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Health Insurance for Visitors

Nowadays tourism is the largest industry in the world. Tourists visit a place for different purpose; some visit just for a vacation and some visit for education and eagerness to know the unknown and see the unknown. Tourists visiting a different country need to be covered by insurance for the touring time

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for different health needs. Specially for the tourists and visitors from a western country who are visiting a developing country need Visitors Health Insurance for the duration of stay in the foreign country. Those from developing countries also need Visitors Health Insurance due to the high cost of health services in the western countries compared to developing countries.
The Visitors Health Insurance field is most developed in the USA in compare to European countries and other countries of the world. This is mostly available for the tourists visiting USA and designed and planed for the duration of stay in USA. These visitors health insurance plans give protection to the visitors from other foreign countries. Unforeseen medical expenses that may arise due to sickness or accidents during the stay in USA are covered in these visitors health insurance plans.
The Visitors Health Insurance cover all the medical and health related expenses that may arise during visiting USA and include expenses for the duration of hospital stay, medicine bills, surgical procedures, all the diagnostic procedure costs and other costs of hospitalization.
Internet has made things simple for every thing including Visitors Health Insurance and Visitors Medical Insurance are available over the internet. You can buy visitors health insurance in the internet. You have to fill up a form online and get the required visitors health insurance policies of your choice. You have option to choose from more than a dozen companies according to your likings. One should always buy visitors health insurance while visiting a foreign country.

October 9th, 2008 | Tags: Health Insurance | Category: Health Insurance | Leave a comment

Effects of Heat on Humans

Effects of Heat: There are 14 documented disorders which can be due to excess exposure to heat. Some of the common and important disorders are discussed below:

(1) Heat stroke: Also known as sunstroke. This is due to failure of heat regulating mechanism of human body . The main feature of heat stroke is very high body temperature of about 110 degree Fahrenheit(430 Centigrade). High temperature is accompanied by convulsion, delirium and partial or complete loss of consciousness. Skin is usually dry and hot. Sweating is absent or very scanty. Death rate is high (about 40%) even it quick medical attention is provided. Treatment of heat stroke consists of rapidly cooling the body in ice water till rectal temperature falls blow 102 degree Fahrenheit. Rectal temperature should be continuously monitored. It indicate the progress of treatment as well as guard against hypothermia, that may occur if cooling is continued for very long . Further treatment of heat stroke is supportive & symptomatic. The patient should be hospitalized for several days, till temperature control & regulatory mechanism become stable.

(2) Heat Hyperpyrexia: This is due to impairment of heat regulating mechanism of human body. It generally have temperature above 106 degree Fahrenheit. It may be seen before heat stroke /sun stroke.

(3) Heat exhaustion: It is not because of failure of heat regulating mechanism ,unlike heat stroke and heat hyperpyrexia. It is less severe than heat stroke and due to imbalance or inadequate replacement of water and salts lost by perspiration due to excess heat. Body temperature may be normal or slightly higher but generally do not cross 102 degree Fahrenheit. It is seen after several days of high temperature. Symptoms of heat exhaustion are dizziness, weakness, and fatigue. Elderly people with heat exhaustion may require hospitalization. Treatment is correction of fluid and electrolyte imbalance.

(4) Heat cramps: It is seen in people engaged in heavy work and muscular activity at high temperature and humidity, mainly those who are not adopted to muscular activities at high temperature and humidity. Heat cramp is due to loss of sodium and chlorides in blood and it causes painful and spasmodic contraction of skeletal muscles.

(5) Heat syncope: Heat syncope is quite common problem . In typical form of heat syncope, person standing in sun suddenly become pale, his blood pressure falls and he collapses. Body temperature is normal. This is due to pooling of blood in legs due to dilatation of blood vessels in legs. This results in reduced venous return to heart and fall in blood pressure and lack of blood supply in brain. The treatment is very simple. The patient is made to lie down in shade with the head slightly down . Patient recovers in 5 to 10 minutes. This type of problem is very common in soldiers standing in sun for parade.

Preventive Measures: The effects of heat can be prevented by following measures.

(1) Replacement of water : People working under high temperature and humidity should encouraged to drink lots of cool water. In hot climate a person requires about one liter of water per hour during physical work and a sedentary worker need half liter of water. There is no need of extra salt in water because sweat contain very less salt, contrary to popular belief that extra salt is required. But if a person is not acclimatized he should take extra salt for first 10 days.

(2) Clothing: The cloth used should be loose fitting and of light color.

(3) Regulation of work: Duration of work at hot and humid condition should be reduced. There should be periods of rest in between intense work. If symptoms of effect of heat like headache, dizziness appear the worker should be removed to a cooler place and adequate treatment given.

(4) Protective Devices: protective goggles, helmets and shields should be used where practicable.

(5) Proper ventilation should be provided and air-conditioning done where practicable.

Tags: Heat cramps, Heat exhaustion, Heat Hyperpyrexia, Heat stroke, Heat syncope, Sunstroke
Posted in Environment & Health | No Comments »
Effects of Radiation on Humans
Sunday, August 17th, 2008

The biological effects of radiation on human can be divided into two groups, somatic effects and genetic effects.

(1) Somatic effects: A dose of 600 to 700 roentgen is invariably fatal in humans and a dose of 400 to 500 roentgen can kill up to 50% of people. Those who are not killed, also suffer from severe damage and radiation sickness. If a person is exposed to 25 to 50 roentgen of radiation it effects white blood cells (corpuscles) and produce lassitude and softening of the muscles. Somatic effects of radiation can be immediate and delayed. Immediate effects are radiation sickness and acute radiation syndrome. Delayed effects take time to develop and can take from few weeks to few years to develop. Delayed effects of radiation are mainly leukemia (blood cancer), malignant tumors ( cancer) shortening of life and fetal developmental abnormalities.

(2) Genetic effects: Somatic effects are seen during ones lifetime of the person exposed to ionizing radiation genetic effects generally manifest in the life of off-spring . Genetic effects of radiation are mainly due to point mutation and chromosomal mutation. Chromosomal mutation generally is involved with sterility and point mutation effects the genes .

Protection from Radiation: The amount of radiation received from outer space is about 0.1rad per year and at present it is not considered a hazard. The additional permissible dose from man made sources is about 5rad per year. Out of all the man made sources x-ray constitute the greatest hazard. In routine fluoroscopy a dose of 4rad is delivered to a part in one minute, which means unnecessary x-ray examination should be avoided, mainly in pregnant woman an children.

