A Summary Of A Talk by Dr.Lakshmi Pal at YWCA ,New Delhi in a workshop held by Mahila Dakshata Samit

1.Teeth Grinding in Children

MYTH: Teeth grinding is due to worm infestation

FACT: Teeth grinding or Bruxism is due to daytime anxiety. Bruxism or teeth grinding by children in the night is a common problem and can begin in the first 5 years of life and seems to be associated with daytime anxiety. Untreated bruxism may create problem with dental occlusion. Helping the child find ways to reduce anxiety may relieve the problem. Bedtime can be made very enjoyable and relaxed by reading or talking with the child permitting review of fears or angers experienced during daytime. Persistent bruxism should be referred to a dentist.

2. Recurrent diarrhoea and fever in infants

MYTH: Due to teething.

FACT: Age related coincidental bacterial or viral infection causes diarrhoea in infants.First tooth usually appears between 6 and 9 months, though it may vary from 3 months to 12 months as well. Common symptoms include drooling of saliva, mood changes, irritability, swollen gums, mild fever etc.

3.Usage of dark glasses or goggles in conjunctivitis.

MYTH: To prevent spread of infection to others by direct looking.

FACT: Conjunctivitis is spread by direct contact with infected secretions and not by directly looking at people. Dark glasses only help in dealing with photophobia (intolerance to sunlight) Bacteria, virus, chlamydia, and allergy can cause conjunctivitis or infection of the conjunctiva. Bacterial conjunctivitis is a common self-limiting condition caused by bacteria like strp.aureus, strp.pneumonia, H.Influenza etc. Patient experiences redness, grittiness, burning and discharge from eyes. On waking the eyelids are usually stuck together and difficult to open. Broad-spectrum antibiotics like tobramycin and moxifloxacillin can be administered for it. A virus also causes viral conjunctivitis and the transmission of this virus is by ocular secretions and disseminated via contaminated objects shared amongst people (towels, pens etc). Adenovirus types 3,4,7 are causative organisms. Epidemic keratoconjunctivitis is caused by Adenovirus 8,19. Transmission is by hand to eye contact. Spontaneous resolution occurs in 15days. Treatment is symptomatic and supportive. Allergic conjunctivitis is seasonal. Lid edema and milky pink appearance of eye are the signs. 4.Dandruff in head MYTH: Dandruff is caused by dry scalpFACT: Dandruff in scalp is caused by a type of fungus or yeast .Dandruff or seborric dermatitis is not due to dry scalp despite manifesting as flaky scales of skin. Dandruff is caused by interaction between normal yeast organisms which live on our skin eg Mallssazia Furfur and active sebaceous glands( oil) which are heavily distributed in our scalp and face.Risk factors of dandruff are oily skin, acne, infrequent shampooing of hair or skin cleansing, weather and stress.Treatment consists of shampoo containing zinc pyrithium, selenium sulfide, coal tar or ketoconozole. Massage this on the scalp and leave it for 5-10mts.5. Usage of inhalers in Bronchial Asthma. MYTH: Inhalers cause addiction and child can never get out of it.FACT: Multi Dose Inhalers are the line of treatment today for Bronchial Asthma. They are prescribed for an extended period and patient does not get habituated to it. Bronchial Asthma is a chronic inflammatory condition of the lung airways resulting in episodic obstruction. This chronic inflammation heightens the twitchiness of airways – airway hyper responsiveness to provocative exposures. Other histopathological changes characteristic of Asthma are-1.Epithelial damage.2.Subepithelial collagen deposition3. Basement membrane thickening4.Mucus gland and smooth muscle hypertrophy. These pathological changes linked to persistent airway inflammation and hyper responsiveness form the chronic basis of bronchial asthma. Signs and symptoms of Asthma-Intermittent dry coughExpiratory wheezingChest tightness, anddyspnoea. Dyspnoea is commonly provoked by physical exertion and airway irritants like cold and dry air, tobacco smoke etc. Viral infection of respiratory tract and allergens lead to exacerbation of asthma for prolonged period .The exacerbation is more during the night leading to severe airflow obstruction. Management-Aim is toDecrease the airway inflammation by using daily controller anti inflammatory medication.Decrease pro inflammatory environment exposureControl comorbid conditions that can worsen asthma. Bronchial asthma can be controlled by long-term usage of Preventers and short time usage of relievers. Since the use of medication is for months and sometimes years it is but natural to use medicines that will cause least side effects. It has been seen that drugs delivered in the inhaler forms are very minimally absorbed in the body and so side effects are minimal in spite of using for extended period of time. At the same time they are more effective because the drug is delivered directly at the affected site.6. Injection Tetanus Toxoid for injuries. MYTH: Take injection Tetanus (TT) after every injury.FACT: Five doses of injection TT are given in childhood and thereafter one dose after every ten years. Tetanus or Lockjaw (Trismus) is caused by a bacteria called clostridium tetani present in soil and dust. This bacteria produces a very powerful neurotoxin called tetanospasmin . Incubation period of Tetanus is 2-14 days or months after injury. Prevention – DPT vaccine administration at age 6 weeks, 10 weeks and 14 weeks followed by 1stbooster at 1 ½ years of age and 2nd booster at 5 years of age. DT vaccine is given at 10 yrs of age. Adults are required to take one dose of injection TT every 10yrs. A booster of TT is