HEALTH TRIBUNE Wednesday, October 31, 2001, Chandigarh, India
 

World Sight Month 2001 concludes today
10 decades of healthy eyes
Dr M.L. Kataria
V
edic hymns pray for a hundred years of good eyesight. While grading the quantum of punishment, in ancient times, Haroon-ul-Rashid included infliction of blindness, second after beheading, in his penal code. So important is eyesight. And yet, we take it so casually, that nearly 20 million of our population is blind, even though 80% of the blindness is curable and almost 100% preventable, except fractional congenital and genetic ocular ailments.

Ayurveda & total health
The liver-saver
Dr R. Vatsyayan, Ayurvedacharya
T
raditionally used to treat various liver disorders, Kutaki is a well-known herb in the ayurvedic system of medicine. Its small perennial plant is found in higher Himalayan ranges. Though the herb is self-generating, unregulated overharvesting has made it threatened to near-extinction. At present, the Himachal Government is encouraging its plantation in the Salooni Forest Division of Chamba. The dried rhizomes of the plant constitute the drug.

Spiritual psychiatry: the human mind
Dr Rajeev Gupta
T
he human mind is never free. It is always engaged in highly complex thought processes. We are slave to our past experiences and emotions. They exert a strong impact on our current thoughts and actions. They are capable of increasing our levels of anxiety and tension. They colour our present feelings and guide our future expectations. Very often, they lead to mental disorders.

Biowar: Anthraxfile
A
nthrax is also called splenic fever, black bain, charbon, malignant pustule, and murrain. It has been known since early times. Hippocrates, Virgil, Pliny, and Galen described lesions that were probably those of anthrax. In 1613 some 60,000 persons died of anthrax in southern Europe.

QUESTIONS & ANSWERS
Eczema & dermatitis
Dr Gurinderjit Singh

 
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World Sight Month 2001 concludes today
10 decades of healthy eyes
Dr M.L. Kataria

Vedic hymns pray for a hundred years of good eyesight. While grading the quantum of punishment, in ancient times, Haroon-ul-Rashid included infliction of blindness, second after beheading, in his penal code. So important is eyesight. And yet, we take it so casually, that nearly 20 million of our population is blind, even though 80% of the blindness is curable and almost 100% preventable, except fractional congenital and genetic ocular ailments.

Eye care, for a life-long good vision, is in fact womb-to-tomb care. All sexually transmitted diseases and infections in the reproductive organs of the mother are preventable unfortunate "gifts" to the innocent foetus and the new born due to criminal and sinful ignorance or negligence of the parents. Law will one day take cognisance of such inherited but preventable maladies for adequate compensation. Therefore, even before and during conception and immediately after birth, a thorough ocular assessment is imperative to make a short and long term plan of the management of visual disabilities discovered at birth.

With 50% of our population below the poverty line, during the very first decade of life, most of the ailments affecting the conjunctiva, the cornea and the retina are due to malnutrition, particularly night blindness. Trachoma, tuberculosis and various other bacterial, fungal and viral infections, are aggravated due to lack of resistance. These are all preventable and curable but, pitiably, may cause permanent damage, affecting visual activity and may result in blindness.

During the first two decades of life, the school-going period, several refractive errors like short and long sightedness due to myopia and hypermetropia may not only adversely affect the learning process but may also be the prime cause of intractable headaches. Very high uncorrected myopic errors may even aggravate retinal detachment causing visual impairment. The annual visual assessment as an integral part of the school healthcare programme is essential. All types of visual refractive errors must be recorded and corrected immediately with suitable lenses. High myopic errors can these days be corrected byLASIK, which anatomically corrects, the corneal curvatures, optical performance of the eye and obviates the use of cosmetically resentful high-powered glasses by youths, particularly girls.

