Research links excess weight to premature death

BY GEOFFREY MULINDWA

Increasingly many people worldwide are either overweight or obese. Being overweight or obese is associated with a higher risk of dying prematurely than being normal weight, according to a collaborative study conducted at Harvard H T Chan School of Public Health and Cambridge University. The study was published on July 13, 2016.

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How does one know whether one is overweight or obese? This is done by calculating one’s Body Mass Index (BMI).

BMI is one’s weight in kilogrames divided by one’s height in metres squared. Because the calculation requires height and weight, it is inexpensive and easy to use for both clinicians and for the general public.

Since in adults above 19 years, height does not change, one can monitor their BMI by keeping an eye on the changes in weight.

Once you have done the above BMI calculation, the table on the top right is an indicator of one’s weight status:

The harmful effects of excess body weight on chronic disease have been well documented. These include increased risk for diabetes, cardiovascular (heart) diseases and cancer. 

To obtain an unbiased relationship between BMI and mortality, it was essential to analyse individuals who had never smoked or had no existing chronic disease. Smokers tend to weigh less than non-smokers, but have a much higher mortality rate

In order to obtain more definitive evidence of the association between excess body weight and premature mortality, researchers joined forces in 2013 in order to establish Global BMI mortality collaboration involving 500 investigators from 300 global institutions.

The researchers looked at data from more than 10.6 million participants from 239 studies carried out between 1970 and 2015, in over 32 countries, in four continents. Out of 10.6 million people, 4 million adult participants were followed over 14 years and 1.6 million deaths were recorded across these studies.

The results showed that participants with the normal/healthy weight had the lowest risk of premature mortality.

The risk of mortality increased significantly over the overweight range.

The BMI of 25-27.4 was associated with seven percent higher risk mortality, the BMI of 27.5-29.9 was associated with a 20 percent higher risk, the BMI 30-34.9 was associated with a 45 percent higher risk, the BMI of 35-39.9 was associated to 94 percent higher risk and the BMI of 40-60 had a three-fold risk. 

Every five units higher BMI above 25kg/sq. m was associated with a 31 percent higher risk of premature mortality. Participants who were underweight also had a higher mortality risk

Looking at specific causes of death, the study found that for each five unit increase in BMI above 25 kg/sq. m, the corresponding increase in risk were 49 percent for cardiovascular mortality, 38 percent for respiratory disease mortality, and 19 percent for cancer mortality.

Researchers also found that the hazards of excess body weight were greater in younger than older people, and in men than in women

BMI is one of the parameters that are assessed at Allan Galpin Health Centre whether one is sick or not. Health education is then given to the client on lifestyle interventions necessary to attain/keep within a safe BMI range.

The author is Director of Medical Services at Uganda Christian University (UCU)

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UCU in cancer screening

BY DOREEN KAJERU 

This Easter semester, the Health Awareness Week (HAW) was spearheaded by Save the Mothers Department under the theme “Safe Motherhood and You.”

It involved several activities such as counselling, sensitization, blood donation, community service and most outstandingly, cancer screening.

Cancer is a common, non-communicable disease that manifests in a number of ways. It affects all age groups, and both genders. Some of the types of cancer include lung, thyroid, kidney, prostate, cervical and breast cancer, among others.

During the week, there was screening at the Alan Galpin Centre for three types of cancer, that is, prostate, cervical and breast cancer.

A total of 116 women were screened for breast and cervical cancer and 23 men for prostate. Four women were referred for further investigation.

Dr. Geoffrey Rwabaingi Mulindwa, the director of Medical Services at the Alan Galpin Centre, said that those with positive test results were then recommended for further tests and diagnosis to rule out or confirm the presence of cancer. “We do not want people to be told that they have cancer at advanced stages,” he said.

Mulindwa added that the increased prevalence of cancer is as a result of change in lifestyle, low or poor awareness and lack of early screening opportunities. Unlike staff, sensitization among the student community is still a challenge because of the lack of a general communication platform.

Cancer just like any other disease condition can be cured and controlled if detected at an early stage. Radiotherapy and other control measures can be adapted to help curb the spread of cancer all over the body.

Dr Mulindwa encouraged people to have healthy sexual relations and exercise regularly, at least 3o minutes daily. Quoting Daniel 1: 12-16, he advised the community to eat healthy and include fruits and vegetables in their diet.”

Immunization of young girls against the Human Papilloma Virus (HPV) can also be done to prevent the contraction of cervical cancer. When this is done, the prevalence of the condition can be controlled.

