Monday, December 22, 2008

Just For Laughs

Some funny ones to start your day. Imagine the tough times our teachers had to endure during our hey days? I know mine had a tough time, especially my geography teacher. Geography was my weakest subject and i remember once during an exam, i didn't know the name of the river on the question paper. It was long and winding, so i wrote "the long and winding river". The teacher minused one mark for that and i ended up choosing history for SPM.

Have a good monday morning people! (click on image to enlarge)

Wednesday, October 15, 2008

Origins of the Kelantanese

Origins of the Kelantanese
by Michael Chick

Following the search for the origins of the Malaysian constitutional “malays”, my journey brings me to Vietnam. There, I meet up with the Cham people. After all, every Kelantanese I've met claim to be descendants of the Mighty Champa Kingdom.
Just who are the Cham? I met up with Dr. Hang, an Anthropologist at Saigon University, Ho Chi Minh City. According to him, the Champa Kingdom is a 2nd Century Kingdom in Central Vietnam.
From 1487, they were continously driven by the Kinh (read as Mongoloid Vietnamese) from Hanoi till Phan Thiet today. Proof of this lies in the fact that there were hundreds of Cham Towers from Hanoi till Phan Thiet (near Mui Ne Beach).

If you'd observe very carefully, you might notice how similar the Cham are to the Kelantanese. The Austronesian Cham of Vietnam look extremely similar, and wear identical headgear to almost everyone in Kelantan. Both male as well as female. Not surprising. The Champa Kingdom had long established trading ties with both the present-day Malaya, Pattani, Aceh as well as Java since the 4th Century. Multiple wars also broke out between the Kingdom of Champa with Java. Migration was simply inevitable.
The Chams were Hindus. They still are today. In fact, all the towers of the Champa Kingdom are of Hindu Origin. One may visit any Museum, from Saigon to Danang till Hanoi. They all have on display, hundreds, if not thousands of Artefacts of this mighty Ancient Hindu Kingdom. It is however, so sad to see the Chams today, getting the short-end of the stick.
Since they were driven by the Kinhs (Hanoi) down south, they live in the most hostile parts of the country. Barely getting rain, the land is almost Savannah-like in nature. Large cacti live in abundance on non-cultivated land.

Visiting the Cham produced mixed feelings. On the one hand, one comes face-to-face with the remnants of a mighty empire. On the other hand, one wonders why the Vietnamese government does little to improve the living conditions of these “bumiputras”. I proposed new theories; that the Cham were in fact the actual people of the Dong Song, Hoabinhian and Sa Hyunh Culture, much to the surprise, but delight of these Saigon Anthropologists. Previously, they only assumed that those cultures belonged to “someone else”, and that Cham History only started in the 2nd Century. Proof being the Temples and Towers. I also highlighted that the Champa Kingdom would have been the second Kingdom of the Hindunization of South East Asia. The first, being Malaya, in the site near Penang called Lembah Bujang, of the 2nd Century.

Upon further scrutiny, there seems to be a lot more than just distant historical similarities between the Cham people, and the Kelantanese. My transalator informed me that there were twin towers located in Qui Nhon. “Much like that in Malaysia”. I was dumbfounded !! I immediatle made the 300km journey. In total, I travelled over 2,000 km by road, boat, and every other imaginable transport available, visiting over 30 major Cham Tower sites along the entire coast of Vietnam.

Furiously making notes, I also found that the similarities did not stop at the fact that there were just twin towers. Cross-examining schematic diagrams of the Cham Towers and KLCC was astounding!
For example, the top and side view schematics, when overlayed, was an identical match.

The similarities did not end there, even a side profile view of the Cham towers and KLCC was a match. I could barely contain my excitement when I made these cross-comparisons. Even the
Saigon Anthropologist Professors were dumbstruck. No one had ever imagined that there was any correlation between an apparently “Muslim-built Design” with that of an Ancient Hindu one. Add to that, it was located in isolated Vietnam. For those who have visited these sites before, pull out your private photo boxes, and confirm for yourself that the pictures I have displayed here have not been doctored in any way.

Considering that Mahathir was of Indian Origin, it does not completely surprise one that he took inspiration from his ancestry in Kerala. However, one might think that it is strange that he took inspiration from 2 apparently incompatible religions to build his monumental icon. It is even stranger that despite using a Hindu-derived icon to symbolize Malaysia, the Hindraf are swept aside and marginalized. Of course, it is even stranger that Najib takes the trouble to fly in from India, Hindu Priests into his home and office to perform covert rites, as per ascertained by the Driver's Sworn Affidavits.
Can seemingly incompatible religions be jointly practised? No? Read on. This might change your mind. Think for a moment of Sai Baba's concept of “All religions lead to God” Concept. The clue lies in Vietnam. There is a Religion called CaoDai-ism. It is very widely practised. CaoDai is a merger of Confusianism, Taosim, Buddhism, Catholism, and Islam. This is a unifying and endemic religion. So is the Cham-Bani religion, which is a merger of Hinduism & Islam. Then, there are The Balinese, practising a merger religion of Animism & Hinduism. Of course, most of Java practices Kejawen which is a combination religion of Animism & Islam. So in reality, Najib's merger of Hinduism & Islam would be merely a copycat version of the Cham-Bani-type of religion of Vietnam. To add to it, he is Bugis, which makes him part Mongolian, part Arab. (No reference intended of his involvement with Altantuya). Hence his pale Mongoloid-type appearance.
Surprisingly, UMNO today has turned to worshipping a Chinese God. And that God, is called the God of Money. So, the combination religion which unites worshiping Corruption and Allah, is called BN (Blatant Narcisism). Since inter-faith combination-worship is now a known Asian trait, is it not strange that UMNO was so quick to dispense with The Sky Kingdom in Terengganu? Perhaps Sky Kingdom Worshippers were not into worshipping Corruption as UMNO fervently does. Wonder what went on in UMNO's minds. I also wonder what Hadhari actually is. (or not...) Take heart, my Hindraf friends. You now have an World Famous Icon, built by an Indian, who took direct inspiration from Hinduism. Not just one building, but a pair of twins, financed with Malaysian Petroleum money. Be proud. This is the best Hindu Representation of Malaysia, the world has ever seen; something which even Semi Value did not anticipate. Hence, his Political Demise. (or should I have said Allaryahum Semi Value??) I can imagine him going “Aiyo yoyoyo..” while smacking his forehead. I'll part, leaving you with a composite picture. Two World-Famous icons “photoshoped” together to illustrate my point. Please do not let the Khmers see this, or they would sue the pants off Malaysia like the Indonesian Parliament almost did with Rasa Sayang. Maybe the Khmer Rouge did discuss this blatant copyright infringement, maybe they did not. But I doubt Pol Pot lost any sleep over this.
I'll keep Malaysia posted at the end of my research in Cambodia.