There is requirement of adequate control & surveillance of x-ray installations, protection of workers, improvement of techniques to reduce dose of radiation.

Effective protective measures include use of lead shields, and lead rubber aprons by radiographers .Lead aprons of 0.5mm thickness of lead reduces the intensity of scattered x-rays up to 90% and all workers should use them who are associated with x-rays. Worker also should wear a dosimeter or a film badge that shows accumulated exposure to radiation. Besides all the above periodic medical cheek up, regular working hours & recreation should be provided to the health workers who are exposed to x-rays.

Radiation hygiene is one of the latest branch of hygiene. International agencies like WHO(World Health Organization), IAEA(International Atomic Energy Agency) and International Commission on Radiological Protection (ICRP) are active in the field of radiation hygiene. The ICRP has recommended that the genetic dose to the whole population from man made sources (other than natural sources) should not exceed 5rems per year over period of 30 years. Many countries in the world have adopted the ICRP recommendation . The main concern is to promote peaceful use of atomic energy with out any problem on heath.

There is growing concern throughout the world in recent times for codes of practice for the safe operation of nuclear power plants and safe disposals of nuclear waste which is generated from nuclear power plants.

Ionizing radiation is the radiation which can penetrate tissues and deposit its energy within them. They are of three types of electromagnetic radiation: alpha particles, beta particles (electron) and protons.

Alpha particles are 10 times more harmful than X-rays, beta particles or gamma rays but they have very little penetrating force. But they are dangerous it enters the body by inhalation or wound. X-rays & gamma rays are of short wave length and can penetrate deep.

Alpha particles can penetrate 4cm in air, 0.05mm in tissue and no penetration in lead. Beta particles can penetrate 6 to 300cm in air, 0.06-4mm in tissue and 0.005 to0.3 mm in lead. Gamma rays can penetrate 400 meters in air, 50cm in tissue and 40mm in lead. X-rays can penetrate 120-240 meters in air 15 to 30cm in tissue and 0.3 mm in lead.

“Non ionizing radiation” in compare to ionizing radiation have longer electro magnetic wave length. As the wave length becomes longer the energy of the electro magnetic wave decreases. So all the non-ionizing radiation have lesser energy than ionizing radiation. In order of increasing wave length that means lesser energy, non ionizing radiation include ultraviolet rays (UV), visible light, infrared rays, microwave radiation and radio frequency radiation.

Units of Radiation

The activity of radioactive material is the number of nuclear disintegration per unit of time. The unit of radioactive activity is Becquerel(Bq). 1 Bq is equal to one disintegration per second. Formerly unit of radiation was curie (Ci).

The potency of radiation is measured in three ways. Roentgen: It is the unit of exposure. . It is the amount of radiation absorbed in air at a given point, that is the number of ions produced in one ml of air . Rad: It is the unit of absorbed dose of radiation, that is the amount of radioactive energy absorbed per gram of tissue in humans or in any material. 1mrad (milliard ) is equal to 0.001rad of radiation. Rem: This is the product of absorbed dose and modifying factors, that means the effects of modifying factors are deducted from absorbed dose and we get the rem. Due to high speed and high penetrating power of x-rays and gamma rays the rem and rad of these are equal. This means the entire dose which is absorbed and modifying factors have no effect.

The above radiation units (roentgen, rad & rem) have been replaced by the new SI units (International System of Units). They are of three types

(1) Coulomb per kilogram(c/kg)has replaced Roentgen unit. 1 roentgen unit is equal to 2.58×104 C/kg. This is the unit for exposure.

(2) Gray(GY): It has replaced rad. It is the unit of dose of ionizing radiation that imparts 1 joule of energy to one kilogram of absorbed material. 1rad is equal to 0.01Grey (GY).

(3) Sievert (sv) has replaced rem. It is the unit of dose equivalent. 1 seivert (Sv) is equal to 100rem.

Dose equivalent(H): The concept of dose equivalent has been introduced due to the fact that all types of radiation do not produce same biological effect per unit of energy absorbed. The dose equivalent (H) of seivert, which is equal to the absorbed dose (D) of grays, multiplied by a quality factor Q, which depends upon the density of ionizing radiation produced in the tissue by the radiation.

H = DQ

The quality factor (Q) of X-ray, gamma ray and electron is equal to 1 (one), whereas for a particle it is 20. From this fact it is clear that particles like ? rays are 20 times more harmful than X-ray or gamma ray.

Radiation is a part of man’s environment. Man is exposed from two sources of radiation natural and man made.

Natural sources of radiation are cosmic rays internal rays like carbon-14 and Potassium-40, atmospheric and terrestrial. Man made sources of radiation are medical & dental X-rays, radioisotopes for treatment of killer disease like cancer, radioactive fall out from nuclear explosions. Miscellaneous man made radioactive sources are television sets, radioactive dial matches, luminous markers, isotope tagged products. They are too small a source of radiation to be significant at present.

Natural sources:

Man is exposed to radiation throughout life continuously. Cosmic rays originate in outer space and become weak as they pass through atmosphere. Generally a person is exposed to about 35mrad of radiation a year. At higher attitude of about 20 km cosmic radiation becomes important. A commercial jet pilot receives about 300mrad of radiation a year compare to normal 35mrad.

Terrestrial radiation: Radioactive elements like thorium, uranium, radium and radioactive isotopes are present in man’s environment e.g. soil, rocks, buildings. Man derives about 50mrad of radiation from terrestrial sources. Some areas like Kerala in India, rock formations contain uranium, where radiation exposure may be as high as 2000mrad per year. Radiation from radioactive gases like radon contribute about 2mrad of radiation per year.

Internal radiation: Man is exposed to internal radiation from radioactive materials stored in body tissues. These include minute quantities of uranium, thorium, radioactive isotopes of carbon(C14), Potassium(K40), strontium(Sr90). From these sources radiation is about 25mrad per year but it may be as high as 70 to 80. it is estimated that a person is exposed to about 0.1rad of radiation per year from natural sources.

Man made sources:

Man is exposed to man made sources of radiation in addition to natural sources.

X-ray: this is the largest source of man made radiation. Two groups of people are exposed to X-ray radiation, patients and radiologists & radio technicians and radiotherapists. When optimum radiographic techniques are used a single X-ray film can give more than 0.02rad.

