Myth: If there are no chills, it cannot be malaria.

Fact: The symptoms of malaria can be misleading as they vary from being mild such as fever and headaches to being more serious like jaundice, difficulty in breathing and decreased urination. Many malaria patients do not suffer from the typical shaking chills in the early stages of the infection. Hence, waiting till you experience chills or rigors to get a blood test or to consult your physician can prove risky as the disease will have progressed by then.

Myth: All types of malaria are basically the same.

Fact: While all types of malaria are caused due to the bite of mosquitoes belonging to the Plasmodium species, each type of malaria runs a different course depending on the sub-species the mosquito belongs to. Of the five species of Plasmodia that are known to infect humans, most cases of malaria in the world are caused by P. falciparum and P. vivax. Whereas cases of infection from P. falciparum may turn severe and even cause deaths, P. vivax generally runs a mild course.

While P. vivax malaria responds well to chloroquine, P. falciparum is treated with newer drugs. However, since a lay person wouldn’t know the difference between the two cases, it’s better to visit the doctor at the first suspicion.

Myth: Nowadays, malaria is rare so we needn’t bother about it affecting us.

Fact: Every year millions suffer from malaria and according to some estimates, nearly two lakh Indians die of its complications. With rapid urbanisation and population migration from malaria-infested rural regions into the cities, many Indian cities are now reporting malaria cases in increasing numbers. One may also contract malaria by travelling to places where the infection is rampant. So, everybody is still at a risk.

Myth: Since malaria is well-known to doctors, a blood test is redundant for treatment.

Fact: Treating malaria merely on clinical suspicion may not be wise because different types of malaria are treated differently. A blood test not only confirms the diagnosis but also ascertain the type of malaria. It also helps in assessing severity of the infection. So when your doctor asks for a blood test, heed to her advice.

Myth: If you have malaria, hospitalisation is a must.

Fact: Most cases of malaria are treated as out patients. Hospitalisation is required only in case of complications or if the severity of the symptoms increases. However, if you start timely treatment, hospitalisation can be avoided.

Myth: Pregnant women shouldn’t take anti-malaria drugs.

Fact: Anti-malaria drugs are safe to use in pregnancy and lactation. Like any drug, anti-malaria drugs also have some minor side-effects, but that should not stop anyone from taking these drugs. Malaria must be treated with anti-malaria drugs, or else it may deteriorate and cause serious or even fatal complications. Benefits of anti-malarial drugs far outweigh their risks.

Myth: Malaria patients should not eat chicken.

Fact: Malaria has nothing to do with what you eat. There are no dietary restrictions for those suffering from malaria and neither chicken nor any other food is known to alter the course of the illness.

Myth: Malaria stays for life.

Fact: Malaria is completely curable with simple, effective treatment. It doesn’t remain with you throughout your lifespan. But there is every chance that the infection can recur if you are once again bitten by an infested mosquito.

Myth: Once you have malaria, you’ll never get it for life.

Fact: Unlike viral infections, such as chicken pox that confer life-long protection, malaria does not confer any protection against repeat infection. The treatment is applicable for the particular attack only and once it is completed, you are still prone to get infected if you are bitten again.

Myth: Malaria spreads only in dirty surroundings.

Fact: That is what people thought in the old days and that’s how the name, ‘mal-aria’, meaning ‘bad air’, got coined. But mosquitoes that cause malaria breed in clean, stagnant collections of water such as tanks, puddles, tree holes, tyre tracks, construction sites and wells, irrespective of the cleanliness of surroundings. If you let water stay in a clean place, it can still be a breeding ground for mosquitoes.

Myth: You can prevent malaria by taking anti-malaria drugs regularly.

Fact: Taking anti-malaria drugs for prevention helps those travelling from non-malarious places to a place known for the malaria menace. These drugs, if taken as prescribed, do help even if the visit is short. The same, however, is not advisable for people already living in areas prone to malaria.

Myth: You’re not at risk of malaria if you stay on a higher floor.

Fact: The female anopheles mosquitoes that spread malaria from one person to another, bite during the night. During the day, they remain hidden and therefore are not visible. Top floors are not safe from malaria as the mosquitoes can reach any floor by flying or by travelling through elevators. The best method to protect against malaria is regular use of bed nets. Long lasting, insecticide treated bed nets are also now available. Mosquito repellents like DEET can be applied to the exposed skin or clothing in the evenings to keep mosquitoes away.

The post Malaria myths appeared first on Complete Wellbeing.

In recent years, the problem is being increasingly detected in developing countries like India, with a prevalence of 4 per cent — 12 per cent. It’s more common among the urban affluent, and is found equally in men and women. In more than 50 per cent cases, symptoms appear before 35 years of age.

What is Irritable Bowel Syndrome?

The problem in Irritable Bowel Syndrome is in the large intestine or the colon—a five feet long tube that connects the small intestine to the terminal parts of the gut, namely the rectum and the anus.

The colon is the final passage for digested food. Here, water, salts and some nutrients are absorbed into the body and the rest is pushed into the rectum for evacuation. ‘Irritable Bowel Syndrome’ results from altered functioning of the colon due to heightened sensitivity or altered movements that cause faster or slower than usual contractions.

Is IBS a serious condition?

Irritable Bowel Syndrome does not cause any serious health complications or threat to life. However, it does affect a person’s quality of life significantly.

What are the symptoms?

Every person experiences different symptoms, which also vary from time to time in the same person. Abdominal cramps, pain, bloating or a sensation of gas and discomfort are the most common manifestations, along with constipation and/or diarrhea.

Those with predominant constipation [IBS-C], experience reduced frequency of bowel movements and after much strain, pass hard, pencil-like or small pellets of stools or no stools at all. Some patients have increased frequency of stools that may be loose or watery diarrhea-predominant [IBS-D], and may feel uncontrollable need to empty their bowels. Still others, suffer from constipation and diarrhea alternately, along with pain [IBS-A].

