Myths and facts about ICU ventilator: small boat in sea storm


 

 Some one who is drowning, a small boat can  save his life, till sea storm settles or the victim reaches a safe land. The boat will not settle the sea storm, but enough to save a person from catastrophe. In reality, ventilator is the invention, which should be worshiped. But contrarily, due to wrong projections and misguided perceptions, it has been hated despite saving lives.

     Although doctors and ventilators are in a similar situation, projected in a wrong way,  hated in spite of doing good work and saving lives. They are hated and despised, despite the only ones of help in life and death situations. Following are few myths and fact about ventilator.

  1. Myth : Once on ventilator, patients do not survive: common myth is that  once the patient is placed on ventilator, he will not survive.  Human body,  when  gets severely  diseased or  under stress, heart and lungs need to be supported for saving the life, till ailment    So, when the battle for saving live is ongoing, almost all the patients will have to be placed on the ventilator. It is a last ditch attempt made to save the patient’s life. However when the patients do not survive people feel that it’s the ventilator which has caused death, rather than a rational thought about severe disease as a cause.

             In reality, it is the severity of disease and possibility of death, when ventilator is required. It is necessary to support life.

  1. Myth : Ventilator is a modality for mere prolongation of life: every disease has a spectrum. Every disease can progress  from a reversible  to irreversible state. As an effort is ongoing while waiting to reverse the process, the patient will need  ventilator to sustain life. Unless the disease reaches a stage of  irreversibility,  ventilator is indispensible  for an  absolute need to maintain life. Since in serious condition, it is an uncertain prognosis.  In retrospect, combined with application of an average wisdom, the time of uncertainty and institution of ventilator   can be  interpreted  as a mistake.  As the whole exercise is labeled as futile and expensive by relatives.   it’s a grey area and the  negative thoughts are fuelled because of retrospective wisdom in hindsight.  The real prognosis can not be predicted in real time.

In reality, Ventilator is a machine which just  supports respiration and not  responsible for  heart beating. Therefore it   buys time for healing and treatment of primary disease.

  1. Myth : Ventilator will cause death:

one can understand this simple logic on the basis that patients are placed on dialysis when kidneys fail. Patients are placed in cast when bones are fractured for a fixed predefined period of time. Similarly patient is placed on ventilator when lungs fail. Ventilator is used till the time  lungs recover and become fully functional.

                        In reality; Risk is because of disease, which needs ventilator and not vice versa. Ventilator is a friendly machine which helps people who have failed lungs.

  1. Myth : Doctors and hospitals keep dead patients on ventilator for financial gains

Fact:  placing patient on ventilator is a very critical decision, taken in best interest of patient to buy time, to so as to treat the disease.  A patient needing on ventilator is actually so sick, that not  instituting ventilator will risk the patient’s life. Knowing all these facts, doctors take a decision to keep the patients on ventilator.

         As once the patient is on ventilator,  it is a stress for the doctor to take the patient off the ventilator. As such ventilator is a SANCTUM SANCTORUM life saving machine,  to be used only in life and death situations.

 

  1. Myth : Its miracle if the patient placed on ventilator survives.

Given the fact that placing the patient on ventilator on scientific facts. There are clear indications  for putting the patient on ventilator.   A much larger patients put on ventilator are actually saved and go home.

Fact:  Everyday thousands of patients are placed on ventilator and sent home to lead a normal life: Any patient who is given general anesthesia is placed on ventilator in the operation theater and then taken off the ventilator at the end of the surgery. In these cases patients are placed on ventilator so as patient can be put to deep sleep (called anesthesia) during which surgery on desired part can be carried out. Soon after the surgery patient are taken off the ventilator and soon thereafter discharged for home after few days of healing.

 

  1. Myth :Doctors place patients on ventilator at their own will:

Fact:   there are scientific parameters which decide when the patient should be placed on the ventilator and when the patient should be taken off the ventilator. So the decision to place the patient is scientific and based on objective parameters.

