Dengue Fever

It is the familiar story line of a small David felling the giant Goliath to the ground; this time it is the small Dengue virus challenging the might of the government and bringing it down to its knees.
Dengue is having a free run this autumn, thanks to the rampant water logging and unrestricted breeding of mosquitoes.
Recognising 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
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. Infusion of platelets is required only if they drop to below 20,000 or when there is active bleeding. Remember transfusions have their own risk of transmitting other infections, of allergic reactions, and their effect lasts barely a few hours.
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 Haemoglobin level paradoxically rises and urination may become less. Some patients show liver involvement (Serum ALT/AST, Bilirubin) or kidney dysfunction (increase in serum creatinine). These usually settle down with good intake of fluids and calories.
Tests for Fever: It is important to remember that all fevers may not be due to other infections such as Enteric Fever (Typhoid), malaria, and common flu that appropriate blood tests will show. It is important to get them done if fever persists for more than 2 days, because Dengue being a viral illness has no specific medicines, while typhoid and malaria have.
Tests should include Haemoglobin, PCV, white blood cell and platelet estimations, and tests for malaria, typhoid, and Dengue.
When to worry: If you have contracted Dengue, lie in bed and take rest for at least a week, drink lots of liquids (water, juices, soups, nimboo paani or ORS), take paracetamol tablets (up to 3 a day), avoid aspirin and ibuprofen as they may trigger bleeding, apply balms on your head and listen to soothing music. Consult your family physician but do not panic. Remember that there is no specific medication for Dengue and yet recovery is the rule.
Critical phase: Contrary to popular belief, the danger phase in dengue is not the 1st 2-3 days of high fever, but around the 5th to 7th day, when the fever begins to settle. Many people who are in a hurry to get back to their normal lives often crash during this phase with low BP and shock. It is therefore crucial to relax at home for a couple of days more.
And do what I am sure, the government is doing; tell yourself “This phase too shall pass”.

Eating Slow Can Help Slim Down

The slim and shapely figures of the overwhelming majority of natives I saw on the streets and trains of China during my visit to that country last week made me stand out amidst them with my Desi central bulge. And as this “ I-am –the-paunchy-one among-them” feeling is not something I feel while in Delhi, Punjab, or Gujarat, I tossed the question ‘What makes the Chinese remain slim?’
I had earlier put it to their genes. True most people with Mongolian traits (Chink eyed ones) like the Tibetans, Chinese, Koreans, Japanese look slim and short with smooth skins stretched over their bones and muscles. But catch them in USA after five years of devouring burgers and pizzas with bare hands, and notice the difference.
Or is it their diet? Most are rice eaters, but if rice was the secret to their shape, I couldn’t fathom why Bongs (Bengalis, a community to which I belong by genes and taste buds) queuing up for a table in front of “Oh Calcutta” get that paunch?
And if it is not rice, and if it is not WHAT they ate, what else could the Chinks have in common?
When my Chinese hosts took me to a traditional restaurant for dinner in Beijing, had me seated at the head of the table with a lavish spread of gourmet dishes, and then handed a pair of chopsticks, I realised I could not devour all that as quickly as I wished!
Fortunately I was not a total stranger to chopsticks, having had to use them as my survival tool during a long training trip in Japan many years ago. I remember that it had taken me a week to get the grip, grasp and movements tuned, and had started eating my full meal with just them, but at a very slow pace.
Old memories wafted in while I sipped the soup and watched how my hosts dealt with the dishes of boiled corn, pumpkins, egg, fish, chicken and even rice with just two thin sticks in between their fingers, nibbling at the food like restless ants.
What eating with chopsticks do is restrict the size of morsels. One can barely take a few grains of rice each time, unlike the large morsels that we Bongs scoop with bare hands and put in our mouths before gulping it down. And nibbling small amounts with chopsticks slows eating and stretches the meal time.
During eating, the food gets absorbed from the intestines and sends signals to the brain that then tells us to stop. If we eat slowly the signal reaches on time stopping us from consuming too much. When we eat quickly and gulp, we often miss the “Enough, Now stop” signal.
Eating slow can be a very effective way to slim down. And chopsticks ensure that you do just that. I have decided to take to chopsticks to get into shape.