What causes ‘Irritable Bowel Syndrome’?

The exact causes of Irritable Bowel Syndrome are hitherto unknown. However, it is believed that many biological, psychological and social factors may be involved. Moreover, these may vary from person to person. The entire gut, from mouth to the anus, is connected to the brain and the spinal cord through an intricate network of nerves. More than 100 tiny proteins, known as gut peptides, also help in the interaction between various parts of the gut and the brain. This brain-gut axis senses the volume and contents of the food as it passes through the gut and based on this information, the nervous system regulates digestion, absorption and transit of food. Altered sensitivity of the gut and altered signal processing in the brain may be the reason for abnormal bowel movements in patients of IBS.

Certain foods, infections, stress and negative emotions may contribute to the hypersensitivity of the gut.

How is it diagnosed?

In the past, the diagnosis of Irritable Bowel Syndrome was made by ruling out other diseases exhibiting similar symptoms. For that, a series of expensive tests such as X-rays, scans, endoscopic evaluation and even biopsies were ordered. The Rome III criteria are the latest criteria laid down by the Rome Foundation^[1] for diagnosing Irritable Bowel Syndrome. It helps physicians diagnose IBS easily, right at the first visit on the basis of a detailed history of the illness and a thorough physical examination.

Rome III states that Irritable Bowel Syndrome should be diagnosed if symptoms have occurred over at least six months, with recurrent abdominal pain or discomfort occurring for at least three days per month in the previous three months. They should be accompanied by changes in the frequency, form or appearance of stools and improvement in the symptoms with defecation. Applied rationally, these criteria can positively predict the diagnosis of IBS in as high as 98 per cent of cases, obviating the need for expensive and invasive tests.

What role does food play in ‘Irritable Bowel Syndrome’?

Dairy products such as milk, yogurt, buttermilk and cheese; fructose and fructans found in fruits, juices, sugar and sweets, grains and tubers; chocolates; artificial sweeteners; chemical additives such as dyes and preservatives, carbonated beverages such as sodas; citrus and caffeine beverages; alcohol; red meat or fish may trigger or aggravate the symptoms of Irritable Bowel Syndrome.

Gluten-containing grains such as wheat, barley and rye are also responsible for aggravating IBS. Lack of fiber in the diet or use of laxatives may also be responsible. In some cases, infections of the gut may precipitate an acute onset of IBS and this is more common in developing countries.

How is ‘Irritable Bowel Syndrome’ treated?

There is no single effective treatment. Certain drugs help relieve spasms and pain and improve bowel function. Antidepressants, anxiolytics and such other drugs are also recommended in some cases. Just as the cause of IBS may vary from person to person, treatment measures too need to be tailored. Several alternative therapies have been tried, but there is no conclusive evidence that they work. The patients can only try and keep their condition in control. Being able to identify the triggers and aggravating factors and avoiding them prevent flare ups.

What can I do?

Some people benefit from totally eliminating dairy products, fruits, wheat, corn, barley, peanuts, soy, processed foods, refined oils, caffeine, chocolates and alcohol. Increasing the intake of vegetables ensures availability of fiber as well as minerals such as calcium. Those with a tendency to constipation benefit from eating a high-fiber diet. Drinking at least 6 – 8 glasses of clean water per day keeps you well-hydrated. Regular walking, swimming, techniques such as biofeedback, hypnosis or counseling, may help in alleviating stress.

It’s tempting to try self-medication but relying on over-the-counter remedies for relieving diarrhea or constipation may do more harm than good.

[1] Rome Foundation, a not for profit organisation that provides support for diagnosis and treatment of functional gastrointestinal disorders [FGIDs].

Last updated on 11^th August 2024

The post Diagnosing and Treating Irritable Bowel Syndrome (IBS) appeared first on Complete Wellbeing.

With the spread of HIV/AIDS, cases of tuberculosis have also started increasing. Tuberculosis tends to get reactivated in immune-compromised HIV/AIDS patients and it is an infection that can spread from the HIV-infected to the non-HIV-infected population. In recent years, as high as 20 per cent of tuberculosis cases have been found to be resistant to many first-line anti-TB drugs [Multi Drug Resistant or MDR TB].

Emergence of resistance to even second-line drugs is also being increasingly reported [Extremely Drug Resistance or XDR TB] from many parts of the world, including India. It is estimated that about two per cent of cases may harbour the XDR TB bacilli and most cases die within months as it is not yet known how to tackle this problem.

India accounts for nearly one-third of the global TB burden with about 8.5 million active cases. It kills about 3,65,000 people every year [1000 deaths a day], more than any other infectious disease, and the annual economic burden is estimated at Rs 1,20,000 crore.

How it spreads

This debilitating, chronic illness is caused by the bacteria Mycobacterium tuberculosis, which was first identified by Robert Koch in 1882. The microbe spreads through air when an infected person coughs. The chances of getting the infection increase with increased proximity and longer duration of exposure to the infected person.

In many, the primary infection of the lungs resolves by itself, but the bacteria may remain dormant in the body. It is estimated that almost half of India’s population have been infected with the tubercle bacillus. In about 10 per cent of such infected people, the disease makes a comeback due to either a reactivation of the dormant bacteria or fresh exposure to infection. Depressed immunity due to aging, diseases such as HIV/AIDS, diabetes mellitus and smoking can increase the risk.

This secondary tuberculosis is what generally causes the classical disease, characterised by low-grade fever and weight loss, developing gradually over a period of some weeks to months. It can affect any organ in the body other than the muscles, but almost 90 per cent of the cases involve the lungs. Lymph glands, intestines, bones and joints, the genitourinary systems, brain and the meninges, the pericardium [the covering of the heart] and the skin can also be affected. Tuberculosis of the lungs results in destruction of the lung tissue and formation of a cheesy material studded with bacilli. When the person coughs, these bacilli get sprayed into the air, spreading the infection. If left untreated, a person with active tuberculosis can infect 10-15 others in a year.