  Contrary to this popular myth, it is a compulsion for the doctor to put patient on ventilator to prevent death in serious situations.  Doctors are usually thinking several steps ahead of lay person about medical science.

  1. Myth :All patients placed on ventilator are unconscious:

 

Fact: this is not necessary. Usually patients are sedated  for their comfort.  they can be made to walk, write and even perform small tasks when on ventilator, depending upon their lung condition.

  Patients are also put on ventilator in case of airway failure when unable to protect their airway for various reasons. Another reason why patients are placed on ventilator is inability of the patients to protect his or her airway. Conscious and alert patients can swallow normally formed mouth secretions.  When patients consciousness level is dulled the ability of the patient to protect his airway is lost or compromised. This causes secretions from mouth to enter into the lungs trough the airway i.e. trachea causing infections in the lungs. The only way to prevent this and protect the patient’s lungs is to place a tube in his airway and then place them on the ventilator.

 

  1. Myth: Patients can be kept alive by placing on the ventilator:

General masses  have a feeling that patient can be kept alive by keeping them on the ventilator. Even  a dead person can be kept alive by placing on the ventilator, which is not true.

In reality:  It is machine used only for breathing and not heart and brain.

  1. Myth : Ventilating the dead patients:

    this is a common allegation on medical profession.  This is no truth in this projected and perceived hearsay.

       Facts: Assumptions are based on thoughts of lay persons. Patients on ventilator, may look like dead, because of the disease, sedation and paralyzed by drugs. But their heart and brain are working, so they can not be declared dead.

    If there is some incident, it  needs to be proved by medical personnel. In reality, it can  be a very rare and remote  exception. These untrue projection are creating lots of mistrust about life saving machine.

The problem is about correct projection and  majority of people without  knowledge of medical science  do not  even  know the large  number of lives  been saved by the ventilators.

In nutshell: serious conditions  and life threatening situations need higher technical interventions, to save a life. If correct projections are made, ventilators are life saving machines.

About ventilator

History of ventilator

South Asians at higher health risks: Low lean mass


The research further establishes that this low lean mass has been a constant in South Asians for almost 11,000 years.

South Asians, even those who move to other countries, are at a higher risk of diabetes than people of most other ethnicity, and according to a study published last week in Nature Scientific Reports, the reason for this is their relatively low lean mass

The research further establishes that this low lean mass has been a constant in South Asians for almost 11,000 years.

Higher lean mass is associated with superior performance in some, but not all, sports.

Mesolithic hunter-gatherer ancestors of South Asians were much taller, but low lean mass has characterised South Asians for at least 11,000 years, putting them at higher risk of type-2 diabetes and other non-communicable diseases (NCDs) such as heart disease, according to the study which analysed 197 archaeological and recent South Asian adult skeletons.

Height decreased by 8.5cm in men and 7.7cm in women when South Asians transitioned from hunting and gathering to farming around 9,000 years ago, but their lean mass (organ and muscle mass) has remained unchanged over the past 11,000 years, the study said.

Since changes in lean mass are unlikely over the next four to five generations, making lifestyle interventions are crucial to containing NCDs, which account for 60% of all deaths in India.

The study suggests that while height is determined by nutritional factors, physique (bone breadth and lean mass) reflects ecological pressures. “The decrease in height probably took place very quickly (over hundreds of years rather than thousands). After the initial drop in height with the adoption of farming, it then continued to decrease very slowly between about 5,000 years ago and today,” lead author Dr Emma Pomeroy, lecturer in the Evolution of Health, Diet and Disease, Department of Archaeology, University of Cambridge, said in an email interview. “The ancient origins of low lean mass in South Asians would be most consistent with long-term adaptations to ecological pressures, rather than more recent dietary change or the impact of 19th-20th century famines exacerbated by British colonial policy,” said the study. Ecological pressures include adaptation to a predominantly hot, equatorial climate, which may have led to selection for lower body mass (which generates less heat and increases heat loss through a greater surface area to volume ratio) to reduce thermal load. “Low lean mass is present at birth in South Asian babies compared with European babies; even after South Asian families migrate to other parts of the world, such as the UK, after several generations in this new environment, their children still have low lean mass compared with children of European ancestry. This strongly suggests a major heritable component to South Asian low lean mass, but the contributions of genetic, epigenetic and environmental conditions are still unclear,” said Dr Pomeroy, referring to a study on type-2 diabetes in migrant South Asians published in The Lancet in 2015. People of South Asian ancestry are at a higher risk of diabetes even after risks like unhealthy diet, sedentary lifestyles and obesity are factored in. For example, South Asians in London have a two to three times greater type 2 diabetes compared with those of European ancestry, with onset typically five years earlier and at a lower body mass index (by 5 kg/m2). “The implications of the study are that low lean mass is a very ancient characteristic, so it is unlikely to change much in the coming generations. This means that other interventions, especially the promotion of healthy lifestyles, are particularly critical to manage the growing health and economic burden of chronic diseases,” said Dr Pomeroy.

