Assault

Dealing with sexual assault

YOUR HEALTH   DR GITA MATHAI

Self medication can be harmful, consult a doctor when your child is sick We perceive India as a safe, tradition bound country that honours women and loves children. Yet, our cities are becoming famous, even internationally, for molestation and rape. The number of cases reported has increased 700 per cent since Independence. And this is probably only the tip of the iceberg. Shame, family pressures, social stigma, economic vulnerability and lack of knowledge of legal procedures coerce a victim into silence. To make things worse, the victim is often regarded by our inadequately educated, underpaid and insensitive police personnel as the one at "fault". Rape is traditionally considered a crime against women. But times are changing. Horror stories abound about homosexual sexual predators targeting, kidnapping and victimising young boys. The victims range from six-month-olds to 80-year-olds. The perpetuators of rape, however, are almost always male. Around 80 per cent of the crime is committed by someone known to the victim. Often, the abuser is a member of the victim's family or belongs to his or her circle of acquaintances. In such cases, the crime is perpetuated in a known place, in either of their homes or that of a friend, relative or neighbour. Today, children of both sexes are in danger, in exclusive neighbourhoods as well as the slums. Their lack of knowledge, inexperience and trusting nature make them ideal victims. Many of these attacks are not random but well planned by a predator known to the victim. Police complaints are often followed by unwelcome media publicity. There are no "special victim units" in the police force yet, that may be trained to handle such cases with discretion and empathy. The guidelines provided deal mostly with the rape of women. The concept of male or child rape is new and the level of expertise in dealing with this is low. Despite this, if a parent or the victim wishes to prosecute the assailant, a physical medical examination, documentation of the evidence and registration of an FIR (First Information Report) must be done. Even otherwise, a thorough medical examination must be undertaken as soon as possible to treat and record lacerations and injuries, both external and internal. The greatest fear about sexual assault is that of acquiring STDs. The number infected varies between 5 and 10 per cent. Infection depends upon several factors, such as the type of sexual contact, number of assailants, and whether or not they had an STD at the time of the assault. The risk of contracting STDs can be reduced by taking medication as a preventive measure. Immediate and effective treatment options are available for some STDs such as hepatitis B, gonorrhea, syphilis, herpes, chlamydia and trichomonas vaginalis. The regimen recommended is a single injection of ceftriaxone, plus an oral dose of azithromycin, plus either secnidazole, tinidazole or metronidazole. Herpes can be tackled with a five or seven-day course of acyclovir. The risk of acquiring HIV infection is less than 1 per cent. However, it is important for medico-legal reasons to document the HIV status immediately. The test should be repeated after six months and then a year. A 28-day regimen of zidovudine and lamivudine provides post-exposure prophylaxis for HIV and should be started as soon as possible, preferably within 72 hours. Injuries and lacerations require a single booster dose of tetanus toxoid. Hepatitis B can be sexually transmitted. Most children today have received three doses of the vaccine as part of their immunisation schedule and are thus protected against the infection. In that case, only a booster dose needs to be given. If the victim has not been immunised in childhood, immunoglobulin needs to be given. In addition, three doses of the vaccine must be given — immediately after the incident, after a month and after six months. Prophylactic treatment against syphilis is not advised. Instead, a blood test can be done after three months to ascertain if infection has occurred. Counselling, psychiatric evaluation and support are necessary for the victim as well as his or her family to overcome the trauma. To protect children — • Make them learn addresses and phone numbers by heart • Teach them certain body parts are not to be touched • Discourage them from talking to strangers • Do not send them anywhere alone, especially after dark • Escort them to and from school bus stops • Encourage physical fitness and teach them martial arts • Teach them to trust their survival instincts and, if needed, run in the opposite direction as fast as they can, shouting all the way. For adults, the best bet is —   To have peepholes in the front door   Avoid dark and deserted areas   Be physically fit and able to run fast. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Left handed or right?