Symptoms and detection

In many cases, tubercular infection may remain without symptoms. As the disease progresses, a low-grade fever can occur, particularly in the evenings. Some may wake up with the body soaked in night sweats. Involvement of the lungs can cause cough, with or without phlegm and sometimes result in coughing up blood. Enlargement of the glands in the neck, loose motions, back ache, blood in the urine and head ache can be the various manifestations of tuberculosis in organs other than the lungs.

In a country like India, where tuberculosis is common, the disease is often diagnosed on the basis of clinical symptoms. Anyone with persistent cough lasting more than three weeks is advised to get the sputum examined for the presence of tubercle bacilli and if needed, an X-ray of the chest. Presence of the tubercle bacilli in the sputum indicates an active, infectious disease in the lungs. Confirmation of tuberculosis in other organs may require invasive tests such as biopsy, needle aspiration or endoscopic examinations. Newer methods such as Polymerase Chain Reaction [PCR] tests may be of limited value.

The cure

Tuberculosis is completely curable if treated adequately and properly. As it is a disease which progresses slowly, the treatment is administered over a period of 6-8 months or more depending on the site and type of infection. Treatment is initiated with four drugs and after two months, 2-3 drugs are continued for the rest of the course. This is done to improve the efficacy and prevent development of resistance to the drugs in the bacilli. It is advisable to take all the anti-tubercular drugs as a single dose in the morning, preferably on empty stomach, so that all the drugs reach their peak levels in the blood at the same time.

The infective bacilli are rendered non-infective within two weeks of initiating the treatment and this fact stresses the importance of early diagnosis and treatment of the disease in preventing its spread in the community. This has also obviated the isolation of tuberculosis patients in sanatoria, practised so widely in the earlier days.

More than half of the tuberculosis patients would die if untreated. If the treatment is not done regularly or is not completed, the disease remains uncured or can recur soon. Incomplete and irregular treatment also increases chances of drug resistance. Treatment of MDR TB is possible, but difficult. Second-line anti-tubercular drugs, chosen after culture and sensitivity test of the sputum sample, have to be taken for two years or more.

Tuberculosis has become a global crisis and is threatening to grow into catastrophic proportions if urgent action is not taken. Controlling tuberculosis is the equal responsibility of individuals, families, the community at large, the government and the medical profession. Without a concerted effort, this old scourge of mankind is sure to become uncontrollable monster.

The post The White Plague appeared first on Complete Wellbeing.

What is Chronic Renal Failure?

A gradual and progressive decline in kidney function is termed as Chronic Kidney [Renal] Failure. Nephrons, the functioning units of the kidneys, get damaged over time and in the initial stages, the loss of nephrons is compensated by the increased functioning of the remaining nephrons. With increased loss of nephrons, the compensation fails and various manifestations of kidney failure start appearing.

Causes

The causes for chronic kidney failure are many and the risk increases with age. Diabetes mellitus is the cause for chronic kidney failure in nearly 40 per cent of patients. The damage to the kidneys starts right in the initial stages of diabetes mellitus and gradually worsens over 5-10 years, more so with uncontrolled blood sugar levels. The first indicator of renal damage in diabetes appears in the form of leakage of micro quantities of the protein called albumin in the urine [the so-called microalbuminuria] and later this protein leak increases, eventually leading to final-stage renal disease. High blood pressure [hypertension] also damages the nephrons and is an important cause for chronic kidney failure in about one-third of patients. Primary diseases of the glomeruli [a cluster of convoluted capillaries in the nephron of a kidney], certain infections, drugs, hereditary diseases, and others account for the rest of the cases of chronic kidney failure. It is noteworthy that most of the causes of chronic kidney failure are preventable.

The manifestations of chronic kidney failure are due to the accumulation of the wastes that are toxic to the body, due to changes in blood pressure, reduction in red cell count [anaemia], inability to maintain the balance of water and salts and of acids and bases, imbalance in the levels of salts like potassium, and changes in the levels of calcium and phosphorus. All these changes develop into a vicious spiral as the disease progresses, affecting the nervous system, the heart, the gut, the bones, and eventually become fatal.

Symptoms

Symptoms of chronic kidney failure develop slowly and are often non-specific. While in diabetes and hypertension, the problem may be identified during the routine follow-up by the treating physician, primary kidney diseases that end up as chronic kidney failure are often identified in patients with high blood pressure and anaemia. Lack of appetite, altered taste, vomiting sensation or even vomiting [sometimes in the morning], and tiredness are some common complaints. Patients may also have increased urination at night. Soreness of the tongue, generalised itching, muscle cramps and bone pains may be other symptoms. In terminal stages, patients may become drowsy or even comatose, and have deep breathing due to accumulation of acids in the blood.

Diagnosis

Confirmation of the diagnosis of chronic kidney failure is not difficult. A blood test will reveal raised levels of blood urea and creatinine, and changes in the levels of potassium and calcium. Examination of the urine may help in identifying the cause of the kidney disease. An ultrasound evaluation of the kidneys for their size and texture may be useful in identifying the causes as well as differentiating the chronic, irreversible kidney failure from the acute, reversible failure.

Measures to be taken

As chronic kidney disease is irreversible, patients who have reached the last stage of kidney failure would need replacement of the kidney by way of transplantation from a healthy, related donor. In the initial stages however, the progression of kidney failure can be checked by proper care and medications. The underlying diseases need to be effectively controlled. Control of blood sugar and blood pressure is of utmost importance. Restriction of salt in the diet helps in controlling the blood pressure and reduces the load on the kidneys. Foods that contain high amounts of potassium like fruits and vegetables may have to be restricted if the potassium levels are very high. Intake of proteins has to be adjusted to the level of protein loss in the urine and increasing levels of blood urea and creatinine. Multivitamins, particularly vitamin D, may have to be supplemented. Ptients with anaemia need to take regular injections of the hormone erythropoietin, so as to increase the production of red cells in the bone marrow. When the urine output is reduced, drugs like furoscemide help in reducing the fluid overload.