Monday, September 29, 2008

Pediatric obesity - some guidelines

Photos and all italics were added by me to explain the meaning of certain words and phrases.

The Endocrine Society (read about The Endocrine Society) has issued practice guidelines for the prevention and treatment of pediatric obesity. The online version was released on 9 September.

Recommendations set forth in the guidelines are as follows:

  • Overweight is defined as a body mass index (BMI) in the 85th percentile or greater, but less than the 95th percentile, and obesity as a BMI in the 95th percentile or greater.
    BMI Categories for Kids:
    Underweight - BMI less than the 5th percentile
    Healthy Weight - BMI 5th percentile up to the 85th percentile
    Overweight - BMI 85th to less than the 95th percentile
    Obese - BMI greater than or equal to the 95th percentile.
    Refer to BMI chart for girls
    here, and for boys here

  • If there is evidence of a genetic syndrome (syndrome = a group of symptoms or identifying features of a disorder or disease; genetics syndrome = a syndrome presented by abnormalities in development and/or growth, which is caused by defects in genes and chromosomes) , referral to a geneticist is indicated.
    Children with a BMI in the 85th percentile or greater should be evaluated for obesity-associated comorbidities (other underlying or co-existing illness/health conditions).
  • As the prerequisite for any treatment, intensive lifestyle modification should be prescribed and supported, including dietary, physical activity, and behavioral components.
  • Dietary recommendations include avoiding consumption of calorie-dense, nutrient-poor foods (eg, sweetened beverages, most "fast food," and calorie-dense snacks); controlling energy intake through portion control in accordance with the Guidelines of the American Academy of Pediatrics; reducing saturated dietary fat intake for children older than 2 years; increasing intake of dietary fiber, fruits, and vegetables; eating timely, regular meals, particularly breakfast; and avoiding constant "grazing," especially after school.

Suggestions set forth in the guidelines are as follows:

  • Pharmacotherapy (treatment with drugs), in addition to lifestyle modification, should be considered in obese children only when intensive lifestyle modification has been ineffective and in overweight children only if severe comorbidities persist despite intensive lifestyle modification, especially those children who have a strong family history of type 2 diabetes or premature cardiovascular disease.
    Pharmacotherapy should be prescribed only by clinicians experienced in using antiobesity agents who are cognizant of the risks for adverse reactions.
    Pharmacotherapeutic options may include: i) sibutramine, which is not approved by the US Food and Drug Administration (FDA) for those younger than 16 years; ii) orlistat, which is not FDA approved for those younger than 12 years; iii) metformin, which is not FDA approved for treatment of obesity but which is approved for those who are at least 10 years old with type 2 diabetes mellitus; iv) octreotide, which is not FDA approved for the treatment of obesity; v) leptin, which is not FDA approved; vi)topiramate, which is not FDA approved for the treatment of obesity; - growth hormone, which is not FDA approved for the treatment of obesity.
  • Bariatric surgery, which refers to surgical procedures performed to treat obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption, is suggested for adolescents with a BMI of less than 50 kg/m2, or more than 40 kg/m2 in whom lifestyle modifications and/or pharmacotherapy have been unsuccessful and who have severe comorbidities. (more about bariatric surgery from Wikipedia).

  • Bariatric surgery is not recommended for preadolescent children; for pregnant or breast-feeding adolescents; for those planning to become pregnant within 2 years of surgery; for any patient who has not mastered the principles of healthy dietary and activity habits; or for any patient with an unresolved eating disorder, untreated psychiatric disorder, or Prader-Willi syndrome (read more about Prader-Willi Syndrome here).

  • To help prevent obesity, clinicians should recommend that infants be breast-fed for at least 6 months and that schools offer children in all grades 60 minutes of moderate to vigorous daily exercise.

  • Clinicians should educate children and parents regarding healthy dietary and activity habits; advocate to restrict availability of unhealthy food choices in schools; ban advertising promoting unhealthy food choices to children; and redesign communities in ways that will maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.