Building muscle mass and high fitness levels have the potential for averting diabetes, and even heart disease.

 

 

Breathing OZONE # rising Pollution


 

Rise in ozone levels is considered as one of the triggers for respiratory ailments. Irritation can occur in the respiratory system giving rise to coughs and an uncomfortable sensation in the chest. It may reduce lung function and make breathing difficult. There are no data available in the country to establish a direct correlation between mortality and high levels of ozone.

Oxidizing substances, such as oxides of nitrogen and oxidants from automobile exhaust, react with Sunlight to produce ozone.

Ozone — a pollutant that cause respiratory ailments, damage crops and forests — has been the highest in Delhi among the NCR cities of Gurugram, Faridabad, Noida and Ghaziabad for the last three years.

highest Ozone pollution in Delhi among NCR cities in last 3 years .

Compared to Delhi, Noida experienced 49 days on which ozone was high, Gurugram recorded 48 days, Faridabad encountered 11 such days, and Ghaziabad encountered eight days of high ozone, in the last three years

Data submitted in the Lok Sabha on Friday by environment minister  revealed that “between 2016 and 2018, Delhi encountered at least 95 days, on which Ozone was found to be as one the ‘prominent pollutants’ in the city’s air”.

“Usually, it is the level of particulate matter (PM10 and PM2.5) that remains high in Delhi,” an official of the Central Pollution Control Board (CPCB) said.

Compared to Delhi, Noida experienced 49 days on which ozone was high, Gurugram recorded 48 days, Faridabad encountered 11 such days, and Ghaziabad encountered eight days of high ozone, in the last three years. Even though ozone in the upper reaches of the atmosphere is good for humans as it absorbs the sun’s harmful ultraviolet rays, when it is generated on the ground level, from vehicular and industrial fumes, ozone undergoes a chemical reaction in the presence of sunlight and turns harmful.

“This year, till May 31, Delhi has already encountered 23 days of high ozone. Faridabad has recorded the highest number of days this year so far, at 55. Gurugram and Ghaziabad recorded six and three

such days, respectively, while Noida didn’t record any such day so far,” the CPCB official said.

Safar, a pollution forecasting agency under the earth sciences ministry, had been issuing warnings of ozone pollution over the past two weeks. The Centre for Science and Environment, a Delhi-based NGO, released a report last week, which also showed that between April 1 and June 5, ozone levels were high on at least 16% days this year, compared to 5% days in 2018.

The highest concentration in 2019 went up to 122 mpcm, which was 1.22 times higher than the eight-hour average standard.