Ocular injuries and viral, bacterial and fungal infections must be promptly diagnosed and controlled, before they damage the cornea resulting in visual loss or impairment. these are 100% curable with a rich arsenal of antibiotics now available. The dreadful trachomas, the scourge of the past, should no longer be allowed to result in scarring of the lids, in growing lashes, corneal ulceration and opacity, requiring transplant and a hunt for cadaver eyes.

With periodical monitoring, careful preventive and promotive ocular healthcare and prompt curative measures for any inter-current ailments, during the first two decades of life, one should normally be able to enjoy uneventfully smooth ocular health during the third, fourth and fifth decades of life. However, fractional and rare congenital and genetic disorders, naming only a few (not to panic the reader) like optic atrophy, retinitis pigmentosa, albinism, microcornia etc may continue to aggravate. Nevertheless, a new ray of hope has dawned on this dark and dismal horizon with ongoing extensive and intensive research on human genome at 16 centres globally. This dynamic period of life is not free of its own hazards. The two most deadly are alcohol and smoking. More than half a dozen impurities in the so-called Indian made foreign liquors and nicotine and tar products in any tobacco are as damaging to the ocular vasculature as to the heart, kidney and brain. The killer himself has the cure, not the physician.

May be, earlier or later, but the sixth and seventh decades demand a lot of ocular attention. Uncontrolled diabetes, hypertension, glaucoma and rapidly maturing cataract badly affect the vision and grossly hamper the life's daily routines and rituals. This is very irksome. One longs for a spouse 10 years younger or an obedient son to take one around. But why wait for so long? With modern techniques of phacoemulsification of the cataractous lens and insertion of an intraocular lens, now available, one need not wait for a cataract surgery till the eye is almost blind, as in the past. Why not get it done while one can still find one's way around? For diabetes, hypertension and glaucoma related ocular complications, grossly impairing the vision, may occur only when high blood sugar, high blood pressure and high intraocular tension are negligently allowed to persist, in spite of excellent medication and surgical techniques now available. A regular expert surveillance is never too costly. And a healthy simple life-style is not costly at all.

The eighth and ninth decades are God's bonus of grace only to those that have, with diligence and dexterity, followed His laws and survived through the seventh and eighth decades of good general and ocular health. And yet, 10 among every such lucky hundred may not be spared age-related retinal degeneration, which may severely affect the acuity of vision of the centre of retina, the macula, is also involved in this senile process. Man never surrenders. And hopefully, regeneration of even this dying or dead sensitive nervous tissue by opening up new channels of circulation may be man's latest achievement, besides gene therapy, laser photocoagulation and radiotherapy are already in vogue.

Among thousands of senior citizens whom we have had the privilege to serve through our several healthcare centres, there are many in the tenth decade of their glorious life and some of them are still without cataract, hypertension, glaucoma, diabetes or senile retinal degeneration! One of them at 97, with a BPof 110/70, still stands on his head for five minutes (now reduced to two minutes on my suggestion) to maintain his retinal circulation. He drives his car, purchased more than 50 years ago. The eye reflects not only its own health but also the health of all the body systems, including vital organs like the brain, the kidney, the liver and the cardio-vascular system. We must endeavour for 10 decades of healthy eyes. It is possible.

Dr (Brig)M.L. Kataria (MS, DOMS, DMRE, MNAMS, FIAMS-besides Ph.D, D.Litt, LLM, MBA etc), an honorary consultant, has been engaged in socio-medical relief work for the last two decades. He, and his team of honorary personnel, are operating 15 healthcare centres in urban, rural and slum areas in Chandigarh, Punjab and Haryana.

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Ayurveda & total health
The liver-saver
Dr R. Vatsyayan, Ayurvedacharya

Ayurveda on diet

Moderation in diet is the golden rule because it leads to happy and perfect digestion and tends to maintain the fundamental principles of the body in their normal state. Hence it behoves a man to take wholesome but as much food as he can digest easily. —Sushruta Samhita

Traditionally used to treat various liver disorders, Kutaki is a well-known herb in the ayurvedic system of medicine. Its small perennial plant is found in higher Himalayan ranges. Though the herb is self-generating, unregulated overharvesting has made it threatened to near-extinction. At present, the Himachal Government is encouraging its plantation in the Salooni Forest Division of Chamba. The dried rhizomes of the plant constitute the drug.