"The objective of interventions in overweight and obese children and adolescents is the prevention or amelioration of obesity-related co-morbidities, e.g., glucose intolerance and T2DM [type 2 diabetes mellitus], metabolic syndrome, dyslipidemia, and hypertension," the authors of the guidelines write. "We suggest that pharmacotherapy (in combination with lifestyle modification) be considered if a formal program of intensive lifestyle modification has failed to limit weight gain or to mollify comorbidities in obese children. Overweight children should not be treated with pharmacotherapeutic agents unless significant, severe co-morbidities persist despite intensive lifestyle modification."
-Journal of Clinical Endocrinology & Metabolism-

Wednesday, September 24, 2008

The China tainted milk story - what actually happened

China’s milk scandal bares government failures

At least 10 nations are now banning Chinese dairy products

Updated 10:30 am 25/09/08

BEIJING - The note posted in July on the Web site of China’s food safety inspection agency came from a doctor: There had been a sudden rise in infants turning up at his hospital with kidney stones after drinking the same brand of formula.
The warning, which urged an investigation, went unheeded. In the two weeks since China began piecemeal reporting about contamination of the milk supply, a picture has emerged of official indifference, greed and government dysfunction.
Among the startling details: the practice of adulterating milk was widely known in the industry, and one dairy knew since late last year that its formula was sickening children. The revelations have dismayed a broad segment of the public — parents — who feel the government has breached their trust. Tens of thousands of children have sought medical care, nearly 13,000 have been hospitalized and four infants have died.
'We trusted the government'“I’m just disappointed because the government should have done more to protect its citizens,” said Liao Yanfang, a migrant worker whose 1-year-old son was found to have kidney stones Tuesday at Beijing Children’s Hospital. Since birth, her only child had been drinking infant formula made by the company at the center of the scandal, Sanlu Group Co., she said.
“I fed my baby powdered milk because ads said it was more nutritious than breast milk. We trusted that the government would provide adequate tests to ensure food quality,” she said.
In the past two weeks, Beijing has recalled a broad array of milk products — all tainted by the industrial chemical melamine — and arrested Sanlu’s chairwoman and several suppliers. It has dismissed officials and offered free medical care to the afflicted. “Nothing like this will ever happen again,” Premier Wen Jiabao pledged. But questions remain about why food and health inspectors ignored growing signs of trouble in the milk supply and when the communist leadership knew about it. Galling to many Chinese is the suspicion that high-level pressures for a successful Beijing Olympics added momentum for a cover-up.
“The dairy products for the Olympic Games were safe. I think the inspection agency already knew about it, and they tried to protect the ’national brand,”’ said Zhou Ze, a law professor at China Youth University For Political Science.
Regaining the confidence of the Chinese public and the world is likely to take concerted doing. The scandal has battered the government’s image, so carefully cultivated during the Olympics.
Governments heavily courted by Beijing have sounded the alarm. Normally pro-China Singapore has banned the sale and import of Chinese dairy products, from yogurt to candy. At least nine other countries have done the same.
Other nations, from Canada to Australia, have increased testing of Chinese food imports. The European Union ordered customs inspectors Tuesday to be on alert for products such as bread or chocolate to insure they contain no contaminated milk.
In the U.S., the Food and Drug Administration expanded its sampling of imports from Asia to include dairy-based candies and desserts. Over the weekend, the agency announced it had started checking imports of bulk food ingredients, including milk powder, whey and some milk-derived proteins. No tainted products from China have turned up.
The overall impression is of an authoritarian government struggling to enforce its writ on a rapidly developing country where officials and businesses often go their own way.
Just four years ago, Premier Wen issued an apology and promised greater transparency when official cover-ups aided the spread of SARS from China to the world. Last year, after exported pet food, cough medicine, toothpaste and toys made with toxic products sickened and killed pets and people in North and South America, the government promised to overhaul safety inspection regimes.
“Although after SARS, the government promised a more open media environment and to protect people’s right of expression, without essential measures, it’s just empty talk. What is really needed is to change the system’s framework,” said Yang Fengchun of Peking University’s School of Government. “The government and companies have lied to people, so it becomes very difficult to make people believe again in what they say.”
This time around, promises of official oversight fell flat in the boisterously growing dairy industry. Almost nonexistent two decades ago, the industry has boomed, transforming once scarce milk and milk powder into staples that have boosted nutritional levels and health from the urban middle class to the rural poor. Unlike the United States, where dairies run farms with thousands of cows and are better able to control quality, milk in China comes from a patchwork of producers. Most are small farms with just a few cows who sell the raw milk to collection stations, which in turn sell mainly to giant dairy processing companies.
“The middleman is where the system breaks down totally,” said David Oliver, a New Zealander who is a dairy industry consultant in Beijing.
Two giant processing companies — Mengniu Dairy Group Co. and Yili Industrial Group Co. — control nearly 60 percent of the total market for milk, yogurt and other dairy products, according to Beijing Orient Agribusiness Consultant Co. But in the past three years, prices for feed, fuel and other costs rose — feed by as much as 30 percent. Further pressures came last year when Beijing enacted price controls to tame double-digit inflation for food.
Milk collectors found themselves squeezed between the farmers asking for more money and the processors who demanded that prices be held down, said Chen Lianfang of Orient Agribusiness.
That squeeze gave suppliers incentives to tamper with the raw milk, watering it down and then adding ingredients, said Chen.
Melamine, a relatively cheap binding agent used in plastics and as a flame retardant, is rich in nitrogen, fooling widely used tests that check for protein. When mixed with formaldehyde, it dissolves in water.
In the wake of the scandal, inspectors found melamine in products from Yili, Mengniu, Sanlu and 19 other dairy companies.
Government officials have painted the middlemen as the main villains. A vice governor of Hebei province, where Sanlu is located, said one of the dairy’s suppliers began using melamine three years ago.
Chinese health officials have said no harm comes from consuming tiny amounts of melamine, less than 0.63 milligrams per kilogram. But some of Sanlu’s infant formula contained up to 4,000 times that amount, as much as 25 milligrams per kilogram.
Trouble with Sanlu’s products began brewing last December, with parents complaining to the company about infants sickened by formula, Chinese state television said. Sanlu bought off one complainer with free milk products. Doctors and reporters also sounded warnings.
At an editorial meeting at one state-run newspaper last week, editors were told that its Hebei-based reporter wrote an “internal reference” sent to Beijing in March about contamination of Sanlu products, said two participants. They requested their names and that of their newspaper not be used for fear of retribution by officials.
A pediatric urologist, Feng Dongchuan, said in a posting July 24 on his online journal that he had treated seven infants for kidney stones at the Pediatric Hospital in the central city of Xuzhou, an unusually high number.
“Coincidentally all consumed a certain famous domestic brand of formula,” Feng wrote. He said more cases were reported in nearby Nanjing.
That day a urologist who would not give his name sent a similar warning to the General Administration of Quality Supervision, Inspection and Quarantine, naming the brand of formula — Sanlu.
The reply, posted a week later, said: “Please report this problem to the health departments.”
Meanwhile, Sanlu was quietly ordering distributors to remove milk powder and infant formula, distributors said. China Central Television said Sanlu knew in June that tests had detected melamine.
At board meetings in the Hebei capital of Shijiazhuang on Aug. 2 and again on Aug. 9, Sanlu executives were confronted by the dairy’s New Zealand investor, the Fonterra cooperative, which urged them to go public. Company executives and local government officials refused.
The central government said it only learned of the scandal Sept. 8 — it does not say how — even though inspection, health and other government departments in Hebei and Beijing knew earlier.