“This is a serious trend as ozone can have an adverse effect on those suffering from asthma and respiratory conditions. If this trend continues or worsens, the graded response action plan will also have to be enforced to address the precursor gases that form ozone — NOx, hydrocarbons etc — and crack down on vehicles and industry,” Anumita Roychowdhury, executive director (research and advocacy), CSE, said

 

More than  100 children dead due to acute encephalitis syndrome (AES) in Bihar


More than  100 children have lost their lives in Muzaarpur this summer from acute encephalitis syndrome (AES).   The  government and  administration have tried to  blame varied causes like  hypoglycaemia (sudden fall in blood sugar), heat wave, and inadequate intensive care units (ICU) in hospitals. The admission of failure  has been left unsaid and left to wisdom of people. The  administration   has failed to respond to an annual outbreak of encephalitis,  that  has  affected 11 districts, including Muzaarpur, with seasonal regularity. While symptoms of Japanese encephalitis (JE) and AES are similar —inflammation of the membrane of the brain that leads to sudden-onset fever, headache, disorientation, tremors, convulsions, and paralysis, but the causative agent is  different. Vaccine-preventable JE is a mosquito-borne a virus from the same genus as dengue and yellow fever viruses.

AES may be caused by a range of factors, including toxins in unripe lychee fruit, viruses, bacteria, fungi, parasites and chemical poisons. If not treated within hours of appearing, 30% of the patients  affected die. In India, AES outbreaks in the past in Muzaarpur have been linked to young, malnourished children eating unripe lychee fruit. Unripe lychees contain the toxins, hypoglycin A and and methylenecyclopropyl-glycine (MCPG) that cause vomiting and a sudden drop in blood sugar. In severely malnourished children, rapid fall in blood glucose levels can kill within hours. India has a standard operating JE/AES containment procedure, which mandates grassroots health workers, including auxiliary nurse-midwives, accredited social health activists, and anganwadi workers, to do household surveys to check children for JE/AES symptoms. If children with sudden fever are referred within hours of developing symptoms as mandated, simple glucose is all that is needed to save many young live.

With the death of six more children on Monday, Acute Encephalitis Syndrome (AES) has so far claimed the lives of 103 children in Muzaffarpur and its adjoining areas in north Bihar, the Muzaffarpur district magistrate said. Of these, 85 children died at Sri Krishna Medical College and Hospital (SKMCH), and 18 children at Kejriwal Maternity Clinic since the outbreak of AES, which causes inflammation of the membrane of the brain that leads to sudden onset fever that can cross 104 degrees F, headache, disorientation, tremors, convulsions and paralysis. If the symptoms are not treated within hours of the first few appearing, 30% of those affected die. AES usually affects very young children who are severely malnourished. “This year has been the worst outbreak of encephalitis cases in the state. Many of the children with the symptoms of AES or JE [Japanese Encephalitis] notably reported convulsion coupled with high fever died of hypoglycaemia, a condition of low blood sugar,” said Dr Gopal Shankar Sahni, the head of paediatric department, SKMCH, where most of the children with AES are being treated.

The deaths were confirmed by SKMCH superintendent, Sunil Kumar Shahi, and civil surgeon, Dr S P Singh. Chairing a high-level meeting to take stock of situation, chief minister Nitish Kumar announced on Monday that the government would bear the cost of treatment and also reimburse transport charges incurred in ferrying patients referred by primary health centres (PHCs). Facing Opposition flak, chief minister convened a review meeting of health, disaster and education departments immediately after his arrival to the state capital from Delhi.

Bihar’s already fragile health care system has been further hit by a doctors’ protest in support of the 24-hour nation-wide strike call by Indian Medical Association (IMA) on Monday in solidarity with their colleagues in West Bengal. AES cases have also been reported from Samastipur, East Champaran and Vaishali. “Eleven children with AES have so far been admitted at our health facilities in Samastipur and Vaishali each. Another six cases are admitted in East Champaran,” Manoj Kumar, executive director of Bihar’s State Health Society, said.

Bihar’s industry minister, Shyam Rajak, and several leaders from the Janata Dal (United) visited children being treated for AES in SKMCH wards. Bihar CM Kumar had earlier announced an ex-gratia compensation of ₹4 lakh each to families of deceased children.

Union health minister Harsh Vardhan on Monday directed another high-level multi-disciplinary team of experts to be sent to Bihar to establish the cause of disease.He also directed the state government to establish a 100-bed paediatric intensive care unit (ICU) at SKMCH. The state will also come up with five virological labs in different districts within a year.

