HEALTH & FITNESS

Asthma management: the critical aspects
The recent incident in which Akriti, a school student of Delhi, had died of an acute asthma attack was not just shocking, but a warning for all the stake-holders in asthma management. The danger of death from asthma is relatively rare, but real. Globally, around 250,000 people die prematurely each year as a result of asthma. But any loss of life from asthma is sad and most unfortunate. It is important to understand that asthma is a chronic but a controllable and manageable illness.

eYESIGHT
Curing cataract: Revolution in IOLs
Forty-three-year-old Seema Kashyap’s (name changed on request) cataract surgery was not a simple case of cataract removal. With highly deteriorated vision-both near and distant -she was completely dependent on spectacles. But what made her condition worse was the fact that she had a complete aversion to her glasses as they gave her a headache.

Teething troubles: Beware of increasing gaps
Gaps in the anterior region of our jaws, i.e. gaps between the front teeth, are easily noticeable. These gaps, if present, should essentially remain constant and not increase or decrease with age, nor should new gaps appear.

Health Notes

n Even short-term exposure to pollutants can cause cancer
n Continuing to work in later life may help ‘avoid dementia’
n Personalised cancer treatment comes closer to reality


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Asthma management: the critical aspects
Dr S. K. Jindal

The recent incident in which Akriti, a school student of Delhi, had died of an acute asthma attack was not just shocking, but a warning for all the stake-holders in asthma management. The danger of death from asthma is relatively rare, but real. Globally, around 250,000 people die prematurely each year as a result of asthma. But any loss of life from asthma is sad and most unfortunate. It is important to understand that asthma is a chronic but a controllable and manageable illness.

Treatment of asthma is relatively simple but generally prolonged. It is a common mistake to stop the treatment after an acute episode gets over. This only aggravates the chronicity of asthma which may turn uncontrollable and severe. Continued maintenance treatment not only keeps the patient free of symptoms, but also promotes a better lung function in the long run.

The asthma management plan includes a comprehensive approach to drug therapy, patient and family education, avoidance of triggers of asthma and prevention of acute episodes or exacerbations. There are two types of medicine commonly required for the therapy of asthma — maintenance (controller) drugs and rescue (or reliever) drugs. Treatment with controller drugs (such as the steroid-inhalers) is required on a regular basis.

Rescue drugs should be used on an “as and when required” basis. The rescue drugs provide an immediate but temporary relief from symptoms. It is for this reason that patients prefer to use these inhalers more frequently than the controller drugs. This may prove to be dangerous. Over-use of rescue drugs increases the chances of toxic effects without exercising an adequate control of asthma.

Drug therapy with inhaled, anti-inflammatory drugs (corticosteroids) constitutes the mainstay of asthma management. This is generally a worrisome advice for most patients who wish to get rid of asthma forever. Unfortunately, there is no real permanent remedy at present which can cure asthma forever.

It is quite possible that a patient may not suffer from the illness on a chronic basis. Some patients may remain symptoms-free ever after a single or a few attacks. But the majority needs a regular treatment, either during the season of attacks or throughout the year, depending upon their disease periodicity.

Asthma severity is a contentious issue of great importance from the management point of view. Severity is not a static or a permanent feature. It is markedly affected by the differences in asthma-phenotypes, risk factors and the presence of other triggers of asthma. Availability and affordability of drugs, access to optimal treatments and appropriate disease evaluation are important determinats of severity and of response to interventions.

The more critical aspects of asthma management lie in patient education, prevention and treatment of an acute attack. This is particularly so in school and pre-school children in whose case the education of parents and teachers is crucial. The acute attack is best prevented with regular maintenance treatment, and treated with the immediate use of both reliever and controller drugs. Patients, including children, should carry their inhalers with them, even in schools, especially in the case of asthma known to be severe.

Schools in particular need to be conscious of the asthma awareness and management plans. This is especially because a large number of students, unknown to their teachers, are likely to suffer from asthma. Each school should preferably stock a kit for asthma attacks. It is simple to handle — a few inhalers with spacer devices for administration. Injectable drugs may also be kept for emergency use. Regular checks are required to prevent the expiry of stored drugs.

