infrastructure. The VHAI chief recommended the formation of a coordination committee at the national level to identify the health need of the people and bring it to the notice of the policy-makers. Rise in malaria deaths The number of malaria deaths in Orissa has gone up more than three-fold during the past five years, according to official figures available here, reports UNI. The reports said while 118 persons died of malaria during 1993,the disease claimed 378 lives in 1997. While 131 persons died in 1994 it doubled in 1995 (271) and claimed 362 lives in the subsequent year. Malaria parasites were found in the blood of 323575 people in 1995 while more than 4.5 lakh people were affected with the disease in 1996 and a little over 4.2 lakh in 1997. According to Orissa Health Minister Jagannath Rout the escalation of malaria deaths was mainly due to the environmental degradation and a cut in the Central plan allocation to control the disease over the years. He said the disease would be fully eradicated in the state after a World Bank- funded central scheme became operational in the state. |
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