Scientifically known as Picrorhazia kurroa, kutaki has been in the focus of research in various parts of the world for its liver-protective, anti-cholesterol, anti-oxidant and immune-modulating activities. The drug contains bitter glucoside kutkin, a non-bitter product kurrin, besides vanillic acid and another substance called kutikisterol.

Ayurveda describes it as bitter in taste and light, dry and cold in effect. While alleviating kapha and pitta, it has a wide range of action on the human body.

Mainly accounted for as Yatrik-uttejak (liver-stimulator), katuki is a digestive, carminative, anti-pyretic, anti-inflammatory and purgative herb. It also possesses bhedaniya (accumulation-removing), anti-viral, anti-coagulant, diuretic and expectorant properties.

Kutaki is the foremost ayurvedic herb used for treating various liver diseases including jaundice and cirrhosis. It is known to stimulate the liver, reduce inflammation and fight viral afflictions. At the initial stage of the alcoholic liver disease, the use of kutaki helps to restore impaired liver functions besides regaining appetite. Though known as a bitter tonic in low dosage, it is a reducing herb if given in higher doses. Some of its common household uses are as under:

It is a very popular home remedy for viral jaundice. For this purpose, half to one gram of its dose is given twice a day with curd or honey. Its various combinations are also administered in cirrhosis of the liver. With its saarak properties, it scavenges the free radicals from the body and helps to restore the normal bio-chemical functions of the liver.

Kutaki is very useful in constipation. Normally, two to five grams of it, if taken at bed time, is sufficient to clean the bowels. But one should be careful about not becoming habitual. Also, given in the virechna (purgation) procedure of the panchkarma therapy, it is considered an excellent medicine that allays pitta diseases.

Certain ayurvedic texts also mention kutaki for the management of angina. For this purpose, a powdered mixture of the bark of arjuna (one gram and of kutaki half gram), should be taken two times a day. Mulathi powder can be substituted for that of arjuna. Due to its anti-inflammatory properties, kutaki is very effective if used in combination with guggul in arthritis.

These days the pharmaceutical market is flooded with many types of liver-function-promoting medicines. Kutaki is an important ingredient of the majority of such formulations. The classic ayurvedic preparation called Arogyavardhini Vati, which contains kutaki as its chief ingredient, is a highly acclaimed medicine for treating various liver disorders besides many other diseases.

Dr R. Vatsyayan is an ayurvedic consultant based at Sanjivani Ayurvedic Centre, Ludhiana. (Phones 423500 and 431500; e-mail:sanjivni@satyam.net.in)

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Spiritual psychiatry: the human mind
Dr Rajeev Gupta

The human mind is never free. It is always engaged in highly complex thought processes. We are slave to our past experiences and emotions. They exert a strong impact on our current thoughts and actions. They are capable of increasing our levels of anxiety and tension. They colour our present feelings and guide our future expectations. Very often, they lead to mental disorders.

Thought process is a natural activity. Even during sleep there is a continuous process of active thought in our brain. Only a severely mentally retarded person lacks thought process. We wrongly presume that we have full control over our thoughts and that we can stop thinking.

Most of our thoughts are not under our control and the process takes place in our unconscious mind. This process is a result of the electrical activity of unlimited connections in the human brain. Animals lack these intricate connections. Their brain does not have much development as compared to the brain of the human being. Even the most advanced computer in the world lacks thought process!Computers can't create thoughts.

Thoughts are responsible for our suffering: The mind struggles and endeavours to come out of the grip of those processes. This attempt to control thoughts makes us restless. It makes us feel weak and helpless. At times we realise that our own thoughts give us pain and suffering. We want to free ourselves from their hold over us. We feel as if we have been badly entangled in the thorny bushes of our own mental activity. At times we become desperate.