-2008 The Associated Press

KKM's press release 24/09/08

Kementerian Kesihatan Malaysia (KKM) ingin memaklumkan maklumat terkini berkaitan dengan isu susu dan hasilan susu dari China yang tercemar dengan melamine.Senarai produk makanan yang tidak terlibat dengan isu melamine dari China telah dikemaskini sehingga hari ini adalah seperti di Lampiran 1.KKM telah menjalankan pemeriksaan dan penyitaan bagi produk-produk hasilan susu di seluruh negara bermula semalam. Setakat ini, laporan penyitaan yang telah dijalankan di pasaran tempatan seperti di Lampiran 2.KKM juga telah mendapatkan kerjasama Kementerian Pelajaran Malaysia (KPM) untuk memastikan semua kantin sekolah tidak menjual produk makanan yang disyaki tercemar oleh melamine dari Negara China.Di pintu masuk negara, KKM dengan kerjasama pihak Kastam Diraja Malaysia (KDRM) memastikan produk yang telah diarah untuk Pemeriksaan Tahap 6 (Auto Rejection) tidak akan masuk ke negara ini. Sehubungan dengan produk-produk makanan lain dari Negara China, KKM telah mengenakan Pemeriksaan Tahap 5 (Tahan, Uji & 1Lepas) untuk memastikan keselamatan makanan tersebut. Di samping itu, aktiviti pemantauan produk makanan akan dijalankan secara berterusan.Sekiranya pengguna telah mengambil sebarang produk makanan yang disyaki tercemar dengan melamine, pengguna dinasihatkan supaya tidak bimbang kerana kesannya sangat sedikit sebab memerlukan kandungan melamine yang banyak. European Commission Directive EC No. 2002/72 telah menetapkan tahap migrasi melamine yang selamat daripada bekas / pembungkus kepada makanan ialah 30 mg / kg makanan. Dalam konteks ini, melamine telah dikesan di dalam minuman, kopi, jus oren, susu fermentasi dalam julat 0.54 – 2.2 mg / kg makanan.Jika pengguna masih ragu-ragu mengenai tanda-tanda kegagalan ginjal, mereka hendaklah segera berjumpa dengan pegawai perubatan untuk mendapatkan sebarang nasihat dan rawatan yang berkaitan.
Kementerian Kesihatan Malaysia
24 September 2008

The Ministry Of Health Malaysia has started a Melamine operation room. The operation room details:


Operation room is opened from 8.00 am till 5.00 pm (office hour) everyday including on public holidays.
Any assistants or enquiries, please contact these numbers :
Tel : 03 - 8883 3655 & 03 - 8883 3503
Email :

For more information on the list of banned & safe products in Malaysia, Q&As and latest press release, you can access the MOH site here or Food & Safety Quality Division here.

Tuesday, September 16, 2008

A nation lacking basic hygiene

Dirtiest among seven nations, the title read.

Online yesterday posted an article on it's front page yesterday regarding a recent hygiene survey done on seven countries, including Malaysia. The article continued...

"KUALA LUMPUR: Would you cook in your toilet? If hygiene is your primary concern, you might consider doing so.
A recent seven-country survey conducted by the Hygiene Council, a global panel of medical experts, found that Malaysian kitchens were more bacteria-infested than bathrooms.With dishcloths and kitchen sinks crawling with germs found in faeces, it is not only great food that's being cooked in our kitchens. Disease and infection are stewing there as well. Overall, Malaysian homes were found to be the dirtiest among all the countries studied, right after India. The cleanest abodes were found in Saudi Arabia..."

You can read the whole article here.

What got me even more worried is the fact that this survey was done in homes ( and 70% of the samples were highly contaminated with E.coli, a kind of bacteria found in human faeces).

