Vision Can Be Saved If Detected Early

June 23rd, 2009 admin Child Health,Eyes 0

A most common primary intraocular (inside the eyes) malignancy of childhood arises from primitive retinal cells of the eye. About 90% cases are diagnosed less than 3 years of age.

A common presentation is white pupillary reflex, some with squint and some with inflammation of the eye. In our country, most of the patients present with advance stage when the tumor extends externally.

In advance stage though the chance of saving eye is less but when other eye is examined and if a small lesion is detected, can be treated by focal therapy (Photocoagulation with Laser). Early detected is very important in that respect.

When treating retinoblastoma, it is first and foremost important to understand that it is a malignancy. When the disease is contained within the eye, survival rates exceed 95% in the western world.

However with extra ocular spread survival rates decreases to under 50%. Therefore, in deciding on a treatment strategy, the first goal must be preservation of life then preservation of eye and finally preservation of vision.

The modern management of intraocular retinoblastoma currently incorporates a combination of different treatment modalities including chemotherapy, photocoagulation with Laser, cryotherapy, radiation therapy and surgery like enucleation (removal of globe).

Metastatic disease is managed with intensive chemotherapy, radiation and bone marrow transplantation. Among all of this treatment options — the best, cheap and less hazardous option is photo-coagulation with Diode Laser if tumor is detected in early stage with a very small lesion. If laser is applied, eye can be saved, even useful vision can be preserved.

The treatment of children with retinoblastoma requires a team approach including an ocular oncologist, pediatric ophthalmologist, pediatric oncologist and radiation oncologist.

The chemo, radiation therapies are very expensive. Comparing all modalities, the photocoagulation therapy with Diode Laser is cheaper. This facility is available at the government set-up in Sylhet MAG Osmani Medical College Hospital. The facility is available on courtesy of WHO. Expert manpower is available there and moreover the service is offered at free of cost.

The facility of laser photocoagulation can save valuable life of a child and also rescue a family from a danger point. Children with intraocular retinoblastoma who have access to modern medical care have a very good prognosis for survival.

Children Risks From Environmental Hazards

June 11th, 2009 admin Child Health 1 Comment

Children are exposed to serious health risks from environmental hazards. Over 40 percent of the global burden of disease attributed to environmental factors falls on children below five years of age, who account for only about 10 percent of the world’s population.

Environmental risk factors often act in concert, and their effects are exacerbated by adverse social and economic conditions, particularly conflict, poverty and malnutrition. Timely action needs to be taken to allow them to grow up and develop in good health, and to contribute to economic and social development.

Polluted indoor and outdoor air, contaminated water, lack of adequate sanitation, toxic hazards, disease vectors, ultraviolet radiation and degraded ecosystems are all important environmental risk factors for children and in most cases for their mothers as well.

Particularly in developing countries like Bangladesh, environmental hazards and pollution are a major contributor to childhood deaths, illnesses and disability from acute respiratory disease, diarrhoeal diseases, physical injuries, poisonings, insect-borne diseases and perinatal infections.

Childhood death and illness from causes such as poverty and malnutrition are also associated with unsustainable patterns of development and degraded urban or rural environments.

Major environment-related killers in children under five years of age

Diarrhoea kills an estimated 1.6 million children each year, caused mainly by unsafe water and poor sanitation.

Indoor air pollution associated with the still-widespread use of biomass fuels kills nearly one million children annually, mostly as a result of acute respiratory infections. Mothers, in charge of cooking or resting close to the hearth after having given birth, are most at risk of developing chronic respiratory disease.

Malaria, which may be exacerbated as a result of poor water management and storage, inadequate housing, deforestation and loss of biodiversity, kills an estimated one million children under five annually, mostly in Africa.

Unintentional physical injuries, which may be related to household or community environmental hazards, kill nearly 300000 children annually: 60000 are attributed to drowning, 40000 to fires, 16000 to falls, 16000 to poisonings, 50000 to road traffic incidents and over 100000 are due to other unintentional injuries

Health-damaging exposure to environmental risks can also begin before birth. Lead in air, mercury in food and other chemicals can result in long-term, often irreversible effects, such as infertility, miscarriage, and birth defects.

