7th April~World Health Day 2008

Theme: The theme for the year 2008 is "PROTECTING HEALTH FROM CLIMATE CHANGE". It highlights the need to understand the adverse impact of varied climate changes that are prevalent in present times and protect public health from the same. Raising concern on the harmful effect of climatic variability will help in tackling weather related disasters and vector-borne diseases such as malaria and dengue. Possible activities to stregthen the defense against climatic change are proper use of natural resources like water, taking proper action during health emergencies and controlling infectious diseases.

History: In the year 1948, the World Health Organization held the first World Health Assembly. The Assembly decided to celebrate 7th April of each year, with effect from 1950, as the World Health Day. World Health Day marks the founding of the World Health Organization and is an opportunity to draw worldwide attention to a subject of major importance to global health each year.

Other Important Days:
January: Blood Donor Month
24 th Jan: Women's Healthy Weight Day
February: Children's Dental Health Month
4th Feb: World Cancer Day
March: Save your Vision Month
13th Mar: World Kidney Day
April: Alcohol Awareness Month
7th April: World Health Day
May: Allergy and Asthma Awareness Month
12th May: International Nurses Day
June: Scleroderma Awareness Month
5th June: World Environmental Day
July: Cord Blood Awareness Month
1st July: Doctors Day
August: Children's Eye Health and Safety Month
23rd Aug: Health Unit Coordinator Day
September: Healthy Aging Month
28th Sept: World Heart Day
October: Breast Cancer Awareness Month
12th Oct: World Arthritis Day
November: Healthy Skin Month
14th Nov: World Diabetes Day
December: Drunk & Driving Prevention Month
1st Dec: World AIDS Day


In case of any queries please feel free to contact Dr Anil K Dhull

Sleep Functioning and Great Tips

Sleep is one of those funny things about being a human being -- you just have to do it. Have you ever wondered why? And what about the crazy dreams, like the one where a bad person is chasing you and you can't run or yell. Does that make any sense?
If you have ever wondered about why people have to sleep or what causes dreams, then read on. In this article, you'll find out all about sleep and what it does for you.

Dreaming occurs in the fifth stage of sleep.

Characteristics of Sleep

We all know how sleep looks -- when we see someone sleeping, we recognize the following characteristics:
If possible, the person will lie down to go to sleep.
The person's eyes are closed.
The person doesn't hear anything unless it is a loud noise.
The person breathes in a slow, rhythmic pattern.
The person's muscles are completely relaxed. If sitting up, the person may fall out of his or her chair as sleep deepens.
During sleep, the person occasionally rolls over or rearranges his or her body. This happens approximately once or twice an hour. This may be the body's way of making sure that no part of the body or skin has its circulation cut off for too long a period of time.
In addition to these outward signs, the heart slows down and the brain does some pretty funky things.
In other words, a sleeping person is unconscious to most things happening in the environment. The biggest difference between someone who is asleep and someone who has fainted or gone into a coma is the fact that a sleeping person can be aroused if the stimulus is strong enough. If you shake the person, yell loudly or flash a bright light, a sleeping person will wake up.
For any animal living in the wild, it just doesn't seem very smart to design in a mandatory eight-hour period of near-total unconsciousness every day. Yet that is exactly what evolution has done. So there must be a pretty good reason for it!
Reptiles, birds and mammals all sleep. That is, they become unconscious to their surroundings for periods of time. Some fish and amphibians reduce their awareness but do not ever become unconscious like the higher vertebrates do. Insects do not appear to sleep, although they may become inactive in daylight or darkness.
By studying brainwaves, it is known that reptiles do not dream. Birds dream a little. Mammals all dream during sleep.
Different animals sleep in different ways. Some animals, like humans, prefer to sleep in one long session. Other animals (dogs, for example) like to sleep in many short bursts. Some sleep at night, while others sleep during the day.

Really?
Cows can sleep while standing up, but they only dream if they lie down.
Whales and dolphins are "conscious breathers," and they need to keep breathing while they sleep, so only one half of the brain sleeps at a time.