Now, what do you think the outcome of this survey would have been like if it was carried out on our eateries outside. Most probably the finding would have been published in an article entitled "Malaysians eating shit at outside eateries".

So, Malaysians please, please give some priority to personal hygiene.

1)Please make sure you wash your hands with soap after using the toilet, even if you just took a leak. But, sadly, in Malaysia, the public toilets are a far cry from the word clean! Most of them don't even have running water, leave alone soap!

2) Please wash your hands with soap before eating, even if you had just washed your hands 10 minutes ago...or you might just end up eating shit!

3) Please make sure your children take a bath and clean themselves up after coming home from school. Do not allow them to touch anything in the kitchen, fridge or dining area unless they've at least washed their hands with soap.

4) Please make sure your maids and those babysitters wash their hands with soap as above and after changing your child's diaper. Also please make sure diapers are disposed off properly.

Here's a chart to show you the proper way to wash your hands.

Friday, February 8, 2008

Depression - What you need to know

What is Depression?
Everyone feels down, blue or sad occassionally, but these feelings usually pass off or resolve within a couple of days or so. When these feelings become prolonged and are accompanied by other symptoms, then it can be said as depression. World Health Organisation (WHO) defines depression as "a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration."
When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.

Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder.
Depression occurs just as commonly in developing countries like Malaysia as it does in other developed countries as well, with a lifetime occurence between 8% - 10%.

In 2006, WHO and World Bank assesed the level of disability that is brought about by this disorder and found that depression is the fourth most disabling disease in the world. It is also predicted to become the 2nd most disabling disease in the world by the year 2020. The World Health Organization also estimates that more people die from suicide than from Tuberculosis deaths in the Asia Pacific region. The most common cause for death by suicide is Depression.

Depression occurs more in women than in men in a ratio of 1:2. There are many postulates to this. Some of them include that women may be more willing to discuss their emotional issues and that women have hormonal changes that may increase the risk of depression. Men may self-medicate their depression with alcohol or drug use. Also the apathy that is accompanies depression often makes them not want to seek treatment or help.

What are the different forms of depression?

There are several forms of depressive disorders.

  • Major depressive disorder and dysthymic disorder.
    Major depression is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. It is disabling and prevents a person from functioning normally. It may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
  • Dysthymic disorder or dysthymia, is a prolonged (two years or longer) and less severe disorder than major depression. Here, the disorder may not be as disabling as major depression. People with dysthymia may experience one or more episodes of major depression during their lifetime (more oftenly multiple).

Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:

  • Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, hallucinations, and delusions.
  • Postpartum depression - if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
  • Seasonal affective disorder (SAD) - is a depressive illness during the winter months, when there is less sunlight. Antidepressants and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy. It can also be treated with light therapy as a monotherapy, which is not as effective as combined therapy.
  • Bipolar disorder, which is also known as manic-depressive illness, is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression).

What are the symptoms of Depression?

Symptoms of depression differ in severity, frequency and duration from person to person.

Symptoms include:

  • Persistant sad, anxious or "empty" feeling or low mood for a duration of more than 2 weeks
  • Loss of interest and enjoyment in aspects of life and anhedonia. (Anhedonia is when a person is unable to find pleasure from activities, even from activities that were pleasurable before, such as hobbies).
  • General feeling of tiredness, fatigue or lethargy.
  • Changes in weight

  • Loss of appetite or overeating

  • Sleep disturbances

  • Lack of interest in sex (decreased libido)

  • Irritability, anxiety and confusion,

  • Poor concentration,

  • Feeling of loneliness, hopelessness

  • Feelings of guit, uselessness, and worthlessness,

  • Thoughts of death, suicidal thoughts and suicide attempt

  • A variety of physical conditions like back pain, headaches, giddiness, gastic problems and chronic pain.
Depression as a diagnosis can only be made if a patient has at least five of the symptoms described above for at least two weeks.

There are various illnesses and medical conditions that can also cause or that may occur concurrently with depression

What causes depression?

1. Depression may be triggered by major life events such as the death of a relative or friend. Stressful situations such as divorce, financial difficulties or job loss can also trigger depression. Depression can sometimes be caused by a person’s lifestyle. Childbirth can also trigger post-natal depression in women, as can loneliness, especially in the elderly.

2. One of the chemicals in the brain known to affect a person's mood is serotonin – depressed people are often found to have an imbalance in the way that serotonin works in their brains.

3. Genetics predisposition

Some types of depression run in families, indicating that a biological vulnerability can be inherited. This seems to be the case with manic-depressive illness. Studies of families, in which members of each generation develop manic-depressive illness, found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: not everybody with the genetic makeup that causes vulnerability to manic-depressive illness has the disorder. Apparently additional factors, possibly a stress environment, are involved in its onset.Major depression also seems to occur, generation after generation, in some families. However, it can also ossur in people who have no family history of depression. Whether the disease is inherited or not, it is evident that individuals with major depressive disorder often have too little or too much of certain neurochemicals.

4. People with low self-esteem

Psychologic makeup also plays a role in vulnerability to depression. People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression.

5. Serious or chronic physical illness

Serious or chronic physical illness or major surgery may also trigger depression. Some commonly prescribed medications, including some cardiovascular drugs, hormones, birth control pills and drugs used to treat Parkinson’s disease, may also bring on depression, or make it worse.

