He said Repaglinide is a scheduled poison used in the treatment of diabetes and is not permitted to be used in products categorised as traditional medicines.

“The product label indicates that Pao Ni Kang is to be used as a traditional medicine for increasing energy and perspiration,” he said in a statement.

Dr Hasan said medicines with Repaglinide can only be dispensed by doctors or pharmacists and their use without the supervision of a doctor can result in serious adverse effects such as hypoglycemia or abnormal diminished content of glucose in the blood.

He advised users of the product to stop taking it immediately and seek professional advice if they are unwell or suffer from the adverse effects.

Traders who have stocks of the product should stop their sale, distribution or use immediately because it is contrary to the Control of Drugs and Cosmetics Regulations 1984, Dr Hasan said.

Individual offenders can be fined up to RM25,000 or sentenced up to three years imprisonment or both for the first offence and fined RM50,000 or sentenced up to five years imprisonment or both for subsequent offences, he said.

Erring companies can be fined up to RM50,000 for the first offence and up to RM100,000 for subsequent offences, he added

Malaysian Society of Otorhinolaryngology and Head & Neck Surgeons president Dr Yap Yoke Yeow said NPC was one of the most treatable cancers.

“If they come to us at the early stages of the cancer, most patients respond well to radiotherapy and chemotherapy and have good outcomes,” he told The Star.

Dr Yap said 70% of NPC patients were diagnosed only six months after the first symptom was noticed and treatment was delayed due to lack of awareness of its early symptoms.

For this reason, the society and the Health Ministry recently started a nationwide campaign to increase the awareness level on NPC and other head and neck cancers such as oral, laryngeal and pharyngeal.

The 2006 National Cancer Registry showed NPC was the fifth most common cancer in Malaysia, but grouped under head and neck cancer, and 2,884 cases were reported in the peninsula the highest number after female breast cancer (3,525) and higher than colorectal (2,866) and lung (2,048) cancer cases.

Dr Yap said people with immediate family members suffering from NPC and middle-aged Chinese, Malay or those from indigenous groups in Sabah and Sarawak should go for screenings while general practitioners should refer patients with neck lumps to ear, nose and throat (ENT) specialists for further investigation.

A neck lump is the most common NPC symptom, followed by hearing loss or ringing or buzzing in the ear, blood-stained saliva or nasal discharge and double vision.

Dr Yap said a study in Sarawak revealed that the Bidayuhs had 26 NPC cases per 100,000 people compared with one per 100,000 worldwide.

There were 5.4 cases per 100,000 in the peninsula and 13.5 per 100,000 in Sarawak.

NPC is caused by many factors and is linked to genes, preserved food such as salted fish and vegetables which contain carcinogenic nitrosamines and the Epstein-Barr viral infection.

The cancer was common in the Guangdong province in China, Hong Kong, Taiwan and the South-East Asia region, indicating a possible genetic link, he said.

The Malaysian 2008 Nasopharyngeal Carcinoma Database showed that carpenters were a high risk group and pesticides and formaldehyde used in the timber industry were possible causes.

Another ENT surgeon, Dr Yeo Sek Wee said the lower income group tended to seek treatment at a late stage of cancer.

He said he was also seeing more cases of tongue cancer.

He urged those with prolonged mouth ulcers to seek treatment and people should visit dentists on a regular basis.

Dr Yeo said the prognosis for all head and neck cancers were good if treated at the early stages.

Its deputy minister, Datuk Rosnah Abdul Rashid Shirlin based on Schedule 16, Rule 41 of the Food Regulations 1985, carbendazim is not allowed in orange juice in the country.

“However, according to the United States Environmental Protection Agency, carbendazim residue in orange juice up to the level of 80 parts perbilion does not pose public health risk,” she said in a statement here recently.

She was commenting on a report yesterday that Coca-Cola Co. had alerted U.S. federal regulators about low levels of fungicide in its own orange juice and in competitors’ juice, prompting increased government testing for the residue.

The U.S. Food and Drug Administration said Coca-Cola found levels up to 35 parts per billion of the fungicide, far below the European Union’s maximum residue level of 200 parts per billion.