Social worker, Tamanna Hashmi, has lodged a complaint case with the Chief Judicial Magistrate (CJM), Surya Kant Tiwary, against the Union Health Minister Vardhan, and Bihar Health Minister, Mangal Pandey, for negligence resulting in the deaths of more than 100 children; apathy in launching awareness campaigns; and flipflops in starting medical research to identify the viruses and other causes that have led to death of children. The CJM heard the complaint and fixed June 24 as the date for the next hearing.

 

 

 

 

   

1,000 people at Delhi’s RML Hospital for anti-rabies shot in a day #dogbite#straydogs


Until last year, Ram Manohar Lohia (RML) hospital used to get around 200 patients daily for anti-rabies vaccination. This number has grown manifold over the last six months and on Monday it crossed 1,000. Hospital authorities blamed the unavailability of anti-rabies vaccine at state and municipal corporation-run hospitals for this surge and said if the vaccine wasn’t made availabile at all centres soon, it could lead to a fullblown crisis

“There is a limit to how much we can stretch our resources,” said Dr V K Tiwary, the medical superintendent of RML hospital. At Safdarjung hospital also, which is run by the Centre, officials said there has been significant increase in the rush of patients for the vaccination. Anti-rabies vaccine is needed to prevent the development of disease in persons who have been bitten by an infected animal, The first dose of anti-rabies vaccine has to be injected within 24 hours of the bite — the sooner the better. However, people who had queued up at RML on Monday said they had been running from one hospital to the other in search of the vaccine but to no avail. “I went to two government hospitals in east Delhi. Both said they didn’t have the vaccine. I cannot afford private treatment,” said Kavita Singh, a resident of Mandavali, east Delhi. While government hospitals give anti-rabies vaccine for free, it costs nearly Rs 1,500 for five jabs at private facilities. For patients with severe and deep bite, the administration of anti-rabies serum is required in addition to the vaccines, which costs above Rs 2,000. Authorities in at least two big state-run hospitals — Guru Tegh Bahadur (GTB) in East Delhi and Lok Nayak in central Delhi — confirmed the crisis. “For the last two weeks, there is no anti-rabies vaccine in our hospital,” Dr Arvind Mohan, deputy medical superintendent of Lok Nayak hospital said. He claimed the shortage is from supply side itself. “The vaccine shortage has been there for almost six months but we were managing things by making local purchase initially. Now, even the local suppliers have given up,” Dr Mohan said. Dr Sunil Kumar, medical director of GTB hospital also confirmed they are also running short of anti-rabies vaccines. “We are issuing tenders to purchase the vaccine,” he said. There is no anti-rabies vaccine at municipal hospitals either, senior civic agency officials from both the north and the south corporation confirmed. “The government manufacturer is not supplying the vaccine from last few months due to nonavailability. Patients are either being told to purchase it privately or being referred to other hospitals,” said an official ,Delhi, as per the last annual report of all municipal corporations combined, had witnessed over 27,407 dog bite cases from February 2018 to February 2019. South Delhi was worst affected. Real numbers are expected to be much higher as the figures do not include patients that go to private clinic or hospitals that are not bound to report, said a source. In April, Safdarjung hospital had stopped accepting new cases of dog-bite due to the rush. “Situation has improved a little over the last few weeks. But steps are needed to restore or arrange supply of the vaccine in all anti-rabies clinics to avert crisis situation,” a doctor said.

Microplastic have found way into the human gut


In the next 60 seconds, people around the world will purchase 1 million plastic bottles and 2 million plastic bags. By the end of the year, we will produce enough bubble wrap to encircle the equator 10 times. Though it will take over 1,000 years for most of these items to degrade, many will soon break apart into tiny shards known as microplastics, trillions of which have been showing up in the oceans, fish, tap water and even table salt.

Now, we can add one more microplastic to the list: the human gut.

In a pilot study with a small sample size, researchers looked for microplastics in stool samples of eight people from Finland, Italy, Japan, the Netherlands, Poland, Russia, the UK and Austria. To their surprise, every single sample tested positive for the presence of a variety of microplastics.