Radioactive fallout:

Nuclear explosions release tremendous amount of energy in the form of heat, light, radiation and also it releases many radioactive substances like carbon (C14), iodine (I 131), cesium (Cs 137) and strontium (Sr 90). Cesium and strontium are very important because they are released in large quantities and their half lives are 30 years and 28 years respectively. They float for few years and due to air current the particles are distributed throughout the world. Miscellaneous sources contribute too small am out of radiation to be important.

October 9th, 2008 | Tags: Environment & Health | Category: Environment & Health | Leave a comment

Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder (OCD) is characterized by obsessive thoughts and compulsive behaviors that hamper day to day activity. Most common forms of OCDs are fear of contamination by germs or dirt, so patients keep washing hands very frequently and having to check and recheck such actions as whether a door is locked or not. The degree by which individuals get affected varies, but all cases of OCD generally take up more than1 hour per day and are undertaken to relieve the anxiety triggered by the core fear. Doctors treating patients of OCD must ask specific questions regarding recurrent thoughts and behaviors, because patients often conceal their symptoms due to embarrassment by the content of their thought and their actions. Physicians must enquire about specific clues like, chafed and reddened hands or patchy hair loss which are due to repetitive hair pulling. Symptoms like depression, anxiety, eating disorders, and tics (eating of earth) are common. Some of the OCD are of benign nature, which does not cause any problem. But some are very much embarrassing and time consuming and harmful in the long run. Some patients are obsessive with counting numbers.

Kleptomania is a dangerous form of OCD, in these patients there is an uncontrollable urge to steal any valuable or non-valuable article whenever the patient finds an opportunity to steal. These kleptomania patients are in need of urgent behavioral and psychiatric treatment.

Onset of OCD is usually gradual, beginning in early adulthood. Childhood OCD is not uncommon. Prevalence of OCD is about 2-3% throughout the world. This disorder usually takes waxing and waning course but certain cases steady deterioration of psychosocial functioning takes place.

Twin studies suggest a genetic predisposition. OCD is more common in males and in the first born children. The OCD is thought to involve the orbital frontal cortex, caudate nucleus, and globus pallidus. The caudate nucleus is involved in acquisition and maintenance of habit and skill learning. Interventions that are successful in reducing obsessive compulsive behaviors decrease the metabolic activities of caudate nucleus.

Treatment of OCD: if OCD is consuming time more than one hour per day it should be treated medically and by behavior therapy. Chlomipramine, fluoxetine, and fluvoxemine are approved for treatment of OCD by USFDA. Chlomipramine is a tricyclic antidepressant which has many side effects. Fluoxetine and fluvoxemine, are equally effective like chlomipramine with lesser side effects, that’s why these two are the preferred drugs for treatment of OCD. Fluoxetine is given at the dose of 40-60 mgs per day in divided doses and fluvoxemine is given 100-300 mgs per day. Only about 50% patients show improvement with medication alone. When therapeutic improvement is achieved long term maintenance is indicated. If pharmacotherapy is combined with behavior therapy than the result is much more encouraging than either of the treatment modalities alone.

For the individuals, particularly with time consuming compulsions behavior therapy gives as good a result as that given by medication. The techniques of behavior therapy include gradual increase in exposure to the stressful situations, maintenance of a diary to clarify the stress factors, and homework assignments which substitute new activities for compulsive behaviors. If patient is gradually exposed to increasing degree of the stressful situation, slowly patient develops tolerance to the stressful situation and it becomes normal over a period of time.

October 9th, 2008 | Tags: Obsessive Compulsive Disorder | Category: Obsessive Compulsive Disorder | Leave a comment

Unraveling Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia that makes people forget names, places and things and lose track of time and events irretrievably still remains a mystery. Science has so far failed to fully understand the exact cause of this brain disorder, let alone develop a cure. Alzheimer’s strike at old age and occasional memory lapse is the first symptom. The condition deteriorates rapidly and those suffering from its severest forms may not be able to recognize even their closest family members. Moreover, the patients often experience delusions and hallucinations.

The name “Alzheimer’s disease” entered the medical lexicon in 1907 following a description of the condition by the German physician Dr Alois Alzheimer at a scientific meeting the year before. Dr Azlheimer happened to treat a female patient in 1901, who had some peculiar symptoms like problems with memory, unfunded suspicions about her husband’s fidelity and difficulty in speaking and understanding what was said to her. After her death, which was about five years later, he performed an autopsy on her. He found that her brain had shrunken dramatically, particularly in the cortex region, the outer layer involved in memory, thinking, judgement and speech.

We still do not know the cause of the disease, but recent advances in neuro-imaging techniques have shown that those suffering from it have two abnormal structures in their brain: plaques formed of deposits of a sticky protein fragment called beta-amyloid, and tangled or twisted fibres of another protein called tau inside the dying neurons.

Most people develop plaques as they age, but those with Alzheimer’s tend to form them on a much larger scale and earlier than others. Ever since the discovery of these unusual elements in the brain of Alzheimer’s patients, scientists have been trying to find out what causes the trigger for their formation.

Recently published in an article of Nature Medicine, came up with an interesting finding. The scientists first isolated beta-amyloid from the brains of Alzheimer’s patients, and separated them as monomers, oligomers and insoluble plaque. They then injected these separately into the brains of mice. They found that memory was impaired only when soluble beta-amylid oligomers were administered the hippocampus (brain region where memory is stored) of the animals.

In an study by researchers in the UK and Canada, which appeared last week in Nature Cell Biology, says that the best way to treat Alzheimer’s is to trick the brain into not producing the tau protein, which forms the aggregates called tangles. The scientists, who studied the chemistry and structure of the tau protein, designed an enzyme inhibitor which uses a sugar molecule to lower the production of the protein. With the new insights, scientists hope that the management of Alzheimer’s disease, which is estimated to cost more than $300 billion a year-may become easier. Perhaps here may soon be drugs that can treat the worst of neuro degenerative disorders.

Tags: Tau protein
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Why Weight Sways After Losing it
Wednesday, June 11th, 2008

Losing weight may be easy, but maintaining it is difficult. But scientists (so we) now have better understanding of long term weight maintenance.