Most orange juice products made by Coke and other companies in the U.S contain a blend of juice from different sources including Brazil.

Carbendazim is used to combat mould on orange trees in Brazil.

Rosnah said Malaysia imported 2.775 tonnes of orange juice worth about RM15 million from Brazil since 2010 but did not import oranges from the country during the period.

Dr Wong, who has worked as consultant orthopaedic surgeon in Sibu General Hospital, noted during his years of practice, a large number of locals and those in the surrounding areas of the Division shared this kind of problem.

“Generally, we see this problem in the older age group but nowadays, quite a lot of the population, slightly younger (in their 40s or 50s) are also developing this degenerative disorder. It is a noticeable trend worldwide.

“I have cautioned many people leading a very active lifestyle of this but again, we, in the medical field, are not discouraging people from exercising to stay healthy.

“It shouldn’t be misconstrued as people having to avoid exercise for fear of developing symptoms of osteoarthritis. No, we are not saying that. Rather our message is that people should continue doing what they are doing now — either outdoor or indoor. But we advise them to work out according to their age in terms physical and individual demands,” he told thesundaypost.

While acknowledging that locals were aware of osteoarthritis, Dr Wong, who graduated from University of Nottingham Medical School, UK, lamented many still perceived the disorder as integral to growing old.

“Osteoarthritis is the inflammation of the joint. By that, I mean the joint becomes painful and swollen. Patients have difficulty moving their joints, and the condition can affect all the joints,” he said, adding that the condition affected mostly the knee joints and also those of the hands.

In layman’s term, this medical condition is a degenerative disorder that affects most people as they age.

“It’s estimated 10 per cent of people over 60 years old in Malaysia would have suffered from osteoarthritis. So, it is quite a common problem,” Dr Wong said.

He pointed out that some people were more prone to osteoarthritis than others, saying they were usually the ones who subjected their knees or joints to great physical stress during their younger days.

“Those with knee and joint injuries are a lot likelier to develop osteoarthritis in later life.”

Crucial factors

Dr Wong, who was orthopaedic clinical specialist at a hospital in Ipoh in the 90’s, explained there were multiple causes but “some factors put people at greater risk of getting the condition.”

For instance, a lot of people, in particular weekenders, go for jungle trekking. While this is a good exercise for urbanites, many have complained of knee aches afterwards.

The problem, Dr Wong believed, could be due to uneven trekking paths, coupled with the need for the trekkers to carry their own bodyweight while walking up a slope or hilly part of the route during the trek.

This, he added, exerted tremendous stress on their knee joints.

“People take up jungle-trekking to lose weight and keep fit. But what they don’t realise is this kind of activity is rather strenuous, and they need conditioning before taking it up.

“In other words, they need to be fit first or they could end up getting rheumatic aches and pains that could become worse later on.”

Is the nature of occupation a possible causative factor?

Dr Wong who has worked extensively in hospitals nationwide, noted that among the locals, there was a group of younger people working in logging camps mainly as mechanics and performing multi-tasking.

“Their job involves a lot of lifting heavy things such as spare parts, and most end up having problems with their knees and backs.

“This group is likely to suffer from osteoarthritis but more as an occupational hazard. As they keep doing the same thing for a number of years, in spite being fairly young, they exhibit signs of osteoarthritis,” he explained

Younger people, he said, would not feel the effect much until they got older.

“As people age, the surface of the joints that aid movements develops problems. So, as the surface wears thin, bones rubbing against each other give rise to the problem of osteoarthritis.”

Using the analogy of a car absorber to get his point across, he said as the device wore thin, its ability to carry the same weight became compromised.

Will weight-lifting give rise to knee problems?

Dr Wong said if done without standing up, it would not be much of a problem. However, he pointed out, if free weight-lifting were done often (without proper conditioning), the knees would be subjected to a lot of stress and this might cause problems over time.

To circumvent the problem, regular weightlifters conditioned their muscles to help balance the stress on the joint, he added.

“Leisure weightlifters need to know their condition has to be optimum before taking up that kind of activity.”

