dengue

http://www.telegraphindia.com/1160822/jsp/knowhow/story_103646.

Banish the bite

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Your Health - Dr. Gita Mathai

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Mosquito borne diseases usually arrive with the monsoon. And this year is no exception; there is a resurgence of dengue. And it is we who are to blame. If each citizen took his or her social responsibility seriously, our country would not need to be a marked in red on the WHO maps for dengue!

The disease is spread by the Aedes egypti mosquito, an attractive insect, recognisable by its tiger striped legs (unlike the boring grey of the Culex and Anopheles mosquitoes). It is a friendly insect, which does not stray far from its place of birth. It loves humans and their environment. Unlike the dawn and dusk attacks of other mosquitoes, it bites in the daytime too. It is ferocious when it attacks its prey. One bite is not enough. It either attacks the person repeatedly or bites several human beings in the vicinity. That is why several members of the family can get dengue at the same time.

Four to 10 days after the bite, the affected person suddenly develops a fever. He or she may also suffer from a red rash, headache, pain behind the eyes, in the joints and the abdomen, nausea, vomiting and throat pain. At this stage, it is difficult to distinguish dengue from other fevers.

Within a few days, the white blood cell and platelet counts drop. The liver enzymes can start to rise. The person starts to develop antibodies to the virus which are are detectable in 50 per cent of patients by days 3-5 after onset of illness, and in 99 per cent by day 10.

Keep dengue away

• As little as 2ml of water is enough for mosquitoes to lay eggs. Check your immediate environment for garbage like old tires, bottle caps, even leaves. • Tanks and ponds should be stocked with small, larva-eating fish like guppies. • Pouring a little kerosene or oil on stagnant water creates a thin film on the surface that prevents larvae from breathing. • Put up mosquito-proofing nets on windows and ventilators. Keep doors shut. Sleep inside mosquito nets. • Application of mosquito repellents on clothing (not skin) is effective for a few hours. Patches (mosquito tattoos) contain pure citronella extract and can be placed on clothing. Equal volumes of vanilla extract and water applied on the skin repels mosquitoes for an hour.

A person usually recovers spontaneously from the first attack of dengue. Immunity develops to that particular strain of virus (there are four strains) and lasts for a lifetime. Unfortunately, if there is a subsequent attack of dengue (a different strain), the body's immune reaction produces a severe response.

Complications are more likely in patients under the age of 12 and over the age of 60 years. The white blood cell and platelet counts drop. This can lead to bleeding from various places. If the bleeding occurs in the brain, it can be fatal. The liver becomes enlarged and the liver enzymes elevated. As more toxins are released into the blood, the blood vessels become permeable. Fluid leaks out of the blood vessels and accumulates in the abdomen and in the lungs. The circulating plasma volume is reduced and shock may develop. Eventually, as organs like the liver, heart and kidney do not get enough blood, they can fail.

There are no antibiotics that cure dengue. Treatment is mainly supportive, to reduce the temperature, (paracetemol 10-15mg/kg per dose every 4-6 hours in children and 500mg in adults). Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided.

Plenty of fluids should be given. In critically ill patients, admission to hospital and IV fluids and transfusions (of platelets) may be required. The exact criteria for platelet transfusion varies, and must be carefully done, as there is inherent risk associated with the transfusion of blood components.

There is as yet no vaccine against dengue. Ridding the house and its surroundings of the Aedes mosquito is the key to controlling dengue. Each individual needs to play a proactive role in this.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in

breast milk

Best for baby

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Your Health - