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- Thalassaemia.
- Tooth loss.
- Tuberculosis.
Thalassaemia
It is an inherited condition, in which there is a disorder in the production of haemoglobin and which leads to anaemia
(low red blood cell count). People with the disease have an inability to manufacture sufficient quantities of globin
chains.
The first description of the disease was found over 50,000 years ago, in a valley south of Italy and Greece now covered
by the Mediterranean Sea. The name Thalassaemia is derived from a Greek word meaning sea.
Thalassaemia can be divided into major and minor. The person with the minor form can lead a normal life. He may not
even realise he has the condition.
However, the major form is very serious. The person has severe anaemia requiring regular blood transfusions, and is liable to get:
- infections from the blood transfusion, for example, Hepatitis, AIDS etc. &
- Iron overload, which in turn causes heart complications and diabetes.
The person with Thalassaemia major usually has a shortened life span.
Thalassaemia is better understood in the context of anaemia. Blood is made up of a lot of red blood cells and yellowish liquid called plasma.
Red blood cells are produced constantly. The blood contains a substance called haemoglobin, which carries oxygen from the lungs and circulates
in the body.
Haemoglobin contains a lot of iron, and when red blood cells are broken down, most of the iron is used again to make new haemoglobin.
Haemoglobin also carries away the waste product of carbon dioxide. When something goes wrong with the production of haemoglobin,
defective haemoglobin is incorporated into red blood cells, and as a result, the red blood cells do not function properly. They
are also more likely to die off. This leads to anaemia.
Each haemoglobin molecule consists of two chains, an alpha and a beta chain. The two main types of Thalassaemia are named after the
deficiency in the formation of one of the chains. Thus, alpha Thalassaemia is due to the inability to manufacture enough alpha chains.
And, beta Thalassaemia is the inability to manufacture enough beta chains. It can be likened to a manufacturer of shoes. If you make
too few left foot shoes, you cannot sell any of the incomplete pairs even if you compensate by making more right foot shoes!
Signs and symptoms:
The symptoms of Thalassaemia depend on the genetic defect and its severity. The more severe the genetic defect, the less haemoglobin that is produced
and the more severe the anaemia that results. Thalassaemia minor may not cause any symptoms. If it does, the most common symptom is long-term, mild
anaemia.
Strictly speaking however, there may sometimes be no symptoms - as the definition of a symptom is something that is complained of by the patient.
Thalassaemia minors do not realise they have Thalassaemia minor, so they do not complain. They are thus, "asymptomatic" or with no symptoms.
Someone with Thalassaemia major usually has severe haemolytic disease. This means that the red blood cells are constantly being destroyed, faster than the
body can replace them. Thalassaemia major can usually be diagnosed by 1 year of age, but the age of diagnosis is dependent on various factors, including
access to good doctors and facilities.
The symptoms of Thalassaemia major may include: paleness, jaundice, or yellow coloured skin, failure to thrive, if young, enlarged spleen and liver and
bony abnormalities, especially of the facial bones. Children with Thalassaemia major are normal at birth but become anaemic between the ages of three
months and eighteen months. They become pale; unable to eat and sleep well, and may vomit their feeds. If not treated, they usually die between one
and eight years old.
Causes:
Thalassaemia is a common genetic disease. Thalassaemia is diagnosed through blood tests. A sample of blood is taken to look for a low red blood cell count,
low haemoglobin levels, small red blood cells, or an abnormal red blood cell structure. Sometimes a more complex genetic analysis is needed.
Treatment/Prevention:
Thalassaemia is an inherited disorder. When one parent carries the gene, there is a 50% chance of having a child with Thalassaemia minor with every pregnancy.
None will get Thalassaemia major. When both parents carry the gene, there is a 25% chance of having a child with Thalassaemia major and a 50% chance of having
a child with Thalassaemia minor with every pregnancy. The chances are the same with each pregnancy, no matter how many children the couple may have.
Since Thalassaemia can be passed on from one generation to another, couples should go for screening if they are planning to get married or start a family.
