Saturday, November 14, 2009

What Diabetic patients should know

Another World Diabetes day has come and gone. It was a day of free blood sugar testing,free or subsidised testing for complications of Diabetes,Run for Diabetes,Seminars and Awareness classes etc etc.

In my own way I was also giving free consultation to Diabetes patients.When the testing and consultation are free there will be a rush of patients and I had the same experience.So it was an exhausting day.

Not all who had come were very poor. Many test their blood sugars only occasionally even though they could very well afford it. Many have never tested their Cholesterol,eyes or Kidney functions. Lack of knowledge about Diabetes and its complications were evident in most of the patients. The theme of World Diabetes day UNDERSTAND DIABETES; TAKE CONTROL is so relevant for this group of patients who came rushing to my Hospital for free testing and consultation.
To know more about World Diabetes Day click here

What Diabetic patients should know

Targets for Diabetics
Fasting Blood Sugar 70-120mg/dl
Post meal[after 90 mts] less than 180mg/dl
HbA1c less than 7 percent
Blood Pressure less than 130/80
HDL Cholesterol more than 40 mg/dl
LDL Cholesterol less than 100mg/dl
Triglycerides less than 150mg/dl

What and When to test

1.Test Blood sugar as frequently as possible. At least twice or thrice a month if well controlled.Test HbA1c every 6 months

2.Check Blood Pressure every 3 to 6 months. More frequently if high or low.

3.Lipid Profile [cholesterol test] at least every 6 months if found high once.Otherwise once a year.

4. Cardiac check up [ECG and Tread Mill test and if needed Angiography] once on diagnosis and then every 2-4 years if first examination was normal and there are no symptoms. More frequently if first tests are abnormal or if there are cardiac symptoms.

5.Kidney tests like Urine micro albumin and Serum creatinine every year.

6. Eye check up including retina examination after putting an eye drop to dilate the pupil on diagnosis of Diabetes and then once every 1-2 years.

7. Neuropathy testing on diagnosis and every 2 years if there are no symptoms.

Friday, November 13, 2009

Mass drug prophylaxis against filariasis

To eliminate lymphatic filariasis, the Kerala State Government Health Department has launched a  mass drug administration (MDA) programme  in 11 districts in the State on Novemeber 11,2009.
A lot of confusion is there in the minds of many among the public about the need and possible side effects of this mass drug administration.

Why this mass anti-filarial drug administration in healthy persons?

Let me try to clarify.

What is Lymphatic filariasis?

Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms. The adult worms only live in the human lymph system. The lymph system maintains the body's fluid balance and fights infections. Lymphatic filariasis is spread from person to person by mosquitoes.

People with the disease can suffer from lymphedema and elephantiasis and in men, swelling of the scrotum, called hydrocele. Lymphatic filariasis is a leading cause of permanent disability worldwide

Disease burden

Although lymphatic filariasis very rarely causes death, it is a major cause of clinical suffering, disability and handicap. More than 1.3 billion people in 83 countries and territories (Map) — approximately 18% of the world's population — live in areas at risk of infection with lymphatic filarial parasites. Approximately one third of those at risk live in India, one third in Africa and the remainder in Asia, the Pacific and the Americas.
It is estimated that around 120 million people in tropical and subtropical areas of the world are infected. Almost 25 million men suffer from genital disease (most commonly hydrocoele); an estimated 15 million people — the majority of them women — have lymphoedema or elephantiasis of the leg.

Indian Situation

Filariasis is endemic in 19 States/union territories in India. Estimates based on surveys by Filariasis Survey Units suggested that: about 454 million people (120 million in urban areas) are living in known endemic areas; there are 29 million filariasis cases in the country and 22 million micro-filaria carriers.

The magnitude of infection in children has become much better understood in recent years; indeed, most infections appear to be acquired in childhood, with a long period of subclinical asymtomatic period  that progresses to the characteristic, clinical manifestations of adults.

Global Programme to Eliminate Lymphatic Filariasis

 In 1997, as a result of advances in the diagnosis and treatment of lymphatic filariasis (LF), the disease was classed as one of six infectious diseases considered to be “eradicable” or “potentially eradicable”. Consequently, the World Health Assembly adopted resolution 50.29, calling for elimination of the disease as a global public health problem.
Elimination strategy

The strategy proposed by WHO to achieve the goal of elimination comprises two components:
1.interruption of transmission of filarial infection in all endemic countries through drastic reduction of microfilariae prevalence levels;

2.prevention and alleviation of disability and suffering in individuals already affected by LF.