6. Other causes include:

- Stressful environment

- Adverse life events

- Lack of a supporting relationship

Very often, a combination of genetic, psychologic and environmental factors is involved in the onset of a depressive disorder.Sometimes there are no known triggers at all. Depression can appear suddenly, for no apparent reason.Whatever the trigger, treatments are available that many have found to be safe and effective.Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help over 80% of those who suffer from depression.

What illnesses often co-exist with depression?

Depression often co–exists with other illnesses that may precede the depression, cause it, and/or be a consequence of it. These illnesses also need to be diagnosed and treated. Among them are:

  • Anxiety disorders, such as post–traumatic stress disorder (PTSD), obsessive–compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression. People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat.
    People with PTSD often re–live the traumatic event in flashbacks, memories or nightmares. Other symptoms include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH) USA–funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.
  • Alcohol and other substance abuse or dependence. Research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population.
  • Other medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co–existing depression.Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co–occurring illness.

Disclaimer: Although this website describes depression symptoms, it is meant to be used as information only—not as a diagnosis. Any suspected depression should be evaluated and controlled by a medical professional. Please, consult your doctor if you believe your might suffer from depression. Do not rely on advice from anonymous contacts you initiate from any web site.

Tuesday, January 22, 2008

What is it about your cough?

A cough reflex is actually an attempt by the body to clear excess secretions, mucous, inhaled irritants, toxins and foreign materials from the airways. It is a natural expulsive defence mechanism of the body that protects the respiratory sytem by clearing it voluntarily or involuntarily. Thus, cough should not be stopped or held back.

The sequence of events in a cough reflex:

Inhalation to a high lung volume -> closure of the glottis -> contraction of the expiratory muscles (generating high positive intrathoracic pressure) -> opening of the glottis -> high velocity expulsion of air through the airways -> continued contraction of the expiratory muscles.

The diagram below shows the 4 stages in a cough reflex.

It is noteworthy to bare in mind that any conditions such as those causing weakness of the expiratory muscles, vocal cord pathology or tracheostomies causes impairment in the ability of the body to clear their airways effectively.

An occasional cough is normal as it helps clear foreign substances and secretions from the lungs and helps prevent infections.

Based on the type of we can generally classify cough into:

1.Dry cough - cough that does not bring up any sputum during expulsion
2.Productive cough - cough that brings up sputum or mucus during expulsion

Based on the duration of the cough it is generally accepted that a cough that lasts more than 3 weeks can be considered as chronic cough, although there are some quarters who feel that not every prolonged cough that last more than 3 weeks can be considered as chronic. I will not dig any deeper into it's technicalities in this post (Google it!). Let's try to see the possible causes of chronic cough as there has been a rise in such cases in our primary health care centers.

Among the common causes of chronic cough:

1. Postnasal drip caused by chronic rhinitis and sinusitis

Glands in your nose and throat produce a quart or two of mucus, which cleans and moisturizes our nasal passages. Normally, we swallow the fluid without knowing it, but in rhinitis, the cells lining the nasal passages becomes inflammed and swollen. It then start producing mucus in extensive amounts. The excess mucus then accumulates behind the nose and descend down the throat. This is called postnasal drip and can cause irritation and inflammation that triggers your cough reflex.

Patients with cough due to this condition will typically have frequent clearing of their throat during the day, will complain of cough when talking for prolonged periods of time or when laughing, and will often have worse cough when they first lie down at night.

If the postnasal drip is chronic, your cough is likely to become chronic, too. Though postnasal drip is often obvious, it's possible to have the condition without ever having symptoms.

Sinuses are air filled spaces situated in our skull. The main sinuses are :
Frontal sinus in the forehead, Ethmoid sinus between our eyes, Maxillary sinus in our cheek bones and Sphenoid sinus at the back of the nose.

Sinusitis, similar to rhinitis, is a condition where the cells lining the sinus gets inflammed, swollen and starts producing excessive mucus, which in turn descends down behind the throat, leading to post nasal drip.

There is also a condition called rhino sinusitis which is the combination of both the conditions above.

Common triggers of rhinitis sinusitis:

  • Inhaled irritants such as dust, smog, smoke.

  • Food allergies. Common food that causes allergy are nuts, eggs, wheat, milk and dairy products, soy products, seeds, sea food with shell, etc.

  • Illnesses; Such as flu, colds, bronchitis, ear infections, tonsillitis and asthma

N.B: In asthma, not only does the excess mucus lead to an asthma attack, but it also causes a sufferer to start breathing through the mouth taking in non-filtered, non humidified and cold air. This in turn can trigger and worsens the asthma attack.

2. Asthma

This is a common cause of chronic cough in adults and in children. The cough commonly occurs with wheezing and shortness of breath. The absence of wheezing on the other hand does not mean that the person is not having an asthma attack. There is a type of asthma, sometimes referred to as cough variant asthma, where cough is the only symptom. An asthma-related cough may be seasonal or caused by an upper respiratory tract infection, or exposure to cold air, chemicals or fragrances.

3. Gastroesophageal reflux disease (GERD)

Here there is a back flow of the stomach acid upwards along the esophagus that constantly causes irritation in the esophagus, throat and even the lungs that leads to chronic coughing, heartburn and sour taste behind the tongue. There is also cough that is caused by asymptomatic GERD.

Reflux of acid to the posterior pharynx may cause inflammation and edema of the vocal cords. In some cases, patients will have recurrent aspiration with a consequent low-grade chemical pneumonitis (inflammation of the lung tissue) in the lungs.Finally, GERD may lead to cough by provoking bronchospasm (narrowing of the bonchus, the main airway tube). Acid in the esophagus can induce bronchospasm in patients with asthma via reflex mechanism mediated by the vagus nerve.