If you are already pregnant, and both you and your husband have Thalassaemia minor, you should go for a prenatal diagnostic test to find out whether your
unborn baby has Thalassaemia major. Prenatal diagnosis can be done by chorionic villus sampling or foetal blood sampling. Both tests are conducted under
ultrasound guidance.
Chorionic villus sampling involves obtaining some cells from the placenta for testing. This is done before 10 weeks of pregnancy. Foetal blood sampling
involves obtaining a small amount of foetal blood from the umbilical cord for testing. This procedure is done at about 18-20 weeks of pregnancy.
Based on the result of the test, the doctor will advise you and your husband accordingly. Prenatal diagnosis gives the couple the choice to
continue the pregnancy or not.
The only treatment for Thalassaemia major is regular blood transfusions, usually every three or four weeks. Most children, if given such transfusions, grow
normally and live normally into their 20s. After each blood transfusion, the red cells in the new blood are broken down slowly over the next four months.
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Tooth loss
The most common causes of tooth loss are dental caries, also known as tooth decay, and periodontal disease, which affects the
gums and bone structure that supports the teeth.
Loss of all natural teeth can result in a person's psychological, social, and physical impairment. Some people have difficulties adjusting back
to a normal life after losing their natural teeth. This is because even when missing teeth are replaced with well-constructed dentures, there may
be some limitations in speech, chewing ability, taste perception, and quality of life.
Therefore, it is important to understand how tooth loss occurs and take steps to prevent it, through education, early diagnosis, and regular dental care.
The rest of this article discusses the causes, symptoms and treatments for periodontal disease and dental caries.
Causes:
Plaque contains bacteria, which in turn create toxins (poisons), irritate the gums and result in a breakdown of the attachment of gum tissues to teeth.
The accumulation of plaque and tartar (calculus) at the base of the teeth breeds infection.
Inflammation causes a pocket, which is filled with plaque and tartar, to develop between the gums and the teeth. If left untreated, the infection and
inflammation may start to spread from the gums (gingiva) to the ligaments and bone that support the teeth.
Inflammation causes a pocket, which is filled with plaque and tartar, to develop between the gums and the teeth. If left untreated, the infection and
inflammation may start to spread from the gums (gingiva) to the ligaments and bone that support the teeth.
Eventually, loss of support causes the teeth to become loose and fall out.
Besides plaque, a number of other factors can increase the risk, severity and speed of development of the condition. Smokers, pregnant women and people who
use oral contraceptives are more likely to have periodontal diseases. Poor diet may cause periodontal diseases to progress more rapidly.
Poorly fitted bridges, badly aligned teeth or defective fillings can all contribute to plaque retention and increase the risk of developing periodontal
diseases. Excessive biting forces on your teeth, such as clenching or grinding, may also accelerate the rate at which supporting bone is lost.
Diseases, such as AIDS or diabetes, can lower the tissues' resistance to infection, making periodontal diseases more severe. Certain medications such as steroids,
cancer therapy drugs, some calcium channel blockers and many others - also affect the gums.
Signs and symptoms:
- Red, swollen or tender gums.
- Gums that have pulled away from the teeth.
- Gums appear bright red or red-purple.
- Gums appear shiny.
- Gums bleed easily: blood on toothbrush even with gentle brushing of the teeth.
- Pus between the teeth and gums when the gums are pressed.
- Persistent bad breath or bad taste.
- Permanent teeth that are loose or separating.
- Any change in the way your teeth fit together when you bite.
Treatment:
The teeth have to be cleaned thoroughly to remove deposits from the teeth. Surgical treatment may be necessary if deep pockets have to be opened and cleaned.
Loose teeth may need to be supported. Extraction of a tooth may be necessary for advanced periodontitis so that destruction doesn't spread to adjacent teeth.
For some people, a dental implant may be necessary to replace teeth that are lost. Dental implant is an artificial tooth root that is placed into your jaw to
hold a replacement tooth or bridge. They help restore the confidence about how you feel about yourself, both personally and professionally. With proper care
and maintenance, implants can last a lifetime.
