Ask The Doctor

Find out if your blood pressure is on the rise.

    With Dr Ahmed Adam

Q: What is the normal blood pressure range? --

A: Blood pressure measurements consist of two numbers systolic and diastolic.                                                                                                          

The systolic measurement is the pressure of blood against your artery walls when the heart has just finished pumping. It is the first or top number of a blood pressure reading. The second or bottom number is the diastolic measurement -- the pressure of blood against your artery walls between heartbeats when the heart is relaxed and filling with blood.
Normal blood pressure for an adult over the age of 18 is less than 130 for the systolic pressure and less than 85 for diastolic.
Blood pressure levels at or above 140 over 90 are considered high and can lead to heart, artery and/or kidney damage; atherosclerosis and stroke.

Hypertension is called a "silent killer'' because it does not usually cause symptoms. So know your numbers and get checked out.

Q: Do topical acne medications containing salicylic acid and benzoyl peroxide have an effect on fetuses? -- 

A: Nevena, acne at any age is no fun. And pregnancy is known to cause skin changes.

Benzoyl peroxide and salicylic acid are both popular over-the-counter topical medicines effective against mild acne.

Generally most nonprescription creams are considered safe to use, but the FDA classifies them in category "C", which means their effects on a fetus are not known.

So please check with your health-care provider.

Nurses too busy to take bathroom breaks

Many nurses are putting are putting their health at risk because they are too busy to take a toilet break, a survey said today. The study showed 54% of UK workers put off going to the toilet during their working day without realising the potential health risks. More than a thousand workers aged 16 and over were questioned and nurses, call centre staff and teachers came out as the workers most at risk.

All call centre operators questioned said it was difficult to take a toilet break except during lunch or other designated breaks.
The research, by laxative maker Ex-Lax, also showed 85% of nurses and 75% of teachers found themselves skipping loo breaks because of work patterns. One in four questioned blamed the condition of work toilets for putting them off, with 18% believing they did not provide enough privacy.

Jeanette Haslam, a clinical specialist and lecturer at East London University, said: ``Many people do not realise that they are already suffering from the effects of putting off a trip to the loo. Most commonly, they complain of stomach pain, nausea and bloating - many of the symptoms associated with constipation, which affects nine million people in the UK.''

She added that along with physical symptoms, putting off toilet trips could also cause psychological problems such as lethargy, indecisiveness and poor concentration. The findings of the research will be used to support a Better Bathroom Breaks Campaign to encourage British bosses to make sure their workers have enough toilet time.

Craig Shaw from Ex-Lax added: ``Discussing going to the toilet is still taboo in polite society, but people should never put off going to loo, it  can lead to all manner of health complications.''

Malaria drugs for travelers under debate

Saturday, November 30, 2002

Most of the several million Travelers who travel to malaria-plagued countries  come home healthy thanks to swallowing protective drugs during the trip.

But the number sickened each year because they didn't take those pills has risen by a few hundred since the mid-1990s. Even as tourism in developing countries grows, too many travelers don't know to take anti-malaria medicines -- or skip them from worry about side effects, such as rare psychiatric symptoms linked to Lariam, the most-prescribed drug. Now doctors are looking to a meeting of the world's malaria experts in January to settle just which medication is the best choice for different people heading on vacations, military duty or other trips to malaria-ridden countries.

Don't expect a simple answer.

The malaria parasite has developed resistance to that old standby drug, chloroquine, in most of the world, rendering it largely useless. That leaves most travelers three options: Lariam, a newer and possibly safer drug called Malarone, and the antibiotic doxycycline. Each has pros and cons that make declaring a No. 1 choice for everybody all but impossible, cautions Dr. Bradley Connor, a New York travel-medicine specialist.

"Your one-week business traveler vs. your teenage backpacker across Africa have very different risks," agreed Dr. Kevin Kain, director of the University of Toronto's Center for Travel and Tropical Medicine.

Developing resistance

All three drugs "work well if you take them," Kain said. Customizing the prescription to each patient's health and destination can limit side effects, ensuring travelers don't abandon their pills.

For example, Lariam isn't supposed to be used by anyone with depression, a history of other psychiatric disorders, or epilepsy. Also, it's losing effectiveness in parts of Thailand, Cambodia and Myanmar. On the other hand, Lariam is the only once-a-week pill; the others require remembering a daily dose.

But the backpacker spending three months amid malaria-carrying mosquitoes may want the cheapest option, doxycycline. The busy executive may prefer Malarone because treatment ends one week after returning home; the other two drugs must be taken for a month after returning to kill any still-lurking malaria.

Large areas of Central and South America, the Dominican Republic and Haiti, Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania are considered malaria-risk areas, according to the Centers for Disease Control and Prevention.