4. Respiratory tract infection

A respiratory tract infection almost always cause inflammation of the cells that line the airways. This does to a certain extent make it sensitive to irritants, which in turn triggers a cough reflex.

Other not so common causes of chronic cough:

1. Blood pressure drugs

Chronic cough is a notorious side effect of a group of anti-hypertensive drugs (blood pressure drugs) known as Angiotensin-Converting Enzyme (ACE) inhibitors. This side effect is more apparent among the Asian population and can begin from within a week to even more than six months after starting therapy.

2. Chronic bronchitis

This is long-standing inflammation of the major airways (bronchial tubes) which can cause congestion, breathlessness, wheezing and a cough. This can be caused by infection or in chronic smokers who's airways have been damaged.

3. Bronchiectasis

This is a serious, chronic lung condition in which abnormal widening of your bronchus affects their ability to clear mucus from your lungs. Signs and symptoms include a cough that may bring up discolored sputum or blood, shortness of breath and fatigue. In bronchiectasis, areas of the bronchial wall are destroyed and become chronically inflamed, ciliated cells are damaged or destroyed, and secretions (mucus) accumulate. Also, the bronchial wall becomes less elastic—the affected airways become wider and flabby and may develop outpouchings or sacs that resemble tiny balloons.

The most common cause of this condition is severe respiratory infections. Also can be caused by immune deficiency disorders, hereditary disorders (such as cystic fibrosis), mechanical factors (such as bronchial obstruction caused by an inhaled object, a lung tumor, or other disorders) and from inhaling toxic substances that injure the bronchi, such as noxious fumes, gases, smoke (including tobacco smoke), and injurious dust (silica, coal dust).

4. Lung cancer

This is relatively uncommon. Only a small percentage of people with a chronic cough have lung cancer, and most are current or former smokers. If you smoke now, smoked at one time or your sputum contains blood, see your doctor.

Medical myths

I received this via email update today. Thought it would make an interesting read:

Medical Myths

by Rachel C Vreeman, fellow in children’s health services research1, Aaron E Carroll, assistant professor of paediatrics2 1 Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA, 2 Regenstrief Institute, Indianapolis, IN, USA Correspondence to:R C Vreeman

Sometimes even doctors are duped, say Rachel C Vreeman and Aaron E Carroll. Physicians understand that practicing good medicine requires the constant acquisition of new knowledge, though they often assume their existing medical beliefs do not need re-examination. These medical myths are a light hearted reminder that we can be wrong and need to question what other falsehoods we unwittingly propagate as we practice medicine. We generated a list of common medical or medicine related beliefs espoused by physicians and the general public, based on statements we had heard, endorsed on multiple occasions and thought were true or might be true. We selected seven for critical review:

1. People should drink at least eight glasses of water a day:

We used Medline and Google to search for evidence to support or refute each of these claims. Because "proving a negative" can be challenging, we noted instances in which there was no evidence to support the claim people should drink at least eight glasses of water a day. The advice to drink at least eight glasses of water a day can be found throughout the popular press. One origin may be a 1945 recommendation that stated: A suitable allowance of water for adults is 2.5 litres daily in most instances. An ordinary standard for diverse persons is 1 millilitre for each calorie of food. Most of this quantity is contained in prepared foods. If the last, crucial sentence is ignored, the statement could be interpreted as instruction to drink eight glasses of water a day. Another endorsement may have come from a prominent nutritionist, Frederick Stare, who once recommended, without references, the consumption "around 6 to 8 glasses per 24 hours," which could be "in the form of coffee, tea, milk, soft drinks, beer, etc". The complete lack of evidence supporting the recommendation to drink six to eight glasses of water a day is exhaustively catalogued in an invited review by Heinz Valtin in the American Journal of Physiology. Furthermore, existing studies suggest that adequate fluid intake is usually met through typical daily consumption of juice, milk, and even caffeinated drinks. In contrast, drinking excess amounts of water can be dangerous, resulting in water intoxication, hyponatraemia, and even death.

2. We use only 10% of our brain:

The belief that we use only 10% of our brains has persisted for over a century, despite dramatic advances in neuroscience. In another extensive expert literature review, Barry Beyerstein provides a detailed account of the origins of this myth and the evidence disputing it. Some sources attribute this claim to Albert Einstein, but no such reference or statement by Einstein has ever been recorded. This myth arose as early as 1907, propagated by multiple sources advocating the power of self improvement and tapping into each person’s unrealised latent abilities. Evidence from studies of brain damage, brain imaging, localisation of function, microstructural analysis and metabolic studies show that people use much more than 10% of their brains. Studies of patients with brain injury suggest that damage to almost any area of the brain has specific and lasting effects on mental, vegetative, and behavioural capabilities. Numerous types of brain imaging studies show that no area of the brain is completely silent or inactive. The many functions of the brain are highly localised, with different tasks allocated to different anatomical regions. Detailed probing of the brain has failed to identify the "non-functioning" 90%. Even micro-level localisation, isolating the response of single neurones, reveals no gaps or inactive areas. Metabolic studies, tracking differential rates of cellular metabolism within the brain, reveal no dormant areas.