A person may lose as much as more than 200 kg of weight in 15 to 20 years and gain more than 200 kg. How it is possible and why it happens? It is possible by losing weight and again gaining the lost weight. Why it happens is because the human body is designed to sabotage weight loss at every turn. Once a body is fatter, it wants to revert to what it used to be. Physiology gets changed in two ways, the body needs fewer calories to maintain itself but the craving of food becomes more intense. So, keeping the food away means pitting one’s willpower against several biological processes involving brain, metabolism, hormones, and fat storage. That is why most people can lose weight but only few can sustain it.

Human body is designed to protect against weight lose and starvation. After a period of obesity human body change permanently the way weight is regulated by stimulating the appetite more and protecting the fat stores. After the permanent change the metabolism also changes permanently. The body requires eight (8) calories per day less energy for every pound of weight lose. This difference in energy need before and after weight loss is called “energy gap”.

There are hormonal changes also. Appetite hormone leptin, for example, is appetite regulator. This leptin tells the body to stop eating and store fat after meal. But after weight loss leptin levels are lower than before weight lose. That means appetite is more difficult to suppress. Some people are genetically prone to have lower leptin level and prone to weight gain and obesity. Similarly, another hormone ghrelin, stimulate food intake. Its level in brain falls after meals. But after weight lose the levels of ghrelin increases, and fall after meal is not as marked.

If you lose 10% of your body’s weight all the above mechanisms come into play and try to keep you from losing weight. That is the reason losing 10% of body’s weight is very easy and it becomes very difficult after that. So the person who gains weight after losing it not directly responsible for his weight gain again, it is the biology which is responsible.

There have been some interesting facts about the people who could maintain weight after losing it. They follow certain things like, instead of trying to eat less lifelong to bridge the energy gap, these people exercise more. Exercise influences some biological systems that promote weight regain, encourage the body to be more sensitive to leptons and insulin. These persons also change what they eat. They keep their calories in careful balance with what they expend. They tend to eat low fat foods.

Scientists are trying to find out how to turn the physiological response in our favor and the day is not very far when we will be able to eat and not gain weight. If not what we want to eat, at least we can eat hearts content of food (may not be of our very liking) and not gain weight.

Tags: Energy gap, Ghrelin, Leptin, Weight loss
Posted in Diet & Nutrition, Health Information, Health Tips | 1 Comment »
Common Concerns & Their Solution during Pregnancy
Sunday, June 8th, 2008

There are certain concerns during pregnancy, especially for the first timer. Concerns like what can be done and what can’t be done. What can be eaten and what can’t be eaten. What type of cloths should be worn? If one can travel during pregnancy? What are the exercises are allowed etc.

Exercise: In general, it is not necessary to limit exercise during pregnancy, provided she does not become fatigued or risk injury. Pregnant women improve their metabolic efficiency during exercise and pregnant women who exercise regularly have significant increase in blood volume. If there is no contraindication for exercise like high blood pressure, pregnant women should be encouraged to do moderate intensity exercise for 30 minutes per day like brisk walking. Pregnant women can also do yoga regularly.

Coitus: In general sexual intercourse in pregnant women is not harmful. But, whenever abortion or preterm labor threatens coitus should be avoided. Preferably coitus should be avoided after 30 weeks in pregnancy. But one should be cautious not to cause undue pressure to the abdomen.

Immunization: Immunization of pregnant women should be done according to local guideline by the local health authority. In general, two doses of tetanus toxoid with 4 to 8 weeks gap is done by third or fourth month of pregnancy. Hepatitis B vaccination of 3 doses at 0, 1, and 6 months is done during pregnancy.

Heart Burn: This is one of the commonest complain during pregnancy. It is caused by reflux of stomach contents including gastric acids into lower esophagus. This is most likely caused by upward compression of stomach by enlarged uterus. In most women symptoms are mild and can be relieved by more frequent and smaller meals and avoidance of bending over or lying flat. Antacids may be given for relief. If it is not controlled by the above measure than proper treatment should be instituted.

Travel: Travel has no harmful effect on pregnancy. Travel in properly pressurized aircraft has no danger to pregnant women and can undertake up to 36 hours, should remember certain things like periodic movements of legs, use of seat belts below level of uterus and ambulation every hour. Traveling by road especially in developing countries where road quality is not good should be taken carefully and avoided if journey is more than few hours. Train journey is safe during pregnancy.

Nausea and Vomiting: it is a common complain during the first 3 months of pregnancy called “morning sickness”. Treatment seldom gives complete relief. It can be minimized by giving small and frequent feeds. Avoid foods which cause nausea and vomiting. Smell of some foods precipitate nausea and vomiting and should be avoided. With these measures if it is not controlled than only one should go for medications.

Backache: Low back pain is seen in 70% of pregnant women. Prior low back pain and obesity are the risk factors. Severe back pain may be due to other causes than pregnancy and should be treated accordingly. Back pain can be relieved by making women squat rather than bend over when reaching down. Provide back support while sitting with a pillow and avoid high heel shoes. Do not lift heavy objects and avoid heavy work during pregnancy.

Headache: This is a complaint of early pregnancy. Most of the cases cause of headache can’t be found. Causes of headache like refractive error of the eyes and sinusitis should be ruled out. By mid pregnancy headache disappears if it is due to pregnancy. Pregnant women should get up from bed and from sitting position very slowly and avoid sudden movements.

Bathing: Pregnant women should take bath regularly, but hot water bath should be avoided. Use lukewarm water for bathing. Do not bath in very cold water. During late pregnancy heavy uterus may upset balance of pregnant women and may cause fall due to slipping. For that reason one has to be very careful during bathing.

Clothing: Clothing should comfortable and non constricting. The increasing mass of the breasts may cause pain and look pendulous; a well fitting brassiere is indicated. Constricting leg wear should be avoided.

Bowel Habits: Constipation is common during pregnancy due to increase in transit time and compression of lower bowel by the enlarged uterus. Constipation can be prevented by consuming sufficient quantity of fluid with daily moderate exercise. Food should contain enough fiber.

Pica: This is craving of pregnant women for strange foods and at times non foods. It is a symptom which may be present up to 4% of pregnant women. This may be due to iron deficiency. If iron deficiency is present it should be corrected by iron supplementation.

Excessive Salivation: During pregnancy there may be excessive salivation, may be due to stimulation of salivary glands during pregnancy by starch. Cause should be looked for and treated accordingly. But most of the cases cause is unknown. In general, salivation stops as pregnancy progresses.

