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| Friday, 5 March 2004 |
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Stroke play in medicine
Dr. Githanjan Mendis (Consultant Neurologist and Head of the Sports Medicine Unit and a medical advisory panel member of this page) in an article to mark the national strokes day which fell on February 29th states: With cricket being so much in the air with us today it is not out of place to give a bit of cricketing touch to the strokes day as well. Hence the title strokes play in medicine, which is different from stroke play in cricket. To begin with all sporting events are health promoting, and stroke play in cricket is lovely to watch, but not so the part strokes (cerebrovascular accidents) play in human life. It's devastating. Do you know that strokes take about 5 million lives annually in the world, and another about 5 million are left disabled. The annual incidence of strokes in the world is about 15 million, and strokes has been categorised as the commonest cause of death next to heart disease. In Sri Lanka As far as our country is concerned strokes has been placed in the 3rd category of diseases causing the highest number of deaths. Drugs and preventive action There are newly developed drugs in the world to effectively treat stroked patients, but the costs are prohibitive for the 3rd world countries like us. So the best option for us is to go more for preventive action. Make the people aware of the risk factors, and get them motivated to avoid them. Doctors alone cannot do it This calls for concerted and joint action by all concerned. Doctors alone cannot do it. The action has to be well thoughtout and well planned. The emphasis should not be confined to the national strokes day. Prevention Since risk factors are (a) high blood pressure, (b) heart disease, (c) smoking, (d) mini strokes, (e) obesity, (d) diabetes, (e) lack of exercise, (f) alcoholism, among others, prevention becomes somewhat difficult: because it involves change of the lifestyle to a great extent. Fighting against business interests In changing lifestyles involves discouraging people in consuming some of the widely advertised fast food items how we can effectively do that is the question? This is where cooperation of all sections interested in healthy nation building is needed. We have to get the cooperation of the business sector too, to succeed in this effort quite apart from the policy makers and the media. Smoking In the struggle we have to launch to change the lifestyle and eating habits of the public in preventing strokes, I feel it is worthwhile to look back and study the processes and the actions we took in the fight against smoking, which we have greatly succeeded. I feel the Sri Lanka Strokes Association has a big role to play in this. We should seek the possibility of making national sports events like cricket to carry health messages on strokes prevention and the like, Media cooperation too is vital. ############## First 3 to 5 years HRT ok for women in menopause Three eminent medical professionals in the field of womens health on Tuesday advised that women in menopause could take hormone replacement therapy (HRT) for 3 to 5 years without any risk of cancer, and other related risks found to be associated with HRT. The treatment should be taken in consultation with a doctor. The three professionals Prof. Harsha Seneviratne (Professor of Obstetrics and Gynaecology Colombo Medical Faculty) Dr. Mrs. Chandrika Wijeratne (Consultant Physician and Senior Lecturer Reproductive Medicine-Colombo Medical Faculty and Dr. Kanishka Karunaratne. (Consultant Gynaecologist Cancer Hospital Maharagama) were speaking on Hormone Replacement Therapy (HRT)) at the monthly meeting of the British Scholars Association Sri Lanka, held at the British Council Auditorium in Colpetty. The doctors were basing their advice on the evidence of trials done on HRT benefits and risks internationally, and on personal knowledge gained in practice. The post menopause estrogen loss generally commencing in a women's life in mid 30's, results in a number of symptoms in a women's life like, mood changes, hot flushes heavy sweating, which makes life somewhat miserable. These conditions Dr. Kanishka Karunaratne observed impacts greatly on career women who in their 30's are in their career peak. Even with medical advice most of them decline to take HRT worrying about the cancer risk. The message has to be given to these women that for the first 3 to 5 years there are no risks involved in taking HRT and getting over their physical and mental disabilities associated with estrogen loss following menopause. Dr. Karunaratne and other doctors at the symposium cautioned that continuation of HRT after that period (3 to 5 years) should be done strictly on the advice of a doctor, and not otherwise. Nipping in the bud Prof. Seneviratne emphasised the need for women in their 30s and anybody for that matter to go for regular medical checkups annually which enables early detection of cancers, heart ailments etc, and nip them in the bud with early treatment. A more detailed account of the event will be carried later. Prof. Ravindra Fernando, Professor of Forensic Medicine & Toxicology Colombo University Moderatored the event. ############## The egg debate continues: Dr. Atukorale: Choline essential for animals not for humans Dr. D. P. Atukorale in a statement to this page referring to Dr. A. Nandakumar's comments on his (Dr. Atukorale's) views on eggs in Dr. Nandakumar's article on eggs in this page last week, says, "I am grateful to Dr. Nandakumar for enlightening the readers on the importance of 'Choline Lecithin and Lutein in