World AIDS Day

1st December

All you need to know about AIDS (Acquired Immuno Deficiency Syndrome)

It is estimated that there are 33.3 million people worldwide infected with  HIV. Africa leads the world with highest  HIV  prevalence of 24.5 million infected cases.

The top three countries in the world with most  HIV infected patients are

i). South Africa -Largest population living with the disease about 5 million people

ii). Ghana -2^nd largest population living with  HIV disease a about 3.0 million people

iii). India- 3^rd largest population living with the disease about 2.0 million people

Transmission of human immuno deficiency virus

Infection with  HIV occurs through three primary modes: sexual, parenteral, perinatal.

• Sexual intercourse is the most common way of transmission. Condom use reduces the risk of transmission by approximately 20-fold. Individuals with genital ulcers or sexually transmitted diseases, such as syphilis, chanchroid, herpes, gonorrhea, chlamydia, and trichomoniasis, are the great risk for contracting  HIV.

• The use of contaminated needles or other injection-related paraphernalia by drug users has been the main cause of parental transmission of  HIV.

• Healthcare workers have a small risk of occupationally acquiring  HIV, mostly through accidental injury.

• Perinatal infection, or vertical transmission, is the most common cause of pediatric  HIV  infection. The risk of mother to child transmission is approximately 25% in the absence of breast feeding or antiretroviral therapy. Breast- feeding can also transmit  HIV.

Signs and Symptoms

• Viral syndrome like fever, pharyngitis (inflammation of pharynx), adenopathy (large or swollen lymph nodes). Symptoms may last for two weeks.
• 40-80% of patients will exhibit maculopapular rash usually involving the trunk
• Diarrhea, nausea, and vomiting commonly occurs in infected people

•  Most children born with  HIV are asymptomatic. On physical examination, they often present with unexplained physical signs such as lymph adenopathy (enlarged lymph), hepatomegal (enlarged liver), spleenomegaly ( enlarged spleen), failure to thrive, and weight loss or unexplained low birth weight. and fever of unknown origin.

Diagnosis

• Most commonly used screening method for  HIV  is enzyme-linked immunosorbent assay (ELISA), which detects antibodies against HIV-1.

• There are several methods used for determining the amount of  HIV -RNA.

Treatment.

• The central goal of anti -HIV therapy is to decrease spread and death due to disease through maximum suppression of  HIV replication.
• Secondary goals include an increase in  CD4 lymphocytes.

General measures to be taken by a HIV patient.

• Regular periodic measurement of plasma RNA levels and  CD4 cell counts. It is necessary to determine the risk of disease progression.
•  HIV- infected persons, even those with viral loads below detectable limits, should be considered infectious and should be counseled to avoid sexual and drug use behaviors that are associated with transmission or acquisition of  HIV.

 Treatment during pregnancy.

• Therapy during pregnancy is warranted in light of the dramatic reduction in transmission seen with Zidovudine monotherapy. In general, pregnant women should be treated similar to non pregnant adults.
• Efavirenz drug which is usually used to treat  HIV  is avoided in infected pregnant women because it causes abnormalities in baby.

Obesity – A global epidemic

What is Obesity?

Obesity refers to having excess amount of body fat.

Overweight refers to weighing too much which may come from muscles, bone, fat and water.

Mortality due to Overweight and Obesity

According to WHO studies, it is estimated that around 2.8 million people die every year due to overweight or obesity.

Measurement of Overweight and Obesity

 

Body Mass Index (BMI)

BMI is the most common tool used to estimate overweight and obesity in adults as well as in children.

Adults: The range of overweight and obesity are estimated by using weight and height to compute BMI of a subject.

Children: Children growth rate will be different at different times. So it’s not that easy to decide whether a child comes under obesity or over weight. Thus BMI for children will be calculated by comparing height and weight of children with same age and sex.