Employment: Where more than 3 hours of standing per day is required should be avoided during pregnancy. Pregnant women should avoid jobs which require severe physical strain. Adequate rest should be provided during working.

Medication: Drugs (medicines) which are not safe to the fetus should be avoided during pregnancy.

Excess tea or coffee should be avoided during pregnancy. Any medical problem which arises during pregnancy should be treated by competent medical authority.

Tags: coitus during pregnancy, exercise, heart burn, immunization.
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Obesity: an open discussion
Thursday, June 5th, 2008

Obesity is the result of imbalance of energy (food) intake and output. If energy intake is more than energy output, the energy is accumulated in the body as adipose (fat) tissue, mainly in the abdomen and in subcutaneous (just below skin) tissue. The bad part of fat accumulation is that fat is accumulated in the abdomen first and while reducing weight the abdominal fat is the last to go. This energy is stored for later use if the individual can not get energy supply. So, reduced calorie intake is the cornerstone in reducing weight.

The fundamental goal of obesity reduction is to consume energy (food) below that of expenditure. The “fad diets” does not have any scientific basis. The main regimen that is followed keeps certain facts in consideration relevant to food intake and weight loss. First, 7,500 kcal of energy is approximately one kilogram of fat. Therefore, consuming 100 kcal/day less for a year will produce weight loss of 5 kg, and eating 1,000 kcal/day less will produce weight loss of about one kg per week. Dieticians advice the above regimen for weight loss.

Obese individuals have a higher metabolic rate than normal persons and men have higher metabolic rate than women (due to greater lean body mass) the rate of weight loss is greater in more obese and among men (relative to women). With chronic calorie restriction, metabolic rate diminishes because of reduced lean body mass and possibly because of other adaptations. This fall in metabolic rate with food restriction slows down the rate of weight loss on a constant diet. This is the reason of faster weight loss at the beginning and much slower weight loss later on, if a person is on constant diet.

Weight reduction is not like treatment of a disease that once the disease is cured the person need not to worry. To remain within normal weight by previously obese person require lifelong change of behavior and lifestyle as well as lifelong change of food habit. This lifestyle change has to continue even after reduction of weight to normal. Typically behavior change is brought about by counseling in a group of people and requesting them to monitor and record the circumstances relating to extra eating. Unless the obese person continues to follow the new lifestyle after weight reduction he is bound to gain weight again.

An important aspect of diet therapy is educating the obese person how to prevent weight gain. Knowledge of calorie and nutritional content of food is very important in shaping the food habit for maintaining weight. Generally obese persons liking of food is of high calorie type and there knowledge of calorie and nutrition is very poor. There is no clear evidence that one type of diet is better than others that is why it becomes more important that obese persons should be educated in nutrition and calorie content of different types of foods. In general a diet containing lots of fruits, vegetables, whole grains, and low fat and oil diet is the best diet an obese person can follow. The diet should also contain enough quantity of proteins.

October 9th, 2008 | Tags: Alzheimer’s Disease | Category: Alzheimer’s Disease | Leave a comment

Alternative Medicine: A Broad Perspective

Alternative medicine is any form of medical practice a patient embraces other than mainstream medicine. My personal view as a practitioner of mainstream medicine is “a patient should seek help from alternative medicine only when there is no acceptable treatment or management in mainstream medicine, to alleviate medical problem”. Help of alternative medicine should be taken for chronic long standing diseases when no solution can be provided by mainstream medicine. In late stage of cancer alternative medicine can at least give some psychological support to the patient and family members. If cause of backache can not be defined than ayurveda and yoga can give better management result than modern western medicine. But one should be always be careful about the side effects of alternative medicines, because many practitioners of alternative medicine claim their system to be free from adverse effects. But in reality there are no systems of medicine which have no adverse effects. The rule is simple; everything has some good and some bad things.

The following are some of the alternative medicine practices:

1) Acupuncture: A traditional Chinese medical practice that involves the insertion of hair thin needles into non anatomical energy channels called meridians. The Acupuncture practitioners have mapped the entire body for inserting needles at different locations for different problems.

2) Alexander Technique: A movement therapy that emphasizes efficient use of muscles to relieve pain, decrease skeletal strain and improve posture.

3) Anthroposopic Medicine: A spiritually based system of medicine that incorporates herbs, homeopathy, diet and a movement called eurhythmy.

4) Aromatherapy: The use of essential plant oils (distilled concentrate) in massage, inhalation and bath.

5) Ayurvedic Medicine: This is major Indian traditional medicine system of thousands of years old. They use pulse and tongue diagnosis. Treatment includes herbs, diet, exercise, oil massage and elimination regimens. They claim to heal the body not only the disease. They claim disease to be due to biological imbalance of the body and they try to correct the imbalance.

6) Bach Flower Remedies: Dilute flower infusions used to treat emotional problems.

7) Biofeedback: The use of machinery to translate physiological process into audio visual signals.
Chiropractic: they make adjustments of spinal vertebrae in an effort to affect the neuromuscular functions.

9) Craniosacral Therapy: This is gentle manipulation of spine and cranium.

10) Curanderismo: This is a spiritual healing tradition common in Mexico and Mexican Americans. They use ritual cleansing, herbs and incantations.

11) Dance Therapy: They use dance movements therapeutically to facilitate emotional expression and release.

12) Feldenkrain Body Work: This is highly structured movement sequence which emphasizes proper positioning of the head.

13) Guided Imagery: The use of imagination to invoke specific images to effect (they hope) physiological functions.

14) Homeopathy: developed by German physician Samuel Hahnemann in late eighteenth century in reaction to the toxic adverse effects of allopathic approaches. He postulated that substance that because particular side effects in a normal person can be used to treat or prevent such symptoms in an ill person if administered in miniscule amount, this is known as “doctrine of similars”. For example, poison ivy causes an itchy blistering rash. Highly diluted extract of poison ivy is recommended for treatment of chicken pox which has similar symptoms of itchy blistering rash.

15) Hydrotherapy: This use water at various temperatures, aerated or under pressure. Sometime they add salt and other substance to water.

16) Hypnosis: Under hypnosis the subject or the patient becomes more receptive to specific suggestions. It is used mainly in psychiatry patients.

17) Massage: They use specific gliding and kneading strokes and frictions to achieve muscle relaxation.

18) Meditation: It hardly requires an explanation.