When Prince Siddhartha became aware of the suffering around him and inside him, he wanted to set himself free from it. That was the force and motivation behind him to become the Buddha. When Mohandas Karamchand Gandhi had a similar realisation, he became the Mahatma. These great men first broke their mental shackles. In our times Rajneesh became Osho. He advocated that there are pain and suffering because of the suppression and repression of desires and thoughts. He put forth the doctrine of complete, uninhibited behaviour and action "so that man is completely relieved of his haunting anxieties and guild". He aimed at the complete freedom of the mind. There is no compulsion to agree with such views. But views are views!

Is it possible to have absolute freedom from our own thoughts? For a yogi, it may be possible. Maybe, he can bring them to a complete halt. For most of us mortals it may not be possible. But for us it is not very difficult to get rid of negative thoughts (jealousy, hatred and revenge). If we are truly aware, we can get rid of destructive thoughts and have a pool of positive thoughts which can create energy and peace of mind.Let not our pool of thoughts get polluted . Disease is dis+ease. Let us be at ease. This is the primary lesson of psychotherapy and psychiatry.

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

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Biowar: Anthraxfile

Anthrax is also called splenic fever, black bain, charbon, malignant pustule, and murrain.

It has been known since early times. Hippocrates, Virgil, Pliny, and Galen described lesions that were probably those of anthrax. In 1613 some 60,000 persons died of anthrax in southern Europe.

Robert Koch, in 1876, demonstrated conclusively that a rod-shaped bacterium, Bacillus anthracis, was the cause of anthrax, and on June 2, 1881, Louis Pasteur produced a vaccine that successfully prevented infection. These two events were milestones in medical history, for the anthrax bacillus was the first microorganism that was proved to be the cause of a disease, and anthrax was the first disease to be prevented by a vaccine.

Anthrax occurs throughout the world. The incidence is low in countries where restrictive and preventive measures are in use, but it is still very high among animals in Asia and Africa. The disease has been recognised in America since colonial days. The first human case recorded in the United States occurred in 1834 at Philadelphia.

Sources of infection may be either agricultural or industrial. The important agricultural source is the soil, which, once contaminated, may harbor the spores for years. If anthrax spores are brought to the surface by cultivation or burrowing animals, any susceptible animal may become infected through, a scratch, even though minute, on the feet or legs. People who walk barefoot may contract the infection in the same way. Herbivores may get anthrax by eating contaminated food; carnivores and swine acquire the disease from consuming infected meat. Widespread human infection approaching epidemic proportions, which occurred in England and the United States during and just after World War I, was traced to contaminated horsehair imported from Siberia and China for making shaving brushes.

Animals suffering from an extremely acute form of anthrax are either found dead or die from overwhelming blood poisoning within 12 hours after the first sign of disease. The infection may be classed as acute when death occurs in 12 to 24 hours. A few animals recover from the less acute form, though most die within three to five days.

Human anthrax is classified as internal or external. The internal form, while not so rapidly progressive as in animals, is nearly always fatal unless treated promptly and effectively. This form of the disease tends to localise in certain organs before the bacillus gains access to the blood stream; thus, "woolsorter's disease" is a massive pneumonia, the bacillus being taken into the lungs by breathing contaminated dust from the wool. Intestinal injuries may develop when the bacillus is ingested with inadequately cooked meat. In man, anthrax also may be manifested as a meningitis.

The external form is characterised by the anthrax carbuncle, which typically develops a black centre and this has given the disease its name (Greek anthrax, coal, ulcer). If treatment is not adequate during this stage of development, the bacillus may spread from the carbuncle to the lymphatics and the blood steam, and will result in fatal bacteremia.

Because of the danger of contracting infection, autopsies of suspected animals are usually avoided. Since Pasteur's epoch-making demonstration of the value of his vaccine in preventing anthrax, still further improvements have been made in prevention and treatment. Antianthrax serums give immediate though shortlived immunity, and are useful both for prompt protection and for treatment.

