7th December 1997


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Medical Measures

Cholera at your fingertips

The health sector in this country is often called the "sick giant". Most of us have had health related problems at sometime in our lives but an experience with the healthcare system hasn't always been satisfactory. Beginning this week, The Sunday Times will have a monthly page devoted to medical matters aimed at raising public awareness of health. But you - both doctors and the public are welcome to voice your opinion. Our aim is to ensure better healthcare for the people - towards this end, a series of articles on patients' rights will follow....

What is Cholera ?

Cholera is a deadly diarrhoeal disease that was first discovered way back in 1854. It is caused by a tiny bacteria, 'Vibrio cholerae,' so named as the bacteria, when seen through a microscope, vibrates in a typical manner.

What does it do?

In our intestines, where digested food is absorbed, water is also continuously being absorbed. When the Cholera bacteria invades the intestine, it upsets this mechanism and water, instead of being absorbed, is sent out. A profuse watery diarrhoea, looking much like rice cunjee, results.

How do we get the disease?

Mostly from food and drink. They are contaminated, directly from human excreta which contain the germ or from flies which carry the germ.

What food should we avoid?

Any uncooked food (your favourite 'mallung') is unsafe. Keep all cooked food covered until they are consumed, or else, flies carrying the germ can still contaminate it. Fresh fruit is best avoided during an epidemic. The same applies for ice-cream, if you are not sure of the standards of hygiene maintained in its production. Milk should be boiled before consumption.

Is fish safe?

Shell fish is found in sea water, where the germ grows more rapidly, so it is best avoided, if you are in doubt. Other types of fish are safe but only if they are cooked to boiling point and this applies to other meats as well.

And water?

Boiled cooled water is best. If this is not possible chlorinated water can be used.

How can we protect ourselves?

Simple hygienic measures are of immense value during an epidemic. They include hand washing after toilet, covering all food and consuming home cooked food and boiled cooled water. If you must eat out, prepackaged food (biscuits) are safe as are bottled soft drinks. Avoid food from wayside vendors. Give school children a bottle of boiled cooled water to take to school.

What shouldn't we do?

If you develop diarrhoea, seek medical advice without delay instead of trying home remedies which may not only aggravate the disease but also cause its spread to family members. The early symptoms are watery diarrhoea, vomiting, fever and abdominal pain. Until you are able to seek treatment give the patient plenty to drink.

Is Cholera fatal?

Yes and No. If treated promptly and properly recovery is the rule rather than the exception. At the same time, neglecting early symptoms could lead to rapid deterioration and death.

How serious is the present epidemic?

Over three hundred cases of Cholera have been positively identified. Eight patients have died, three of them in Chilaw. The epidemic, at present is still showing signs of spreading, so all precautions should still be taken.

Is treatment difficult?

No. A simple combination of antibiotics and restoring lost fluid will quickly cure the illness so, there is no need for panic even if you suspect you have the disease. But, early treatment is essential.

Is there a vaccine against Cholera?

Yes, but it is not widely available. However some centres in Colombo offer this vaccine at present.

Rotavirus vaccine almost ready

Health Updates

Rotavirus, a diarrhoea- causing RNA virus, kills more than 600,000 children worldwide every year - more deaths than any other diarrhoea-causing microbe. In last month's Lancet, Dr. Timo Vesikari from the University of Tampere Medical School in Tampere, Finland, reviews the latest progress in rotavirus vaccine research.

Vesikari says that although having been infected once does not always prevent getting a second rotavirus infection, it can reduce the severity of subsequent infections. Therefore, there is hope that a vaccine should significantly reduce the harm this virus does, he says.

The most promising vaccine that is near to approval contains rotavirus that cause disease in rhesus monkeys into which scientists have inserted genes from the virus that causes disease in humans, Vesikari says. When this genetically-altered virus, called rhesus rotavirus tetravalent (RRV-TV) vaccine, is given to a child, it infects the intestine - without causing diarrhoea - and generates an immune response to four of the most common human rotavirus strains.

In recent trials in the US, RRV-TV vaccines were able to prevent reinfection in 57% of the patients and protest against severe rotavirus-induced diarrhoea in 92%. In developing nations, however, where the virus does the most harm, RRV-TV has proved less effective, reducing severe diarrhoea by only 50-60%. These disappointing results in developing nations are similar to those seen with earlier versions of rotavirus vaccines.

Why the vaccine so often fails in developing countries is not known, Vesikari says, but the problem may be that not enough of the altered virus gets into the intestinal cells to generate a strong immune response, perhaps because children in the developing world often have other viral infections that interfere with the uptake of the vaccine.

One way to get around this problem, Vesikari says, is to make an injectable vaccine. Studies of such vaccines in animals have been promising, but human trials still need to be done. In the meantime, the oral RRV-TV vaccine should be approved for use in the US either late this year or early next, Vesikari says, and should become available in Western Europe soon. -The Lancet

Thirty years of transplantation

Your Health

By Dr. Sanjiva Wijesinha

Dr. Barnard's second heart-transplant operation was done on a patient with a failing heart, dentist Phillip Blaiberg, who became the first human being to hold his own heart in his hands! Blaiberg survived several years with his transplanted heart, even writing a book about his experiences.