19) Music Therapy: This involves listening to soothing music, playing instruments and singing.

20) Naturopathy: A mixture of modalities that includes herbs, acupuncture, homeopathy, diet, exercise and hydrotherapy.

21) Native American Medicine: It is a diverse system including prayer, chant, music, healing ceremonies, counseling, herbs, laying of hands and smudge which is ritual cleansing with smoke from sacred plants.

22) Osteopathy: It is mainly for musculoskeletal system by using manipulative techniques.

23) Reflexology/zone therapy: It is manual stimulation of points of hands and feet to stimulate distant organ.

24) Rolfing: Manual therapy to realign the body by deep tissue manipulation.

25) Shiatsu or Acupressure: It is finger pressure at various points to heal.

26) Siddha: An Indian medical system used by Tamil speaking people of Indian state of Tamilnadu. They use herbs, breathing techniques, incantation and muppu (a tri salt preparation).

27) Tai chi chaun: It is a Chinese dance like exercise called “moving meditation”.

28) Therapeutic Touch: It is healing meditation, a secular version of the laying on hands.

29) Tibetan Medicine: They diagnose by pulse and urine examination. Therapy is by diet, herbs and massage.

30) Traditional Chinese Medicine: They use acupuncture, herbs, massage, exercise, diet and diagnose by pulse and tongue examination.

31) Trager Body Work: Light massage with gentle passive movements to help patient maximize freedom of movements.

32) Unani: An Indian medical system derived from Persian system practiced mainly by Muslims.

33) Yoga: An Indian practice that include posture (asanas), breathing exercise (pranayam), and cleansing practice (kriyas). Yoga requires no more explanation than the above due to its popularity and wide acceptances throughout the world.

October 9th, 2008 | Tags: Alternative Medicine | Category: Alternative Medicine | Leave a comment

The Global Magnitude of the Problem of Cancer

Cancer afflict all the communities throughout the world. At present more than 11 million people are diagnosed with cancer and more than 7 million people die due to cancer every year, throughout the world. More than 30 million people are living with cancer at present. In term of incidence, the most common cancers are Lung cancer (12.3% of all cancer), breast cancer (10.4%) and colorectal cancer (9.4%). In terms of death from cancer the most common cancers is Lung cancer (17.8% of all deaths due to cancer).

For a disease, the relationship of incidence to mortality rate is an indication of prognosis. Similar incidence and mortality rate is indication of essentially fatal condition. That is why lung cancer accounts for most deaths from cancer (1.1 million) in the world annually, because its incidence and mortality rate is similar and it is invariably associated with poor prognosis. On the other hand for breast cancer appropriate management can be effective in avoiding fatal out come. That is why although it is second in term of incidence but in terms of mortality it is ranked 5th .

The most important feature of the distribution of cancers between sexes is the predominance of lung cancer among males. Stomach, esophagus and bladder cancers are also common among males. Usually the difference in distribution between the sexes is attributed to the difference in exposure to the causative agents rather than difference in susceptibility. For example cancers of pancreas, colorectal cancer has insignificant sex difference. So, the incidence and mortality due to cancer is not effected by sex.

Burden of cancer in different countries is different from other countries due to difference in distribution . The total cancer burden is highest in the developed countries, due to high incidence of cancer associated with smoking and western lifestyle, i.e. cancer of lung , prostate and breast. On the other hand 25% of the cancers in the developing countries are due to infectious agents e.g. Liver cancer (hepatitis B), Stomach cancer (Helicobacter pylori), and cervical cancer (Human papilloma viruse). In western countries like USA recently there is a decline of incidence and mortality due to cancer. This is due to reduction in smoking prevalence, improvement in early defection techniques and advances in cancer therapy.

In USA there is no nationwide cancer registry. So the incidence of cancer is estimated on the basis of the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database and also from population data from the U.S. Census Bureau. 1.445 million new cases of cancer (766,860 men, 678,060 women) were diagnosed and 559,650 persons (289,550 men, 270,100 women) died from cancer in 2007. Cancer incidence has been declining in USA by about 2% each year since 1992.

Cancer is the second leading cause of death behind heart disease. Under age 85 years cancer has overtaken heart disease as the number one cause of death.

October 9th, 2008 | Tags: Problem of Cancer | Category: Problem of Cancer | Leave a comment

Cancer control (Secondary prevention)

Secondary prevention comprises the following measures:

(1) Cancer registration:

Cancer registration is a sine qua non for any cancer control programme. It provides a base for planning the necessary services and for assessment of the magnitude of the problem of cancer. Cancer registries are of two types: hospital-based and population based registries.

(a) Hospital-based registries: The hospital-based registry includes all patients treated by a particular institution, both inpatients and out patients. Registries collect data as recommended by WHO in the “WHO Handbook for Standardized Cancer Registers”. If follow-up is long-term, hospital-based registries can be of considerable value in the evaluation of diagnostic and treatment programmes and also for research. Since hospital population will always be a selected population, the use of hospital-based registries for epidemiological purposes is limited.

(b) Population-based registries: The best thing to do is to set up a “hospital-based cancer registry” and extend it to a “population-based cancer registry”. 2-7 million is the optimum size of base population for population based registry. The aim is to cover the complete cancer situation in a given geographic area. The data from such registries alone can provide the incidence rate of cancer and serve as a useful tool for initiating epidemiological enquiries into causes of cancer, surveillance of time trends and planning and evaluation of operational activities in all main areas of cancer control.

(2) Early detection of cases:

Cancer screening is the main weapon for early detection of cancer at a pre-invasive (in situ) or pre malignant (cancerous) stage. Effective screening programmes have been developed for cervical cancer (Papanicolaou smear, known as pap smear), breast cancer (mammography) and oral cancer. Like primary prevention, early diagnosis has to be conducted on a large scale. But it is possible to increase the efficiency of screening programmes by focusing on high-risk groups. but there is no point in detecting cancer at an early stage unless facilities for treatment and after care are available. Early detection programmes will require mobilization of all available resources and development of a cancer infrastructure starting at the level of primary health care, ending with complex cancer centers or institutions at state or national levels (tertiary health care).