Hope for clumsy clods

Your Health   Dr Gita Mathai

Being left handed does not come in the way of excellence, at least not for batsman Gautam Gambhir Right handed or left? Worldwide, about 90 per cent of the people prefer to use their right hand for doing things. Not surprisingly, life in all cultures is geared to the right-handed individual. Implements like nuts and bolts are difficult to handle for the left-handed. Incidentally, "right" also means "correct". The word "left" is derived from the Anglo-Saxon "lyft" which means "weak" or "useless". Our brains are wired for handedness. During the process of evolution, the centre for language moved to the left hemisphere in the majority of the people. The human brain functions such that the left and dominant hemisphere controls the right side of the body, making the majority (80 per cent) totally right-handed. The dominance does not extend to the use of the hand alone — such people are also are "right sided". Their dominant eye, ear and leg are on the same side of the body. Problems arise in 20 per cent of the population that doesn't have a dominant hemisphere to determine laterality or handedness. Their brains are "cross wired", giving them mixed handedness or laterality, cross dominance, mixed dominance or cross laterality. In short, the right hand may be matched with the left foot or the left hand with the right eye. This leads to confused, crossed signals in the brain when complex tasks are performed. The electrical and chemical signals have to criss-cross the midline before they eventually reach their final destination in the designated area of the brain. Therefore, such individuals are accident prone, and have things around them explode, collapse, catch fire or fall apart. Day-to-day objects are misplaced, and navigation from one place to another (with left to right confusion) — even along familiar roads — becomes a nightmare. These adults evolved from clumsy children, who kept bumping into things and frequently fell down. Their bodies have scars and evidence of healed fractures. Their school projects get "excellent" for imagination and "zero" for execution. Life is difficult for people with mixed laterality. Career choices are affected, with professions like driving or piloting a plane remaining distant dreams. People with mixed laterality alternate hands when writing and legs when kicking. They hold the telephone to the ear opposite to their writing hand. They subconsciously use one hand first and then the other to perform complex tasks. Earlier, such people were considered ambidextrous, but true ambidexterity is almost unknown. The uncertainty also extends to the mental image of their own limbs or body surface. This causes an inability to rapidly execute commands to turn right or left. The march past becomes a formidable hurdle, with everyone doing a "right turn", while the affected individual wanders off in the wrong direction. Hesitation is evident if they are asked to perform complicated tasks with alternating hands initiating the movement. Slowed reactions preclude split second decisions, causing frequent accidents. Also, people with mixed laterality do not perform well in track and field events. Their feet do not alternate quickly enough. Running is slow and uncoordinated. The good news, however, is that they excel in games involving a bat (such as hockey, cricket, tennis, badminton and table tennis). This is because the bat is held across the body on the dominant side. Mixed laterality also has its advantages. The criss-crossing of brain signals uses and strengthens many normally unused brain synapses and pathways. Hence such people are exceptionally talented, creative and artistic. If portraits or photographs of some famous artists — such as Leonardo da Vinci and Rembrandt — are scrutinised, you will see that they may paint with one hand, while tilting the head to the other side and crossing the opposite leg. This demonstrates mixed laterality. To check your laterality, figure out — * Which hand you use to write, pick up objects or dial the telephone * Which leg you use to kick or which is uppermost when your legs are crossed (this remains constant all through life) * If you cannot hear clearly, to which side you tilt your head * The side of your jaw you use to chew (this is also constant unless there is a dental problem) If you have mixed laterality, it is possible to overcome the "defects" and strengthen both sides equally, in a way that it "compensates" for mixed laterality. These exercises, that require 10 repetitions, may be of help — • While walking, clench and unclench your hands, alternating them with the foot you use to step forward (right hand and left foot) • Standing on one leg at a time • Close one eye first and then the other • Close one ear at a time • Doing yogic breathing through one nostril at a time. If a child is "left" handed, that may be the "right" laterality for him or her. Punishment, ridicule or forceful correction messes up the brain connections. Desist from interference, or you might just have sabotaged the emergence of the next Einstein. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

Gestational diabetes mellitus

Not all sugary

	Your Health   DR GITA MATHAI
Self medication can be harmful, consult a doctor when your child is sick

Shock was writ all over her face and her husband's. "How can I have diabetes," asked the young woman. "When I saw the result of the blood sugar test, I thought it was a mistake. No one in my family has diabetes!" Well, that may be true, but it is also a fact that 2 per cent of the Indian population has diabetes and 15 per cent of pregnant women have abnormal blood glucose values.

