Preventing diarrhoeal and respiratory diseases in children under 4 years

Prof Sunil Sawal talks to the Healthwatch:

Zinc has become a key factor in preventing diarrhoea, and respiratory infections in children under four years.

This research finding was explained by Prof. Sunil Sazwal a researcher of John Hopkins University USA who had participated in this study. He was in Colombo last week to speak at the annual scientific sessions of the Sri Lanka College of paediatrics held at Galadari Hotel, Colombo.

Speaking to the Healthwatch on this study Prof. Sazwal said the Double Blind study was completed four years ago, on a group of randomly selected children from middle class families in India, with very positive results. The children had been fed with fortified milk with nutrients including zinc.

He said "These findings have importance for child health globally and has provided clinical evidence that particular fortified milks that can greatly impact on prevention of anaemia, the burden of common acute illnesses in childhood and their growth".

WHO statistics show diarrhoeal disease a leading cause of sickness and death globally among children aged two years and below. Diarrhoea or watery stools, leads to excessive water loss in children, causing dehydration, which can prove fatal.

Loss of nutrients through diarrhoea can cause children to become weak and malnourished as well, affecting their physical growth and lowering their body's resistance to diseases. Diarrhoea disease is a major cause of infant and child morbidity and mortality in Sri Lanka, as well.

Acute Respiratory Infection (ARI), which includes diseases such as pneumonia, is another leading cause of deaths worldwide in young children. In 2000, ARI killed approximately two million children under the age of five in developing countries alone.

Malnutrition is an important cause of morbidity for children. World Health Organisation reports estimate that in Sri Lanka 16 per cent of children under the age of 5 years are stunted and 30 per cent are underweight.

Approximately one third of children in Sri Lanka suffer from some form of malnutrition. Iron deficiency and iron deficiency anaemia, the major cause of anaemia in Sri lanka, are of particular concern and are regarded as a major public health problem among children in this population. It is especially high among children from low socio-economic groups as such children live in crowded environments and are also prone to recurrent infections.

The objectives of the trial were to evaluate the effectiveness of fortified milks in the prevention of childhood illnesses such as diarrhoeal disease, respiratory morbidity, iron deficiency and anaemia in young children, as well as to observe improvements in their growth.

A total of 633 children between 12 to 36 month of age from a lower middle-class residential area in Sangam Vihar, India, were involved in the 12-month trial. The children were randomly assigned to two groups and asked to consumer two-three glasses of the assigned milk powder each day for one year.

The milk powder tested was milk fortified with Nutri-careTm a special combination of micronutrients including minerals iron, zinc, selenium and copper and vitamins A, C, E; and the same milk without Nutri-careTm (control).

Fidings show that milk fortified with Nutri-careTm can prevent major causes of death and sicknesses in children.

Healthwatch - Colombo Apollo School Bag on students Health Survey

School bags on students' health warrants serious attention

Healthwatch in association with Colombo Apollo Hospital early last year launched an independent survey to find out whether the heavily laden school bags which the children in Sri Lanka are carrying to their schools today is posing a health risk on them.

The random survey was done through a ten point questionnaire sent to a group of students in Colombo through their parents who were assisting this survey.

Out of 500 questionnaires sent 350 have responded so far. And tabulating them we find;

Back pain, neck pain headache

In the random survey done 233 students out of 324 complained of suffering from back pain, 139 from neck pain and 283 from headache.

Injuries

Thirty three students stated that they had suffered injuries as a result of carrying these heavily laden school bags.

By hand

Twenty six students in the surveyed group said they carried their books not in a bag but in hand. The school bags appear to be posing a serious health risk on the students which warrants the attention of the education authorities and calls for a more detailed study.

The study team comprised Dr. Dennis J. Aloysins (Family Physician, Visiting Lecturer-PGIM and ex-President-SLMA) Chairman Dr. Handeep S. Dhillon Consultant Orthopaedic Surgeon, Apollo Hospital Colombo, Dr. Gitanjana Mendis Consultant, Neurologist and Head Sports Medicine Unit, Ministry of Sports, Consultant Paediatrician Apollo Jothinder Kaur.

Co-ordinators:- Chammka de Silva, Apollo Hospital, Anjalie Garnier, Sub- Editor Daily News Edward Arambewela Co-ordinator Healthwatch.

The study team will meet in mid-September to write out a preliminary report on the survey and submit it to the Education Ministry.

Should you use statins?

Several of our readers have been repeatedly asking this question from Dr. D. P. Atukorale, who is on our Medical Advisory Panel. Last week Dr. Atukorale sent us this article, which we found would interest most of our readers.

