Diwali : Blending Sense with Tradition

Diwali, the festival of joy, lights and cuisines, provides a perfect opportunity to blend tradition with dash of sense and demonstrate to neighbours and friends smart new ways of doing old things.

The Eats: A huge amount of effort and resources are traditionally spent in procuring or preparing sweets for neighbours, relatives, colleagues, partners and bosses. My rough guess is that, diabetes, obesity and heart problems being as common as they presently are, most of these traditional delicacies are hardly touched by those for whom they were intended, and find their way to homes of servants, drivers and junior office staff. 

Should you want your sweets to be savoured and remembered, you need to make them appealing, healthy and different so that guests who have nibbled at the same-old-sweets, are game to try more than a mouthful at your home.  Adding and garnishing your preparation with natural sweeteners such as honey, dates, figs and raisins could add originality and make them stand out.  Milder tastes are in vogue these days; hence cutting down on sugar would be wise. And as most adults are wary of greasy sweets, slashing the ghee and oil content, and baking rather than deep-frying could be recipes for success.

Try cut portions of fruits, either raw or stewed, dipped in honey, and topped with spices such as cinnamon, cardammon and fennel seeds as  mouth fresheners or a simple fruit salad with honey and spices, rather than gulab jamoon, barfi or the artificially coloured khoya sweets.

Lights:  The “made in China” coloured tuny bulbs seem to have become the commonest way we adorn our homes on Diwali. Use diyas for a change. Insects and mosquitoes are repelled or killed by fire and smoke, and not by Chinese-made tuny bulbs. Hence if the present outbreaks of Dengue and malaria are to subside after Diwali, you could play your small role too and appear truely traditionl as well.

Crackers and Fireworks:  If you can’t imagine Diwali without them, wear a touch of class and attitude on your sleeves by using eco-friendly ones. These use recycled paper, have less toxic fumes, shed brighter colored lights and conform to lower decibels of sound.

The spirit of Diwali is to celebrate the victorious home-coming of Purushottam Ram, reverred for his uprightness, devotion to duty and kindness to others; hence using fire-works that might set homes ablaze or creating loud noises that scare infants and cause heart attacks in the elderly are not quite in keeping with the spirit. Cracker fumes are known to precipitate acute attacks in asthmatics. Gambling was also not in vogue in the “Thretha yug” and drinking also not part of the tradition of Ramji’s times. 

Celebrating victory of right over wrong, sharing joy and gifts with less privileged, and caring for others may be more in keeping with the spirit of Ramji.  Make this Deepawali be different.

As published in HT City (  Hindustan Times ) dated 31 october, 2010.

Battling Dengue

The scare of the currently raging Dengue epidemic in Lucknow is neither a false alarm nor media hype. Good many people have fallen prey, and several have already died.

The tragedy is that Dengue is assume its most aggressive form in young healthy adults, who were, till yesterday, up and about their usual lives, attending to business, going to college, partying or planning a grand Diwali bash.

Attempts at mosquito control seem to have gone awary. Many might ask if it had started at all, seeing the heaps of polythene bags by the roads. The striped Aedes mosquitoes are easily seen in homes and offices on their dauntless flights landing on arms, necks and feet for their blood meals and injecting the virus through skin pricks.

High fever with body aches, visit to the doctor, the blood test confirming Dengue, falling platelet count, scurrying to hospitals for platelet transfusions, overcrowded hospitals is the usual circuit.

What can you do to protect your self and your family? Here are some practical suggestions:

1.     Involve your neighbours, make a local team, pool some money and arrange people to clear the heaps of polythene bags from the neighbourhood, burning them if necessary. Arrange a fogging machine and organize Malathion spray if possible. Get some kerosene poured on stagnant pools of water in the locality. Dont wait for the government municipality any more.

2.     Call the carpenter and make sure that your windows and doors are netted to prevent mosquitoes from enetering.

3.     Spray insecticides in and around the home daily

4.     Put away your half sleeved shirts, shorts, and T shirts. Start wearing full sleeves, trousers and socks from today. The Aedes mosquito has a short snout and cant sting through a layer of cloth.

5.     Request the principal to allow your child to wear full sleeves and trousers. Girls should wear pants or long skirts with leggings underneath.

6.     Use mosquito repellents on exposed parts of the body (back of hands, neck, and face) on most times.

7.     If fever occurs and stays for more than 2 days, get the blood tests done as advised by your doctor.

8.     Take only paracetamol for fever. Avoid ibuprofen, acetaminophen, nimesulide (banned in most countries) and othe painkillers. They increase the risk of bleeding and can damage organs. A 39 year old woman who was in otherwise good health, is now battling for life with renal and liver failure in our ICU, precipitated by nimesulide for Dengue.

9.     The main risks from Dengue are shock and bleeding. To prevent shock, drink lots of liquids and make sure you are passing good amounts of urine. If nausea and vomiting are cumbersome, IV fluids infused timely can help.

10.   If platelets fall below 20,000, you may require transfusions. Remember they dont grow on trees and are harvested from blood of donors. Hence there is a risk of transmission of other infections such as Hepatitis B or C and HIV. Procure platelets from reputed blood banks and arrange to have them donated by family members.

11.   Many suddenly take a down turn in the 48 hours after fever has subsided and we feel the worst is over. Take rest for an additional 2 days and drink lots of fluid till your condition is truely stable.

The greatest marvel of human nature is believed to be that seeing others die around him man refuses to believe that he too shall die. With Dengue raging in Lucknow, our complacence suggests that we feel quite that way!

