he media have been full of stories about the “super bug from India”. The bug is actually a single-celled bacteria belonging to the Eschericia coli (E. coli) family. The species carries an enzyme called New Delhi metallo-beta—lactamase (NDM-1), which allows it to neutralise all known antibiotics and survive in their presence.
The enzyme was first isolated from a patient who had come to India for elective surgery. When he left, he took the “super bug” with him. No one knows how prevalent the organism is in India, as we do not have a centralised surveillance and reporting system that tracks hospital acquired infections and bacterial antibiotic resistance patterns.
Resistance is not a new phenomenon. Sulpha drugs and penicillin — the first antibiotics — were once hailed as “miracle” drugs. Today, they are hardly used. Overuse and misuse resulted in almost all bacteria becoming resistant to them.
If appropriate antibiotics are administered during a disease process caused by bacteria, the germs die. The host develops antibodies that help the body eliminate the weakened organisms.
E. coli has been around for thousands of years. That’s because the microorganisms developed “plasmids”, stable genetic elements composed of DNA or RNA. These help the bacteria grow resistance to chemicals and antibiotics. Once they have acquired this ability, they pass on the gene to other bacteria, even belonging to different species. Staphylococcus aureus and Klebsiella too have developed multiple drug resistance.
The outbreak of plague in Gujarat in 1994 killed hundreds. The state government realised the disease could be controlled by preventing rats from infesting human habitation and with appropriate antibiotic treatment. The situation was thus brought under control.
The spread of antibiotic resistance too can be controlled with combined concentrated effort. People are often “too busy” to consult a doctor when they are ill. The neighbourhood pharmacy then seems an attractive alternative. The man at the counter (often not a qualified pharmacist) dispenses antibiotics for coughs, colds, fever and diarrhoea. But there is often no rational or appropriate use of antibiotics.
Also, people sometimes do not complete the full course of a drug. They keep a few tablets, popping them for similar symptoms later or dispensing them to friends and relatives. A single dose may temporarily suppress the symptom. In a previously healthy person, the body’s natural defences then take over and eliminate the bacteria. The elderly or those with poor immunity become sicker, requiring the services of a qualified doctor. The bacteria, meanwhile, thrives in the presence of the antibiotic, because either they were not susceptible or the dosage was too small to be effective. Antibiotic resistance develops.
Practitioners of alternative systems of medicine prescribe and dispense antibiotics (which they are not licensed to use) inappropriately, perpetuating the problem.
At times, qualified physicians and surgeons use antibiotics prophylactically, especially after surgical procedures, to “prevent infection”. These antibiotics are eventually excreted by the body. They reach the sewage systems and seep through the earth. Bacteria are naturally present in sewage. They spread and multiply in the presence of the antibiotic.
Cattle and poultry feed are laced with antibiotics to “prevent” infection. Antibiotic resistant bacteria thrive on farms.
Everyone must play his or her part well to prevent another plague with super bugs which places the entire world population at risk.
• Take treatment only from qualified physicians
• Always buy antibiotics with a prescription, not OTC
• Complete the course in the dosage prescribed
Hygiene has to be maintained not just in the hospitals but also at home. Regularly washing hands, an elementary procedure, reduces infection and its spread.
Governments, nationally and internationally, need to maintain surveillance to monitor emerging infections and drug resistance patterns. If everyone — patients, doctors and the public — does not co-operate on a war footing, we may revert to the dark ages of the pre penicillin era. No antibiotic will work against infections and developing an infectious disease will turn out to be a death sentence.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Friday, August 27, 2010
Wednesday, August 11, 2010
work out for well being
Work out your well-being
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Recently, there was some media hype about the so-called negative effects of exercise and suggestions that it could actually be detrimental to health. Many couch potatoes jumped on the bandwagon, proclaiming they had been right all along — that their kind of sedentary lifestyle was preferable and healthier than an active one.
But what the article in question actually said was that a totally sedentary, overweight individual over the age of 50 should not suddenly embark on any intense aerobic activity like running and at the same time start severe dieting. The heart cannot cope with this sudden stress and starvation, increasing the likelihood of a heart attack. This does not mean they cannot do intense exercise; it means they should work up to it gradually under medical supervision.
Few people understand the importance of regular physical activity. They think their daily routine of shopping, housework and workplace activity is sufficient. As a result, 6 per cent of adults in India and 25 per cent of urban adults are clinically obese. The body mass index (BMI) or weight divided by height in metre squared is 30 or more, well above the acceptable norm of 23.