Interruption of transmission of infection can only be achieved if the entire population at risk is covered by mass drug administration (MDA) for a period long enough to ensure a reduction in the level of microfilariae in the blood to a point where transmission can no longer be sustained.
That's why mass administration of anti filarial drugs are advised in healthy individuals living in areas of risk.

The following recommended drug regimens must be administered once a year for at
least 5 years, with a coverage of at least 65% of the total at-risk population:

a.6 mg/kg diethylcarbamazine citrate (DEC) + 400 mg albendazole; or

b.150 µg/kg ivermectin + 400 mg albendazole (in the case of co-endemicity with onchocerciasis).

c.A third option is to follow a treatment regimen using DEC-fortified cooking salt daily for a period of 12 months.

As a part of this programme 11 Districts in Kerala has started the second round of MDA this Novemeber using DEC and Albendazole.

Side effects of the drugs.

There has been reports in the media about children becoming sick after taking the tablets. Is this true? Is it serious?

Both DEC and Albendazole is best taken in full stomach. Many temporary side effects can be prevented by taking care to eat well before ingesting the medicines.
Side effects due to these medicines are rare, not serious and lasts for few minutes to hours only.
Most common side effects are dizziness,nausea,vomiting,headache and fatigue. Some may develop fever and skin rashes which may indicate succesful elimination of microfilaria.

Children below 2 years and elderly people above 65 are not required to take the drugs.
All others are advised to take the drugs.

 Let us try to eliminate the dreaded elephantiasis from our community.

Wednesday, November 11, 2009

H1N1 Flu 2009 - Epidemiological and Clinical data from India

The 2009 H1N1 Influenza [Swine flu] pandemic is continuing to spread in India, may be with less virulence. The Indian Health authorities have published the initial epidemiological and clinical data of this pandemic.I am publishing some of the data here for wider dissemination.
Here is the link for the information I am publishing here.


As of November 10th 2009 there has been 505 deaths out of a total of 14680 confirmed cases.
Total Lab confirmed cases     1468   
       Total number of Deaths          505            

States            Number of Deaths
                                     Maharashtra           209
                                     Karnataka              118
                                     Andhra Pradesh       49
                                     Gujarat                    40
                                     Kerala                      22
                                     Rajasthan                 17
                                     Delhi                        16
    Rest of the States reported less than 10 deaths.

Saturday, November 7, 2009

Chronic cough and Alternative medicine

"Doctor, He is coughing badly for the last 4 months."

A man in his mid 20s was saying about his thin and frail looking father who was sitting slumped on my patient's chair.

"4 months!!! You did not take him to any doctor?" was my angry question.

Son: "Yes, he was under a doctor's treatment for 4 months".

Me: "Were any blood tests done or any sputum or X ray examination done?'

Son: 'One blood test was done long back, which was normal.'

Me: 'Who was the doctor who treated him?' [I was curious].

Son: 'Father does not like strong modern medicines, so he was under the care of a

Homeopathic doctor'.

Me: 'Then why have you brought him here?'

Son: 'He is becoming weak day by day, lost weight and is not eating anything'.

I was almost sure of the diagnosis before I examined him. There were nothing obvious in his clinical exam except some altered breath sounds and pallor. So I asked him to take an X ray film of the Chest without wasting anymore time.

In an hour's time the Son came in to my room with the X ray. Yes as I suspected the X ray showed tell tale signs of Tuberculosis of the Lungs.

"It is TB". I offered him reference to the Government Health Center [for confirming the diagnosis by sputum examination and for free medicines]. He, as I guessed took the offer as he was not that well off.

Few days ago I had another man of about 65 years with almost similar history. Cough for 3 to 4 months and homeopathy treatment. He also turned to be suffering from sputum positive Tuberculosis.

Why these doctors are not thinking about TB? Are they taught the signs and symptoms of Lung TB? Can they treat Tuberculosis?
Only modern anti tuberculous antibiotics can cure a patient of TB, not homeopathic or ayurvedic medicines.

I know many homeopathic and Ayurvedic doctors who refer patients to Modern Medicine doctors as soon as they realise they cannot help the patient. But some never do, may be fearing they will be considered incompetent or due to sheer lack of knowledge.

I know all doctors can make mistakes. I have made many mistakes too. But if you find a patient is not getting better, a doctor should re-think the diagnosis, do further tests or refer to some one else better equipped to deal with the illness. I always do that.

Both the above patients must have spread the tuberculosis bacteria around their house and surroundings in the 3 to 4 months they were coughing out sputum.

If the situation is like this how can we ever eradicate or control TB?