Avoid osteoarthritis

Dr Wong advised that people going for games, especially among the older age groups, should be careful about what they planned to do. He said there were many badminton enthusiasts in this part of the world, and among them were some veterans who still played like in their younger days.

“We are not saying they shouldn’t do it but they need to know their limits. Perhaps, they have to modify — maybe take it a bit easy.

“If they continue to compete aggressively, they will certainly run into problems of osteoarthritis of the joint.”

Exercise, he added, was something very good but people had to look at the type of exercise they were doing.

“As we grow older, modification to our lifestyle, including exercise, is of paramount importance.”

Symptoms and signs

Outdoor buffs need to be careful, and alert to problems related to the development of osteoarthritis.

“People need to watch out if they develop signs of pain or stiffness — their joints are not moving as well as before.

“People need to be careful if they experience pain and some limitations to their movement, especially if these are associated with swelling
of the joint.

“They need to immediately see a doctor to diagnose the underlying problems,” he cautioned.

Treatment

According to Dr Wong, people who do a lot of outdoor work must cut back on their activities when they suspect they are developing symptoms of osteoarthritis.

“Rest is a crucial part of the treatment. If you rest any inflammation of the joints long enough, most of them will actually heal. Most cases of osteoarthritis in the early stages are self-limiting.

“You don’t really need to take medication. Rather, it is a
matter of resting the inflammed joints and modifying the activities. This will suffice for most patients.”

However, he pointed out some form of medication may be necessary if the symptoms persisted after resting.

“Simple medication is administered to reduce inflammation and swelling in the joint. Swelling occurs mostly in the knee – the most stressed part.”

He said modification of activities was actually “a very important part of the treatment.”

“If the activity is modified well enough, people can still lead an active lifestyle without comprising their health or mobility.”

Visco-supplement

He added that every joint contained fluid to spread the load more evenly and reduce friction.

“As people advance in years, their metabolism rate slows down and the joints also produce less fluid. In layman’s term, visco-supplement is to get oil into
knee joint to reduce frictional force between two opposing surfaces.

“Visco-supplement helps even up the load so that no particular part of the joint is subjected to very high stress.”

Dr Wong said visco-supplement was usually given to patients with knee pain in the early stages — either stage one or two — for better protective effect.

“For patients with early symptoms, visco-supplement
by way of injection is definitely
a more preferable form of treatment compared to oral medication. It can be an additional treatment method for those people carrying on an active lifestyle.

“For stages three or four (advanced stages), visco-supplement does not help very much and other forms of treatment such as surgery will be more effective.”

Dr Wong clarified that visco-supplement was not a cure for osteoarthritis as it merely provided a protective effect and slowed down the degenerative process.

“For now, there is no known cure for osteoarthritis – a disease of degeneration and of wear and tear.”

Future trend

He said among the Asian population, osteoarthritis of the knee was one of the most common disorders that doctors had come across.

“In the western environment, hip problem is the more common complaint. I think the difference is cultural as Asians tend to squat more compared to their western counterparts.

“But with the westernisation of eastern culture, the problem will eventually be shared by the different cultures.

“Eventually, osteoarthritis of the hip will catch up with us,”
Dr Wong predicted.

The research, published in the US journal the Proceedings of the National Academy of Sciences, is based on a study of mice that were fed a diet of about 70 percent of the food they normally consumed.

Scientists found the calorie-restricted diet triggered a protein molecule, CREB1, that activates a host of genes linked to longevity and good brain function.

“Our hope is to find a way to activate CREB1, for example through new drugs, so to keep the brain young without the need of a strict diet,” said lead author Giovambattista Pani, researcher at the Institute of General Pathology, Faculty of Medicine at the Catholic University of Sacred Heart in Rome.

Researchers have previously discovered that mice on diets showed better cognitive abilities and memory, less aggression, and tended to avoid or delay Alzheimer’s disease. But they have not known exactly why.

“CREB1 is known to regulate important brain functions as memory, learning and anxiety control, and its activity is reduced or physiologically compromised by aging,” said the study.