“This is the first such study, so we did a pilot to see if there are any microplastics detectable at all,” said Philipp Schwabl, a gastroenterologist at the Medical University of Vienna and lead author of the study. “The results were astonishing.” There are no certain health implications for their findings, and they hope to complete a broader study with the methods they have developed.

Microplastics — defined as pieces less than .02 inches long, roughly the size of a grain of rice — have become a major concern for environ- mental researchers during the past decade. Several studies have found high levels of microplastics in marine life, and last year, they were detected in 83% of tap water samples around the world (the highest contamination rate was in US, where 94% of samples were contaminated).

Researchers have long suspected microplastics would eventually be found in human gut. One study estimated that people who regularly eat shellfish may be consuming 11,000 plastic pieces per year.

The new paper, which was presented  at a conference in Vienna, could provide support for marine biologists who have long warned of the dangers posed by microplastics in our oceans. But the paper suggests that microplastics are entering our bodies through other means, as well.

To conduct the study, they selected volunteers from each country who kept food diaries for a week and provided stool samples.

Up to nine different kinds of plastics were detected, ranging in size from .002 to .02 inches. The most common plastics detected were polypropylene and polyethylene terephthalate — both major components of plastic bottles and caps.

Still, Schwabl cautioned against jumping to conclusions. “It is highly likely food is being contaminated with plastics during various steps of processing or packaging.” Whether microplastics pose a health risk to humans is unknown, though they have been found to cause some damage in fish and other animals. Additionally, the ones detected in the study are too large to be a serious threat.

source

“Dog lover” but lack love towards human child? #straydogs #Rabies #dogbite #infections


In a very recent incident, while out  for a routine morning walk in a Delhi park, I was suddenly jolted by violent barking sounds of dogs. The loud barking sounds were intermixed with cries of a child. I just saw the child running and screaming  for his life. Two stray  dogs were near him,  trying to hunt  him as a prey. As they got nearer to him, I somehow managed to get some stick from a plant and managed to save the child and shoo away the dogs. The nine year old child just clung to me, almost pale, dizzy and his eyes closed with fear. His football was in his lap, which he was trying to use as shield. A shield which society, government, courts and so called “dog-lovers” failed to provide. This child must be the life for his parents and could have been in a great trouble that day because of apathy of few “Animal Lovers”. For whom animal love is like a hobby to be projected for hollow public applause. I looked around, a gentleman was comfortably sitting  with his small dog and reading newspaper. He did not even bother to look at what was happening. He was the person, who used to feed these stray dogs and claimed himself to be a “Dog lover”.  He was totally unperturbed by the fact that a child was about to lose his life because of these wolf like dogs roaming freely. Fed by him, the stray dogs were like friends to him and used to attack others who did not feed them, or were new or  oblivious to the danger. What was bothering was his apathy to the child and victims  and the fact that he continued to feed that violent stray, unperturbed during  the incident.  Similar apathy has been displayed by government and courts with a result that thousand suffer from dog bite every day.

Is it not hypocritical that you care for a violent stray who is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans.  Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate  sense of hatred towards such dog lovers is a consequence and  a natural thought.

Apart from the injury part, Rabies is a disease spread by dog bite, which is not treatable. Getting anti-Rabies serum becomes another Herculean task.

Courts have also upheld animal rights. That is right  but they did not formulate  policies to ensure guard safety of  humans from these violent strays.

           Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.

Animal lovers  while pretending  of “dog love” have  formed NGOs and have  donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from  such preventable cause raise a question on this issue.

    Apathy of these so called dog lovers towards humans is appalling. 

Besides dog bite and injuries, animal and dog poop is an health hazard. Following are the diseases which occur in community because of animal poop.

Problem of animal poop with dust : It is all around us.  It is actually even a bigger health problem than open defecation by humans. Humans defecate in country side and in open fields. But stray animals and dogs are everywhere. Even owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

       Life threatening infections : dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. A dog’s digestive system can handle just about anything that it eats and this makes its poop very toxic. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. These heavy loads of bacteria increase the risk of infections in the community. But pregnant women, children and people with suppressed immune systems may are more prone to these infections. Many diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources in our country. This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.  This may be an important cause of high rates of community acquired infections among our population.