Sleep and the Brain
If you attach an electroencephalograph to a person's head, you can record the person's brainwave activity. An awake and relaxed person generates alpha waves, which are consistent oscillations at about 10 cycles per second. An alert person generates beta waves, which are about twice as fast.
During sleep, two slower patterns called theta waves and delta waves take over. Theta waves have oscillations in the range of 3.5 to 7 cycles per second, and delta waves have oscillations of less than 3.5 cycles per second. As a person falls asleep and sleep deepens, the brainwave patterns slow down. The slower the brainwave patterns, the deeper the sleep -- a person deep in delta wave sleep is hardest to wake up.
At several points during the night, something unexpected happens -- rapid eye movement (REM) sleep occurs. Most people experience three to five intervals of REM sleep per night, and brainwaves during this period speed up to awake levels. If you ever watch a person or a dog experiencing REM sleep, you will see their eyes flickering back and forth rapidly. In many dogs and some people, arms, legs and facial muscles will twitch during REM sleep. Periods of sleep other than REM sleep are known as NREM (non-REM) sleep.
REM sleep is when you dream. If you wake up a person during REM sleep, the person can vividly recall dreams. If you wake up a person during NREM sleep, generally the person will not be dreaming.
You must have both REM and NREM sleep to get a good night's sleep. A normal person will spend about 25 percent of the night in REM sleep, and the rest in NREM. A REM session -- a dream -- lasts five to 30 minutes.
Medicine can hamper your ability to get a good night's sleep. Many medicines, including most sleeping medicines, change the quality of sleep and the REM component of it.
Missing out on a good night's sleep can seriously affect what happens when you're awake.

Dreams and Improving Sleep Habits
Why do we have such crazy, kooky dreams? Why do we dream at all for that matter? According to Joel Achenbach in his book Why Things Are:
The brain creates dreams through random electrical activity. Random is the key word here. About every 90 minutes the brain stem sends electrical impulses throughout the brain, in no particular order or fashion. The analytic portion of the brain -- the forebrain -- then desperately tries to make sense of these signals. It is like looking at a Rorschach test, a random splash of ink on paper. The only way of comprehending it is by viewing the dream (or the inkblot) metaphorically, symbolically, since there's no literal message.
This doesn't mean that dreams are meaningless or should be ignored. How our forebrains choose to "analyze" the random and discontinuous images may tell us something about ourselves, just as what we see in an inkblot can be revelatory. And perhaps there is a purpose to the craziness: Our minds may be working on deep-seated problems through these circuitous and less threatening metaphorical dreams.
Here are some other things you may have noticed about your dreams:
Dreams tell a story. They are like a TV show, with scenes, characters and props.
Dreams are egocentric. They almost always involve you.
Dreams incorporate things that have happened to you recently. They can also incorporate deep wishes and fears.
A noise in the environment is often worked in to a dream in some way, giving some credibility to the idea that dreams are simply the brain's response to random impulses.
You usually cannot control a dream -- in fact, many dreams emphasize your lack of control by making it impossible to run or yell. (However, proponents of lucid dreaming try to help you gain control.)
Dreaming is important. In sleep experiments where a person is woken up every time he/she enters REM sleep, the person becomes increasingly impatient and uncomfortable over time.

How Much Sleep Do I Need?

Most adult people seem to need seven to nine hours of sleep a night. This is an average, and it is also subjective. You, for example, probably know how much sleep you need in an average night to feel your best.
The amount of sleep you need decreases with age. A newborn baby might sleep 20 hours a day. By age four, the average is 12 hours a day. By age 10, the average falls to 10 hours a day. Senior citizens can often get by with six or seven hours a day.

Tips to Improve Your Sleep
Exercise regularly. Exercise helps tire and relax your body.
Don't consume caffeine after 4:00 p.m. or so. Avoid other stimulants like cigarettes as well.
Avoid alcohol before bedtime. Alcohol disrupts the brain's normal patterns during sleep. Try to stay in a pattern with a regular bedtime.