his article in (Health Watch Feb. 20). However I stand by what I have mentioned regarding above compounds. "I mentioned that choline is essential for animals and not for humans. Choline is often linked with vitamins by drug companies to sell lecithin which is a phospholipid containing choline with the claim that Lecithin can reduce blood cholesterol which is not so in humans." I am quoting from Cambridge Encyclopedia 3rd Edition (2000) which under the heading choline page 175 states: "The most common form of phospholipids play a key role in the structure of biological membranes. It is an essential component of the diet of some species but not humans. Phospholipids containing choline also known as lecithin, commonly sold in health food shops to reduce cholesterol absorption a feat which it does not achieve." A.N. says that choline is essential for normal brain development in foetus. Can A.N. quote the name of any textbook in pharmacology or obstetrics which states that pregnant mothers have to be given choline during pregnancy. I would be very grateful to A.N. if he can quote the name of a book in pharmacology and therapeutics or a textbook in cardiology or general medicine which states that (a) choline reduces the serum cholesterol level in man and (b) choline is useful in the treatment of coronary artery disease in man (not in animals). One should not confuse human nutrition with animal nutrition. Vitamin C is an essential vitamin for all herbivores and man but it is not an essential vitamin for carnivores who manufacture their own vitamin C. Cholesterol is necessary for human metabolism but it is not necessary for us to eat cholesterol in the forms of meat or eggs as human beings manufacture the required amount of cholesterol in the liver. ############## Rs. 231 million Regional Toxicology Research Centre here A grant of 1.25 million pounds sterling (approximately rupees 231 million) was awarded to a team of researchers from Australia and Sri Lanka recently for a study to reduce deaths from pesticide poisoning. The principal applicants are Professor Nicholas Buckley from Australian National University and Professor Nimal Senanayeka of the University of Peradeniya. Co-applicants are Professor Ravindra Fernando and Professor Rezvi Sheriff from the University of Colombo and Professor Andrew Dawson and Dr. David Henry form Australia. The World Health Organisation estimates that nearly half a million people die from acute pesticide poisoning in the world each year. In Sri Lanka, over 2000 deaths are reported from pesticide poisoning annually. The Sri Lankan project will be the first attempt to systematically test whether a range of strategies can reduce long-term neurological damage and deaths from pesticides. The Australian-Sri Lankan collaboration will, over the next five years, aim to improve assessment of sub-acute and long-term morbidity; promote 'evidence-based' treatment; develop new antidotes (and assess their cost effectiveness) and see if pesticide regulation can reduce the rate of severe or fatal poisoning. If successful, this programme may become a model for the region as to how to substantially reduce this largely hidden tragedy. This collaborative work of the Universities of Colombo, Peradeniya and Newcastle and the Australian National University will be establishing a Regional Toxicology Research Centre in Sri Lanka. The grant was made by The Welcom Trust, Prof. Fernando said. ############## Dr. Desmond Fernando on 'Stanols and Sterols' Herewith I am sending you an article from 'Bandolier' which suggests that Stanols and Sterols of plant origin (Phytostanols and Phytosterols) lower LDL (Bad Cholesterol) when taken in the diet. I would like to know from a Botanist whether vegetables contain Phytostanols and Phytosterols and what these vegetables are - The article: Plant sterols and stanols reduce LDL cholesterol In the January issue of eBandolier there is an interesting review sterols, stanols and cholesterol that begins: Bandolier 64 examined a randomised trial that examined the effects of plant stanols on cholesterol, and found that they were beneficial. But that study was just the one, and with a limited number (100) of subjects. Now we have a systematic review that confirms and extends the results. Plant stanols and sterols have a structure that is very similar to that of cholesterol, and the difference between stanols and sterols is that the former are saturated and the latter are not. Sterols have functions in plants similar to that of cholesterol in animals. Foods enriched with stanols or sterols lower serum cholesterol levels by reducing intestinal absorption of cholesterol. Stanols and sterols are now found in a variety of margarine and other food products, usually as esters which are hydrolysed in the upper small bowel. They displace cholesterol in absorption processes, though the methods are still speculative. A systematic review of randomised trials from a previous meta-analysis that tested foods containing stanols or sterols, review articles, and questioning experts participating in a specialist workshop were used to derive conclusions. The review concluded with the comment: "The two meta-analyses confirm that stanols and sterols taken at about two grams per day will reduce LDL cholesterol by about 10 per cent or about 0.3 to 0.5 mmol/L in adults. There is a cost, estimated at about Sterling Pound 70, a year because stanols or sterol margarines are more expensive than traditional margarine. But there is also a benefit. The calculation is that this reduction in cholesterol should reduce the risk of heart disease by a quarter." |
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