Prevention:
Good oral hygiene, including thorough tooth brushing and flossing, and regular professional dental cleaning, is the best means of prevention.
Some of the measures to take are:
- Brush your teeth at least twice daily. Use a soft-bristle brush and fluoride toothpaste to remove plaque and food.
Floss once daily to remove plague and food stuck in the gums and teeth. Also brush your tongue. Replace your
toothbrush every three months because germs accumulate and bristles lose efficiency.
- Check for gum disease: swelling, tenderness, or bleeding, constant bad breath or bad taste, loose or shifting teeth.
Gums should be coral pink, not red.
- Eat a nutritious, balanced diet. Avoid gooey, gummy, or hard candy that stays in the mouth longer than other sweets.
- Visit your dentist at least once a year
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Tuberculosis
Tuberculosis, or TB, is an infectious disease. It is caused by a germ known as mycobacterium tuberculosis. Up until a little
more than 50 years ago, there were no drugs to cure TB. Now, we have adequate facilities and means to diagnose, prevent and
treat TB. Yet, we are still facing a worldwide epidemic of TB. Worse, we are seeing an emergence of a TB germ that is resistant
to the drugs we use to treat the disease. WHO estimates that TB kills about 2 million people a year worldwide.
TB infections are spread through the air. When people who are infected cough- or sneeze, they spray TB germs into the air.
Another person gets infected when they inhale these TB germs.
Risk of getting TB:
Not everybody who gets infected with the germ develops an illness. The body's immune system 'walls off' the TB germ, which can
lie dormant in the body for years. But even in people who have no apparent deficiency in their immune system, TB develops in
about 10% of those infected, especially, if recently infected. However, if the person's immune system is weakened e.g. by AIDS
or drugs the chance of getting sick will be higher. Hence, the risk of developing active TB disease is higher in certain groups:
- Children.
- Close contacts of untreated infectious TB cases.
- Persons with underlying medical conditions such as HIV disease and diabetes.
Symptoms:
The following features should always raise the suspicion of TB:
- Cough lasting longer than 3 weeks.
- Coughing out blood.
- Feeling tired all the time.
- Fever and night sweats.
- Loss of weight.
If you have a cough that persists longer than 3 weeks or any of the other symptoms, see your doctor right away.
If you know of someone who has the same symptoms, encourage the person to go as well. Your doctor will get you to
go for a chest X-ray. In some patients, however, further investigations are necessary e.g. sputum tests.
Complications:
Untreated or under-treated TB may lead to the following complications in the infected person:
- Destroyed lungs.
- Pneumothorax (collapse of the lung).
- Meningitis (infection of the coverings of the brain).
- Enteritis (infection of the intestines).
- Death.
TB Treatment:
TB disease can be cured with anti-TB drugs. To be effective, the drugs must be taken exactly as prescribed. Treatment
usually involves a combination of several different drugs. Because TB germs die very slowly, anti-TB drugs must be taken
for 6 to 9 months. TB patients must continue to take their medicine until all the germs are killed, even if the symptoms
of disease go away and they start to feel better.
Poorly supervised or incomplete TB treatment is worse than no treatment at all. People who fail to complete standard treatment
are not cured. The TB germ in their bodies may develop resistance to the drugs, and the next person e.g. a family member, who
gets infected, will have the same drug-resistant germs. Treatment would then become more prolonged, more expensive, and
probably more toxic to the patients.
About 50% of patients do not take their medicines as prescribed. These patients may therefore not be cured and thus may
continue to spread TB to more people. The WHO has advocated DOT as the standard of care for TB patients.
DOT - Directly Observed Treatment: It means having your TB treatment supervised at the polyclinics. Trained nurses
will observe you taking the correct dosage and combination of TB medications. It is therefore very important to follow the
doctor's advice and complete TB treatment, not only for its cure, but also to curb its spread. The best way to do this is
receive your treatment under the Ministry of Health's DOT programme.
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