Mice that were genetically altered to lack CREB1 showed none of the same memory benefits if they were on a low-calorie diet as mice that had the molecule, and showed the same brain disabilities as mice that were overfed.

“Thus, our findings identify for the first time an important mediator of the effects of diet on the brain,” Pani said.

“This discovery has important implications to develop future therapies to keep our brain young and prevent brain degeneration and the aging process.”

According to Marc Gordon, chief of neurology at Zucker Hillside Hospital in Glen Oaks, New York, the findings could shed new light on why some people who are obese in middle age encounter cognitive problems later in life.

“Mid-life obesity has been associated with late-life dementia. However, the physiological basis for this association remains unclear,” said Gordon, who was not part of the study.

“These investigators have studied the effects of limiting caloric intake in mice, and have identified a biochemical pathway that may mediate at least some of the brain’s responses to dietary restriction.”

This is possible as the larvae of Toxorhynchites consumes the larvae of the aedes mosquitoes, he said.

“Dengue is one of the world’s biggest threats which kills more than 22,000 people every year.

“The Subang Jaya Municipal Council (SJMC) is collaborating with Universiti Sains Malaysia (USM) to contain the threat by releasing Toxorhynchites,” he told reporters after opening a local authority environmental health conference here Wednesday.

He hoped other local authorities would follow suit to undertake the same approach.

Meanwhile, SJMC health director Dr Roslan Mohamed Hussin said Toxorhynchites were first released in 2010 with the approval of the Health Ministry.

The process was carried out in two stages, with 200 pairs released each time, he said.

Dr Roslan said SJMC managed to reduce the threat in the municipality by 70 per cent this year.

“The Toxorhynchites do not suck blood, only the nectar of plants, aside from eating the aedes larvae,” he assured.

“Psoriasis appears as raised red patches of skin covered with slivery-white scales,” says Dr Steven Chow, consultant dermatologist and medical advisor to the Psoriasis Association of Malaysia.

The condition, which affects one in 50 Malaysians, occurs when the body’s immune system sends out faulty signals that speed up the regeneration of skin cells. A hereditary condition, it first manifests when lesions appear on the arms, elbows and legs.

“One of the worst things about psoriasis is that people don’t understand that they are not going to get the condition if they touch someone with it,” says Dr Chow, dispelling the myth that psoriasis is contagious. He hopes that with recognition of World Psoriasis Day, which fell on Oct 29, people will become more aware of the condition and how to deal with it.

“When treating psoriasis, I try to help the patient go through it with his or her pride intact. This is because psoriasis influences how others treat the patient, socially, emotionally and even sexually. All these will affect how the patient feels about himself or herself.”

The first time Dr Chow meets the patient is very important. “I will do a thorough study of all that has happened in the patient’s life,” he says. This allows him to identify what triggers the condition.

In most cases, the lesions start to appear when a person is between the ages of 15 and 35. “Sometimes, the condition flares up because of injury to the skin or an adverse reaction to certain medication. Sometimes, it’s simply a case of being too stressed. I’ve seen people who take time off work to relax and their condition improves. The moment they go back to work, it starts again.”

One thing that frustrates Dr Chow most is the misinformation patients receive about the condition.

“Everyone knows a cure for it, except doctors. I knew of a man who had gone to every charlatan in town. His body was so abused by what they were giving him that he ended up in the ICU. He later died.”

Although the condition is incurable, treatment helps minimise its effects and how often the patient suffers a relapse. “A difficult area to treat is psoriasis of the scalp,” says Dr Chow.

“Many patients delay seeking treatment because they think it’s dandruff. Previously, treatment used to be messy and smelly. Now, there are new creams, ointments and gels in the market which are odourless and which makes it easier for me to treat psoriasis of the scalp.”

Dr Chow says the hardest patients to treat are those who have given up hope. “People harp on the incurability of the condition. They hope for a miracle but don’t want to think about changing their lifestyle. They actually think they have no stress.”

His advice to sufferers is simple: “Control your psoriasis, don’t let psoriasis control you.”