Classification for BMI

Classification	BMI
Underweight	<18.5 Kg/m2
Normal weight	18.5-24.9 Kg/m2
Overweight	25-29.9 Kg/m2
Obesity(class1)	30-34.9 Kg/m2
Obesity(class2)	35-39.9 Kg/m2
Extreme obesity (class3)	≥40 Kg/m2

                                                                              

Waist circumference

Excess level of abdominal fat is a vital risk factor for numerous diseases. Measurement of waist to hip ratio is useful in identifying diseases.

Increasing waist lines enhances the risk for cancer

A high waist circumference is associated with enhanced risk for type 2 diabetics, hypertension, cardiovascular diseases (CVD) and dyslipidemia in patients whose BMI is in between 25 and 34.9 Kg/m²_.Men are at greater risk if their waist circumference is more than 40 inches (102 cm).Women is at increased risk if their waist circumference is greater than 35 inches (88 cm).

Reasons:

Overweight and obesity occurs due to energy imbalance. Body weight remains the same when the no.of calories taking in is equal to the no.of calories burns. If consumption of calories is more compared to burning of calories this leads to overweight and obesity.

Other factors that tips towards overweight and obesity includes inactive lifestyle, family history and genetic causes, hormone related problems like hypothyroidism, cushing’s syndrome and polycystic ovarian syndrome (PCOS), smoking and lack of sleep, attitudes and emotional factors, eating habits and income.

Risks of Overweight and Obesity

                                                                                                 

Heart diseases  Brain stroke  Liver damage High blood pressure  Reproductive problems Type2 diabetics Abnormal blood fats Osteoarthritis Sleep apnea Gall stones Colon cancer Endometrial cancer Breast cancer Kidney cancer

Stop Smoking and Prevent Your Major Risk of COPD

Chronic obstructive pulmonary disease COPD is characterized by air flow limitation that is not fully reversible. COPD is the third leading cause of death in the world. The airflow limitation is usually both progressive and associated with an abnormal swelling of the lungs to harmful gases or particles. It is of two types

Chronic bronchitis, in which symptoms include recurrent excess mucus secretion in wind pipe with cough that occurs on most days for at least 3 months of the year.

 Emphysema, is abnormal permanent enlargement of air spaces, accompanied by destruction of walls of wind pipe. The main cause for this disease is exposure to environmental tobacco smoke, but other chronic inhalational exposures can also lead to COPD. It is mentioned in one of the study that the prevalence of COPD in western countries had been higher than those reported from Asian countries. The disease prevalence rate is slightly more in men than in women.

Prevention of the COPD

Cessation of Smoking

Cessation of smoking can help you to lessen the disease up to 80%. Nicotine gum, transdermal patch, inhaler, nasal spray aids in cessation of the smoking.

Avoiding inhalation of lung irritants like chemical fumes and noxious gases have been linked to the prevention of COPD. Wearing mask while two wheeler drive, and in places where there is probable of exposing to noxious gases can prevent you from developing disease.

Vaccination

Flu vaccination in COPD helps in reducing disease. Exacerbations of disease are reason for many deaths. Taking vaccinations helps in decreasing the exacerbations, commonly recommended vaccines are influenza and pneumococcal vaccine. The US centers for disease control and prevention (CDC) recommend that pneumococcal vaccination be administered to all patients of at least 65 years of age as well as to younger patients with chronic medical illness, including COPD.

Exercise:

In severe illness and old age, supervision of physiotherapist will be able to provide you with an exercise regime suitable for your specific condition. Exercise is needed for strengthening of lung muscles, breathing exercise should be important part of your regime. Walking is good, even if it is for 10 min with slow pace, will strengthen your body. Cycling is another thing which needed to be included in your exercise regimen, exercising your diaphragm strengthens breathing muscle. With inhaling slowly through your nose and exhaling slowly.

Eating strategies:

• Clear the airways of mucus before eating.
• Choose softer foods that are easier to chew swallow e.g.; mashed potato, soups, bananas.
• Limit food that can cause bloating e.g.; beans, onions, cauliflower and soft drinks.
• Drink plenty of fluids. 6 to 8 ounce glasses everyday to keep mucus thin and easier to cough up.
• Limit caffeine in any form like cola, chocolate etc. as it might interfere with your medications.
• Eat whole grain cereals, breads, crackers, rice every day.
• Eat more dark green vegetables and more oranges and carrots.
• Choose low fat or fat free milk and other milk products.