When these measures become inadequate to maintain the renal function, regular dialysis [method of removing impurities or wastes from the blood when the kidneys are unable to do so], followed by kidney transplantation, is the only hope. However, these measures are not only expensive, but need utmost commitment from the patient and the relatives. With such facilities being available in most parts of the country, awareness regarding these options is also growing. However, financial considerations remain the biggest obstacle in obtaining these measures for many.

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A virus transmitted by mosquitoes, chikungunya is yet another example of microbes jumping into the civilised world from the jungles as a result of relentless destruction of natural habitat and depleting forest cover.

Chikungunya was first reported from Tanzania, Africa, in 1952.

The illness has nothing to do with chicken, or bird, flu, as some believe. The term is an adaptation of kungunyala, a verb in Makonde, a Tanzanian lingo, meaning “that which bends up.” It describes the bent-up posture caused by severe joint pain, the hallmark of chikungunya.

Chikungunya arrived in India in 1963. Cases of the illness were first reported from Kolkata. Early on, the illness was reported sporadically and considered non-fatal.

Epidemic concerns

In 2005, the illness started spreading in epidemic proportions from Reunion Islands in the Indian Ocean. Thousands of cases, with 100s of deaths, have been reported from southern and central India ever since.

This increased virulence has been attributed to changes that have recently occurred in the structure of the virus [mutation]. These changes have enabled the virus to be transmitted by the mosquito, Aedes albopictus, in addition to Aedes aegypti, its traditional vector. This has also resulted in severe transmission of the illness we are now witness to.

Symptoms

In typical cases, symptoms of chikungunya appear suddenly and dramatically with fever and joint pain. The pain in the joints, with or without swelling, develops over a few hours, as one joint after the other gets affected.

The pain may be so severe in certain cases that the affected individual is unable to even move. S/he is often confined to bed. Headache, low backache, a reddish rash on the limbs and trunk, and redness of the eyes may be the other presenting symptoms.

The fever normally lasts for two days and comes down abruptly. However, joint pain, intense headache, sleeplessness and extreme weakness can last for a variable period, usually for 5-7 days, or, in some cases, even for weeks, or months.

However this may be, the mere presence of joint pains with fever should not be labelled as chikungunya, because a host of other febrile diseases can also present with joint pains and fever. Dengue fever, another viral infection spread by Aedes aegypti mosquito, may, for instance, have similar symptoms in the early stages of infection. However, unlike dengue, chikungunya does not produce haemorrhages [bleeding], or shock. It is also rarely fatal.

Confirmation of chikungunya is possible only by means of blood tests that are expensive. Worse still, they are not readily available. Your doctor would be the best judge to confirm, or rule out the illness, or call for blood tests.

Self-limiting illness

In a majority of cases, chikungunya resolves on its own, in about a week. Generally, no specific treatment is needed. Simple analgesics like paracetamol can be used to ease pain. Potent anti-inflammatory drugs are best avoided. Use of steroids, herbal remedies, or other “magic drugs” may also be best avoided. For those with persistent joint pain, drugs like chloroquine are reported to be beneficial.

Most deaths attributed to chikungunya occur in elderly and debilitated patients who may already be suffering from other illnesses involving major organs.

Preventing chikungunya

Since chikungunya is spread by mosquitoes, the best way its spread can be checked is by tackling mosquito population and/or menace. Given that Aedes mosquitoes are day-time biters, use of bed nets may not protect against chikungunya. It would be advisable to wear long-sleeved shirts and long pants when you are outdoors. This will provide effective “cover” for your body from mosquito bites. Mosquito repellents may also be applied on exposed skin and clothing to keep mosquitoes away.

The best method to prevent all mosquito-borne infections is to destroy the larvae that develop in stagnant water. Aedes mosquitoes breed abundantly in small pools of clean water in flower pots, window shades, buckets, used tyres and the like, that are thrown out in the open, at construction sites, and overhead tanks that are left uncovered. It is mandatory to clear debris, and also clean overhead water sources, at regular intervals.

One can also effectively keep chikungunya away with the participation of the community. Every locality is the responsibility of the people living there rather than the administration. This is, in fact, one of the most practical ways to check and/or prevent mosquito-borne diseases, such as chikungunya.

The post Chikungunya: Fever that Bends the Joints appeared first on Complete Wellbeing.

Typhoid fever is one such food-borne infection that is common in the developing world. Presenting a subtle illness during the initial phase, typhoid may be difficult to identify. It can cause fatal complications in 3-4 weeks.

Epidemics of typhoid-like illness have been known to mankind for millennia. Since it closely mimics typhus fever – a serious infective illness caused by microbes called Rickettsiae – it was termed as typhoid [typhus-like] fever. By the 1800s, it was clearly defined as an infection affecting the intestines. It was, thus, called enteric fever.

Now, typhoid is identified as a dreadful infection, especially in the developing world, where poor sanitation and bad hygiene are common dangers. It is estimated that every year about 20 million people suffer from typhoid and nearly 60,000 die of its complications. In recent years, resistance to commonly-used antibacterial drugs has become a cause for concern.

Source of infection

Typhoid is caused by bacteria called Salmonella typhi. These microbes occur exclusively in humans and is, therefore, the only source of infection. The bacteria are shed in the faecal matter by acutely ill patients as well as chronic carriers – those who recover from the illness, but continue to shed the bacteria for months. Food and water handled by infected persons, or contaminated with faecal matter due to poor sanitation or houseflies, can also be a medium of transmission of the bacteria from person to person.