In case of any queries please feel free to contact: Dr Anil K Dhull

Nerve Blocks, Miracle in Pain Relief

Nerve blocks are used in the diagnosis and treatment of some painful conditions, and to provide pain relief during many conditions.

What drugs are used?
The most common drugs are local anaesthetic agents, which block all types of nerve conduction. They prevent pain and may also prevent movement in the area until the block wears off.
A variety of local anaesthetic drugs is available:
Bupivacaine ("Marcaine", "Sensorcaine") is a common longer-acting anaesthetic, widely used for epidurals, spinals and other blocks;
Cocaine is still used as a local anaesthetic in special cases;
Lidocaine (also called "Xylocaine","Lignocaine") is the most common of the short-acting local anaesthetics, and is used in many procedures;
Mepivacaine is similar to Lidocaine.
Ropivacaine is a new longer-acting agent which appears to be safer than Bupivacaine; and
Tetracaine is used mainly for spinals.
Other drugs may be added to the local anaesthetic, including epinephrine (adrenaline), to decrease bleeding, and sodium bicarbonate, to decrease the acidity of the drug, in an attempt to make it work faster.
For spinals and epidurals, narcotic painkillers such as morphine and fentanyl can be used, usually in addition to a local anaesthetic.
Will it hurt?
Most local and regional anaesthetic techniques involve using a syringe and needle to inject drugs in the correct place. Unfortunately, this can often be uncomfortable, and the local anaesthetic may sting during injection. Most patients consider this discomfort a small price to pay for pain relief during and after surgery.
During the operation, patients may still be able to feel touch and pressure. Occasionally (e.g. during delivery of a baby by Caesarean Section), patients may feel tugging. But patients should not feel pain during the operation.
Will it work?
When the right amount of the right drug is injected in the right place, it will eventually work and provide good pain relief. The problem areas are usually putting the drug in the right place and waiting long enough for it to work. In some cases, the correct spot is easy to identify (e.g. spinal anaesthesia) while, in other cases (e.g. epidural, sciatic nerve block), it is harder to find the correct spot. Most blocks take 5-20 minutes to work.
Commonly used blocks are usually 90-99% likely to work, depending on the type of block and the skill of the anaesthetist.
What are the potential side effects and/or complications?
In general, local or regional anaesthesia is very safe, and usually safer than a general anaesthetic. However, the potential for side effects or complications exists with any form of anaesthesia.
The most common side effect of a block is a temporary weakness or paralysis of the affected area. This is often useful to the surgeon, and wears off after a while.
The complications that may arise depend on the specific block. They usually occur when the local anaesthetic is injected in the wrong place. If a large volume (10-20 mls.) of local anaesthetic is injected into a vein by mistake, it may cause convulsions and even cardiac arrest. This is why physicians always inject local slowly; sucking back on the syringe to check the local is not going into a vein. Major nerve blocks are safe when performed by physicians trained in the technique, and in resuscitation, in an area equipped with oxygen, suction, drugs, and other essential equipment.
Why choose a local or regional anaesthetic?
Surveys indicate that anaesthetists would often choose local anaesthesia if they required surgery themselves, for the following reasons:
local anaesthesia avoids some of the risks and unpleasantness, such as nausea and vomiting, which sometimes occurs with general anaesthesia;
local anaesthesia often lasts longer than the surgery, providing pain relief for several hours after the operation;
local anaesthesia may reduce blood loss; and
some patients feel more "in control" when they are awake during surgery.