Source: writings of Dr Walter E. La Grange, DVM; and Dr Elizabeth Burbank Atwood, VMD.

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QUESTIONS & ANSWERS
Eczema & dermatitis
Dr Gurinderjit Singh

Q What is dermatitis?
A
Dermatitis literally means the inflammation of the skin, but dermatologists use the term to refer to a specific group of inflammatory skin diseases.

Q What is eczema?
A
From the Greek word meaning "a boiling out", eczema has been used as a descriptive term since the sixth century, but there is no clear agreement among dermatologists as to the meaning of the term and its use is controversial. In general, dermatitis is used commonly in the USA and eczema is used so in Europe.

Q Why is dermatitis so important?
A
Up to 25% of all patients presenting themselves with a new skin disease have a form of dermatitis. Patients typically suffer from itching that distracts them from their daily activities, and they are desperate for getting relief.

Q What is atopy?
A
Atopy refers to the predisposition to developing asthma, allergic rhinitis, and an associated skin disease appropriately called "atopic dermatitis" and referred to by many lay persons simply as "eczema".

Q How does atopic dermatitis present at different ages?
A
Atopic dermatitis may present at any age, but 60% of the patients experience their first outbreak by their first birthday, and 90% by their fifth. Four clinical phases are recognised:

1. The infantile phase (two months to two years): characterised by intense itching, erythema, papules, vesicles, oozing and crusting. Patients typically develop eruptions on the cheeks, forehead and scalp, with less involvement of the trunk of extremities. Dermatitis clears in half of the patients by three years of age.

 2. The childhood phase (3-11 years): More chronic, lichenified scaly patches and plaques that may have crusting and oozing. The classic areas include the wrists, ankles, backs of the thighs, buttocks, and antecubital and popliteal fossae, although other areas, including extensors, may be involved in early childhood. Two thirds of the patients clear by the age of six years.

3. The adolescent/young adult phase (12-20 years): Thick, dry, lichenified plaques without weeping, crusting or oozing that involve the face, neck, upper arms, back and flexures.

4. The adult phase (20 years): Most commonly involves the hands, sometimes the face and the neck and rarely diffuse areas. Only 10% of the infantile or childhood cases of atopic dermatitis persist into adulthood.

Q What factors provoke or exacerbate atopic dermatitis?
A
Excessive washing without appropriate skin lubrication is the most common irritant as repeated water exposure degrades the skin's barrier to external irritants and internal water loss. Important topical irritants include wool, synthetic fabrics, poorly fitting clothes, mineral oils, solvents, sand and excessive perspiration. Airborne particles (such as tobacco smoke, animal dander, moulds and house dust mites) exacerbate disease in some patients, especially infants, with severe dermatits.

Q Can atopic dermatitis be cured?
A
No, but a variety of measures can control it:
Avoid provoking factors (scrubbing, too frequent bathing, scented soaps, etc.) Reduce dryness and pruritus by applying emollients to the moist skin. Use mild, unscented soaps only on hairy or oily areas, and water only to bathe other areas. Wear cotton clothing as much as possible, and if the arms and forearms are affected, wear long-sleeved shirts to reduce evaporation from the skin. For acutely inflamed and weeping skin, use open wet-to-dry compresses because they are soothing, antipruritic, cleansing, hydrating and cooling. For subacute or chronic lesions, topical corticosteroids are the mainstay of the therapy. Typically, younger patients require less potent steroids and vice versa.

New medications used to treat atopic dermatitis include the immunomodulators' cyclosporin (ineffective topically, effective orally) and tacrolimus (effective topically). Azathioprine, UVB and PUVA are also effective for more severe cases of atopic dermatitis.

Dr Gurinderjit Singh, MD, is the President of the Indian Association of Dermatologists, Venereologists and Leprologists (North Zone). He is based at the Mohan Dai Oswal Cancer Research Centre, Ludhiana.

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