SUGGESTION: the Government, NGOs  and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the  dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives  and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights  should be limited accordingly.

Millions of preventable disease deaths: whose moral burden is it?


Diseases can be  preventable or unpreventable, have  good  or  bad prognosis. But once patient  enters hospital,  what ever may be the reason or genesis of ailment, it becomes a moral responsibility of doctors.  Health care professionals  can be trash-talked   or ridiculed by media and anyone, even for worst prognostic cases.   But  large numbers of deaths   happen  due to preventable causes like accidents , drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. In fact the burden of   negligence here is massive and  these deaths are unpardonable.   Who ultimately carries the moral burden of millions of  preventable deaths?

Common causes of  such  disease, sufferings  and death , specially in developing and poor countries:

  1. Dietary risks and diseases spread by  water sanitation and hygiene.   These  have  direct  linked with bad sanitation and poor hygiene practices. Poor sanitation is the leading cause of diarrhea, malnutrition, cholera, jaundice ( hepatitis A and E) , worm infestations, typhoid and other enteric fevers, which lead to chronic malnutrition and lowered immunity that further feed the infectious disease cycle.  Apart from infectious disease like diarrhea, but also pneumonia and tuberculosis, which are leading killers across all age groups.
  2. Undernourishment in   children  will cause them to be  underweight, stunted and wasted, and makes them  more vulnerable to infections. They are at higher risk of dying of childhood infections.

Working sewage-disposal systems, waste disposal management, protection of water supply from contamination and hand-washing practices are essential components to reduce preventable deaths.

  1. Poor sanitation, unsafe water and low public health also increase drug-resistant infections in low-income and middle-income countries. Lowering of antibiotic consumption  can not be achieved  because superbugs ,  and antibiotic resistance  are already in the environment and continue to spread through contaminated food, water and hospital equipment.

Antibiotics overuse is rampant as they are  used to treat diarrhea and upper respiratory tract infections. Improving sanitation, providing clean water, adopting personal hygiene and getting vaccinated can reduce infections.

  1. Air pollution : air pollution is a public health crisis.  Masses are forced to breathe in air which  contains pollutants  in  unsafe limits, some are carcinogenic. It  is a cause of  millions of deaths  It is besides many fold of this number live their life with morbidity. Polluting vehicles, industry, lesser trees and plantations, poor practices and not enough governance and policies have resulted in poisonous air to breathe. Diseases like COPD, asthma and lung cancer are few common ailments.
  2. A::Dog bite (rabies ), Animal poop and Human – animal interface:   Not properly disposed  animal poop is a  cause of generation of infections and diseases, requiring heavy use of antibiotics and consequently leads to emergence of further antibiotic resistance bacteria. This cycle of production of infections and use of antibiotics perpetuates a vicious cycle.  Stray animals still defecate at every place.  Poop of Stray dogs, cattle and pigs stays in environment and causes life threatening infections. Hundreds of diseases are described due to poor control of human animal interface.

But stray animals and dogs are everywhere. Owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

         B::   Life threatening infections : dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. Many diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

               C:: Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources.  This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.

6.     Mosquito borne diseases: millions die because of vector borne disease , as mosquito control  has been inadequate.  Malaria, dengue,  chickengunya  and many other lethal  diseases spread  due to mosquitoes.

 

7.      Preventable natural disasters exacerbated by human activity: floods, famine, disease outbreaks.

8.      Road, rail  accidents and other accidents: are mostly  preventable errors.

         The role of health care professionals in present day circumstances remains misunderstood and underappreciated, as they assume the responsibility for continuous care of the sick or injured. People who have never treated a patient  in their life time influence health policies, which effects  millions. Excessive preventable deaths are  just a symptoms of a larger problem.  Who  is the one who feels moral burden of millions of preventable deaths?