What does a Mouth Ulcer Mean? 

What To Do When One Shows Up

The common problems are soreness and redness inside the mouth, white plaques, and ulcers.

Stomatitis, Glossitis and Angular Cheilitis:

• If tongue is reddened and sore and /or if angles of mouth are white and sore it is likely vitamin B deficiency.
• Normally physician prescribes you vitamin B supplements.
• Drink cooked rice water from parboiled or other unpolished rice.

White Plaques:

• If white plaques are seen in mouth with no fever, it is likely fungal infection, which is common in infants.
• Clean mouth with gauze swab, apply gelatin white with cotton brush.
• If fever is also there, It may be diphtheria. Symptoms include patches over the throat, very high fever. Physician usually starts treatment with antibiotics.
• In adults oral candidiasis may be seen in malnourished, pregnancy, diabetes and nowadays increasingly in AIDS patients.

Many small vesicles in or near mouth

Herpes infection: Usually occurs along with other serious infection. Often painful and person may have difficulty in swallowing. Application of gelatin violet is enough.

Painful ulcer in mouth

• Look at ulcer – If small, one or two, centrally white, with surrounding redness and pain more while eating, mostly it is aphthous ulcer.
• This heals by itself, treatment is not essential.
• If needed chlorhexidine mouth wash 2-3 times a day for five days can be used.
• Physician usually prescribes you a vitamin B complex tablet.
• Avoid tobacco chewing/lime/betel nut/gutka.
• Salt absorbs redness and inflammation, mix 1 table spoon of salt in ¼ cup of water, pour it in your mouth, and make sure it is concentrated at ulcer site. Spit water out after 1 min.

Painless ulcer in mouth

This could be oral cancer. This is the commonest form of cancer in India. Consult the physician immediately. This cancer is curable if referred early. Finding this cancer early and referring it in time is a major goal of health system.

Pain and swelling inside the mouth and fever

With or without white plaques it could be diphtheria

.

Prevention of Food Borne Diseases, the Five Keys to Safety Food

According to WHO these are 5 main preventive steps to prevent food borne diseases

Food borne diseases are due to consumption of contaminated food. It is one of the health hazards and cause of death in developing countries like India. According to one of the study conducted by Indian council of Medical Research (ICMR), India. There were 10 outbreaks among 900 study group. The type of food responsible for these outbreaks includes. Kaddu ka kheer (sweet prepared from desiccated milk and bottle guard) Milk shakes, Chicken Biryani (dish prepared from rice and chicken), Fruit salad, Mango juice, Jaggery rice. And organism responsible for these out breaks is S. aureas.

Keep clean

• Wash your hands before handling food and often during food preparation.
• Wash your hands after going to the toilet.
• Wash and sanitize all surfaces and equipment used for food preparation.
• Protect kitchen areas and food from insects, pests and other animals.

Separate raw and cooked

• Separate raw meat poultry and seafood from other foods.
• Use separate equipment and utensils such as knives and cutting boards for handling raw foods.
• Store food in containers to avoid contact between raw and prepared foods.

Cook thoroughly

• Cook food thoroughly, especially Meat, poultry, eggs and seafood.
• Bring foods like soups and stews to boiling to make sure that they have reached 70 ͦ C. For meat and poultry, make sure that juices are clear, not pink. Ideally, use a thermometer.
• Reheat cooked food thoroughly.

Keep food at safe temperatures

• Do not leave cooked food at room temperature for more than 2 hours.
• Refrigerate promptly all cooked and perishable food (preferably below 5 ͦ C) .
• Keep cooked food piping hot (more than 60 ͦ C) prior to serving.
• Do not store food too long even in the refrigerator.
• Do not thaw frozen food at room temperature.