Getting over the social stigma

EUGENE Cross, 69, is president of the Psoriasis Association Of Malaysia, a non-profit organisation which aims to provide information and support to those suffering from the condition.
Cross been suffering from psoriasis for the past 45 years.

“At first, I thought it was dandruff. When I went to the UK, a dermatologist told me, ‘My son, this is psoriasis. You’ll carry it to your grave,” says the retired engineer with the Malaysian Air Force.

“At that time, treatment was horrible. It was cold tar which was smelly and brownish. I was also in pain whenever there was a relapse. One time, I was on medical leave for a whole year. I couldn’t turn or stretch my body because the skin would crack and bleed.

“At work, I was assigned to a desk job because I couldn’t do on-site investigations. In the end, I wasn’t promoted and retired with the rank of Major.”
Determined to look on the bright side of things, Cross talks about the devotion his family showed him. “Thank God for my wife. Do you know, there was a time when she would sweep the house and collect one bowl of dead skin every day?”

Others, however, have not been as understanding: A cashier in a supermarket once refused to hand him his change. Instead, she put the money on the counter. Of all the stories he tells, the saddest is of a 17-year-old girl who committed suicide because she was unable to handle the stigma.

Cross notes that stress is a common factor amongst psoriasis sufferers. “There’s usually terrible stress when the lesions first erupt. Mine started when I was a cadet officer and the ragging was so bad. Others have similar stories.

Either they have lost a family member, had final exams or a breakdown in their love life. Some foods also trigger my condition.”

Among the foods he cannot eat are brinjal, yam, peanuts and durian.

Signs and symptoms of psoriasis
1. The characteristic lesions are where the skin appears to have a red base with silvery scales forming on top.
2. The skin surrounding the affected area is normal.
3. There are changes in the nails.
4. Sometimes, the affected area is itchy.
5. Patients also suffer from joint pain.

The 19-year study involved about 39,000 women with an average age of 62.

Those taking multivitamins or supplements of iron, Vitamin B-6, folic acid, magnesium, zinc and copper had, on average, a 2.4 percent increased chance of death over the course of the research.

Iron had the highest associated risk.

But one supplement – calcium – appeared to reduce the risk of death.

The study, appearing in the The Archives of Internal Medicine, didn’t look at a possible direct cause-and-effect dynamic. It was an observational study based on self-reported supplement use and, its authors say, a range of factors aside from the use of supplements could have impacted the outcome.

“The headline,” CBS News medical correspondent Dr. Jennifer Ashton cautioned, “like many, can be deceiving. This study was based on associated findings – it did not show a biologic cause-and-effect. (It was a) very large study done from 1986 to 2004 in Finland, very large study. They looked at almost 40,000 women, average age 62. That’s important. They found in this group, 85 percent of them too took at least one dietary supplement a day, very similar to what we do here in this country. (The study) found an associated increased risk of desk among these older women for those in particular taking vitamin B-6, folic acid, iron, magnesium, zinc and copper. (The research) didn’t say why, but did show that they had an increased risk of dying.”

What is it about these supplements that causes the increased risk?

“In general,” Ashton responded to “Early Show” co-anchor Chris Wragge, “we don’t know. One well-respected doctor I work with said he’s very skeptical about dietary supplements not because he thinks they don’t work, but precisely because he thinks they do work. And in fact, we don’t have enough data, we don’t have enough well-constructed research to show us what the effect of these particular vitamins can do, especially when taken in high doses, excessive quantities.

“In particular, this study showed iron had an increased risk of death. And we know that, for certain people with certain types of blood disorders, excessive iron can be dangerous to the heart and liver.”

“Early Show on Saturday Morning” co-anchor pointed out that many women take iron supplements, including those who are pregnant.

“Most women, most patients don’t consider these supplements to be like medication,” Ashton pointed out, “and in fact, they should.”

Ashton offered tips for anyone taking supplements:

“Number one, if you are taking anything, especially when you’ve been taking it for (a long time), you want to discuss these with your doctor. You want to try to avoid self-diagnosis and falling into that trap of the marketing and advertising claims that a lot of these supplements portend. And also, do not assume that more is better. Really, do not take more than the recommended dosage, because we do know that these vitamins, like anything, can be dangerous.”