Statistics explain the reason for India being the diabetic capital of the world. Many are not yet diabetic but have “Metabolic Syndrome X”, which places them at high risk for heart attacks. Metabolic Syndrome X is diagnosed if you have:
• Raised blood pressure (systolic BP > 130 or diastolic BP > 85 mm Hg)
• Raised triglycerides ( > 150 mg/dL or 1.7 mmol/L)
• Reduced HDL cholesterol ( < 40 mg/dL or 1.03 mmol/L in men; < 50 mg/dL or 1.29 mmol/L in women)
• Raised fasting plasma glucose (FPG > 100 mg/dL or 5.6 mmol/L)
All these parameters can return to normal with a dedicated approach to diet and exercise.
After an emotionally exhausting and stressful day at work, 30 minutes of brisk walking or a workout in the gym can reduce stress, elevate the mood and rejuvenate the body. This is because exercise releases chemicals from the calf muscles that increase the levels of mood elevating serotonin in the brain. Regular exercise combats depression and increases feelings of self worth.
With exercise the lipid profile becomes normal and this prevents any build-up of harmful plaques in the blood vessels. This, in turn, prevents strokes and heart attacks.
Many often complain they are “too tired to exercise”. But actually, regular physical activity boosts energy levels. A good night’s sleep is the key to a productive day. Exercise does promote good sleep, but it needs to be completed at least an hour before bedtime. Or else the racy pumped-up feeling may not let you fall asleep. Students who want to study late can benefit from a short burst of high intensity exercise like a run around the house. It is healthier and probably more effective than coffee or other caffeine laced beverages.
Some of the chemicals released during exercise like the HSP (heat shock protein) help cells develop immunity and fight cancer and other diseases.
Exercise must be started young. The epidemic of childhood obesity is on the rise the world over. A child growing up in a family where no one exercises is unlikely to be motivated to do anything with spare time other than watch TV, play on the computer or eat snacks. Such children grow into obese adults with Syndrome X.
Walking for an hour and covering a distance of 4km in that time seven days a week is ideal. If you are between 20 and 50 years and have no health problems, jogging the same distance would be more beneficial. Children less than 10 years need to run for 20 minutes to half an hour every day. At least 20 minutes should be also spent on warming up, cooling down and stretching, preferably 10 minutes before and 10 minutes after exercise. Core strength is also essential for fitness and can be improved with sit-ups, push-ups and squats. Ten to 20 repetitions of each are all that are required.
Remember, exercise moderation is the key to success. Build up to your dream fitness level gradually to avoid strain to the heart, muscles, bones and joints.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Recently, there was some media hype about the so-called negative effects of exercise and suggestions that it could actually be detrimental to health. Many couch potatoes jumped on the bandwagon, proclaiming they had been right all along — that their kind of sedentary lifestyle was preferable and healthier than an active one.
But what the article in question actually said was that a totally sedentary, overweight individual over the age of 50 should not suddenly embark on any intense aerobic activity like running and at the same time start severe dieting. The heart cannot cope with this sudden stress and starvation, increasing the likelihood of a heart attack. This does not mean they cannot do intense exercise; it means they should work up to it gradually under medical supervision.
Few people understand the importance of regular physical activity. They think their daily routine of shopping, housework and workplace activity is sufficient. As a result, 6 per cent of adults in India and 25 per cent of urban adults are clinically obese. The body mass index (BMI) or weight divided by height in metre squared is 30 or more, well above the acceptable norm of 23.
Statistics explain the reason for India being the diabetic capital of the world. Many are not yet diabetic but have “Metabolic Syndrome X”, which places them at high risk for heart attacks. Metabolic Syndrome X is diagnosed if you have:
• Raised blood pressure (systolic BP > 130 or diastolic BP > 85 mm Hg)
• Raised triglycerides ( > 150 mg/dL or 1.7 mmol/L)
• Reduced HDL cholesterol ( < 40 mg/dL or 1.03 mmol/L in men; < 50 mg/dL or 1.29 mmol/L in women)
• Raised fasting plasma glucose (FPG > 100 mg/dL or 5.6 mmol/L)
All these parameters can return to normal with a dedicated approach to diet and exercise.
After an emotionally exhausting and stressful day at work, 30 minutes of brisk walking or a workout in the gym can reduce stress, elevate the mood and rejuvenate the body. This is because exercise releases chemicals from the calf muscles that increase the levels of mood elevating serotonin in the brain. Regular exercise combats depression and increases feelings of self worth.
