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.

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“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

 

 

 

Missing measles vaccination fueling global spike in measles cases


Measles cases up by 300% in 2019 as vaccinations dip

This has led to a 30% spike in measles cases worldwide since 2016, taking cases to 6.7 million and deaths to 110,000 in 2017. India confirmed 55,399 measles cases in 2018.

High income countries ; children missing vaccination;

USA 2,593000

France —608000

United kingdom– 527000

Argentina — 438000

Italy  — 435000

Low & middle income countries; children missing vaccination

Nigeria –   4 million

India     –  2.9 million

Pakistan-  1.2 million

Indonesia- 1.2 million

Ethopia   – 1.1 million

 

Children unvaccinated against measles are fuelling global outbreaks, with more than 110,000 measles cases being reported worldwide in the first three months of 2019, up nearly 300% over the same period last year, Unicef said on Thursday.

This has led to a 30% spike in measles cases worldwide since 2016, taking cases to 6.7 million and deaths to 110,000 in 2017. India confirmed 55,399 measles cases in 2018.

Globally, each year around 21.1 million children on average don’t get the first dose of the measles vaccine, which has led to around 169 million children remaining unvaccinated between 2010 and 2017, according to Unicef.

Measles is a highly infectious virus that causes death and debilitating complications, including encephalitis (swelling of the brain membranes), severe diarrhoea, pneumonia, ear infections and permanent vision loss.

India has 2.9 million children unvaccinated against measles, the second highest number after Nigeria, which is home to 4 million children not vaccinated against the disease, said Unicef.

The measles-rubella vaccine is safe and has saved at least 21 million lives since 2000, according to the World Health Organization (WHO), but fake news campaigns spread by anti-vaxxers — those who oppose vaccination ,  have led to people saying no to vaccination even in countries that have eliminated the disease.

Immunisation coverage must be at least 95% to achieve ‘herd immunity’, the threshold over which unvaccinated people in a community are protected, according to WHO. “It is critical not only to increase coverage but also to sustain vaccination rates at the right doses to create an umbrella of immunity for everyone. The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike,” said Henrietta Fore, Unicef executive director, in a statement.

The US, which eliminated measles in 2000, tops the list of high-income countries with the most children not receiving the first dose of the  of the vaccine between 2010 and 2017, which prompted the American Medical Association last month to urge big social media and technology companies such as Amazon, Facebook, Google, Twitter, Pinterest and YouTube, to stop anti-vaccine groups from spreading misinformation on their platforms.

Since launch of the Measles Rubella (MR) vaccination campaign in India in February 2017, 305 million children in 32 states/ UTs using the Serum Institute of India vaccine is WHO pre-qualified for its quality and safety and used the world over, but the campaign has been stalled by misinformed parents in some parts of India, including Delhi,” said a health ministry official who did not want to be identified.

The MR vaccine being used in the campaign as well as for Routine Immunization, is very safe and effective against measles. It is made in India and is exported for use world over. Two doses of this vaccine provides more than 95% protection against the disease that has been eliminated in four countries (Bangladesh, Bhutan, DPR Korea and Timor Leste) in WHO’s South Asia region and transmission of the virus is likely to have been interrupted in Sri Lanka. Elimination and Rubella Control to review progress in the battle against measles The global coverage of the first dose of the measles vaccine was reported at 85% in 2017, with the coverage for the second dose being at a lower 67%. In high income countries, while coverage with the first dose is 94%, coverage for the second dose drops to 91%, according to the latest data.

About measles

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About Measles and Vaccination


Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with a cough, runny nose, red eyes, and fever. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body.

Cause;;Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family  Paramyxoviridae.

The virus is highly contagious and is spread by coughing and sneezing via close personal contact or direct contact with secretions. It can live for up to two hours in that airspace or nearby surfaces.  Measles is so contagious that if one person has it, 90% of nearby non-immune people will also become infected.  Humans are the only natural hosts of the virus, and no other animal reservoirs are known to exist.

Risk factors for measles virus infection include immunodeficiency caused by HIV or AIDS,  immunosuppression following receipt of an organ or a stem cell transplant,  alkylating agents, or corticosteroid therapy, regardless of immunization status;  travel to areas where measles commonly occurs or contact with travellers from such an area;  and the loss of passive, inherited antibodies before the age of routine immunization.

 

Vaccination;;Measles can be prevented with MMR vaccine. The vaccine protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States. Of these, approximately 500,000 cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since then, widespread use of measles virus-containing vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. However, measles is still common in other countries. Unvaccinated people continue to get measles while abroad and bring the disease into the United States and spread it to others.

 

CDC recommends that children get two doses of MMR vaccine:

  • the first dose at 12 through 15 months of age, and
  • the second dose at 4 through 6 years of age.

Teens and adults should also be up to date on MMR vaccinations.

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what is Mechanical ventilator? A machine critical to save life


A medical ventilator (or simply ventilator in context) is a machine designed to provide mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently.

While modern ventilators are computerized machines, patients can be ventilated with a simple, hand-operated bag valve mask.

Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesiology  (as a component of an  anesthesia machine .