This can be easily achieved with a brief sensitisation and educational programme for the teachers. Panic during an attack must be avoided at all costs. Immediate administration of preliminary treatment is more important than even calling a doctor or shifting a patient to the hospital or a clinic.

Crucial time is invariably lost during shifting. Each teacher can easily act as an “on-site doctor” before the availability of more definitive treatment. The traditional First-Aid kits used to contain bandages and other items for injuries. Adding asthma-inhalers to the kits is most appropriate for the schools.

The writer is Professor & Head, Department of Pulmonary Medicine, PGI, Chandigarh.

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eYESIGHT
Curing cataract: Revolution in IOLs
Dr Mahipal Sachdev

Forty-three-year-old Seema Kashyap’s (name changed on request) cataract surgery was not a simple case of cataract removal. With highly deteriorated vision-both near and distant -she was completely dependent on spectacles. But what made her condition worse was the fact that she had a complete aversion to her glasses as they gave her a headache.

So when it was time for her to get the cataract operated upon, doctors also had to ensure that post-surgery, she did not remain dependent on spectacles. In routine phaco-emulsification, the foldable intraocular lens that is implanted can help the patient have either clear distant vision or near vision-meaning there is still a requirement for spectacles because the lens can correct only one power.

But for patients like Seema, the latest multi-focal intra-ocular lens (IOL) comes as a boon. This single lens can take care of both near vision and far sight simultaneously. So when this lens is inserted, there will be reduced dependence on spectacles day and night for all distances.

The multi-focal IOL works in such a manner that at any given time when one focus is used, the other focus becomes so blurred that it becomes imperceptible. Therefore, the brain visualises only one image, either for distance or for near. Initially, one may see glare and halos around light especially at night but after a while the brain adapts to it.

However, all patients may not be suitable for Multi-focal IOLs. It is only after a thorough examination that the doctor decides which lens is best for you. With medical technology advancing at a fast pace, the kind of lenses available for cataract patients can be customized to a great extent.

Aspheric lenses are extremely popular as they provide better contrast sensitivity and improve one’s vision in dim light conditions. Toric IOLs are special lenses useful in patients with cylindrical power or astigmatism. A lot of people are combining cataract and refractive surgery for completely rejuvenating their eyesight.

There are various types of IOLs:

Monofocal IOL: The power of the lens can help one see distant objects without glasses but the patient needs spectacles for performing any work at near distance. Or vice-versa - the patient may be able to see near objects but not distant once. So, the patient would need spectacles to focus on objects at different distances.

Mutli-focal IOL: The new multi-focal and accommodating IOLs offer the possibility of seeing well at more than one distance, without glasses or contacts. These lenses have a variety of regions with different power that allows patients to see at a variety of distances.

Toric IOLs: Toric IOLs are designed to correct astigmatism. Most surgeons who treat astigmatism in their cataract patients tend to use astigmatic keratotomy (AK) which involves making incisions in the cornea. But some patients may have lenticular astigmatism, caused by irregularity in the shape of the natural lens capsule. This can be corrected with a toric IOL.

Aspheric IOLs: Another leap in the IOL technology are the aspheric IOLs which can provide improved contrast sensitivity and visual acuity, improving the ability to see in varying light conditions such as rain, snow, fog, twilight and night-time darkness.

Piggyback lens: If you have a less than optimal result from the original intra-
ocular lens used in your cataract surgery, an additional lens over the top of the
one you have currently can be implanted. This approach, known as a "piggyback
lens," can improve vision and may be considered safer than removing and replacing
the existing lens.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi.
Email: drmahipal@gmail.com <mailto:drmahipal@gmail.com>.


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Teething troubles: Beware of increasing gaps
Dr H.S. Chawla

Gaps in the anterior region of our jaws, i.e. gaps between the front teeth, are easily noticeable. These gaps, if present, should essentially remain constant and not increase or decrease with age, nor should new gaps appear.

If you notice gaps forming between teeth, or the existing gaps increasing, it should be taken seriously: generally it is an alarming signal of some disruptive process brewing inside your mouth. The underlying causes could be the following:

Gum disease: This is a major cause for gaps increasing or new ones forming. Unfortunately, gaps appear only when periodontal (gum) disease is at an advanced stage. It does not give you timely warning of an impending problem.