Before I start answering the readers' query, mostly from heart patients whether they should use statins, let me first explain what statins are.

Statins:They are a group of cholesterol lowering drugs, used in protecting damage from Coronary Heart Disease (CHD) and prevent heart attacks. The three mostly prescribed stating in Sri Lanka are Lovastatin, Simivastatin and Atrovastatin.

As I said earlier these drugs statins generally provide benefit to people with heart disease, and those who are having its risk factors, like diabetes and high cholesterol levels.

Guidelines of taking Statins

Statins are expensive drugs and atorvastatin 10mg lovastatin 10mg or simvastatin 10mg tablets cost about Rs. 6 each i.e. Rs. 180 per month at S.P.C. outlets. Out of these, atorvastatin is the most effective in bringing down LDL (bad) cholesterol and raising the HDL (good) cholesterol and bringing down serum triglycerides.

Majority of cardiologists known to me prescribe atorvastatin, one pill (10mg or 20 mg) a day at bedtime or with evening meal because body manufactures more cholesterol at night than during the day. To get the results of statin therapy it usually takes 6 to 8 weeks, when your family doctor will like to measure your lipid profile to find whether he has to increase the dosage.

At the same time your family physician might arrange for SGPT test (which should not exceed three times the upper normal limit) and also a CK test to find out whether there is any evidence of myositis.

Alternatives if you cannot tolerate Statin

Other medications are available if you cannot tolerate statins and they are -

(a) Nicotinic acid (Niacin) which lowers cholesterol and triglyceride levels and it raises HDL (good) cholesterol, Niacin is poorly tolerated by most patients.

(b) Fenofilrates can help to lower triglyceride levels. Fibrates also raise HDL levels. Common fibrates are Gemfibrozil, Clofibrate, and fenofibrate. Out of these 3 drugs, fenofibrate raises HDL and lowers triglycerides more than other fibrates.

(c) Policosanol

For patients who are unable to tolerate statins and fibrates due side effects such as (i) muscle pains and muscle weakness due to myositis (confirmed by doing serum CK levels and (ii) liver toxicity (confirmed by high serum SGPT levels, you should stop statins and fibrates and inform your family doctor who may prescribe a drug called policosanol (10mg or 20 mg nocte) and as far as I am aware this new drug does not cause myositis or hepatic toxicity.

How do Statins work?

Statins block an enzyme that causes the liver to produce cholesterol, thereby preventing excess amounts of cholesterol entering the blood stream.

Statins too have antioxidant properties (an antioxidant helps to prevent deterioration of oxygen) by preventing oxidation of LDL cholesterol, statins decrease plaque formation. Statins also have antiinflammatory properties; they reduce inflammation in plaques, preventing plaques from rupturing and forming clots that can lead to a heart attack. Statins also act on platelets and other clotting factors to reduce clot formation.

Disadvantages of taking Statins

Disadvantages of taking statins appear relatively minor. Rarely you may experience an upset stomach, gas, constipation and abdominal pain and cramps. Usually these symptoms fade away as your body adjusts to statin therapy. Although rare, liver toxiaty can occur. If you have underlying liver disease, your liver function may have to be monitored. Also very rare are achy tender muscles (a condition called myositis). If you experience muscle soreness, pain and muscle weakness, you may have to stop the drug and undergo muscle enzyme blood test, CK.

To prevent dangerous drug interactions, please inform your family doctor about any other drugs including over the counter drugs and herbal remedies. Erythromycin and clarithromycin, two commonly prescribed antibiotics can increase the risk of statin induced myositis.

Should I use Statins?

To answer this question first consider your health history. You should probably take a statin if you.

(a) are diagnosed with heart disease especially C.H.D.

(b) have already experienced a heart attack

(c) have diabetes

If you do not have heart disease or diabetes, consider your risk factor profile. Certain risk factors such as cigarette smoking, hypertension (B.P. of 140/85 or more), family history of coronary heart disease (whether you have had a mother, father, sister, brother, daughter or son with heart disease), low HDL - cholesterol (under 40mg/dl), your age (men over 45 and women over 55 have a higher risk) and elevated C-reactive protein (CRP) level.

In conclusion, if you have known heart disease you should be on a statin; the more coronary risk factors you have, the more you need to consider taking a statin.

Effects of Statins in older people

What is the evidence about the use of statins in older people? The answer is there is evidence from good trials involving over 31,000 participants where statin has been compared to placebo, that stains work as well in older people as in younger people.

Risks such as coronary death, nonfatal myocardial infraction, silent infarction as well as unstable angina were reduced by an average of 32% by participants older than 65 years and was similar to risk reduction in participants younger than 65 years (31%).