Once in the gut, the bacteria escape the acid in the stomach and soon find their way through the lining of the small intestinal wall. They are captured by the macrophages, the defensive blood cells, and through them the germs enter the blood and reach the liver, bone marrow, and spleen, from where they start multiplying. They are then excreted through the bile juices. Fever and other manifestations of the disease result from the response of the human host to the multiplying microbes.

Symptoms

Untreated typhoid fever runs a course for about four weeks; the late complications that may occur by the third or fourth week may prove fatal.

During the first week, the body temperature in the affected person rises slowly to about 102°F, and there may be headache, malaise, abdominal pain etc., Patients may also have constipation, or diarrhoea. Some patients may have bleeding from the nose. By second week, the fever rises further and the patient feels very weak and may be unable to even get up. In about a third of the patients, there may be a pinkish rash over the abdomen and trunk. They are called rose spots.

Many patients have diarrhoea with greenish, “pea-soup-like” stools; and, some may have constipation. Some may also have confusion and agitation. The abdomen may be distended and there may be pain in the right lower part of the abdomen. The liver and spleen enlarge by this stage, and the physician can feel them easily.

By third week, some patients may develop complications of typhoid fever. Bleeding from the gut and perforation of the ulcers in the small intestine may result in peritonitis and sepsis. They are the most dreaded complications. They may develop even after the patient has shown improvement.

These complications may need urgent medical and/or surgical intervention. Rare complications include encephalitis [brain fever] with confusion or delirium, and they may also affect the heart, pancreas, kidneys, bones etc.

Diagnosis

The diagnosis of typhoid fever is not easy. The illness does not offer definite clues. Confirmation of infection is possible only with a culture of blood, or other material. Even these may sometimes prove elusive as only about 50-70 per cent of cultures may show a positive report. Cultures of bone marrow aspirate and gastric or intestinal secretions may provide a higher yield of 90 per cent, but these are difficult to obtain. Serological tests, like the popular Widal Test, are neither sensitive nor specific and are, therefore, not reliable as diagnostic tools for typhoid fever.

Treatment

Typhoid fever is treated with antibacterial drugs that kill Salmonella typhi. Chloramphenicol, a drug that blocks the multiplication of the bacteria, was widely used for typhoid earlier, but lack of efficacy and cases of serious adverse effects have made them redundant today.

In recent times, Salmonella has also developed resistance to many commonly-used antibacterial drugs. Quinolones like ciprofloxacin are oral antibiotics used for treating typhoid fever, but resistance to these drugs is also emerging. Ceftriaxone injections, or oral azithromycin, are being used more often these days in the treatment of typhoid fever. The treatment is usually given for 10-14 days.

In some patients, symptoms may relapse after a few days and they may need treatment all over again. About 1-4 per cent of cases may become chronic carriers, and they would need antibiotic treatment for about six weeks.

Prevention

Prevention of typhoid fever essentially involves clean eating habits and maintenance of personal hygiene. Use of boiled water and eating only hot and steaming food would minimise the risk of typhoid infection. Raw foods, and food and beverages from street vendors should be avoided.

Effective vaccination is available against typhoid fever; the protection can last for about 3-4 years after vaccination. This is highly recommended for travellers from the developed world, when they visit endemic areas of typhoid fever. Vaccination should be taken at least a week prior to travel.

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Termed allergic rhinitis, hay fever represents irritation and inflammation of nose and eyes. It is caused by allergic reaction to a variety of air-borne substances and affects as many as one-fifth of the population. What’s more, the problem is on the rise the world over, thanks to increase in pollution and shifting lifestyles.

Hay fever generally starts in childhood. It can, however, occur at any age following exposure to allergens over a prolonged period of time. Among the common allergy-causing substances in the air are pollen, moulds, animal dander, smoke, dust and fumes. The time of onset and duration of symptoms depend largely on the type of the causative allergen.

Pollen particles are tiny, male sex cells produced by trees, grass, weeds and flowers. Pollen from garden flowers are large and waxy; they are less likely to cause allergy, while those of trees, grass and weeds are extremely small and easily spread by the wind. These get inhaled with the air we breathe; they trigger allergic response and cause inflammation of the airways.

Blame it on pollen

The pollinating season usually heralds allergic symptoms. Most cases of allergic rhinitis are caused by weeds and grasses and these plants pollinate between May and September, while trees pollinate in spring. The distribution of pollen particles also depends on the weather. The pollen is released early in the morning and as the day gets warmer, more pollen is released and the pollen count peaks by the evening. The amount of sunshine, rainfall, humidity and the speed and direction of the wind can all influence the spread of pollen.

Moulds, on the other hand, are present throughout the year and can grow outdoors as well as indoors – especially in damp places. Pet dander, insects like cockroaches, fumes of mosquito repellents, perfumes, tobacco smoke and many others can also trigger allergic rhinitis.

Symptom picture

Symptoms of itchy, runny nose and watery eyes, with irritation, usually appear immediately after exposure to the causative allergen; they can vary from mild to severe. Mild cases may be brief, infrequent episodes of runny nose with sneezing and itchy, teary eyes. Many patients keep clearing their throats and rubbing their nose often. As the condition worsens, congestion and stuffiness of the nose increase. There may be loss of smell and altered taste. The blocked nose can also lead to sinusitis and headaches.

Dripping of mucous from the back of the nose into the throat may also cause frequent cough. Severe cases may even have bleeding from the nose.

With the symptoms lasting weeks or months, the ability to concentrate gets affected, while physical and social activities are hampered and sleep may be disturbed.

Allergic rhinitis is also sometimes accompanied by other allergic disorders like asthma and eczema of the skin.