At the advanced stage of gum disease, pus forms as a result of interaction between bacteria, food items and the soft tissue around the teeth. The accumulation of pus on any side of the gum of your teeth would push the tooth away in the opposite direction, thus creating a gap.

The appearance of gaps is a matter of concern and dental consultation should be sought right away. You may need gums treatment and also the essential oral hygiene measures to keep your gums healthy.

Presence of additional (supernumerary) teeth: The presence of an additional tooth between the roots of two teeth will obstruct the adjacent teeth coming together when these erupt into the mouth. You may see a gap between your teeth. An X-ray picture will show the presence of an un-erupted supernumerary tooth. Generally, the extraction of this additional tooth will solve the problem and space between the teeth is likely to close with the passage of time.

Large tongue: If you have uniformly larger-than-normal spacing between teeth, it may be due to the large size of your tongue. You need to consult your dentist, who may advise you a few tongue exercises.

Missing teeth: In case you have got tooth/teeth extracted, there naturally will be a gap. This gap, in all probability, is likely to narrow down over time by the movements of the adjacent teeth, thereby creating unseemly gaps between those teeth. An extracted tooth should always be replaced as soon as possible.

Improper cleaning of teeth: If you are not cleaning your teeth properly, you are leaving dental plaque on the sides of the teeth. Each time you eat — particularly food containing sugar — acid is formed instantly, and slight dissolution of enamel from the sides of the teeth occurs.

Many a time, because of extended neglect of oral hygiene, this leads to even concavities on the sides of the teeth. It is absolutely essential not to be lethargic in matters of oral hygiene.

Aging: Teeth are broader near the occlusal region and taper towards the gums. As one ages, bone level goes down, and so does the gum which covers it. Thus, more of the cervical portion of the tooth becomes visible.

Since the tooth is narrower at the cervical area, larger inter-tooth spaces
become visible. Aging is another factor which also increases the gaps between
teeth. However, the appearance of gaps between teeth due to aging is relatively
a very slow process.

What should you do when you discover gaps between teeth?

First and foremost, if you have a tooth missing for any reason, get it replaced. Secondly, the first thing to suspect when some changes in the original positioning of your teeth are seen is gum disease. It is well known that over 95 per cent of the population above the age of 35 suffers from some degree of gum disease.

Gaps due to gum disease appear quite late in the progression of the disease. Bleeding from the gums is an early sign of the disease. In case, your gums bleed even slightly, at any time of the day, including during brushing, consult your dentist.

The writer, Head of the Dental Department, The Apollo Clinicx, Chandigarh,
is a former Head, Oral Health Sciences Centre, PGI, Chandigarh.
Email: chawlahs@gmail.com.


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Health Notes
Even short-term exposure to pollutants can cause cancer

WASHINGTON: Exposure to environmental pollutants even for a short period can prompt genes to undergo reprogramming, and thereby increase an individual's risk of developing cancer and other diseases, say Italian scientists.

University of Milan researchers have shown that inhaling certain environmental pollutants can damage DNA in as short a period as three days.

"Recently, changes in gene programming due to a chemical transformation called methylation have been found in the blood and tissues of lung cancer patients," said investigator Dr Andrea Baccarelli, assistant professor of applied biotechnology at the University of Milan. — ANI

Continuing to work in later life may help ‘avoid dementia’

LONDON: Alzheimer's disease may be kept at bay by continuing to work later in life, say scientists. Researchers at the Institute of Psychiatry at King's College, London, came up with the proposition after analysing data from 1,320 dementia patients, including 382 men.

The researchers found that continuing to work even in old age helped men to keep their brains sharp enough to delay dementia. Dementia is caused by the mass loss of cells in the brain, and experts believe one way to guard against it is to build up as many connections between cells as possible by being mentally active throughout life. This is known as a "cognitive reserve". — ANI

Personalised cancer treatment comes closer to reality

LONDON: Researchers at the University of California, San Diego School of Medicine, have announced the development of an efficient system for delivering siRNA into primary cells, which may one day lead to personalised cancer treatment.

"RNAi has an unbelievable potential to manage cancer and treat it," Nature
magazine quoted Dr Steven Dowdy, Howard Hughes Medical Institute Investigator
and professor of cellular and molecular medicine at UC San Diego School of
Medicine, as saying. — ANI

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