As published in HT City (Hindustan Times) dated 24 october , 2010.

Dengue Fever : Treatment Guidelines

Dengue is having a free run this autumn, thanks to the abundant rains, ramapant water logging and unrestricted breeding of mosquitoes. Almost every household in and around Lucknow has either had a bout of fever in the last month or is likely to in the next one. 

Recognizing Dengue Fever (DF): It is a viral infection transmitted by mosquitoes and presents as a sudden febrile illness of 2-7 days’ duration, with 2 or more of the following:

1.     Headache

2.     Pain behind the eye balls

3.     Severe body aches

4.     Pain in the joints

5.     rash

In children, DF is usually mild. In adults, it can be quite incapacitating, with associated nausea, vomiting, depression and fatigue. Dengue Haemorrhagic Fever (DHF) is a more severe form of the disease associated with bleeding from different parts of the body such as red spots or patches in the skin, bleeding from the nose or gums, passage of black stools or vomiting of blood.

 One of the main concerns in Dengue is the fall in platelet counts from its normal range of above 150,000. Platelets play a vital role in preventing or stopping bleeding from small blood vessels. If their numbers fall to less than 20,000, risk of bleeding becomes significant.

 The other concern is shock. Dengue sometimes causes fall in blood pressure due to leakage of plasma from capillaries with loss of blood volume. The Hemoglobin level paradoxically rises and urination may become less.

 Tests for Fever: It is important to remember that all fevers may not be due to Dengue and Enteric Fever (Typhoid), malaria, and common flu are equally ramapant these days. Further, while Dengue is a viral illness with no specific medicines, typhoid and malaria need specific medications and can be far more dangerous to life than Dengue.

If fever persists for more than 2 days and is severe, tests should include Hemoglobin, white blood cell and platelet estimations, a peripheral smear for malaria, and a serological test for Dengue. The serological test for typhoid often does not show up in the first few days of this infection and hence can be misleading if done too early.

 When to worry: If you have contracted Dengue, lie in bed and take rest for atleast a week, drink lots of liquids (water, juices, soups, nimboo paani or ORS), take paracetamol tablets ( upto 3 a day), avoid aspirin and brufen as they may trigger bleeding,  apply balms on your head and watch TV. Consult your family physician but do not panic. Remember that there is no specific medication for Dengue and yet recovery is the rule.

 Platelets and IV fluids. For platelet counts to come down is not unusual during Dengue but infusions are required only if they drop to below 20,000 or when there is active bleeding. Remember that infusions of platelets have their own risk of transmitting other infections, of allergic reactions, and their effect lasts barely a few hours.

Those with low BP and shock may need intravenous fluids to replace some of the plasma that has leaked out.

 Recovery: Once the fever starts subsiding, one starts feeling better. Nausea, vomiting, weakness and low feeling may linger for a few more days. It is wise to drink lots of fluids and take life easy for a few more days before resuming work.

 As published in HT City ( Hindustan Times) Dated 17 october, 2010.

The Indian Super Bug!

Indian doctors were galvanized last month when the prestigious medical journal, Lancet, published an article describing super bugs that are virtually resistant to all known anti-biotics, and alleging that they originated from the Indian subcontinent.  To add insult to injury, the lead authors, who were British, named this germ after New Delhi (NDM1), consigning the name of our national capital to the immortal pages of medical notoriety.

What most Indians found blasphemous was the fact that although this highly resistant strain was also isolated from other parts of the world, the authors chose to name it after New Delhi, a city from which no sample had actually been tested, and went on to sound a travel advisory cautioning Britishers to travel to India for “medical tourism”.

Development of resistance in bacteria to the latest and strongest antibiotics called Carbepenems, is however alarming news. Alexander Fleming, who had discoverd the first antibiotic, penicillin, in 1941, would have been a very sad man if alive today. While scientists have discovered numerous antibiotics ( I could count 120) over the last 7 decades, germs have discovered ingenuous ways of escaping them with equal promptness.

When Carbapenems (Meropenem and Imipenem) were launched around a decade back, we had thought that the fight against germs was finally over. The last 3 years have shown that despite using high doses of expensive antibiots (they cost around 2 to10, 000 per day!) bacteria are able to survive, multiply and attack, accounting for a growing number of deaths from sepsis.

It is however difficult to deny that antibiotic resistance is common in India. Take the example of the most frequently used ones called quinolones (ciprofloxacin, norfloxacin, ofloxacin etc) that we pop so easily when we have fever, loose stools or any symptom remotely suggestive of an infection. With easy availability, low price, favourable safety profile and widespread use most bugs are now resistant to this group of drugs. Consequently, when treating a serious infection like typhoid fever, one remains worried whether thiese drugs will work or whether we should add another for safety.

Resistance increases with more usage, inadequate doses that allow some germs to remain and fight back, and easy over-the-counter (OTC) availability, as often happens in India. Resistance, once developed, often gets passed from one bug  to another through a portion of DNA called plasmids.

Another common cause is the indiscriminate or excess use of antibiotics in veterinary practice and in growing live stock. Drugs are used in animals that are used as human food, such as cows, pigs, chickens, fish, etc., and these drugs can affect the safety of the meat, milk, and eggs produced from those animals and can be the source of superbugs The chemicals pass into our bodies and evoke resistance in the germs that dwell in our skin or gut.

While scientists continue their search for newer more lethal antibiotics, with the emergence of super bugs, the fight seems far from over and speculation remains rife as to who will have the last laugh - the injudicious man or the ingenous bug.

As published in HT City ( Hindustan Times) dated 10 october, 2010.