Women’s exposure to pesticides, solvents and persistent organic pollutants may potentially affect the health of the fetus. Additionally, while the overall benefits of breastfeeding are recognised, the health of the newborn may be affected by high levels of contaminants in breast milk. Small children, whose bodies are rapidly developing, are particularly susceptible — and in some instances the health impacts may only emerge later in life.

Furthermore, children as young as five years old sometimes work in hazardous settings. Pregnant women living and working in hazardous environments and poor mothers and their children are at a higher risk, as they are exposed to the most degraded environments, are often unaware of the health implications, and lack access to information on potential solutions.

WHO recognises the need to educate and train health care providers at all levels in the prevention, diagnosis and management of children’s diseases linked to environmental risk factors. Efforts are undertaken to enable those “in the front line”, the health professionals dealing with children and adolescents’ health, to recognise, assess and prevent diseases linked to, or triggered by environmental factors.

With low-cost solutions for environment and health problems can be applied in many cases. For instance, simple filtration and disinfection of water at the household level dramatically improves the microbial quality of water, and reduces the risk of diarrhoeal disease at low cost. Improved stoves reduce exposures to indoor air pollution. Better storage and safe use of chemicals at community level reduces exposures to toxic chemicals, especially among toddlers, who explore, touch and taste the products found at home.

Hygiene and sanitation

Washing hands with soap before food preparation, before meals and after defecating significantly reduces the risk of diarrhoeal disease.

Air pollution

Good ventilation in the home, clean fuels and improved cooking stoves decrease indoor air pollution and the exacerbation and development of acute respiratory infections.

Disease vectors

As children usually go to bed earlier than adults at the time mosquitoes become active, the use of insecticide-treated mosquito nets and the screening of windows, doors and eaves provide a very effective means of protecting them against malaria.

Chemical hazards

Ensure safe storage, packaging, use and clear labelling of cleaners, fuels, solvents, pesticides and other chemicals used at home and in schools.

Children are our future, numbering over 2.3 billion worldwide and representing boundless potential. Child survival and development hinge on basic needs to support life; among these, a safe, healthy and clean environment is fundamental.

Dr Md Rajib Hossain

Smoking and Diabetes

June 5th, 2009 admin Diabetes 1 Comment

The harmful effects of smoking. Studies show that smokers are five times more likely than that of the nonsmokers to have gum disease. For smokers with diabetes, the risk is even greater. If you are a smoker, diabetic and age 45 or order, you are 20 times more likely than a person without these risk factors to get severe gum disease.

Smoking increases your risk of getting type 2 diabetes
Some recent research shows there is a significant relationship between diabetes and smoking. The more you smoke, the more chance you have of getting diabetes. If you smoke 16 to 25 cigarettes a day, your risk for type 2 diabetes is 3 times greater than a non-smoker. When you quite smoking, your risk decreases during the years that follow.

Smoking affects the way insulin works in your body
In type 2 diabetes, the body does not respond to insulin made by the pancreas. Insulin helps blood glucose enter into the cells for fuel. When you smoke, your body is less able to respond to insulin. When your body resists insulin, your glucose level increase in the blood. Resistance does not start to reverse until you do not smoke for 10 to 12 hours.

Smoking makes it harder to control your diabetes
Studies show that smokers have poorer glucose control than non-smokers do. Smokers who quit have the same blood glucose control as non-smokers. When you have type 1 or type 2 diabetes, glucose control is very important. The HbA1c test checks how well you control your glucose level over 3 months. The goal is to keep your A1c at 7 percent or less. When you have diabetes and you smoke, your A1c level increases. If you quit smoking, your A1c level may decrease to the same level as a non-smokers.

Smoking increases your risk for getting other problems from diabetes
When you have diabetes and smoking habit, your chances are greater for getting other health problems form diabetes — complications. You can get serious eye problems, kidney problems, nerve problems, heart and blood vessel disease and so on.

Even for people who do not have diabetes but smoke, the risk of getting other health problems is greater. The more and the longer you smoke, the more your risk increases. Smoking and diabetes together greatly increase the danger of getting complications. To lower your risk, you must control your glucose levels and quit smoking. Diabetic people will be benefitted in many ways when they quit smoking.