3. Hair and fingernails continue to grow after death:

Morbid information about the body captures the imagination and reinforces medical mythology. In All Quiet on the Western Front, the author describes a friend’s fingernails growing in corkscrews after the burial. Johnny Carson even perpetuated this myth with his joke, "For three days after death hair and fingernails continue to grow, but phone calls taper off." To quote the expert opinion of forensic anthropologist William Maples, "It is a powerful, disturbing image, but it is pure moonshine. No such thing occurs." This myth does have a basis in a biological phenomenon that can occur after death. As Maples and numerous dermatologists explain, dehydration of the body after death and drying or desiccation may lead to retraction of the skin around the hair or nails. The skin’s retraction can create an appearance of increased length or of greater prominence because of the optical illusion created by contrasting the shrunken soft tissues with the nails or hair. The actual growth of hair and nails, however, requires a complex hormonal regulation not sustained after death.

4. Shaving hair causes it to grow back faster, darker, or coarser:

Another common belief is that shaving hair off will cause it to grow back in a darker or coarser form or to grow back faster. It is often reinforced by popular media sources and perhaps by people contemplating the quick appearance of stubble on their own body. Strong scientific evidence disproves these claims. As early as 1928, a clinical trial showed that shaving had no effect on hair growth. More recent studies confirm that shaving does not affect the thickness or rate of hair regrowth. In addition, shaving removes the dead portion of hair, not the living section lying below the skin’s surface, so it is unlikely to affect the rate or type of growth. Shaved hair lacks the finer taper seen at the ends of unshaven hair, giving an impression of coarseness. Similarly, the new hair has not yet been lightened by the sun or other chemical exposures, resulting in an appearance that seems darker than existing hair.

5. Reading in dim light ruins your eyesight:

The fearful idea that reading in dim light could ruin one’s eyesight probably has its origins in the physiological experience of eye strain. Suboptimal lighting can create a sensation of having difficulty in focusing. It also decreases the rate of blinking and leads to discomfort from drying, particularly in conditions of voluntary squinting. The important counterpoint is that these effects do not persist. The majority consensus in ophthalmology, as outlined in a collection of educational material for patients, is that reading in dim light does not damage your eyes. Although it can cause eye strain with multiple temporary negative effects, it is unlikely to cause a permanent change on the function or structure of the eyes. Even in patients with Sjögren’s syndrome (an autoimmune disease that features inflammation in certain glands of the body), decreased functional visual acuity associated with strained reading improves when they stop reading. One review article on myopia concludes that increased use of one’s eyes, such as reading in dim light or holding books too close to the face, could result in impaired ocular growth and refractive error. The primary evidence cited was epidemiological evidence of the increased prevalence of myopia and the high incidence of myopia in people with more academic experience. The author notes that this hypothesis is just beginning to "gain scientific credence." In the past reading conditions involved even less light, relying on candles or lanterns, so increased rates of myopia over the past several centuries does not necessarily support that dim reading conditions are to blame. In contrast to that review, hundreds of online expert opinions conclude that reading in low light does not hurt your eyes.

6. Eating turkey makes people especially drowsy:

The presence of tryptophan in turkey may be the most commonly known fact pertaining to amino acids and food. Scientific evidence shows that tryptophan is involved in sleep and mood control and can cause drowsiness. L-tryptophan has been marketed as a sleep aid. The myth is the idea that consuming turkey (and the tryptophan it contains) might particularly predispose someone to sleepiness. Actually, turkey does not contain an exceptional amount of tryptophan. Turkey, chicken, and minced beef contain nearly equivalent amounts of tryptophan (about 350 mg per 115 g), while other common sources of protein, such as pork or cheese, contain more tryptophan per gram than turkey. Any effects of the tryptophan in turkey are probably minimised by consuming it in combination with other food, which would limit its absorption according to expert opinion. In fact, consuming supplemental tryptophan on an empty stomach is recommended to aid absorption. Other physiological mechanisms explain drowsiness after meals. Any large solid meal (such as turkey, sausages, stuffing, and assorted vegetables followed by Christmas pudding and brandy butter) can induce sleepiness because blood flow and oxygenation to the brain decreases, and meals either high in protein or carbohydrate may cause drowsiness. Accompanying wine may also play a role.

7. Mobile phones create considerable electromagnetic interference in hospitals:

In a search by we could not find any cases of death caused by the use of a mobile phone in a hospital or medical facility. Less serious incidents, including false alarms on monitors, malfunctions in infusion pumps, and incorrect readings on cardiac monitors, have occasionally been reported. Although no references or dates are given, one government website published an anecdote in 2002 describing how use of a mobile phone in an intensive care unit resulted in an unintended bolus of adrenaline (epinephrine) from an infusion pump. After publication of a journal article citing more than 100 reports of suspected electromagnetic interference with medical devices before 1993, the Wall Street Journal published a front page article highlighting this danger. Since that time, many hospitals banned the use of mobile phones, perpetuating the belief. Despite the concerns, there is little evidence. In the United Kingdom, early studies showed that mobile phones interfered with only 4% of devices and only at a distance of <1>


Despite their popularity, all of these medical beliefs range from unproved to untrue. Although this was not a systematic review of either the breadth of medical myths or of all available evidence related to each myth, the search methods produced a large number of references. While some of these myths simply do not have evidence to confirm them, others have been studied and proved wrong. Physicians would do well to understand the evidence supporting their medical decision making. They should at least recognise when their practice is based on tradition, anecdote, or art. While belief in the described myths is unlikely to cause harm, recommending medical treatment for which there is little evidence certainly can. Speaking from a position of authority, as physicians do, requires constant evaluation of the validity of our knowledge.

Summary points

Even physicians sometimes believe medical myths contradicted by scientific evidence. The prevalence and endorsement of simple medical myths point to the need to continue to question what other falsehoods physicians endorse. Examining why we believe myths and using evidence to dispel false beliefs can move us closer to evidence based practice.