Author: noorali

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Science Behind the Use of Probiotics

There is increasing trend towards the use of probiotics and prebiotics by patients suffering from certain kinds of illnesses and by the public in general.

The word probiotics is a compound of a Latin and a Greek word. It means “favorable to life.” Probiotics, as defined by the Food and Agricultural Organization of the United Nations (FAO), are live microorganisms administered in adequate amounts which confer a beneficial health effect on the host.

The largest group of probiotic bacteria in the intestine is lactic acid bacteria, of which Lactobacillus acidophilus, found in yogurt, is the best known. Yeast is also a probiotic substance. Probiotics are also available as dietary supplements. These bacteria do not promote or cause disease. They are friendly germs.

Prebiotics refer mainly to certain foods, and occasionally to certain food products, that support the growth of probiotics. Included among prebiotics are foods such as regular artichokes, oats, leeks, onions, honey and whole grain breads or cereals.

The concept of using probiotics is not new. It goes back to the late nineteenth century. People tried to improve their health by supplementing their natural intestinal bacteria by additional bacteria taken by mouth. The Lactobacilli group of bacteria, found in yogurt, was the first identified probiotic. In the 1920s and 1930s, many doctors recommended acidophilus milk for the treatment of constipation and diarrhea. This treatment was effective for many patients.

In the 1950s, medical researchers began to study L. acidophilus as a possible answer to some of the digestive side effects of taking antibiotics. We know that antibiotics upset the natural balance of the intestinal organisms by killing the good bacteria along with the bad ones. The researchers thought that taking oral preparations of L. acidophilus might offset the side effects of the antibiotics.

According to Harvard Women’s Health Watch, probiotic therapy has been best studied for the treatment of diarrhea. It may also help people with Crohn’s disease, irritable bowel syndrome, and other gastrointestinal problems. Probiotics that help restore the balance of bacteria in the vagina may be useful in treating such common female urinary and genital problems as bacterial vaginosis, yeast infection, and urinary tract infection. More study is needed to know which probiotic strains work best for which conditions.

Harvard Women’s Health Watch suggests that people considering probiotics keep the following points in mind:
-The recommended doses range from 1 billion to 10 billion colony-forming units (CFU)—the amount contained in a capsule or two—several days per week.
-A daily supplement for one to two weeks may improve conditions such as infectious or antibiotic-related diarrhea.

The microorganisms in probiotic supplements need to be alive when you take them (or when they’re freeze-dried for capsules). They may die on exposure to heat, moisture or air. Some require refrigeration. See Harvard Health Publication (www.health.harvard.edu) and (www.usprobiotics.org).

In summary, probiotics are bacteria that help maintain the natural balance of bacteria in the intestine. The normal human digestive tract contains about 400 types of probiotic bacteria that reduce the growth of harmful bacteria and promote a healthy digestive system. Probiotics is not a panacea for all gastro-intestinal problems. Lot more research is required to establish the role of probiotics in health and illness.

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Fainting Attacks Amongst Children and Young Adults

A passed out child. (Top Photo Group/Thinkstock)
A passed out child. (Top Photo Group/Thinkstock)

A young man visits his doctor with a history of recurrent fainting attacks. Parents are worried. They want to know what could be the cause.

A transient, self-limited loss of consciousness, usually leading to falling is termed as syncope. Syncope is a common clinical problem accounting for five per cent of hospital admissions and up to three to five per cent of emergency department visits.

Syncope is a major challenge for the practicing physicians. It is very important to know the cause and clinical characteristics of syncope in children. Although most often benign, it can be a symptom of serious underlying conditions. It is estimated that 15-40 per cent of children and young adults have had at least one episode of syncope. Approximately one to two per cent of children presenting with syncope have a serious underlying disorder.

A paper published by the Department of Pediatrics, Peking University, retrospectively analyzed the causes of syncope and diagnostic workup of 154 consecutive children.

They found autonomic-mediated reflex syncope (also known as vaso-vagal or neuro-cardiogenic syncope) was the most common cause in 65.6 per cent of children, whereas cardiac disorders were found in 10 cases (6.5 per cent) comprising the second cause of syncope in children.

Other causes included psychological, neurological and metabolic disorders. Although many causes were studied, 25 cases (16.2 per cent) were found to have no definite cause for their syncope.

Vaso-vagal syncope is a temporary loss of consciousness associated with a drop in arterial blood pressure, quickly followed by a slowed heart rate. It usually occurs while standing. It may happen while a person is lying down. Emotional stress, stressful condition and pain may trigger an episode.

The fainting may occur suddenly or is associated with warning symptoms such as fatigue, weakness, nausea, sweating, pallor, visual disturbances, abdominal discomfort, headache, pins-and-needles, lightheadedness or vertigo. A person may feel hot or cold. He or she may have slurred speech and keeps yawning. During the faint “seizure-like” activity may occur.

Diagnosing vaso-vagal syncope is usually not difficult. It has a typical history and always completely normal physical examinations and ECGs. It is commonly seen in pubertal girls, but can happen in males. Usually, there is a clear precipitating cause of syncope.

Cardiac syncope can have be associated with life-threatening diseases. Therefore finding a cause for cardiac syncope is very essential.

A thorough medical history, ECG and echocardiography (ultrasound of the heart) can reveal life-threatening cardiac causes of syncope. Twenty-four-hour monitoring of the heart rhythm (Holter monitor) also helps in the diagnosis. Cardiac syncope often occurs suddenly or during exercise. Children with cardiac syncope often have history of cardiac diseases and they were often younger.