Experts’ views
All smokers need stop smoking in a clear, strong and personalised manner. Ask every tobacco user if s/he is willing to make and attempt to stop smoking at this time (within the next 30 days for example).

Assist all people with smoking cessation. For those unwilling to attempt cessation at this time, stress the 5 R’s.

Relevance: provide individualised information on the hazards of smoking.

Risks: Emphasise the increased risks of heart disease and diabetes complications arising from the combination of smoking and diabetes.

Rewards: Review benefits of smoking cessation.

Roadblocks: Assure people of your willingness to assist in their efforts to stop smoking.

Repetition: Review people’s thoughts about cessation during their following visit.

Key messages
* Review major steps of smoking cessation

* Set a date to stop smoking

* Identify likely relapse triggers and make specific plans for coping with them before stopping smoking

* Assess for nicotine replacement therapy

* Discuss any concerns about weight gain and other concerns related to diabetes

* Make referral for additional smoking cessation support, prescribe nicotine replacement, provide self-help materials, or otherwise assist in a specific plan

* Arrange for ongoing contact

* Schedule follow-up contact either in person or via telephone

* Follow-up contact should occur soon after the date set to stop smoking, preferably within the first week.

Vegetarian Diet Planning

June 5th, 2009 admin Weight Loss 1 Comment

Adopting a healthy vegetarian diet is not as simple as scraping meat off your plate and eating what is left. You need to take extra steps to ensure you are meeting your daily nutritional needs. Find out what you need to know about a plant-based diet.

Vegetarian diet planning
A healthy vegetarian diet consists primarily of plant-based foods, such as fruits, vegetables, whole grains, legumes, nuts and seeds. Because the emphasis is on nonmeat food sources, a vegetarian diet generally contains less fat and cholesterol, and typically includes more fiber.

Meat alternatives
Milk:
Drink fortified soymilk, rice milk or almond milk in place of cow’s milk.

Butter: When sautéing, use olive oil, water, vegetable broth, wine or fat-free cooking spray instead of butter. In baked goods, use canola oil.

Cheese: Use soy cheese or nutritional yeast flakes, which are available in health food stores.

Eggs: In baked goods, try commercial egg replacers a dry product made mostly of potato starch.

Ensuring adequate nutrition
A vegan diet, for example, eliminates food sources of vitamin B-12, as well as milk products, which are a good source of calcium. Other nutrients, such as iron and zinc, are available in a meatless diet, but you need to make an extra effort to ensure they are in yours.

Protein: Your body needs protein to maintain healthy skin, bones, muscles and organs. Vegetarians who eat eggs or dairy products have convenient sources of protein. Other sources of protein include soy products, meat substitutes, legumes, lentils, nuts, seeds and whole grains.

Calcium: This mineral helps build and maintain strong teeth and bones. Low-fat dairy foods and dark green vegetables, such as spinach, turnip and collard greens, kale, and broccoli, are good sources of calcium. Tofu enriched with calcium and fortified soy milk and fruit juices are other options.

Vitamin B-12: Your body needs vitamin B-12 to produce red blood cells and prevent anemia. This vitamin is found almost exclusively in animal products, including milk, eggs and cheese. Vegans can get vitamin B-12 from some enriched cereals, fortified soy products or by taking a supplement that contains this vitamin.

Iron: Like vitamin B-12, iron is a crucial component of red blood cells. Dried beans and peas, lentils, enriched cereals, whole-grain products, dark leafy green vegetables, and dried fruit are good sources of iron. To help your body absorb nonanimal sources of iron, eat foods rich in vitamin C such as strawberries, citrus fruits, tomatoes, cabbage and broccoli at the same time you consume iron-containing foods.

Zinc: This mineral is an essential component of many enzymes and plays a role in cell division and in the formation of proteins. Good sources of zinc include whole grains, soy products, nuts and wheat germ.

Since no single food provides all of the nutrients that your body needs, eating a wide variety helps ensure that you get the necessary nutrients and other substances that promote good health.