I still remember the day one of my friends excit edly announced to us that a surgeon in South Africa had transplanted the heart of one human into another.

That was thirty years ago - on December 3, 1967 - when a thirty-strong surgical team led by Dr. Christian Barnard removed the healthy heart of a 25-year-old woman who had died in a car accident and transplanted it into the chest of 55-year-old heart patient called Louis Washkansky.

Although Washkansky lived only eighteen days with his new heart, Dr. Barnard quickly followed his operation with a similar one on another patient with a failing heart, dentist Phillip Blaiberg, who became the first human being to hold his own heart in his hands! Blaiberg survived several years with his transplanted heart, even writing a book about his experiences.

It was significant that Dr. Barnard transplanted the heart from a non-white donor into Dr. Blaiberg (who was white), a deed which carried a significant message in apartheid ruled South Africa where at the time they had separate neighbourhoods, toilets and even ambulances for the separate races!

Those pioneering operations by Dr. Barnard paved the way for the many heart transplants that have followed. Today thousands of people all over the world are alive and well, thanks to other person's hearts beating inside their chests.

And it is not only the human heart that has survived the journey from one body to another. Corneas, kidneys, livers and even lungs have successfully been grafted from person to person.

A couple of months ago nearly 1500 transplant recipients (including five from Sri Lanka) congregated in Australia to participate in the World Transplant Games. From September 29 to October 5, athletes aged between three and seventy years from 51 countries met in Sydney, competing in eleven different sports, ranging from athletics to tennis. The common feature among all these sportsmen and women was that each and every one of them had undergone an organ transplant.

Harry DumontI had the privilege recently of meeting one of those who represented his country at the Games in both the singles and doubles tennis events. Australian Harry Dumont underwent a life saving heart transplant in 1989, following two serious heart attacks in 1984 and 1985. At the time he had his transplant, his heart function was so poor that he could not walk more than ten yards without getting severely breathless.

"Most of us competitors would not be alive today without our transplants," says Harry, who was given the heart of a 27-year-old man who died in a traffic accident. "These games give us the chance to play sport at a competitive level and also enable us to express our gratitude to the families of those who have donated their organs."

Australia won the most number of medals at these Games (72 golds in a total of 176) coming out ahead of Britain and the US. The next World Transplant Games will be held in TilIberg, Holland in l999, but before that, the South Asian countries are planning to stage the first SAARC Transplant Games next year in Amritsar, India.

"In Australia," says Harry "there is a lot of encouragement for transplant recipients to participate in sports. The Australian Transplant Sports Association organises regular try-out days in a variety of sports, athletics, archery, racquet games, swimming etc., where professional coaches provide advice and assistance."

Harry played a fair bit of tennis in his younger days, but work (as an engineer running his own business) began taking over more and more of his time and he "gave the game away". It was only after his transplant that he returned to the game as part of a regular exercise programme.

Taking part in competitive sports is not easy for heart transplant patients. In the normal person, regulation of the heart is done by both the brain (which rapidly stimulates the heart to pump faster when blood flow needs to be increased) as well as the slower endocrine system (which produces hormones like adrenaline and steroids that increase heart rate).

A transplanted heart is not connected to the nervous system, so the brain no longer exercises control over the heart rate, making a rapid response impossible if the body suddenly needs an increased heart output. Thus people like Harry depend on their "adrenaline drive" alone to cope with exercise, which makes a gently increasing warm-up period essential before getting into exercise.

One purpose of the Transplant Games is to increase awareness of the need for transplantation and to encourage more people to discuss organ donation and register as donors. The Games demonstrate that folk who have had transplants undergo a definite improvement in their quality of life and can once again lead productive and useful lives.

"Isn't it ironic," laughs Harry "that I only got the chance to fulfill my boyhood dream and represent my country, which is any sportsman's ambition, only after I got my new heart?"

You should know...

When to immunise your child ....

At birth - BCG vaccine

At 3 months - Triple and Polio vaccines, first dose

At 5 months - Triple and Polio vaccines, second dose

At 7 months - Triple and Polio vaccines, third dose

At 9 months - The Mumps, Measles and Rubella vaccine (MMR)

After 1 year - The Japanese Encephalitis vaccine (JE)

At 18 months - The Triple and Polio vaccines, fourth dose

... And if you miss the scheduled date of your child's vaccination, you can get your vaccine on any later date.

Polyunsaturated benefits

Remember those "Polyunsaturated Fatty Acids"? The kind that is present in all those margarines touted by supermarkets as being good for your heart?

Well, they may have another use as well reducing gastric ulcers. Latest research in Britain has shown that a diet rich in these Acids (vegetables, fish and grains, for example) will reduce the incidence of Helicopter pylori, a bacteria thought to be linked to peptic ulcer...

Little Alcohol good for you?

Most medical experts say 'No'. But how little is little?

The amount of alcohol varies with what you drink. The percentages of alcohol in some of the 'popular' beverages are: Beer - 2-5% Wine - 10-15% Arrack - 40% Whisky, Brandy - 40% and over 'Kasippu' - depends on ingredients! But remember, always, that no alcohol is better than a 'little' alcohol.

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