India’s health : Then and Now

The country celebrated its 69th Independence Day last week. It is therefore a good time to look back on how India’s health has fared over this period. In numerical figures, we have covered some ground, but like the proverbial glass, optimists see it as half full, while pessimists view it as half empty.
The average Indian who expected to live till 32 years of age in 1950, is living twice as long now. Fewer children are dying in their first year of life (Infant mortality rate) and less mothers are dying of childbirth.
The national figures are however a mixed bag – some states and sections of society have done almost as well as developed countries, while some have lagged behind close to where we were half a century ago, dragging down our national figures.
The reduction and control of diseases mentioned above owe much of their success to several government initiatives as well as non-governmental organisations.
The major challenge of India is the dual fight of a ‘developing’ country’s basic health concerns such as malnutrition, low immunisation rates, hygiene, sanitation, and infectious disease while on one hand, while tackling environmental pollution and lifestyle choices such as alcohol consumption, smoking, and high fat diet are set to increase the incidence rates of heart diseases, strokes, diabetes and cancers, on the other.
Health and education are two sectors where results show up late. Unfortunately most governments have focussed on short term solutions like industrialisation, trade and defence, allocating less than 2% of spending on health (compare with 9 to 10% in developed countries).
While elections are decided by recent perceptions, we need leaders with far-sightedness to bring back the focus on health and education.
Here is a summary chart for those who like facts and figures;
1.Life Expectancy: Increased from 32 years in 1947 to 65 years in 2011, BUT we are nearly 15 years less than western countries.
2. New-born Mortality: Reduced to 37/1000 births in 2008, BUT still approximately 10 times more than western countries.
3. Child Mortality (0-5yrs): Reduced to 63/1000 in 2010 BUT still about 10 times more than western countries.
3.Almost 67% children are still not fully immunsed.
4. Maternal Mortality: Reduced to 254/lakh births in 2008 from 677/lakh births in 1980, BUT still almost 15-50 times more than western countries. (nearly 70,000 deaths per year)
5. Malnutrition In children under 5years: Reduced to 44% in 2006 from 67% in 1979, BUT still nearly 20 times more than western countries (Approximately 50% children under three are underweight)
6. Polio Eradicated almost completely: 1 new case recorded in 2011.
7. Leprosy: Eliminated in 32 States/UTs i.e. <1 1.27="" 2011-12.="" but="" case="" cases="" in="" lakh="" new="" p="" people="" reported="">8. Small Pox: Eradicated in 1977
9. Cholera: Reduced to 1939 new cases/year in 2006 from 2768 new cases/year in 1997. Sanitation and clean water are essential for total elimination

Building a Healthier Future Through School Health Programs

Despite the state of Uttar Pradesh having one of the worst health indices in the country, its dynamic Chief Minister, Akhilesh Yadav has been quick and far-sighted to realise that the key to setting things right in the long run may not lie in just building expensive hospitals, but supplementing it with creating health-consciousness in the minds of its young citizen so that they refrain from picking up risky habits and do not fall prey to preventable diseases.

In India, school is where several million young people spend around 6 hours of time each day for up to 13 years of their lives, providing a unique setting not just to impart scholastic education, but raise awareness on health issues that could impact their health and that of the nation.

In an unusually progressive step that matches what occurs in developed nations, Uttar Pradesh has become the first state to introduce health awareness as a component in its school curriculum. Based on the WHO concept of “school health promotion”, it has introduced a book called “ Hum Aur Hamara Swasthya” in its Madhyamik Shiksha curriculum, and is launching it in its basic education as well.