Use safe water and raw materials

• Use safe water or treat it to make it safe.
• Select fresh and wholesome foods.
• Choose foods processed for safety, such as pasteurized milk.
• Wash fruits and vegetables, especially if eaten raw.
• Do not use food beyond its expiry date.

14th November

     World  Diabetes Day   

                  

The Whys And Whats Of Diabetes, Drive Diabetes and Its Complications Away with A Healthy Life Style

Diabetes is fast gaining the status of a potential epidemic in India with more than 62 millions diabetic individuals currently diagnosed with the disease. In 2000, India (3.7 million) topped the world with the highest number of people with diabetes mellitus followed by china (20.8million) with the United States (17.7 million) in second, third place respectively.

Preliminary results from a large community conducted by the Indian council of medical research (ICMR) revealed that lower proportion of the population is affected in states of Northern India (Chandigharh 0.12 million, Jharkhand 0.96 million) as compared to Maharashtra (9.2 million) and Tamil Nadu (4.8 million) as stated by one of the article named ‘‘The current state of diabetes mellitus in India’’.

Diabetes

Diabetes is a metabolic disorder it is characterized by high blood sugar levels. It also interrupts in metabolism of carbohydrates, fats and proteins. Diabetes is due to inadequate insulin in the body (Insulin is a hormone which regulates metabolism of carbohydrates and fats by promoting the absorption  of glucose). Diabetes is of two types.

Type 1 diabetes: 5% to 10% of all diabetic cases

                           Develops in childhood

                            Pancreas doesn’t make insulin

Type 2 Diabetes: 90% of all diabetic cases

                           Do not produce enough insulin or

                            Have resistance to insulin

 Risk factors for  Diabetes

  

Risk factors for Type 1 Diabetes

Autoimmune (autoimmune is a condition in which body loses its ability to recognize its own body cells and starts destroying them) destruction of pancreatic beta cells resulting in absolute deficiency of insulin.

  Risk factors for Type 2 Diabetes

High Blood Pressure

High fat and Cholesterol levels

Smoking

Sedentary life styles

Over weight

Family history

                                

 Symptoms

·Polyuria  (urinates frequently and abnormally large amounts)

·Polydipsia (excessive thirst)

·Polyphagia (excessive hunger)

·Weight loss (In type 2 diabetes , weight loss is less common)

Non-Medical treatment for diabetes

·Medical Nutrition therapy is recommended for all patients with diabetes.

·A meal plan is highly recommended which has moderate carbohydrate and low in saturated fat.

·Aerobic exercises can improve insulin resistance and decrease blood sugar levels and may helpful in reduction of cardiovascular risk factors.

·Exercises should be started slowly from 10 minute to 30 minutes a day.

·Older patients and patients with other disease conditions like heart diseases, joint diseases need to follow particular plan as told by your physician.

Recognize your blood glucose levels with these symptoms

Complications

Diabetic Retinopathy:

·If you have problems in vision and you are a diabetic patient you should consult ophthalmologist for every 6 to 12 months

·Laser photocoagulation has improved sight preservation in diabetic patients

Diabetic Neuropathy:

·Peripheral neuropathy is the most common complication in type 2 diabetes.

·Symptoms that indicate Peripheral neuropathy is paresthesias, Numbness ,Pain.

·Hand is more prone than feet.

·In some patients diabetic diarrhea is observed which is usually controlled by 14 day antibiotic treatment.

Diabetic Nephropathy

·Glucose and blood pressure control are most important for prevention of Nephropathy.

·Blood pressure control is most important for retarding the progression of established nephropathy.

Peripheral vascular disease and foot ulcers

·Claudication (impairment in walking) and non healing foot ulcer are most common in type 2 DM

·Local debridement and appropriate foot wear  and foot care are important in the early treatment may be beneficial in more advanced lesions

Coronary artery disease

·Multi risk factor intervention reduces macro vascular events.

·The National cholesterol education program adult treatment panel III guidelines classify the presence of DM as coronary heart disease risk.

     Reduce Your Risk  Factors