given to injured persons who have completed their primary immunization series if –1. The wound is clean and minor but more than 10yrs have passed since last booster.2.Wound is more serious and more than 5yrs have passed since the last booster.7. What causes Chicken Pox? MYTH: Chicken Pox is caused by ‘Mata’ (Goddess)!FACT: Chicken pox is caused by a virus called varicella Zoster. It is a highly contagious disease. It usually starts with vesicular skin rash mainly on the body and head rather than the peripheries.Incubation period is 10-21 days.Giving two doses of vaccine at 1 yr and 5 yrs of age respectively can prevent chicken pox. But adults who have missed the vaccination in childhood can take the vaccine doses now.Treatment with antiviral drugs like Acyclovir or famcyclovir should be started within 24-48 hours from rash start. Treatment with antivirals is effective in reducing the severity and complications of the disease. Since complications are seen more in adults antiviral treatment is also recommended mostly in adults.Some parents think that it is better for children to get chicken pox than to get vaccine and so they go to the extent of exposing their children to others who have the disease. But the fact is children are better off receiving the vaccine, which is a weakened form of the virus, rather than getting the disease which can sometimes be fatal.8. JAUNDICE. MYTH: Jaundice is solely a waterborne disease.FACT: Jaundice due to Hepatitis A and E are waterborne diseases but Malaria, Dengue, Hepatitis B, C, stone in bile duct also causes jaundice but are not waterborne.Malaria and Dengue fevers are caused by mosquito bites and Hepatitis C and B are by body fluids. MYTH: Jaundice is always due to liver problem.FACT: Not always breaking down of RBCs in the blood and obstruction of bile duct can cause jaundice.In hemolytic anemia like Sickle cell disease, sphrocytic anemia etc RBCs are hemolysed or broken down and high bilurubin levels leading to jaundice occur. Similarly in Bile duct obstruction eg. Due to stone bilurubin levels in the blood goes up. MYTH: In jaundice itching means recovery.FACT: Obstructive jaundice is often accompanied by itching. But it is not a sign of recovery. Itching is caused by deposition of bile salts under the skin. When obstruction is relieved the deposition stops and jaundice improves. MYTH: Sugarcane juice can cure jaundice.FACT: Although sugarcane juice is rich in carbohydrates but it is not a cure for jaundice. On the other hand because of unhygienic conditions prevailing in our country in extracting the juice from sugarcane it can become a mode of spread of various bacterial and viral infections including Hepatitis. MYTH: Turmeric and other yellow food items should be avoided in jaundice.FACT: Turmeric and other yellow food items do not aggravate jaundice. MYTH: When a newborn has jaundice it means baby has not adjusted to mothers milk.FACT: Breast milk is the safe and only complete food for newborns. Jaundiced babies should be breastfed. There is a condition called Breastmilk jaundice where on stopping the breast-feed jaundice improves but since reintroducing breast milk in these babies does not give rise to jaundice again, this is not a contraindication for breast feed.9. DIABETES. MYTH: People with diabetes cant eat anything sweet.FACT: Sweets can be eaten in moderation by people with type 2 diabetes, if eaten as part of healthy meal plan, combined with exercise. Limiting intake of sweets is mandatory because sweets contain a lot of calories and a lot of sugar, which is a carbohydrate. Diabetics should have a dessert only after a low calorie meal. MYTH: Eating too much sweets can cause diabetes.FACT: Diabetes Mellitus is caused by a combination of genetic and lifestyle habits. It is not caused by eating too much sugar. But eating lots of sweets can lead to obesity, which can increase the risk of developing type 2 diabetes. MYTH: Diabetes is infectious.FACT: Diabetes is not infectious but if family history exists then chances of getting Diabetes is high.10. HEART DISEASES. MYTH: Heart Diseases are disease of the elderly.FACT: Though the risk increases with age but roots of heart disease may be planted as early as childhood. The build up of plaque in arteries takes years to develop and grow. Young adults who grew up on fast food and sedentary lifestyles are at increased risk of Heart Disease. So today we are seeing men and women in their 30s and 40s contracting heart attacks. MYTH: Heart Disease does not affect children.FACT: Heart disease can affect people of any age. Congenital heart disease , infections that damage heart and problem of overeating and junk food with lack of exercise put strain on the heart of children. With the growing prevalence of obesity in children there is more heart disease in young adults due to under controlled risk factors like high Blood Pressure and increases levels of cholesterol in the blood. MYTH: Heart disease doesn’t affect those who are fit and strong.FACT: Staying fit and active improves the health of heart but it doesn’t eliminate the risk of getting heart disease. MYTH: I did not see any symptoms but still got a heart attack.FACT: Increased cholesterol levels and high blood pressure that are risk factors for heart disease can exist without causing any symptoms. So periodic health check ups is a must. MYTH: My BP is under control with medicines and so I can stop taking medicines now.FACT: High blood pressure gets under control with medication but does not get cured. So medicines have to be continued. 2 oz of liquor, 16-20 oz of beer and 2 glasses of wine are permissible daily consumption limits for average adults. Large quantities of alcohol damage the heart.