This book, written by a medical specialist and health expert and produced by a non-profit organisation called HOPE Initiative (Health Oriented Programs and Education), covers ten topics that that are considered universally important:

1. Sanitation and Hygiene that describes the seven steps of hand washing and covers toilet etiquette
2. Life style diseases such as excess consumption of fast food, lack of physical exercise, calculating one’s Body Mass Index, and tackling obesity in school children.
3. Managing examination stress
4. Bullying, ragging and violence in schools
5. Road Traffic accidents and their prevention
6. Global warming
7. Knowing about but resisting peer pressure initiation to alcohol, tobacco and drugs
8. Mosquito menace: simple steps to be taken at home and locality to ward off malaria and dengue
9. Hepatitis and its prevention. Ensuring vaccination from this preventable scourge
10. Celebrating festivals such as Diwali and Holi in a safe and healthy manner

The well-illustrated attractive book with pictures and cartoons aims to extend its reach beyond students to their siblings and parents, in what is described as a “school-to-community” approach. And to make the health topics interesting, HOPE has produced 6 documentary movies and 3 educational games as supplement.

The spade work for introducing health education in schools had begun few years ago with the Education Department of UP government engaging HOPE to provide training to teachers of 6000 schools of 25 districts of the state on health issues, with support from the philanthropic BMS Foundation.

Supporting school health programs to improve the health status of our nation’s young people has never been more important. Their health is critically related to the health-related behavior they choose to adopt.

Public health experts estimate that even a modest decline in the number of adolescents getting addicted to tobacco each year for instance, could lead to significant reduction in the incidence of heart and chest diseases, and save many lives from cardiac and cancer deaths in the community.

Barbers Join the Hepatitis Prevention Drive

Do you always make sure if your barber or beautician is using a fresh new blade each time you go to the salon or parlour for your hair-cut, pedicure or waxing,?
Shaving or piercing of the body with re-used sharp instruments help Hepatitis B and C viruses to spread from one host to another and maintain their unrelenting presence in the community.
Pamela Anderson, the Hollywood actress of ‘Bay watch’ fame became the most famous international poster girl for Hepatitis C when she contracted the infection from her then-boyfriend by sharing a needle for a tattoo.
These viruses are normally present in body secretions, serum or blood of infected individuals and are highly infective. Up to a million of these viruses could be present on a needle tip.
Skin piercing allows small amounts of serum to come in contact with the needle. If the needle is not cleaned properly and re-used in another person, there is a high chance of transmitting an infection such as hepatitis B from an infected person to a new host.
A family of 3 brothers was shocked and surprised when they had tested positive for Hepatitis B during a free screening camp last year. After delving deep into their history for possible sources of infection, we discovered that the three had visited a village fair together and got tattooed at the same stall with the same needle on that occasion.
What has intrigued medical scientists is how the hepatitis B and C viruses keep spreading in the community and maintain their prevalence of 4%. Most of those who test positive, do not have history of blood transfusion or surgery, suggesting that some other route must be at play. The missing link in the puzzle could be the re-used blades and needles that barbers and beauticians use.
HOPE Initiative kicked off a unique campaign last week by inviting 90 barbers to a seminar and discussing with them how some of their practices could be inadvertently spreading these viral infections to their clients. They took surprisingly keen interest in learning about these bugs and seemed quite willing to use fresh new blades for each client.
The challenge now is to reach out to all barbers in the country and encourage them to modify their practice, and on clients such as you to insist that your barber or beautician uses new sharps each time when you visit them.

Tales of Hepatitis B

Hepatitis B, a viral infection of the liver, has its mixed bag of stories – some of them are good while others are tragic. Here are some lessons from a single family.

Happy tale 1: If diagnosed on time, you can keep your liver healthy, protecting it from damage.
Anoop, a 36 year old software engineer working with a multinational company who was diagnosed to have this infection 6 years ago during a blood screening drive, visited me last week. His recent blood reports were perfect: the liver functions were absolutely normal and his fibroscan showed that his liver was as soft and supple as any healthy person’s. He was of course on a daily oral tablet costing a mere Rs 800 per month, all these years, but there was no trace of any live virus in his blood. When he asked me how long he expected to live, I could not suppress a laugh. “As long as elderly people do in India” I answered.

Happy tale 2: You can prevent getting infected by a very effective and affordable vaccine.
His wife and child had tested negative for Hepatitis B on blood screening tests and Anoop, on the recommendation of a doctor, had get them to take 3 shots of the Hepatitis B vaccine. Their recent blood tests had shown high titres of protective antibodies. His face lit us when I told him that they were well protected for the rest of their lives from at least one potentially serious disease, ie Hepatitis B. And could he plan to have another child with the assurance that the infection will not spread to the new born? He had the green signal.
The earlier concern of high cost is now history. What used to cost Rs 500 for each shot now costs Rs 50 or less. It means you can get a life time of protection with three doses for as little as Rs 150!