BLOCKS FOR VARIOUS PARTS OF THE BODY
Local infiltration for cuts and small procedures
For small cuts and the removal of small skin lesions, local anaesthetic is injected around the site. This may require several injections, but it is usually simple, safe and effective.
Blocks for eye surgery
The idea of having an eye operation while awake seems unpleasant to many patients. However, it is actually one of the best and most successful types of local anaesthesia. With the latest advances in cataract surgery, the operation is being done with smaller incisions, requiring less anaesthetic. For some operations, only eye drops are required. Other procedures require local anaesthetic to be injected around or behind the eye.
Very rare complications include: injecting into the fluid surrounding the brain, causing seizures; puncturing the eye; or a blood clot forming behind the eye, which may delay surgery.
Blocks for hand and arm surgery
Various types of block can be used:
Local infiltration. Injection of local anaesthesia around a cut or for a small operation works well and is very safe.
Blocks of individual fingers, or of nerves at the wrist are also safe and reliablle.
Intravenous Regional Blocks. A tourniquet is put around the upper arm. Local anaesthetic is put into a vein in the hand to numb the arm. This works well, but after about 40 minutes to an hour, the tourniquet becomes painful. Sometimes a second, lower tourniquet solves this problem. The anaesthetist has to be careful to ensure that the tourniquet remains inflated until the local anaesthetic is absorbed into the tissue.
Axillary block. This involves blocking the major nerves as they enter the arm, usually by placing a needle in the arm pit. A small electrical shock may be used to help find the right position to inject the local anaesthetic.
Spinal and epidural anaesthesia
Spinal anaesthesia involves putting local anaesthetic in the patient's back to "freeze" the lower part of the body. It is usually very safe and effective. It may be associated with less blood loss, and less risk of dangerous blood clots, than general anaesthesia.
Spinal anaesthesia is suitable for many procedures in the lower half of the body. Common uses for spinal anaesthesia include:
Caesarean section
hernia repair
hip and knee surgery
transurethral resection of prostate (TURP)
most procedures on the foot or leg
In general, spinal anaesthesia provides excellent pain relief during all these procedures. Patients may feel some stretching or tugging during delivery of the baby by Caesarean section, or during handling of the bowels in a hernia repair. Major orthopaedic surgery may include cutting bone and hammering to insert artificial joints, and some patients dislike the noise and/or vibration this causes. Spinal anaesthesia is especially useful during TURP surgery, as it allows the patient to detect side effects of the washing solution used in the bladder (it makes their vision fade temporarily) and it encourages clotting in the cut blood vessels.
Technically, there are two types of "spinal" anaesthesia: true spinal, or "intrathecal" anaesthesia, and epidural or extradural anaesthesia.
The first technique involves injecting local anaesthetic into the CSF, the fluid which surrounds the spinal cord. This produces a very intense nerve block very quickly, with only a small amount (half teaspoon) of local anaesthetic. The major disadvantage of a spinal anaesthetic is a drop in blood pressure, caused by temporary blockage of the nerves that control blood flow into the legs, so that blood collects in them. This can be treated with intravenous liquids and drugs, if necessary.
Headaches after spinal anaesthesia used to be a major problem. Now, with the use of very small specially-designed needles, headaches are very rare. If they occur, they can be treated with rest, adequate liquids to drink, simple pain-killers such as Paracetamol or Tylenol, and if necessary by an procedure called an "epidural blood patch".
Epidural or extradural anaesthesia uses a larger volume of anaesthetic, positioned in the fat and veins further away from the spinal cord. This block takes effect more slowly, which can be an advantage in some cases. For example, an epidural is less likely to produce a severe drop in blood pressure than a true spinal block. The other major advantage is that a small tube or catheter can be placed in the epidural space to allow the block to be continued over a period of hours or days, while a true spinal block only lasts a few hours.
The major disadvantage of epiduralanalgesia is that larger amounts of local anaesthetic are used (about 20 mls.) which can cause serious complications if they are put in the wrong place. In a vein, the local anaesthetic may cause convulsions or cardiac arrest. In the CSF, it may spread too high, which may stop the patient breathing. Fortunately, all of these complications can usually be treated by an anaesthetist, without long-lasting problems.
Pain relief in labour
If relaxation and breathing exercises prove ineffective, nitrous oxide ("laughing gas") or narcotics (demerol, pethidine, morphine) may help. However, epidural analgesia is the most effective form of pain relief in labour, and it can even be extended for use in forceps delivery or Caesarean section.
A small, sterile plastic tube is placed in the patient's back by an anaesthetist. Local anaesthesia is inserted, providing pain relief. Sometimes narcotic pain killers are added for increased effect. Pumps can be used to keep the epidural "topped up".
Side effects may include temporary weakness in the legs, difficulty passing urine, and/or a decrease in blood pressure.
Rare complications may include headache, decreased breathing, and/or seizures. Cases of paralysis may occur as a result of: injecting the wrong drug; a clot or infection in the epidural space; and/or inadequate treatment of complications, but this is an exceedingly rare complication.
Women who have epidurals in labour may be more likely to have forceps deliveries or Caesarean sections. They may also be more likely to have backache after delivery than women who did not have epidurals.
Epidural analgesia may avoid the potential complications of an emergency general anaesthetic, and is especially useful for women with high blood pressure, twins, or breech presentation.
Other types of nerve block
There is a wide variety of other nerve blocks, including blocks at the ankle, around the groin, in the buttocks, underneath ribs and in various locations on the face. Nerve blocks are also used in the diagnosis and treatment of some painful conditions, such as the use of epidural steroid injections for some types of back pain.
CONCLUSION
All medical procedures have risks and benefits. For many operations, the risk/benefit ratio for local or regional anaesthesia is better than for general anaesthesia. Patients should ask whether their operations can be done under local or regional anaesthesia, and discuss this issue with their physicians.