With exercise the lipid profile becomes normal and this prevents any build-up of harmful plaques in the blood vessels. This, in turn, prevents strokes and heart attacks.
Many often complain they are “too tired to exercise”. But actually, regular physical activity boosts energy levels. A good night’s sleep is the key to a productive day. Exercise does promote good sleep, but it needs to be completed at least an hour before bedtime. Or else the racy pumped-up feeling may not let you fall asleep. Students who want to study late can benefit from a short burst of high intensity exercise like a run around the house. It is healthier and probably more effective than coffee or other caffeine laced beverages.
Some of the chemicals released during exercise like the HSP (heat shock protein) help cells develop immunity and fight cancer and other diseases.
Exercise must be started young. The epidemic of childhood obesity is on the rise the world over. A child growing up in a family where no one exercises is unlikely to be motivated to do anything with spare time other than watch TV, play on the computer or eat snacks. Such children grow into obese adults with Syndrome X.
Walking for an hour and covering a distance of 4km in that time seven days a week is ideal. If you are between 20 and 50 years and have no health problems, jogging the same distance would be more beneficial. Children less than 10 years need to run for 20 minutes to half an hour every day. At least 20 minutes should be also spent on warming up, cooling down and stretching, preferably 10 minutes before and 10 minutes after exercise. Core strength is also essential for fitness and can be improved with sit-ups, push-ups and squats. Ten to 20 repetitions of each are all that are required.
Remember, exercise moderation is the key to success. Build up to your dream fitness level gradually to avoid strain to the heart, muscles, bones and joints.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Monday, August 2, 2010
colds and flu
Season of colds and coughs
YOUR HEALTH
DR GITA MATHAI
The monsoon has set in, bringing much relief from the scorching sun and prickly heat. The cool showers and damp surroundings have also ushered in an epidemic of sniffles and sneezes. This effects the young and old alike. There is a constant fear — is this just a cold, or something more sinister? Could it be avian or swine flu?
Both cold and flu start with similar symptoms of headache, body ache, fever, runny nose and cough. Only the severity varies. In flu, the person is unable to move out of bed, whereas one suffering from a cold is not completely incapacitated.
Colds are caused by around 200 types of viruses, the commonest of which are the rhinoviruses (rhino means nose). They spread through droplets sneezed or coughed into the air by an infected person. The virus can also survive on clothing and articles like tables and books. The infection sets in around three days after exposure.
Children have not yet developed immunity against the cold viruses. Also, they are more likely to come in contact with infected children in schools and parks. Many parents, unfortunately, do not let ill children stay at home. In many schools, children with coughs and colds are advised to “take the test and then go home”. By this time they may have infected the entire class.
Children may develop eight to 10 colds a year. Each can last up to two weeks. This makes parents feel the child is always ill. They do not document the number of illness-free days in between one infection and the next. Many of these children are erroneously diagnosed as “primary complex” and started on rifampicin, isoniazide and other anti-tuberculosis medication. As children grow, their immunity builds up. The number of infections decreases to two to three a year.
A perpetually runny nose and cough without fever may not be due to a bacterial or viral infection. It may be due to an allergy to pollen, paint, incense or mosquito mats, coils and repellents. Smoking predispose one to colds. In children, toxic allergenic smoke may be inhaled passively from a smoking adult.
The classic symptoms of a cold are mild fever (it is best to buy a digital thermometer and check the temperature instead of relying on touch), less than 102° F, watery or slightly yellow nasal discharge, a scratchy irritated feeling in the throat, cough and body ache.
The condition is best tackled with rest. If the temperature goes above 100.5° F, or if the body ache is severe, paracetemol can be taken. Adults do not require more than 500mg. In children the dose is 10-15mg per kg of body weight. It can be repeated after four to six hours. Aspirin is contraindicated in children. A sore throat can be tackled with frequent salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used for prolonged periods, atrophy of the nasal mucosa.
Anti-histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. They shouldn’t be taken without medical supervision. Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
A doctor should be consulted if —
• The fever has lasted more than three days
• There are chills
• The headache is continuous
• There is abdominal pain or vomiting
• There is ear ache
• Breathing becomes difficult
• A cough persists
• There is drowsiness.
In children, continuous crying or grunting needs to be taken seriously.
Antibiotics will not shorten the course of a cold or prevent one from appearing. But they need to be taken in case of complications like ear infection, sinusitis, bronchitis or pneumonia. The medication needs to be taken in the prescribed dose for the correct duration under medical supervision.
The likelihood of catching a cold can be reduced by washing hands regularly, cleaning toys and table surfaces, using disposable tissues to blow the nose, covering the nose and mouth while coughing and sneezing, and not attending school or work while infected.