Tragic tale : Although Anoop was happy with his reports and those of his wife and child, he still finds it impossible to erase the memories of his father’s illness and death. They had taken him to a hospital for swelling of feet, pain and distention of abdomen, where his blood tests and ultrasound had showed a shrunken cirrhotic liver with a large cancer in it. The cause, the doctor had explained, was Hepatitis B infection that had been going on for years, but had not been detected in time.
His end had been agonising: he had become bed-ridden, groaning with pain most of the time. He had required repeated admissions to hospital for tapping of fluid from the abdomen and infusion of expensive medicines. Towards the end, he would lapse intermittently into coma. Finally he had vomited of a large amount of blood, a spectacle that haunts the family to this date.

World Hepatitis Day, celebrated on 28th July, is round the corner. It is an occasion when hospitals and NGOs set up camps and offer free testing and vaccination for Hepatitis B. Get yourself and your loved ones tested and vaccinated this year.

Children with Three Parents

The latest salvo that reproductive biologists have fired at traditionalists since test-tube babies and surrogate motherhood has been the recent creation of babies with genetic material from three parents.
The scientific proof and benefits have been so compelling that UK has become the first country in the world to legalise it in 2015 despite several waves of protests and criticism from “conventional” moralists.
Alan Saarinen is 11 year old and looks and behaves like any other “normal” school girl of her age, playing sports and performing well in her class. She is however one of the rare 50 children in the world who has DNA from 3 parents: her father, mother and a third lady who contributed mitochondria to fortify the defective egg of her mother.
Before she was born, her parents had tried for a baby for 10 long years. Each time her mother Sharon had conceived through numerous IVF procedures, the pregnancy had ended up in a spontaneous abortion or miscarriage.
It was then that the doctors discovered that Sharon carried a rare genetic trait due to which the mitochondria, the small power batteries of her ovum, were weak and defective. As a result the embryo’s organs requiring most amounts of oxygen, such as heart, brain and muscles, did not develop and function properly.
Dr Jaques Cohen of New jersey, USA was the first to experiment with this technique that removes the cytoplasm containing the defective mitochondria of the diseased ovum and replace it with normal mitochondria obtained from an ovum from a healthy donor woman. The “corrected” ovum is then fertilised with the sperm in the laboratory as is done for test tube babies.
While 90% of DNA is present in the nucleus of human cells comprising 23000 genes, small amounts comprising 15 genes are also present in mitochondria.
The potential of this technique was quickly recognised in the United Kingdom that has legalised it, but funnily the USA has withheld permission for this procedure at present. The concerns of the American regulatory authorities and civil society is that a formal permission may make this technique go down the un-ethical slippery slope of “manufacturing” tailor-made babies in the laboratory.
New scientific developments in human reproductive biology always evoke sharp criticism and stiff resistance from ethics groups due to fear of potential misuse. Left to unscrupulous scientists, this technology can undoubtedly be used to produce “made-to-order” babies and in large amounts, almost like cloning animals.
But as of now frustrated couples undergoing treatment for infertility in British clinics are looking forward to have their own babies with this technique from 2016.

Epilepsy, SUDEP and Miracles

During review of an un-anticipated death of a 45 year old man in our hospital, I came across the term SUDEP. This is the story of a businessman who had had epilepsy for several years and been on irregular treatment with his anti-epileptic medications, resulting in frequent recent fits. His seizures had been controlled in the emergency, but had been advised precautionary admission for a day.
He was last seen smiling and chatting with his wife, somewhat resentful about having to spend a day in hospital. A few hours later, while under close monitoring, his heart suddenly stopped and despite resuscitation, he died.
SUDEP is the acronym for Sudden Unexpected Death in Epileptic Patients, and seems to occur in one of every 1000 people suffering from epilepsy claiming over 100,000 lives every year. That is indeed a rather high figure given that epilepsy affects more than 1% of the population, amounting to over 1 crore in India itself.The cause of SUDEP has intrigued neurologists and cardiologists for long. The person found dead often does not show signs of a recent seizure, such as tongue bite or urination suggesting that the cause could have been an irregular heart rhythm. Bursts of irregular electrical activity in the