IT turns out that catching cancer early isn’t always as important as we thought.

Some tumors are too slow-growing to ever threaten your life. Some are so aggressive that finding them early doesn’t make much difference. And today’s treatments are much better for those somewhere in the middle.

Those complexities are changing the longtime mantra that cancer screening will save your life. In reality, it depends on the type of cancer, the test and who gets checked when.

“We can find cancer early. We can reduce the burden of the disease. But along the way, we’re learning our tests are not as perfect as we’d like,” says the American Cancer Society’s Dr. Len Lichtenfeld, a longtime screening proponent. “We’re learning that we’re now finding cancer that would in fact never cause harm.”

Now cancer specialists are struggling to find a new balance: to quit over-promising the power of early detection and to help people understand that the tests themselves have risks – while not scaring away those who really need it.

Least controversial are cervical and colorectal cancer screenings. They can spot pre-cancerous growths that are fairly easy to remove, although even some of those tests can be used too frequently. More serious questions surround other cancers – like which men, if any, should get a PSA blood test to check for prostate cancer, and whether women should start mammograms in their 40s or wait until they’re 50.

Also in question is whether doctors will be able to head off another looming controversy: Just which smokers and ex-smokers should get a pricey CT scan that can detect lung cancer but also is prone to false alarms? A recent study found the scans could save some lives. But guidelines aren’t due out until early next year that would decide who is at enough risk to outweigh the test’s potential harm – such as a risky, invasive biopsy to tell if a suspicious spot is cancer or just an old smoking scar.

Yet already people like 80-year-old Fred Voss of Sunderland, Md., are seeking out the tests.
“It was a big relief, and it gave me something to watch,” says Voss, who participated in the CT study but wanted to get tested again to make sure nothing had changed.

Today, guidelines for how to handle some of the most common cancer screenings conflict. And, they’re written for the average patient when many people may need a more customized decision, says Dr. Jeanne Mandelblatt of Georgetown University. She has studied breast cancer risk for a government panel that recommends most women not begin screening for the disease until age 50.

Consider this, she says: The average woman has a 3 percent lifetime risk of dying of breast cancer, a low risk for a disease that women find so scary. But the chances of getting breast cancer do gradually increase with age and other circumstances.

So if you’re 40 and have several risk factors – like dense breasts and close relatives with the disease – then you have the same risk as an average 50-year-old, not an average 40-year-old, and might consider earlier mammograms, Mandelblatt says. Few primary-care doctors have the time to go into that kind of detail.

Adding to the confusion are testimonials from cancer survivors that a screening saved their lives. Dartmouth researchers recently studied how often that’s true for mammograms, and estimated that about 13 percent of women in their 50s whose breast cancer is detected by the tests survive as a result.

What else plays a role? Treatments have dramatically improved in recent years, saving more lives. Also, increasingly powerful mammograms are detecting more low-risk tumors, the kind that probably wouldn’t have threatened a woman’s life in the first place.

Still, mammograms are “not perfect, but they’re the best we have,” cautions Mandelblatt. She thinks the Dartmouth estimate is somewhat low.

PSA tests for prostate cancer are a much tougher call. Last month, a government panel recommended an end to routine PSA screenings, a step further than other major medical groups that urge men to weigh the pros and cons and decide for themselves. But the U.S. Preventive Services Task Force found limited, if any, evidence that screening average men improves survival. That’s largely because so many men are diagnosed with slow-growing tumors that never would have killed them; still, they have treatments that can cause incontinence, impotence or even lead to death.

“We really – underline the word `really’ – have to pull back the messaging on prostate cancer,” says the cancer society’s Lichtenfeld, who himself isn’t sure of the test’s net worth. PSA testing took off on the basis of “blind faith” that they would work, not science, he says.

What really worries Lichtenfeld is that ever more powerful cancer screenings are being developed, before doctors have a way to tell exactly which early tumors should be removed.

“We have cells in our body that are abnormal all the time, and our bodies deal with it,” he says. “Our technology takes us further and further down the early-detection path, and we need to sort through all this.”

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