Despite the epidemic of diabetes in our young urban adults, statistics about the exact prevalence of the disease in pregnancy are difficult to obtain. Many pregnant women are not tested. In centres offering antenatal care, the presence or absence of "sugar" in the urine — an unreliable test at best — is used to diagnose diabetes.

Blood should be tested as part of routine antenatal care. A fasting glucose level of more than 126mg/dL or 7mmols/L in pregnancy is considered abnormal. A blood sample can also be drawn one hour after ingesting 50g of glucose. A normal value is less than 140mg/dL or 7.8mmols/L. If it is higher, it needs to be followed by a three-hour OGTT (oral glucose tolerance test) with a 100g glucose load. A positive diagnosis is made if the fasting value is 105mg/dl, the one-hour value 190 mg/dL, the two-hour value 165mg/dL and the three-hour value 145 mg/dL or more.

Some of the women with these values are diabetics who are asymptomatic and unaware of their condition. Others have relative insulin insufficiency, or MODY (maturity onset diabetes of the young), and are already on oral diabetic medications. Women with polycystic ovarian syndrome may be on the oral diabetic drug metformin. They may become overtly diabetic during pregnancy.

Others with abnormal blood sugar levels have gestational diabetes mellitus (GDM), a peculiar type of glucose intolerance which first appears during pregnancy in an otherwise normal woman. It can occur at any time during the pregnancy, though it is more likely to occur after 24 weeks. The exact reason for gestational diabetes is not known.

Women at risk are those who

* Have a family history of diabetes,

* Have a BMI (body mass index — that is, weight in kilogram divided by height in metre squared) of more than 30,

* Are older than 25,

* Have previously had large babies (more than 4kg) or still births.

The glucose in the mother's blood crosses over via the placenta to the baby. The excess sugar supplied makes the baby grow rapidly. The baby's pancreas starts to work overtime to lower the sugar to normal by secreting insulin. The excess calories are stored as fat. This gives rise to a large baby (macrosomia) weighing more than 4kg. This in itself increases mortality by 50 per cent. The size may cause the baby to get stuck in the birth canal. Forceful extraction can result in fractures of the collarbone or paralysis of the nerves to the arm. After birth, the baby's pancreas continues to produce high levels of insulin as it is acclimatised to do so. This may cause the blood sugar levels in the baby to drop precipitously. The baby may then have seizures. In addition, it may develop other problems such as low blood levels of calcium and magnesium. Many babies also die (that is, are still born) while others (up to 50 per cent) may have breathing difficulties.

About 33 per cent may have polycythemia (excess blood) and 16 per cent develop jaundice at birth or soon after.

Mothers with GDM are also prone to develop other complications during the pregnancy such as hypertension. Almost 60 per cent of these women develop GDM in subsequent pregnancies, particularly if there has been maternal weight gain between the two pregnancies. Around 35 per cent will go on to develop diabetes in the next 15 years. The blood sugar in mothers with GDM should be well controlled to prevent complications in her as well as the baby. Diet regulation is needed to keep the sugars under control. Since not all women with GDM are obese, the diet has to be adjusted in accordance with the mother's BMI. The diet should consist of 40 per cent carbohydrate, 20 per cent protein and 40 per cent fat.

Pregnant women do not really "have to eat for two". The calorie requirements are

*35kcal/kg/ 24hour for a woman of normal weight (BMI 25).

* 24kcal/kg/ 24hour for overweight women (BMI 25-30).

* 12 to 15 kcal/kg/24hour for morbidly obese women (BMI 30-40).

* 40kcal/kg/24hour for underweight women (BMI less than 25).

A combination of diet control and aerobic exercise such as brisk walking for 45 minutes every day usually keeps the blood sugars normal. If the sugars remain high, insulin therapy may have to be started. Many of the oral diabetic medications cross the placenta and cause hypoglycaemia in the baby. Some of them are, however, used under supervision.

Unlike other forms of diabetes, which are permanent, GDM disappears after delivery. It, however, acts as a warning. Exercise for 45 minutes or more a day, reduce your weight and maintain your BMI at 23. That way, diabetes may not plague you in your later years.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in