Diagnosis

The diagnosis of allergic rhinitis is apparent when someone presents with typical nasal and eye symptoms. A viral infection of the upper airways, however, can also result in stuffy and runny nose, but in such cases, fever is common and the condition is self-limiting [3-5 days]. In some of these cases, the secretion may turn yellowish, suggesting pus [infection].

The real challenge in hay fever lies in identifying the causative allergen. While seasonal allergic rhinitis is likely due to pollen, a perennial problem may be triggered by house dust, fumes and so on. A skin test, by pricking the suspected allergens into the skin, may be of value in some cases. Estimation of blood levels of the antibody [immune system-related proteins], Immunoglobulin-E [IgE], responsible for allergic reactions, can also be done.

Managing hay fever

The most important measure in the treatment of hay fever is avoidance of the causative allergen. But, this is easier said than done. Most patients need anti-histamines or anti-allergy medications for controlling symptoms. These drugs block the action of histamine, the mediator released in the process of an allergic reaction. Many anti-histamines are now available, some of them over-the-counter [OTC]. The newer, less sedating anti-histamines act a bit slowly and are more expensive.

New anti-histamine nasal sprays are also available; they minimise certain side-effects. Decongestant nasal drops reduce the swelling of the nasal passages, but their effect is temporary. Besides, they may cause return of symptoms on withdrawal. For chronic and more severe cases, corticosteroid nasal sprays may be needed. Corticosteroids stop the allergic reaction and reduce the inflammation and swelling, thereby providing effective relief from symptoms. Being locally effective, these sprays do not have any significant adverse effects on the body and can be used for a long time, if required. There are certain blocking agents and sprays of ipratropium, a drug that dries up the secretion, that can provide relief from symptoms.

Some cases of severe, long-lasting hay fever may be treated by immunotherapy, or desensitisation by using minute amounts of the causative allergen for a certain duration. However, this treatment consumes time as well as money, and the results are not predictable. Consult your physician for the best result. Also, do not self-medicate when symptoms persist, or become chronic.

Some alternative approaches like ayurveda, acupuncture, homoeopathy, and herbal remedies, are suggested to relieve, or prevent, hay fever symptoms. Speak to a therapist, in the given field, to find out what suits your individual needs best.

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Located in the right upper abdomen, it weighs about one-and-a-half kg. It is a filter, a factory, a store-house, and a gland, all rolled into one.

Liver is the gateway for the blood draining the gastro-intestinal [gut] tract. It receives all that is absorbed in the gut, filtering and detoxifying many harmful substances. This is one reason why liver is vulnerable to many insults through food.

Liver is the “industrial unit” that produces various proteins including albumin and clotting factors. Liver also secretes bile, the juice that is needed to emulsify fats in the gut. Glycogen, vitamins and minerals are also stored in the liver.

Being an organ of such vital importance, liver has the extraordinary ability to recover from injuries and regenerate. Minor insults to the liver, therefore, may not even manifest clinically; however, by the time signs appear, the affected person usually has significant injury in the liver tissue.

Hepatitis is inflammation [swelling] of the liver. Many infectious agents, drugs, toxins and chemicals, metabolic abnormalities, auto-immune diseases etc., can cause hepatitis. The most common causes being viral infection, drugs and alcohol. Most cases of hepatitis manifest as acute illnesses and are self-limiting, with the liver healing on its own.

If the inflammatory process persists beyond six months, it is termed as chronic hepatitis. This may result in scarring of liver. This is called cirrhosis.

Viral hepatitis

Viral infections are, by far, the most common causes of hepatitis [viral hepatitides], affecting any age group. It is more common in children and adolescents. More than 95 per cent of viral hepatitides are caused by the hepatitis group of viruses, named Hepatitis A, B, C, D and E [Hepatitis F and G have also been reported]. These viruses replicate within the liver cells and, in the process, cause injury and inflammation of the liver.

Hepatitis A and E are spread through contaminated food and water [faeco-oral route] and cause seasonal epidemics of hepatitis the world over, particularly in the poor and developing countries.

Hepatitis A is one of the oldest diseases known to mankind and also one of the most contagious. In areas with poor sanitation and overcrowding, it often strikes the young.

Hepatitis E was first reported from India. It is common in tropical countries.

Hepatitis A and E generally run a mild course and are self-limiting; rarely, however, Hepatitis E can cause fulminant [severe] hepatic, or liver, failure.

Hepatitis B and C are transmitted from blood to blood through transfusions, needle pricks, sexual contact, or vertically from the mother to the baby in the womb; the primary sources being unsterilised injection needles or surgical instruments and/or inadequately screened blood and blood products. It is estimated on a global scale about two billion people are infected with Hepatitis B virus [with more than 350 million having chronic infection] and 150-200 million people infected with Hepatitis C. In about 5-30 per cent of patients, Hepatitis B and C cause chronic infection and some of these develop sequelae [condition/s resulting from a prior disease, injury, or attack], like cirrhosis of liver and liver cell cancer. About one per cent of patients with Hepatitis B may develop fulminant liver failure.

Viral hepatititides manifests initially with lack of appetite, altered taste, nausea, vomiting, upper abdominal discomfort and a mild degree fever. After about a week, the patient may notice yellowish or dark-coloured urine, followed by yellowish discoloration of eyes and skin [jaundice]. By this time, fever and other symptoms usually subside. Jaundice may persist for 1-2 months in Hepatitis A and E, and for 3-4 months, or longer, in Hepatitis B and C. Many patients suffer from generalised itching during this phase.

Liver function tests [LFT] in these patients show increased levels of bilirubin and liver enzymes. Specific viral infections can be identified with serological tests [laboratory test done on blood serum].

The presence of jaundice raises concern in many. It is common to find people seeking alternative medicines for treating jaundice. It must be emphasised that jaundice is only a sign of raised blood levels of the yellow pigment bilirubin. It can have several causes and should, therefore, be evaluated. For example, in areas where malaria is rampant, a blood test for malarial parasites is a must in all cases of jaundice.