DISCLAIMER: This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Health Mirror, the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

In case of any queries feel free to contact Dr Anil K Dhull

Is alcohol more dangerous than ecstasy?

Scientists in Britain are proposing a complete revamping of drug classifications in the wake of findings that reveal some major discrepancies between a drug's legality and its safeness. A study surveying health, crime and science professionals regarding the dangers of a set of 20 legal and illegal drugs, published in The Lancet in March 2007, found that alcohol and tobacco, which are legal in Britain and the United States, are considered by experts to be more dangerous than ecstasy and marijuana, which are illegal in both countries.
In Britain, under the Misuse of Drugs Act, illegal drugs (including prescription drugs sold on the street) are classified as A, B or C. Class A is supposed to be the most harmful, and Class C is supposed to be the least harmful. For instance, heroin is a class A drug, and marijuana is a class C drug. The study was intended to achieve harm rankings for 20 drugs, 15 illegal substances and five legal substances that have shown potential for harm, using a systematic, scientific approach. The researchers surveyed two separate groups of experts including medical doctors, mental health professionals, scientists and forensics experts. Each group returned similar ranking results for the 20 drugs based on three primary features:
· physical harm to the person using the drug
· the drug's potential for abuse and/or dependence
· the drug's ill effects on society
Probably the most notable discrepancy is the position of alcohol, a legal drug, at 13 places above ecstasy, an illegal, class A drug. And LSD, also a class A drug, was ranked considerably less harmful than benzodiazepines, a class C group of drugs.
The results seem to call into question exactly which method the British government is using to determine the relative harmfulness of drugs. According to the authors of the study, "Tobacco and alcohol together account for about 90 percent of all drug-related deaths in the U.K." Yet both of those substances are legal. In the United States, a study published in the journal of the American Medical Association in 2000 shows that 95 percent of drug-related deaths in the United States are from alcohol and tobacco use.
With little documentation that attempts to explain the current governmental ranking criteria, the study proposes a method for classifying drugs that uses scientific assessment. The classifications would be based on the three indicators of harm as presented to experts in the study -- personal, physical harm; abuse/dependence potential; and social harm. In the study, the rankings for each of the criterion were combined, with the researchers taking the mean of the three scores, to obtain the overall rankings listed above.
Of course, the legal status of drugs like alcohol and tobacco skews the results. Their legal status makes them far more available, so an accurate side-by-side comparison with a drug like heroin on all three criteria is impossible. Availability will always affect social effects of any given drug. Drugs that are easily available, legal and non-stigmatized logically will result in more widespread use, more adverse reactions and more money spent on police assistance and/or hospital care as a result of those adverse reactions.
Still, availability most likely wouldn't skew the abuse potential or the personal, physical harm associated with a drug. So the study does at least reveal some possible inconsistencies in British (and U.S.) drug law. Ultimately, the researchers believe that the foundations of drug policy need to be more transparent, since those foundations effect everything from public education to criminal sentences to treatment programs to methods of control and enforcement. They point out that without a clear, scientific basis for determining a drug's legal status and harmfulness, it's hard to establish credibility in the policies that dictate how a "drug war" is carried out, and it's hard to determine how effective those policies really are.