Dr. Mulindwa advised the community always to seek medical advice about body changes or conditions like the constant headaches because in most cases they are symptoms of a disease.

Ear syringing: dealing with blockage of ears

 

BY ALEX TAREMWA 

Ear syringing is the act of removing earwax, dead skin or a foreign body by way of gentle flushing with warm water via a narrow nozzle attached to a custom-designed syringing device.

“Ear wax is normal and is produced to form a protective coating over the skin in the ear canal. Ears are normally self-cleaning. The movement of one’s jaws whilst eating and talking helps to move the wax along the canal where it will usually fall out naturally without one noticing,” Christine Waako, a Clinician at Allan Galpin Health Centre told The Standard .

The amount of ear wax produced varies from person to person.

However, some people produce excessive amounts which can lead to a blockage in the ear canal. One is likely to develop a blockage of wax in the canal if they:

  • Use cotton ear buds to clean the ear as this pushes the wax deeper into the canal
  • Wear a hearing aid, ear plugs or use in-ear speakers for i-pods or similar gadgets, as these can all interfere with the natural process of wax expulsion
  • Have abnormally narrow ear canals
  • Have a particularly hairy ear canal
  • Are elderly because the ear wax you produce is drier and harder
  • Have a dry skin problem such as eczema or psoriasis.

Treatment of ear blockage may not require visiting a health centre. Here is a simple step-by-step process to manage one in case it arises:

Use olive oil drops two or three times daily for about 14 days as follows:

  • Lie on your side with the affected ear uppermost
  • Pull the outer ear gently backwards and upwards to straighten the ear canal
  • Put 2-3 drops of olive oil into the affected ear(s) and gently massage just in front of the ear
  • Stay laying on your side to allow the wax to soak in for around ten minutes
  • Afterwards, wipe away any excess oil but do not plug your ear with cotton wool as this simply absorbs the oil.

Initially your hearing problem may worsen after the above process. This is why one is advised to concentrate on treating one ear at a time.

In most cases, after 14 days, the wax will have softened sufficiently to encourage the wax to come out without further intervention.

However, if your hearing is still impaired, please see a medical practitioner for further advice and management.

Alternatively, there are now over-the-counter kits available from pharmacies. These contain a wax softener, which you use for 3-4 days, and a small bulb syringe to enable you to remove the wax from your ear canals yourself.

Usually ear syringing is considered after the above recommendations have proved to be unsuccessful.

Ear wax needs to be softened as above for 3-5 days before attempting to syringe.

Although the risks are low and our nurses are specially trained to perform this procedure, there is still a small chance (thought to be around 1 in 1000) of complications occurring such as a perforated ear drum, middle ear infection, external canal infection or causing ringing in the ear (tinnitus).

If you experience any pain, discharge or bleeding from the ear, sudden deafness or buzzing, foreign bodies in the ear or dizziness, seek medical advice from a health practitioner.

What to do before and after an animal bite

BY GEOFFREY MULINDWA 

Director Medical Services, Allan Galpin Health Centre 

 

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During the Easter break in 2014, a spouse to an employee at the university was bitten by a stray dog while sitting on a boda boda at a junction on Jinja Road. That was a source of anxiety on the part of the family.

Allan Galpin contacted the Department of Veterinary Services at the district, who were not of much help. She was treated, recovered from her wounds and has been followed with no incident.

Last (Trinity) semester, an employee from the Dining Hall was bitten by a dog on campus while going for work at 6.30 am in the morning. This employee was also treated for her wounds and received human Anti-Rabies vaccine. She has also been treated and she recovered from her wounds.

In both incidences neither the patients developed symptoms of rabies nor were the dogs diagnosed to have rabies.

Transmission 

All species of mammals are susceptible to rabies virus infection, but only a few species are important as reservoirs for the disease. Here in Uganda cases of rabies have been identified in domestic animals like dogs, cats, cattle and goats and also in wild animals like foxes, jackals, monkeys, rabbits and the mongoose. Several species of insectivorous bats are also reservoirs for strains of the rabies virus.

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The majority of rabies cases reported to the Center for Disease Control and Prevention (CDC) each year in USA occur in wild animals like raccoons, skunks, bats, and foxes.

Transmission of the rabies virus usually begins when infected saliva of a host is passed to an uninfected animal. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host.

Though transmission has been rarely documented via other routes such as contamination of mucous membranes (i.e. eyes, nose, mouth), aerosol transmission, and corneal and organ transplantations, it is possible.

The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people are similar to those of many other illnesses, including fever, headache, and general weakness or discomfort.