(3) Treatment:

Treatment facilities should be available to all cancer patients. Some of the cancers are amenable to surgical removal, while some others respond favorably to radiation or chemotherapy or combination of both. Since most of the known methods of treatment have only complementary effect on the ultimate outcome of the patient, multi-modality approach to cancer control has become a standard practice in cancer centers. In the developed countries cancer treatment is geared to high technology. For those who are beyond the curable stage, the goal must be to provide pain relief. A largely neglected problem in cancer care is the management of pain. The WHO has developed guidelines on relief of cancer pain “Freedom from cancer pain” is now considered a right for cancer patients.

Tags: Cancer registries, Cancer screening
Posted in Cancer | 1 Comment »
Cancer control (Primary Prevention)
Sunday, August 24th, 2008

Cancer control consists of a series of measures based on present medical knowledge in the fields of prevention, early detection through screening and population education, diagnosis, treatment, after care and rehabilitation, aimed at reducing the number of new cases, increasing the number of “cures” and reducing the invalidism due to cancer.

The basic approach to the control of cancer is through primary prevention and secondary prevention. It is estimated that at least one third of all cancers are preventable. If we analyze the causes of cancer it is seen that environmental factors are the most important in causation of cancer which are modifiable. Genetic factors which are not modifiable are responsible in small number of cases of cancer.

Primary prevention:

Cancer prevention till recently was mainly concerned with the early diagnosis of the disease (secondary prevention), preferably at a precancerous stage. Advancing knowledge has increased our understanding of causative factors of some cancers and it is now possible to control these factors in the general population as well as in particular occupational groups through population education and legislation.. They include the following:

(1) Control of tobacco and alcohol consumption: Primary prevention offers the greatest hope for reducing the number of tobacco induced (tobacco related) and alcohol related cancer deaths. It has been estimated that control of tobacco smoking alone would reduce the total burden of cancer by over a million cancers each year globally. Some countries (e.g. Norway) have adopted ambitious programmes to eradicate tobacco smoking by the year 2000, which has given encouraging results.

(2) Personal hygiene: Improvements in personal hygiene may lead t declines in the incidence of certain types of cancer, e. g. cancer cervix. Women with good personal hygiene have very low incidence of cervical cancer.

(3) Radiation: Special efforts should be made reduce the amount of radiation (including medical radiation) received by each individual (patients, medical professionals, workers at nuclear reactors) to a minimum without reducing the benefits.

(4) Occupational exposures :The occupational aspects of cancer are frequently neglected. Measures to protect workers from exposure to industrial carcinogens should be enforced in industries.

(5) Immunization: In the case of primary liver cancer, immunization against hepatitis B virus prevent people from hepatocellular carcinoma (liver cancer).

(6) Foods, drugs and cosmetics: These should be tested for carcinogens and legislation should be available to make these less harmful.

(7) Air pollution: Control of air pollution is another preventive measure which can prevent lung cancer and many respiratory problems.

(8) Avoidance of sun: Non melanoma skin cancers (basal cell and squamous cell) are induced by cumulative exposure to ultraviolet (UV) radiation. Reduction of sun exposure through use of protective clothing and changing patterns of outdoor activities can reduce skin cancer risk among Caucasians. Sunburns, in childhood and adolescence, are associated with increased risk of melanoma in adulthood. Sunscreens decrease the risk of actinic keratoses, the precursor to squamous cell skin cancer, but it may increase risk of melanoma. Sunscreens prevent burning, but this may encourage more prolonged exposure to the sun and may not filter out wavelengths of energy that cause melanoma.

(9) Energy balance: Risk of cancer increases as BMI (body mass index) increases over 25 kg/m2. Obesity increases risks for cancers of the colon, breast (female postmenopausal), endometrium, kidney (renal cell), and esophagus, although causality is not established. Relative risks of colon cancer are increased in obesity by 1.5–2.0 fold for men and 1.2–1.5 fold for women. Obese postmenopausal women have a 30–50% increased risk of breast cancer. A hypothesis for the association is that adipose tissue serves as a depot for aromatase (an enzyme) that facilitates estrogen production. Adiposity is also associated with poorer survival and increased risk of recurrence after treatment.

(10) Treatment of precancerous lesions: Early detection and prompt treatment of precancerous lesions such as cervical tears, intestinal polyposis, warts, chronic gastritis, chronic cervicitis, and adenomata is one of the cornerstones of cancer prevention.

(11) Screening for Cancer: Screening for cancer is one of the measure to prevent cancer. In the developed countries some of the cancer screening are compulsory e.g. screening for cervical cancer (Papanicolou smear known as pap smear) has virtually eradicated cervical cancer. But due to absence of this type of screening and poor personal hygiene in developing countries cervical cancer is still one of the commonest cancers in these countries.

(12) Legislation: Legislation has also a role in primary prevention. The solution to cancer control problems is not to be found in research laboratories, but in legislatures. For example, legislation to control known environmental carcinogens (e.g. tobacco, alcohol, air pollution) is inadequate or only moderately enforced in a number of countries.

(13) Cancer education: An important area of primary prevention is cancer education of general population. It should be directed at “high risk” groups. The aim of cancer education is to motivate people to seek early diagnosis and early treatment and also learn how to prevent cancer by changing lifestyle and food habits etc. Cancer organizations in many countries remind the public of the early warning signs (“danger signals”) of cancer. These are:

(a) A lump or hard area in the breast.

(b) A persistent cough or hoarseness.

(c) A change in a wart or mole.

(d) Excessive loss of blood during menstrual period or loss of blood outside the usual menstrual period.

(e) Blood loss from any natural orifice.

(f) A swelling or sore that do not heal.

(g) Unexplained loss of weight.

There is no doubt that the possibilities for primary prevention are many. Since primary prevention is directed at large population groups (e.g., high risk groups, school children, occupational groups, youth organizations) the cost can be high and programmes difficult to conduct . Primary prevention, although a hopeful approach, is still in its early stages. Major risk factors have been identified for a small number of cancers only and far more research is needed in that direction.

October 9th, 2008 | Tags: Cancer control | Category: Cancer control | Leave a comment

Causes of cancer

Cancer is a chronic disease. As with any other chronic diseases, cancer has a multifactorial etiology (cause). Carcinogens are the substances which can cause cancer to humans.