     .

 

Bedaquiline: New anti TB drug: Govt may allow usage by private health sector


 

Bedaquiline is  a TB drug which is also known by the trade name  Sirturo. Bedaquiline works by blocking an enzyme inside the Mycobacterium tuberculosis bacteria called ATP synthase. This enzyme is used by the bacteria to generate energy. Without the ability to generate energy, the TB bacteria  are killed.

Bedaquiline is used in combination with other TB drugs to treat pulmonary TB in adults when they have multi drug resistant TB (MDR-TB

It should only be used when effective  Tb treatment cannot otherwise be provided.

It should be always be used in combination with at least 3 other TB drugs which drug susceptibility testing has shown that the patient is susceptible to. If drug susceptibility testing is not available then bedaquiline should be used with at least 4 other drugs to which the patient is likely to be susceptible.

The safety and efficacy of the drug in the treatment of HIV positive patients with MDR-TB has also not yet been established.

side effects of bedaquiline                          

The most common side effects are headache, dizziness, feeling sick, being sick, joint pain and increases in liver enzymes. Side effects can be experienced by more than one in ten people.

Another  side effect is that QTc prolongation.

The US Food and Drug Administration (FDA) on 28th December 2012 granted approval for bedaquiline to be used to treat drug resistant TB.  FDA News Release, 31st December 2012 . In October 2013 the CDC issued new federal guidelines on the use of the drug, for the treatment of multi drug resistant TB.

Government may allow private sector to use key drug used for treating tuberculosis

Around 2.1 million people have TB in India, of which an estimated 30,000 people have MDR-TB. Only 6,500 patients are on the bedaquiline-based treatment regimen, which may cause severe side effects such as heart problems and hearing impairment.

The Union health ministry (India) is considering a proposal to allow bedaquiline, a controlled-access drug used in the treatment of multi-drug resistant tuberculosis (MDR-TB), to be open for prescription in the private sector.

Being a controlled-access drug, bedaquiline is dispensed only by the government to people with MDR-TB. At least four courses of treatment are needed. The drug costs Rs 28,000 per course, which means the cost per patient is Rs 1.12 lakh on medicine alone.

Around 2.1 million people have TB in India, of which an estimated 30,000 people have MDR-TB. Only 6,500 patients are on the bedaquiline-based treatment regimen, which may cause severe side effects such as heart problems and hearing impairment. “Technical opinion is being sought as there is no consensus among experts on opening access to the private sector,” said a senior health ministry official familiar with developments.

The health ministry, in collaboration with the departments of health research, biotechnology etc, is working out an institutional mechanism to give bedaquiline to patients in the private sector. “There is a huge pharma lobby that is building an argument for putting everyone on bedaquiline, but it doesn’t work like that. Even though it is being hailed as a wonder drug, it has side effects that include hearing loss. It’s a new drug, so we don’t really have adequate data on its long-term treatment outcome,” the official quoted above said.

“People generally assume bedaquiline is safer than other drugs but they forget that compared to a 6-8 months course for other medicines, a bedaquiline-based regimen could go up to 18-24 months. The longer duration could have its effects that our experts are looking at,” he added.

The ministry has begun compiling data on treatment outcome for all oral treatment regimens among Indians, which also includes the bedaquiline-related course. “About 20 patients in the private sector in Mumbai have been given conditional bedaquiline access by the government. But the entire private sector can be given access only if they strictly adhere to the drug-compliance regimen for complete cure and to stop the patient developing extremely drug-resistant TB,” the official said.

There will be strict vigilance. “Since it is a long-term regimen, it’s verifiable. A call will be taken soon,” said a second ministry official, requesting anonymity.

The United States Agency for International Development (USAID) has provided 22,000 doses to the government. “We don’t want to deny patients newer drugs if it benefits them, so we are considering the idea,” said the first health ministry official.

The United States Agency for International Development (USAID) has provided 22,000 doses to the government. “We don’t want to deny patients newer drugs if it benefits them, so we are considering the idea,” said the first health ministry official

 

 

 

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