Influenza vaccine is available and can be given to reduce the likelihood of catching seasonal flu but not the common cold. Immunisation is advisable for children under two, those over 65, asthmatics and those with compromised immunity.
Supplements of vitamin C, zinc, iron, B complex and some herbs like Echinacea are anecdotally said to reduce the number of colds. These claims have not been substantiated by double blind controlled studies.
The number of colds can be reduced by maintaining a hygienic and healthy lifestyle with at least 40 minutes of aerobic activity a day.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
YOUR HEALTH
DR GITA MATHAI
The monsoon has set in, bringing much relief from the scorching sun and prickly heat. The cool showers and damp surroundings have also ushered in an epidemic of sniffles and sneezes. This effects the young and old alike. There is a constant fear — is this just a cold, or something more sinister? Could it be avian or swine flu?
Both cold and flu start with similar symptoms of headache, body ache, fever, runny nose and cough. Only the severity varies. In flu, the person is unable to move out of bed, whereas one suffering from a cold is not completely incapacitated.
Colds are caused by around 200 types of viruses, the commonest of which are the rhinoviruses (rhino means nose). They spread through droplets sneezed or coughed into the air by an infected person. The virus can also survive on clothing and articles like tables and books. The infection sets in around three days after exposure.
Children have not yet developed immunity against the cold viruses. Also, they are more likely to come in contact with infected children in schools and parks. Many parents, unfortunately, do not let ill children stay at home. In many schools, children with coughs and colds are advised to “take the test and then go home”. By this time they may have infected the entire class.
Children may develop eight to 10 colds a year. Each can last up to two weeks. This makes parents feel the child is always ill. They do not document the number of illness-free days in between one infection and the next. Many of these children are erroneously diagnosed as “primary complex” and started on rifampicin, isoniazide and other anti-tuberculosis medication. As children grow, their immunity builds up. The number of infections decreases to two to three a year.
A perpetually runny nose and cough without fever may not be due to a bacterial or viral infection. It may be due to an allergy to pollen, paint, incense or mosquito mats, coils and repellents. Smoking predispose one to colds. In children, toxic allergenic smoke may be inhaled passively from a smoking adult.
The classic symptoms of a cold are mild fever (it is best to buy a digital thermometer and check the temperature instead of relying on touch), less than 102° F, watery or slightly yellow nasal discharge, a scratchy irritated feeling in the throat, cough and body ache.
The condition is best tackled with rest. If the temperature goes above 100.5° F, or if the body ache is severe, paracetemol can be taken. Adults do not require more than 500mg. In children the dose is 10-15mg per kg of body weight. It can be repeated after four to six hours. Aspirin is contraindicated in children. A sore throat can be tackled with frequent salt water gargles. Saline nose drops can be administered in each nostril every three hours. It is better to avoid decongestant chemical nose drops as they can cause rebound nasal congestion, habituation and, if used for prolonged periods, atrophy of the nasal mucosa.
Anti-histamines can cause drowsiness. Both anti histamines and cough suppressants can cause side effects. They shouldn’t be taken without medical supervision. Traditional remedies like ginger tea, rasam, rice gruel and chicken soup help soothe the throat, relieve congestion and maintain hydration and nutrition.
A doctor should be consulted if —
• The fever has lasted more than three days
• There are chills
• The headache is continuous
• There is abdominal pain or vomiting
• There is ear ache
• Breathing becomes difficult
• A cough persists
• There is drowsiness.
In children, continuous crying or grunting needs to be taken seriously.
Antibiotics will not shorten the course of a cold or prevent one from appearing. But they need to be taken in case of complications like ear infection, sinusitis, bronchitis or pneumonia. The medication needs to be taken in the prescribed dose for the correct duration under medical supervision.
The likelihood of catching a cold can be reduced by washing hands regularly, cleaning toys and table surfaces, using disposable tissues to blow the nose, covering the nose and mouth while coughing and sneezing, and not attending school or work while infected.
Influenza vaccine is available and can be given to reduce the likelihood of catching seasonal flu but not the common cold. Immunisation is advisable for children under two, those over 65, asthmatics and those with compromised immunity.
Supplements of vitamin C, zinc, iron, B complex and some herbs like Echinacea are anecdotally said to reduce the number of colds. These claims have not been substantiated by double blind controlled studies.
The number of colds can be reduced by maintaining a hygienic and healthy lifestyle with at least 40 minutes of aerobic activity a day.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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