1. Environmental factors: Environmental factors are responsible for at least 90 per cent of all human cancers. The major environmental factors identified include the following:

a. Tobacco: Tobacco in various forms of usage (e.g. smoking, chewing, sniffing) is the major environmental cause of cancers of lungs, larynx, mouth, pharynx, esophagus, bladder, pancreas and also kidney. It has been estimated that cigarette smoking is responsible for more than one million premature deaths every year throughout the world in the form of cancer, respiratory problems and also in many other way. There is hardly any organ system which is not affected adversely due to cigarette smoking.

b. Alcohol: Excessive intake of alcoholic beverages is associated with esophageal and liver cancer. Some recent studies have suggested that beer consumption may be associated with rectal cancer. It is estimated that alcohol contribute to about 3 per cent of all cancer deaths in the world.

c. Diet: Dietary factors are also related to cancer. Smoked fish and meat is related to stomach cancer (consumption of smoked fish causes cancer), less intake of dietary fiber can cause intestinal cancer, excessive beef consumption can lead to bowel cancer and a high fat diet can lead to breast cancer. A variety of other dietary factors such as food additives and contaminants are also blamed to be carcinogenic. Diet rich in vitamins, minerals and antioxidants reduce the incidence of cancer.

d. Occupational exposures: These include exposure to benzene, cadmium, chromium, arsenic, asbestos, polycyclic hydrocarbons, vinyl chloride, etc. Many others remain to identified. The risk of occupational exposure is considerably increased if the individuals also smoke cigarettes. Occupational exposures are reported to account for 15 per cent of all human cancers. Occupation like road construction and handling of coal tar causes cancer of skin. Chimney sweepers are prone to develop prostate cancer.

e. Viruses : An intensive search for a viral origin of human cancers revealed that hepatitis B virus can cause hepatocellular carcinoma (liver cancer). The Epstein-Barr virus (EBV) is associated with 2 human malignancies, Burkitt’s lymphoma and nasopharyngeal carcinoma. Cytomegalovirus (CMV) is a suspected oncogenic agent of classical Kaposi’s sarcoma. Human papilloma virus (HPV) is the main suspect of cancer cervix. Main causative agent of cervical cancer is most likely a virus, due to the fact that it is almost non existence among Christian nuns who are not engaged in sexual intercourse. Whereas the incidence is very high among females with multiple sex partners. Hodgkin’s disease is also believed to be of viral origin. The human T-cell leukemia virus is associated with adult T-cell leukemia/lymphoma in United States and southern part of Japan .

f. Parasites: Parasitic infections can also increase the risk of cancer. Schistosmiasis in Middle East causes carcinoma of the urinary bladder.

g. Others: There are numerous other environmental factors such as sunlight, aeration, air and water pollution, medications (e.g. estrogen) and pesticides which are suspected to be related to cause cancer. Exposure to sun can cause skin cancer in white people, that is why skin cancer is most commonly seen in Australia and New Zealand.

h. Customs, habit and life styles: Customs, habits and lifestyles of people may be associated with an increased risk for certain cancers. The familiar examples are the demonstrated association between smoking and lung cancer, tobacco and betel chewing and oral cancer etc. Kangri cancer is seen in Kashmir. This is due to holding an earthen pot full of burning coal, in front of abdomen during winter months to keep the body warm. The skin around umbilicus is exposed to constant heat, which causes skin cancer.

2. Genetic factors: Genetic influences have long been suspected . For example, retinoblastoma occurs in children of the same parent. Certain people are more likely to develop cancer (leukaemia) than normal children. However, genetic factors are less conspicuous and more difficult to identify. There is probably a complex interrelationship between hereditary susceptibility and environmental carcinogenic stimuli in the causation of a number of cancers.

October 9th, 2008 | Tags: Causes of cancer | Category: Causes of cancer | Leave a comment

Marijuana and Cannabis & Other Related Compounds

Cannabis sativa contains more than 400 compounds in addition to delta-9-tetrahydrocannabinol (THC), Marijuana and Cannabis. Marijuana cigarettes are prepared from the leaves and flowering tops of the plant, and a typical marijuana cigarette contains 0.5–1 g of plant material. Hashish is prepared from concentrated resin of Cannabis sativa and contains a THC concentration of 8 and 12% percent by weight. “Hash oil,” a fat soluble plant extract, may contain a THC concentration of 25–60% and may be added to marijuana or hashish to increase potency. Smoking is the most common form of marijuana or hashish use. During smoking more than 150 compounds in addition to THC are released in the smoke.

Specific cannabinoid receptors (CB1 and CB2) have been identified in the central nervous system. High densities of these receptors have been found in the cerebral cortex, basal ganglia, and hippocampus.

Marijuana is the most commonly used illegal drug in the United States. Studies suggest that about 37% of high school students in the United States have used marijuana. Marijuana is relatively inexpensive and is often considered to be less hazardous than other abused drugs and substances, which is why its use is common. A very potent form of marijuana called sinsemilla is now available. Use of marijuana with crack/cocaine and phencyclidine is increased.

Methamphetamine

Methamphetamine is referred to as “meth,” “chalk,” “ice,” “speed,” “crank,” “glass,” or “crystal” in the street. Methamphetamine use is increasing in the US and other western countries. Methamphetamine can be taken by orally, by smoking, snorting, and intravenous injection. Individuals who abuse or become dependent to methamphetamine report that use of this drug induces feelings of euphoria and decreases fatigue associated with difficult life situations. Headache, difficulty concentrating, diminished appetite, abdominal pain, vomiting or diarrhea, disordered sleep, paranoid or aggressive behavior, and psychosis are the adverse effects. Dental caries is seen with chronic use and symptoms are blackened, rotting, crumbling teeth. Life-threatening methamphetamine toxicity may present as high blood pressure, heart failure, subarachnoid hemorrhage, stroke, cerebral hemorrhage, convulsions, and coma.

Lysergic Acid Dietylamide (LSD)

LSD is a very potent drug; 20 microgram can induce profound psychological and physiologic effects. Effects of LSD may persist for 12–18 hours. Visual illusions, and extreme change of mood, usually occur within 30 min after LSD intake. Tolerance develops rapidly for LSD-induced changes in psychological function when the drug is used one or more times per day for more than 4 days. Withdrawal symptoms are absent with LSD. There have been no reports of death caused by the direct effects of LSD.

Panic episode is the most frequent acute medical emergency, which may persist up to 24 hours. Supportive reassurance and, if necessary, administration of small doses of anxiolytic drugs is the management for the problem.

October 9th, 2008 | Tags: Drugs | Category: Drugs | Leave a comment