Medical ventilators are sometimes colloquially called “respirators”, a term stemming from commonly used devices in the 1950s (particularly the “Bird Respirator”). However, in modern hospital and medical terminology, these machines are never referred to as respirators, and use of “respirator” in this context is now a deprecated anachronism signaling technical unfamiliarity.

Function                                  

In its simplest form, a modern positive pressure ventilator consists of a compressible air  reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable “patient circuit”. The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When over pressure is released, the patient will exhale passively due to the lungs’ elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold.

Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (e.g. pressure, volume, and flow) and ventilator function (e.g. air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computer-controlled  turbo-pump.

Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient’s needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Canada and the United States and in many parts of world, respiratory therapists are responsible for tuning these settings, while biomedical technologists are responsible for the maintenance.

The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive.

Noninvasive methods, which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods require     intubation.  For long-term ventilator dependence will normally be a tracheostomy  cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.

Life-critical system

Because failure may result in death, mechanical ventilation systems are classified as a life critical-system and precautions must be taken to ensure that they are highly reliable, including their  power supply .

Mechanical ventilators are therefore carefully designed so that no single point of failure can endanger the patient. They may have manual backup mechanisms to enable hand-driven respiration in the absence of power (such as the mechanical ventilator integrated into an  anesthetic machine . They may also have safety valves, which open to atmosphere in the absence of power to act as an anti-suffocation valve for spontaneous breathing of the patient. Some systems are also equipped with compressed-gas tanks, air compressors, and/or backup batteries to provide ventilation in case of power failure or defective gas supplies, and methods to operate or call for help if their mechanisms or software fail.

history of ventilator

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Reasons of having excessive thirst:


If some ones  feels  the need to   drink lots of water, most of time  reason is usually  known . For example,   not  drinking enough of it. But some times there can be more sinister mechanisms and need evaluation. There can be number of diseases,  which can  present  by  excessive thirst.   This derangement is  more  other than merely being dehydrated.

If drinking more fluids for several days hasn’t helped, there can be reasons other than dehydration.

Dehydration:

If some ones  feels  the need to   drink lots of water, most of time  reason is usually  known . For example,   not  drinking enough of it. Dehydration occurs if some one  does really hard work  in the ground or  sweating in the sun. The loss of fluids need to be replenished .

Dehydration commonly happens, in cases of food poisoning ,  diarrhoea, vomiting, inability to eat or drink  and loose motions.

Diabetes

One of the most important symptom of diabetes is thirst.  All types of  diabetes will present as increased intake of water and being thirsty.  Frequent urination, another common symptom of diabetes, will bring on thirst.   Therefore  excessive thirst and urination, along with unexplained weight loss, fatigue, or irritability, can be indications of diabetes.

Dry mouth

The abnormal dryness of the mucous membranes in the mouth, due to decreased  flow or change in the composition of saliva.  It is  also known as xerostomia, is often mistaken for excessive thirst.  Causes of dry mouth include smoking tobacco, use of  marijuana, stress, anxiety, or  aging.  But certain drugs (antidepressants) and autoimmune diseases can also cause dry mouth.

One  may think  being thirsty, whereas  actual reason is  having a dry mouth.

Dry mouth can present as :

  • a burning sensation or soreness in your mouth
  • changes in your sense of taste
  • difficulty speaking, eating or swallowing.

Menstrual blood loss

Estrogen and progesterone levels can both affect fluid volume.  If blood flow is more, it can  also cause  more  blood loss.   The blood loss will cause increase in thirst.

 

Thyroid problems

When the thyroid function is deranged , hormone  production is erratic can,  produce increased  or less e hormone. Thyroid dysfunction can   spur a variety of nonspecific symptoms, including abnormally heavy periods, anxiety, feeling hot, and dry mouth. These all can lead to increased thirst.

 Stress

Stress or specially chronic  stress is a cause for  adrenal gland dysfunction specially if  stress is severe.  This can cause dizziness,  depression, anxiety, and  severe  thirst.

 

Diuretic  and food containing diuretics:

    Drugs that produce lot of urine  are diuretics. They  can cause feeling of thirst.

Foods that have a diuretic effect can make you thirsty because they cause you to urinate more. Foods like melons,  ginger, celery, asparagus, beets, lemons.

 

Low-carbohydrate  diets:

        One of  side effect of Keto- diet  is thirst. The eating plan  significantly cuts down on  carbohydrate intake.   Carbohydrates s absorb  more water than protein and fat.

 

Pregnancy:

excessive thirst can happen in pregnancy due to many reasons for example  Increased urination,  nausea and morning sickness

Excessive bleeding:

Ongoing or sudden blood loss,   can  cause  thirst levels  in order to  make up for the fluid loss.

 

Diabetes insipidus:

Diabetes insipidus is a rare disorder that affects water absorption.   It can cause loss of huge  amounts of water  by production of litres of urine.   Cause can be brain or kidney called as central and nephrogenic respectively.

Psychogenic  polydipsia:  this is an urge to drink more water and  patients are unable to control the urge.  Patients may have intake of many litres per day.

 

 

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