Adding to the complex decision, the Food and Drug Administration recently took two steps that may influence prescriptions:

 The FDA strengthened warnings that Lariam may cause psychiatric side effects ranging from anxiety and dreams to hallucinations, depression, occasionally even psychotic behavior. Those risks have long been known, but the updated warnings stress that people with active or recent depression and other risk factors shouldn't take Lariam.

However, the FDA cautions that the drug's alleged link to suicide has not been proven, and calls Lariam an important option. Travel-medicine specialists estimate serious side effects occur in one in 10,000 to one in 15,000 Lariam users.

 Separately, the FDA added to competitor Malarone's label results of a new study of 1,000 travelers that favorably compared Malarone to Lariam. The drugs appeared equally effective, but 5 percent of Lariam users had side effects bothersome enough to stop the drug, compared with 1.2 percent of Malarone users, says Kain. The Toronto physician headed the study funded by Malarone maker GlaxoSmithKline. The side effects were bothersome but not serious.

Not yet risk-free

Malarone isn't risk-free -- people with serious kidney damage can't use it -- and after just two years of sales, it doesn't have Lariam's 17-year track record. Likewise, doxycycline's side effects include nausea, heartburn, sunburn and, for women, yeast infections.

Those advantages and disadvantages are the reason the Centers for Disease Control and Prevention wants to debate the matter at its January meeting, before it updates the government's official health advice for travelers.

Meanwhile, specialists advise people heading for developing countries to consult a travel clinic or other doctor with specific expertise in the destination; a regular doctor might not know they need anti-malaria pills, much less which one. Give the clinic a complete history of medical or psychiatric problems.

"It's not in any of our interests to make people sick with malaria drugs. What we're trying to do is stop people from coming back in body bags from their holiday," Kain said. 

World AIDS Day warns of HIV spread

Speaking on Saturday -- the eve of World AIDS Day -- UNAIDS head Peter Piot said the social prejudice suffered by people with AIDS could be as destructive as the disease itself.

He said: "Discrimination and stigma continue to stand as barriers.

"Stigma silences individuals and communities, saps their strength, increases their vulnerability, isolates people and deprives them of care of support.

"We must break down these barriers or the epidemic will have no chance of being pushed back," he added.

Piot said Africa's HIV/AIDS epidemic was fuelling a widening and increasingly serious famine threat in southern Africa, where more than 14 million people in Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe face critical food shortages.

"AIDS combining with other factors including droughts, floods and in some cases short-sighted national and international policies cause a steady fall in agricultural production and to cut deep into household income," he said. As its name implies, World AIDS Day will draw attention from nations around the globe. Events of all sorts are planned -- from bake sales in London to parties in Singapore.
As nations prepared to mark World AIDS Day, the UK revealed that the number of new cases of HIV looks set to rise by 25 percent. According to new data from the Public Health Laboratory Service (PHLS), by the end of September, 2,945 new diagnoses had been reported for 2002 which is an increase from 2,354 new cases in the same period last year.

Dr Kevin Fenton, head of the HIV and STI division of the PHLS Communicable Disease Surveillance Centre, told the Press Association: "We now appear to be seeing more than twice as many new HIV diagnoses each year than we were at the end of the 1990s.

"We were very concerned last year when we saw a record number of new HIV diagnoses but these latest figures are even more disturbing.

"We are not only diagnosing infections that were acquired many years ago. HIV is a current, not historical problem."
To mark World AIDS Day on Sunday, an eastern Indian state plans to unfurl what local officials say is the longest banner ever. The six-kilometre long banner and is printed with slogans seeking to raise awareness about HIV/AIDS prevention, said Anjana Chopra, the top AIDS official in Orissa state.

Up to 100,000 people -- mostly students campaigning to raise awareness about AIDS -- will sign the banner, which will be displayed on the main street of the state capital, Bhubaneshwar.
About 4 million people in India are affected with HIV, according to the government.


Left: P. Diddy gets a hug from an adoring fan while visiting South Africa.

while visiting South Africa.

Meanwhile, in South Africa U.S. rapper Sean "Puff Daddy" Combs will headline MTV's "Staying Alive Concert" to be broadcast globally to mark World AIDS Day. "We're here to raise awareness through the world about the still growing epidemic here, but also most importantly to raise awareness to how strong and beautiful you all are," Combs said.

It's estimated that one child dies every minute from AIDS complications and one in five people are HIV-positive.

"This is a human race war," he said. "And we shouldn't be able to go to sleep at night ... with the knowledge that there are millions and millions of people dying in Africa."
In February, U2 singer Bono joined Microsoft founder Bill Gates at the World Economic Forum to bring attention to several issues confronting Africans, including AIDS.

Bono said, "What's going on is actually a crisis of the order never experienced before. I think HIV-AIDS has set back development to the point where we're living with statistics that we should not be living with. It's an everyday Holocaust."


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