Management

No specific treatment is needed for most cases of acute viral hepatitis. Normal diet is allowed and bed rest is unnecessary. As progression to chronic hepatitis is the rule in Hepatitis C, antiviral therapy with interferon alpha may be beneficial.

Vaccines are now available for the prevention of Hepatitis A and B. Vaccination against Hepatitis B is now a part of Universal Programme of Immunisation for the Newborn in many countries, including India. It is also recommended for people at high risk of contracting Hepatitis B, such as healthcare personnel, recipients of frequent transfusions and dialysis as well as sexual and/or close contacts with chronic carriers of Hepatitis B.

The role of sanitation and personal hygiene in the prevention of water-borne infections need not be over-emphasised. Adequate toilet facilities, use of clean drinking water and frequent washing of hands are simple, yet important measures in the prevention of epidemics of Hepatitis A and E. Universal precautions for prevention of blood-borne infections like the use of disposables and gloves as well as mandatory screening of blood and blood products for Hepatitis B and C are a must.

Drugs and toxins

Many medications/drugs and toxins can cause injury to liver cells resulting in acute hepatitis. Withdrawal of the offending agent leads to recovery. Alcohol can cause liver cell injury, acute and chronic. A binge of alcohol can lead to acute hepatitis, in some. It manifests as upper abdominal pain, nausea, vomiting, and jaundice.

Non-alcoholic steatohepatitis

Non-alcoholic steatohepatitis [NASH] is being increasingly recognised as an important cause of liver disease that may eventually lead to cirrhosis. It is characterised by the presence of fat droplets and inflammatory cells in the liver. It occurs as a part of metabolic problems seen in cases of insulin resistance, obesity, and diabetes.

A related but milder condition called fatty liver may be seen in as many as 80 per cent of patients with obesity. NASH and fatty liver are usually identified by imaging studies like ultra-sound scanning or CT scans. A liver biopsy is confirmatory. Dietary restrictions and loss of weight with subsequent improvement in the metabolic parameters can lead to resolution of these abnormalities.

Silver-lining

The silver-lining is most causes of liver cell injury are preventable and self-limiting. Given the enormous capacity of the liver to regenerate, most cases of acute hepatitis heal on their own, without any complications. If we are a bit more careful with our food and lifestyle, we can prevent most of the problems that affect the liver, our largest internal organ.

The post ABC of Hepatitis appeared first on Complete Wellbeing.

Today, the disease named after Parkinson is ranked among one of the most common neuro-degenerative diseases that affects about 30 per cent of people in their seventies.

Parkinsonism is, in actuality, a syndrome characterised by features of Parkinson’s disease, in association with other neuromuscular manifestations. More of this later.

It ain’t as simple, in reality, though – because many of the changes that occur with normal aging mimic Parkinsonism. It is, therefore, important to differentiate between them – if proper treatment is to be offered.

What happens

Our balance, posture and movements are controlled by a complex mechanism involving the cerebral cortex and brainstem — with dopamine being the essential neurotransmitter [chemical messenger] in the process. Progressive loss of nerve cells and depletion of dopamine, particularly in the substantia nigra, a part of the brain stem, results in Parkinson’s disease.

Loss of dopamine simply affects balance, posture, movements, memory, and concentration.

It is not yet clear what causes dopamine loss. Experts believe that a combination of genetic and bio- logic factors, triggered by some environmental insult, may be responsible. It is estimated that, per decade of life, about 9-13 per cent of approximately 4,50,000 dopamine-producing neurons in the substantia nigra undergo age-related attrition and/or death.

With advanced age, about 70-80 per cent of such neurons may be lost when the disease first manifests itself.

A number of environmental neurotoxins, industrial chemicals, metals, pesticides and herbicides have, of course, been reported as possible causes for Parkinsonism. It is suggested that they may accelerate the process of nigral cell death.

Role of genes

In some individuals, a certain genetic susceptibility may play a role. Recently, defects in the genes coding for the proteins alpha-synuclein and parkin have been identified, particularly in young patients developing Parkinsonism.

Injury from oxygen free radicals, overexcited N-methyl-D-aspartate [NMDA] receptors, overactive immune response, heightened inflammation and infectious organisms have all been blamed as causative factors for Parkinsonism. This is not all. The substantia nigra and other parts of the brain may also characteristically show fibrous deposits in some individuals. This is called as Lewy Bodies — the hallmark of Parkinson’s disease.

A resting tremor, rigidity of muscles, slowness of movements and postural instability are characteristic features of Parkinsonism. Rest tremor is an easily recognisable and specific sign of Parkinson’s disease. It usually starts on one side of the body and may remain so for a long time. Classically appearing as pill-rolling movements with the thumb and fingers, it occurs when the arm is resting with support and disappears with action. Resting tremor is a reliable clue to the diagnosis of Parkinson’s disease. Slowness of movements is another important feature that distinguishes Parkinson’s disease — this is also the most disabling.

Lack of expression on the face with reduced blinking [mask face], abridged arm swinging while walking, difficulty in arising from the chair, or turning around, or rolling over in bed, are some of the manifestations of slow motor activity. Eventually, the person may develop a stooped posture and slow, shuffling walk.

Decreased motor activity can lead to many other problems. Difficulty in walking and unstable posture can increase the risk of falls and injury. Patients can also suffer from problems while swallowing with risk of aspiration pneumonia. Constipation and problems in passing urine can also occur. Also, as many as 70 per cent of individuals, affected by the disorder, may have difficulty in speaking.

It is common to find Parkinsonism individuals bogged down by depression, anxiety, or behavioural problems. Dementia, or memory loss, can occur in progressive forms of the disease.