brain seems to find its way to the heart via the Vagus nerve. In the above patient who died in our hospital, that is what the cardiac monitor actually showed: the heart jerked irregularly and came to a sudden stop!
Epilepsy, a condition characterised by recurrent seizures without any obvious underlying disease, presents with episodic unexpected loss of consciousness usually with abnormal body movements. There are 6 types described: tonic-clonic, tonic, clonic, myoclonic, absence or atonic. Fortunately, there are now several effective medications available to prevent seizure activities, but the patient has to be counselled well to take them regularly without missing a single dose.
Epilepsy is indeed common and has afflicted even great men such as Alexander, Julius Caesar and Napoleon who were said to have suffered from the “falling sickness”. In more recent times celebs such as Edgar Allan Poe, Lewis Carol (writers), Theodore Roosevelt ( President of USA) , Elton John (singer) and several others are on the list, indicating that it does not come much in the way of achievement and longevity in most.
Missing doses of medications can however endanger life of the 
patient or those around him. Two months ago when I was rushing to the airport to catch a night flight, the car in which I was traveling suddenly came to halt in the middle of a busy road due the driver suffering a seizure. My experience of being stranded on the highway with an unconscious convulsing driver frothing at the mouth and the prospect of missing the flight was nightmarish, but I soon found myself thanking God for a miracle that saved my life: the unconscious driver’s right foot had fallen on the brake pedal and not the accelerator when he had suffered the seizure.

Yoga : Sum, Substance and Hype

If Google hits and evidence on the net is anything to go by, it seems indisputable that Yoga brings health benefit to its regular users. And had the proof of its benefit been tenuous, leaders and people of 170 countries would not have adopted an Indian practice only on our present government’s enthusiastic foreign policy initiatives.

Yoga increases the body’s flexibility and reduces stress. It improves muscle strength, perfects your posture, prevents breakdown of cartilage, stabilises joints, restores bone mass and protects the spine.

There is also growing evidence that it improves heart functions, reduces elevated blood pressure, brings down high blood sugar levels in diabetics and mobilises excess fat from the liver in patients with fatty liver.

The breathing exercises, with which a session typically starts, improve lung functions, increasing oxygen supply to body organs. The focus on smooth breathing and its voluntary regulation is a simple useful way to improve concentration and dispel anxiety.

Recent research is also beginning to show that Yoga may boost your immunity by enabling the body to generate higher levels of antibodies after vaccination.
A Norwegian study found the Surya Namaskar, a sequence of 8 postures, to be particularly effective in boosting immunity and improving circulation.

Two modern-day ailments seem to respond particularly well to Yoga. Migraine sufferers reported less frequent attacks with the Bridge Pose (Sethu Bandha Sarvangasana). Yoga also helps reduce food craving, a common underlying cause of the present epidemic of obesity. It improves sleep and, interestingly even sexual function in stressed out overworked young people working in multi-national companies and often struggling across different time zones.

If everything is so hunky-dory, where then are the rough edges that need smoothening?

Yoga, which started not just as a physical but also a mental and spiritual practice in ancient India around the 6th or 5th century BCE has now come to be viewed as a series of postures to tone the body. This transformation occurred around the 11th century AD, when Hatha Yoga became the popular form that largely shed the mental and spiritual aspects of the practice.

The problem of today is yet another one: that yoga gurus clamouring for limelight seeming to be at variance on the correct ways, postures and mudras in which Yoga should be practiced, leaving the public somewhat confused.

Further, in their zeal and ambition they cross boundaries of common sense, advising followers to stop all medications and rely only on Yoga.

An old patient of mine of Hepatitis B whose viral counts had become undetectable with antiviral medicines 2 years ago and was instructed to continue the tablets, came to me last week with a recent report in which his viral counts had shot up to 6 lacs! He had stopped the medications at the behest of a popular Yoga guru!