There may be also discomfort or a prickling or itching sensation at the site of bite. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hyper salivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water).

Death usually occurs within days of the onset of these symptoms. The acute period of disease typically ends after 2 to 10 days. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive.

Disease prevention includes administration of both passive antibody, through an injection of human immune globulin and a round of injections with rabies vaccine.

Once a person begins to exhibit signs of the disease, survival is rare. To date less than 10 documented cases of human survival from clinical rabies have been reported and only two have not had a history of pre- or post-exposure prophylaxis.

Diagnosis 

In animals, rabies is diagnosed using the direct fluorescent antibody (DFA) test, which looks for the presence of rabies virus antigens in brain tissue. In humans, several tests are required.

Within a few hours, a diagnostic laboratory can determine whether or not an animal is rabid and inform the responsible medical personnel.

The laboratory results may save a patient from unnecessary physical and psychological trauma, and financial burdens, if the animal is not rabid.

In Uganda diagnosis is mainly done on clinical grounds. Laboratory diagnosis can only be carried out in the Veterinary Central Laboratory in Entebbe.

Management of suspected rabies cases 

Following potential exposure to rabies, the wound or site of exposure should be cleansed under running water and washed for several minutes with soapy water as soon as possible after exposure. Disinfectant and dressing should be applied.

The use of vaccines after exposure should be considered whenever a person has been attacked by an animal. In the un-immunized individuals 5 doses of human anti-rabies vaccines is given over a month on days 0, 3, 7, 14 and 30.

Rabies in humans is 100% preventable through pre-exposure prophylaxis (prevention) and prompt appropriate medical care.

Yet, more than 55,000 people, mostly in Africa and Asia, die from rabies every year, a rate of one person every ten minutes.

Pre-exposure prophylaxis should be offered to those at high risk like those working in quarantine stations, animal handlers, veterinary surgeons and field workers likely to be bitten by wild animals.

The most important global source of rabies in humans is from uncontrolled rabies in dogs.

Children are often at greatest risk from rabies. They are more likely to be bitten by dogs, and are also more likely to be severely exposed through multiple bites in high-risk sites on the body.

Severe exposures make it more difficult to prevent rabies unless access to good medical care is immediately available.

This major source of rabies in humans can be eliminated through ensuring adequate animal vaccination and control, educating those at risk, and enhancing access of those bitten to appropriate medical care.

Recently, at the prompting of the UCU Health and Safety Committee, the Facilities and Capital Projects in collaboration with the District Veterinary Department has carried out killing of stray dogs on the campus.

The control of stray dogs off-campus is the mandate of the Municipality Veterinary Department .

Allan Galpin gets Shs 50m machine

Zac
Zac Tamale, the senior laboratory technician at Allan Galpin Health Centre, operates the new machine (on his right) through a computer.

BY ALEX TAREMWA

Allan Galpin Health Centre has set itself new target following the acquisition of a first of its kind, GYAN laboratory chemistry analyser at a cost of about Shs 50m.

The fully-automated, Belgian-made equipment with standard control that can test over 20 laboratory samples at ago, will, in the words of Zac Tamale, a laboratory technician at Allan Galpin, boost the diagnosis of patients and cut on the number of staff and student referrals the clinic makes to external, more sophiscated hospitals.

“With this machine, we can monitor variations in hypertension, blood
pressure, cholesterol and fat, bone profiles, blood calcium and iron in the
body,” Tamale explained.

In addition to the above list, the machine has the capacity to also look into
liver, kidney and heart related complications. This development comes at an opportune moment when Uganda Christian University (UCU) has unleashed plans of running a medical school in conjunction with Mengo Hospital.

The Allan Galpin Director of Health Services, Dr Geoffrey Mulindwa, said
the new acquisition, coupled with the expertise and know-how that the
centre currently boasts, will help the community around the university
considering that it is the first of its kind in Mukono.
“The clinic now has the capacity to carry out diagnosis on body organs like the liver, kidney and to assist clinicians improve on diagnosis and treatment planning,” he said.

Mulindwa added that “this will, to some extent, reduce on referrals for investigations, improve on timely decision-making to have better outcomes and cut the cost considering that UCU plans to delve into medical education and integrating faith service and learning.”

Its operation temperature is 37 degrees Celsius and has a high precision
diluter with an automatic probe wash cycle in between tests to avoid cross-contamination.

Mulindwa is confident the white piece of gadgetry, which is the size of an HP LazerJet 5200 dtn printer, that is only operational when connected to a computer, would help his staff do many blood chemistry tests for the liver kidney, heart, bone and lipid profiles.