In prosper which is a study involving 5804 people between 70 to 82 risk reduction was 15 (3-26). In heart Protection study which included 5806 people over 70, the risk reduction was 18. It was found that in above trials statins were particularly effective in people with low HDL (good) cholesterol levels.

Cost-effectiveness of Statin treatment

Cost benefit analysis shows that lipid - lowering therapy is relatively cost effective compared with other interventions (Huse D. M. et al Am. J. Cardiol, 1998;82;1357-63).

Statins as mentioned earlier cut diabetes deaths. If physicians routinely prescribe statins to diabetic patients with substantial risk of having a heart attack, this could prevent at least 10,000 heart attacks, strokes and major heart operations each year in UK and about 100 million worldwide.

Simon O'Neill, Head of Care Developments, Diabetes UK says "Many people could benefit greatly if offered statins as an integral part of their diabetes care programme."

Heart drug becomes cancer killer

US scientists say they have successfully tweaked a common heart drug to make it fight cancer.

Digoxin or digitalis, which comes from the foxglove plant, is normally used to steady the rhythm of the heart and help it beat more efficiently.

Now a University of Wisconsin-Madison team has changed some of its building blocks to make it target tumours.

The proceedings of the National Academy of Sciences work provides hope other 'natural' drugs can be manipulated.

Dr Jon Thorson and colleagues found they were able to change sugars attached to the drug.

The technique they used is called neo(new)-glyco(sugar)-randomisation.

It changes the way sugars are grouped on a drug, which, in turn, changes the way the drug works.

In the case of digitalis, switching around the sugars boosted its ability to target cancerous cells and kill them in the laboratory.

Ultimately, it might be possible to tweak the drug enough so it is able to treat cancer without having any effect on the heart, said Dr Thorson.

The neoglycorandomisation technique could also help doctors developing drugs for other diseases, he said.

"We've already taken this chemistry and applied it to many different classes.

"It's possible to extend it to antibiotics and antivirals. If you want to plug a sugar and see what it does for you, this is the best way to do it," he said.

Hazel Nunn of Cancer Research UK said: "This technique is an important biomedical advance, which could increase the chances of finding active drugs against cancer and a wide range of other conditions. "But any drugs developed using this technique will need to go through rigorous clinical trials to determine their safety and effectiveness in humans.

"Although this research is exciting, the benefits for patients are likely to be a number of years away."

Courtesy: BBC

The role of the pancreas

About the size of a banana, the pancreas lies just behind the stomach. The healthy pancreas performs a continuous and exquisite balancing act, managing to sustain smooth stable blood sugar levels by releasing just the right amount of insulin as glucose levels wax and wane throughout the body. Beta cells within the pancreas are the source of hormone insulin.

When beta cells fail to produce enough insulin, glucose builds up in the blood, causing hyperglycaemia. The opposite - low blood sugar is called hypoglycaemia.

In concert with the pancreas, the liver helps manager blood-sugar levels by storing excess glucose in a form called - glycogen.

When commanded by the pancreas the liver converts glycogen back into glucose for use by the body.

(Source: Guide To Living with Diabetes)

The role of sugar

It is a common misconception that eating a lot of sugar causes diabetes. Medical evidence shows that getting fat-regardless of sugar intake - increases the risk of diabetes among the genetically susceptible individuals: still eating too much sugar is unhealthy. Since it provides poor nutrition and contributes to obesity.

Another misconception is that people with diabetes have an abnormal craving for sugar.

In reality though they have the some desire for sweets as most others when it is not controlled, diabetes can lead to hunger - but not necessarily for sugar.

Recent studies have shown that a diet high in fructose - sugar derived from fruits and vegetables - can contribute to insulin resistance and even diabetes in animals regardless of their weight.

(Source: Guide to Living with Diabetes)

Air pollution deaths exceed road fatalities

World Health Organisation - WHO, reports that nearly 3 million people now die each year from the effects of air pollution.

This is three times more than the one million people who die annually in road accidents.

WHO says while governments work hard to reduce road accidents they don't pay much attention to the more serious problem of air pollution deaths, which is mainly caused by exhaust fumes of motor vehicles being driven on the roads.

While deaths from heart and respiratory diseases from breathing, polluted air may lack the drama of deaths from an automobile crash with flashing lights and sirens, they are no less real, says the WHO report.

"Air pollutants include carbon monoxide, ozone, sulphur dioxide, nitrogen oxides and particulates" - all of which stem from the combustion of fossil fuels such as coal and gasoline.