Sources
·"Alcohol, tobacco among worst drugs." CNN.com. Mar. 23, 2007.http://www.cnn.com/2007/HEALTH/03/23/drugs.report.ap/index.html
·"Annual Causes of Death in the United States." Drug War Facts.http://www.drugwarfacts.org/causes.htm
·"New 'matrix of harm' for drugs of abuse." Bristol University. Mar. 23, 2007.http://www.bris.ac.uk/news/2007/5367.html
· Nutt, David, et al. "Development of a rational scale to assess the harm of drugs of potential misuse." The Lancet, 2007; 369:1047-1053.http://www.thelancet.com/journals/lancet/article/ PIIS0140673607604644/fulltext
·"Scientists want new drug rankings." BBC News. Mar. 23, 2007.http://news.bbc.co.uk/1/hi/health/6474053.stm?ls
· HSW team http://recipes.howstuffworks.com/alcohol1.htm
· Photo courtesy: Carolina Brewing Company

In case of any queries please feel free to contact Dr Anil K Dhull

How can nicotine be good for me?

By now the health hazards of smoking and tobacco use are well known. Smoking is the chief preventable cause of death in the United States and a major contributor to many types of cancer, heart disease and other serious or potentially fatal conditions. Cigarettes are also expensive, addictive and they leave a bad odor. However, medical researchers have begun to show interest in one of the most reviled components of cigarettes -- nicotine. And they're interested in this potent, powerfully addictive substance for its health benefits.
Over the past decade, new research has taught us more about how nicotine affects the brain and the body. Some of it is good news -- for example, a lower incidence of Alzheimer's disease in smokers. Research has pointed to a compound called acetylcholine as the reason. Nicotine is structurally similar to acetylcholine, a naturally-occurring compound that serves as a neurotransmitter. Nicotine binds to nerve receptors and makes nerve cells fire more frequently. In one study, a group of Alzheimer's patients were given nicotine patches, while another received a placebo. Those with nicotine patches maintained their cognitive abilities longer and sometimes even recovered lost cognitive function. A follow-up study indicated that nicotine may also boost cognitive abilities in elderly people who aren't suffering from Alzheimer's but who are experiencing the typical mental decline associated with old age.
Nicotine is the highly addictive substance found in tobacco that gives users a buzz. It may also have some health benefits.
The transformation with nicotine happened when the nicotine patch was introduced. Intended to help smokers quit, the nicotine patch also opened up a whole new way of studying the drug. Suddenly scientists had a reliable delivery system -- one without the numerous carcinogens found in cigarettes -- that could be standardized across various studies. A 1982 study revealed that patients with ulcerative colitis had fewer flare-ups when taking nicotine. However, side effects proved nicotine to be a poor long-term treatment.

In 2000, a study performed at Stanford revealed surprising results about nicotine's effects on blood vessels. Contrary to popular opinion, the study showed that nicotine actually boosts the growth of new blood vessels. The discovery may lead to new treatments for diabetes. Many people with severe diabetes experience poor circulation, which can lead to gangrene and ultimately, limb amputation.

Researchers from the Scripps Research Institute published a study in 2002 that revealed a connection between nornicotine -- a chemical found in tobacco and also created when the body breaks down nicotine -- and a reduction of Alzheimer's symptoms. However, nornicotine is toxic, pointing to the need for a nontoxic substitute.

­­In 2006, Duke scientists found that people with depression who were treated with nicotine patches reported a decrease in their depressive feelings. The results were perhaps not surprising for a drug associated with imparting a "buzz." However, the research also showed a direct link between nicotine and an increase in the release of dopamine and serotonin, two vital neurotransmitters. A lack of dopamine or serotonin is a common cause of depression.

Warning: Cigarette smoking & tobacco chewing are injurious to health.

In Case of any queries please contact Dr Anil K Dhull