In some, there may be dysfunction of the autonomic nervous system characterised by fall in blood pressure on standing, resulting in dizziness, or fainting. Early onset of dementia, falling and hallucinations and lack of tremors usually indicate Parkinsonism rather than Parkinson’s disease.

Beyond diagnosis

Diagnosis of Parkinson’s disease is primarily based on clinical findings, as imaging studies and other investigations are of limited value. Presence of any two – tremors, rigidity and slowness of movements – would strongly suggest the possibility of Parkinson’s disease.

Cerebrovascular disease and multiple small strokes, Alzheimer’s disease, dementia with Lewy bodies, encephalitis caused by influenza, progressive palsy and multiple system atrophy [wasting] can have symptoms similar to Parkinson’s disease. Essential tremors and senile gait may also be confused with Parkinson’s disease in the elderly.

It should also be kept in mind that certain drugs can cause symptoms of Parkinsonism, when elderly patients are on multiple medications.

The post Parkinson’s Disease: When tremors rule appeared first on Complete Wellbeing.

The problem is only being accentuated with depletion of water resources, global warming, unprecedented growth of cities and pressures of globalisation and commercialisation of water supply.

Water-borne diseases affect nearly four billion people every year, with more than 2.5 million deaths, most of them among poor children. Water-borne infections of the alimentary tract constitute about 3.7 per cent of the global burden of disease, the sixth highest burden on a global scale. And, if one also considers other water-related diseases like helminthiasis [worms] and diseases spread by mosquitoes that breed in stagnant water, the burden looks staggering.

Preventable problems

Yet, all this is preventable with well-planned and careful management of water usage. Although mortality rates have declined in recent years, owing to improved sanitation and better healthcare, much needs to be done with almost one-sixth of humanity lacking access to clean water.

There is nothing we can do without water. Apart from its need for drinking and preparation of food, water is also needed for cleansing and recreational activities. The worst part – water stagnation anywhere in the vicinity of human dwellings can be a source of disease-carrying insects.

Water-related infections can, therefore, manifest on account of consumption of contaminated water, inadequate personal hygiene and through intermediate hosts of microbes that thrive in water, or insect vectors that breed in water.

Come summer, the squelching heat increases the demand for water on the one hand – scarcity of water forces the use of unpotable water, on the other. Also, the advent of monsoon leads to water stagnation everywhere, providing a fertile breeding ground for vectors of human disease. It’s no surprise that water-borne diseases increase manifold in either conditions.

Many infections of the gastro-intestinal tract result from drinking contaminated water. While natural water bodies like wells, ponds, lakes, rivers, and even ground water provide the “soil” for microbes to thrive, most naturally-occurring microbes do not cause any illness.

Disease-causing microbes or harmful chemicals can contaminate water through discharge or seepage of untreated sewage or domestic and animal wastes into water bodies, storage tanks, or distribution lines. Improper storage of drinking water also promotes multiplication of disease-causing germs and is an important source of infections in cities.

Microbial battlefield

Although there are many microbes that are spread through water [faeco-oral route], it is viruses like hepatitis A and E, rotavirus and norovirus, bacteria like Salmonella, Shigella, Campylobacter, E coli and Vibrio cholera, parasites like Giardia, Entamoeba and Cryptosporidium and helminths like Schistosoma that cause most of the water-borne infections.

Norovirus is an emerging viral disease that is now blamed for almost 50 per cent of all cases of diarrhoea worldwide.

Most infections of the gastro-intestinal tract manifest with abdominal discomfort or pain associated with a bloating sensation, followed by vomiting and/or diarrhoea, sometimes with stools mixed with blood. Some may also have fever and other bodily symptoms too. The severity and duration of the symptoms depend on the causative agent.

While most cases are self-limiting and improve within 5-7 days, patients with profuse diarrhoea may succumb if adequate fluid replacement is not provided. Young children, the elderly and immuno-compromised patients are at special risk of developing life-threatening complications and accordingly merit special attention. The passage of many watery stools, repeated vomiting and failure to eat or drink normally, dizziness on standing and increased thirst are indications for more aggressive fluid replacement and even hospitalisation.

Gruels, carrot soup, rice water [congee], fresh fruit juice, weak tea, tender coconut water, a salt-sugar-water solution, oral rehydration solution, or if nothing is available, clean water can all be used for rehydration. Normal food should be continued to maintain nutrition in all such cases.

Use of anti-diarrhoeals to abruptly stop diarrhoea is not proven to be beneficial and may cause harm if used in children. Use of specific anti-microbial drugs is warranted only in cases such as suspected cholera, traveller’s diarrhoea, patients with high grade fever or blood in stools and/or in proven bacterial or protozoal infections.

Hepatitis viruses A and E are also transmitted through the faeco-oral route and cause brief febrile illness followed by yellowish discolouration of eyes and skin [jaundice].

Leptospirosis, more commonly known as Rat Fever, is a multi-system illness caused by a spiral bacteria called Leptospira. Common in rural parts of India, it is contracted through wading or bathing in water bodies contaminated with urine of infected rats. In most cases, leptospirosis passes off as a minor illness; however, in some, it can cause complications like liver and kidney failure that may be fatal.

Other dangers

Recreational water illnesses are spread by swallowing, breathing, or having contact with contaminated water from swimming pools, spas, or natural water bodies. Swimming, when ill, with diarrhoea can easily contaminate large pools or water parks. Apart from gastro-intestinal infections, recreational water illnesses can involve skin, ear, eye, respiratory, or the nervous systems, and some of these may be fatal.

Mosquitoes breed in stagnant water and mosquito-borne diseases are on the rise all over the world. Malaria, dengue, chikungunya, West Nile encephalitis, Japanese encephalitis and many others have become formidable challenges to mankind.

If mankind has to survive this “watery grave,” concerted efforts are needed towards scientific management of water resources and cleanliness.

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