The authors of the Peking paper say that neurological causes of syncope should be considered if syncope is associated with seizure activity, syncope spells seen in any position, there is disorientation or neurologic abnormal signs. Diagnostic tests like EEG, CAT scan and MRI should be able to give us an answer.

A metabolic cause was entertained when the child had a history of metabolic diseases, prolonged anger or violent vomiting and diarrhea. Children with psychiatric disorders were adolescent girls with prolonged syncope spells and had more frequent syncopal episodes.

In summary, syncope in children may result from a wide variety of causes. In most cases, appropriate investigations will give us the diagnosis. History taking, physical examination and electrocardiography are the core of the syncope workup. Most causes of syncope are benign.

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Sexual Activity and Mysterious Headaches

Do you get mysterious headaches with sexual activity? May be not. But for one reader of my columns this has become a significant problem.

It is estimated that patients who have headache with sexual activity account for approximately one per cent of all headache patients. It is likely that the prevalence of this headache is underestimated, since patients often feel embarrassed to report intimate details about their sexual activities.

This condition has been given many names: benign coital headache (most of the time no serious underlying cause is found), masturbatory headache, orgasmic cephalagia (as it occurs usually at or near orgasm).

Apparently, headache related to sexual activity has been recognized since the time of Hippocrates. But the first systematic descriptions of this condition appeared in medical literature in 1974. Since then primary headache associated with sexual activity has become a well defined entity.

Coital headache is usually a recurrent, benign headache and is more common in men than in women. It can occur just before, during, or immediately after orgasm. The headaches are usually dull and throbbing and last from minutes to hours. Occasionally, some patients experience a sudden, explosive headache that occurs during orgasm.

Three types of sexual headaches are recognized.

The first, the dull type, is described as a dull ache in the head and neck that intensifies as sexual excitement increases, peaking at orgasm. This type of headache is little less common than type two.

Type two, also known as vascular or explosive coital headache, is a sudden, severe, explosive headache that occurs just before or at orgasm and persists for a few minutes to 48 hours. This is the most common type of coital headache. Patients find orgasmic headache frightening, distressing and disabling.

Type three is a postural headache, resembling that of low cerebro- spinal fluid pressure that develops after coitus. This type of headache is rare.

When patients first present with coital or orgasmic headache, it is mandatory to exclude serious underlying condition like ruptured aneurysm and bleeding in the brain. When a patient presents with a new type two coital headache of sudden onset, a CT scan should be performed, and even if this is negative, a lumbar puncture should be obtained, says one research paper.

Aneurysm without rupture can present as coital headache. To pick this condition it is necessary to do an angiography and MRI of the cerebral blood vessels. Other cause for coital headache is central nervous system vasculitis.

During the acute phase of pain, usual analgesics (ibuprofen, diclofenac, acetaminophen, ASA) can be tried but are considered of limited value to relieve the pain. In 25 per cent of the patients the pain may last more than two hours and up to 24 hours. Other medications which have been tried with some success are triptans, propranolol and indomethacin.

Fortunately, the prognosis is good and in the majority of patients where no underlying pathology is identified. With time the headaches disappear without any specific treatment.

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St. Maarten – A Healthy Place for R & R

Photograph shows Noorali savoring the beauty of St. Maarten sea side resort (obviously not a nudist colony).

First, we should get the name right. Is it St. Maarten or St. Martin?

Both names are correct. The northern part of this Caribbean island is French with 21 square miles (54 km2) of land. The southern part of the island is Dutch with 16 square miles (41 km2) of land. The French call their part of the island St. Martin and Dutch call their part of the island St. Maarten. Collectively, the two territories are known as “St. Martin/St. Maarten”

This tropical island is the smallest inhabited island in that area with a population of the entire island of approximately 72,000 people. Both parts of the island live in harmony. You can go from one end of the island to the other without restrictions. No questions are asked. But culturally the two areas are different.

On the French side, they speak French or English with a distinct French accent. They use Euro as their main currency and the main town, Marigot, has a distinct European flavour. The clothing stores have mostly European style apparels. About 35,000 people live on this part of the island. The French side is known more for its nude beaches, clothes, shopping (including outdoor markets), and rich French and Indian Caribbean cuisine.

On the Dutch side, English is more widely used although Dutch is the primary language. Netherlands Antillean guilder is their main currency although American dollar is accepted on both sides of the island. The main town, Philipsburg, looks and feels like a typical Caribbean island town. About 37,000 people live on the Dutch side. This part of the island is known for its festive nightlife, beaches, jewelry, exotic drinks made with native rum-based liquors and plentiful casinos.

The island is also known as a shopper’s paradise as it offers high quality duty-free goods in numerous boutiques. Popular goods include local crafts and arts, exotic foods, jewelry, liquor, tobacco, leather goods as well as most designer goods.

Salt and sugar cane industries are dead. The main economy is tourism and many Caribbean cruises include a stop over in Philipsburg. Phillipsburg has twelve gambling casinos and four duty-free streets full of shops and restaurants along the harbour. Also there is a beach and a board-walk just where the ship docks. One million tourists visit the island each year.

In summary, if you are looking for a quite, healthy, relaxing holiday then St. Martin/St. Maarten is a bargain. The relaxing island provides plenty of time to enjoy the diverse cultures, beaches, water sports, shopping, casinos and excellent food on both sides of the island.

If you are an ardent environmentalist and a naturalist and are looking for a nudist colony then keep French side in mind. They don’t believe in wearing designer clothings on nude beaches. Now I know where I forgot my Speedo. Is that a good reason for a second trip?

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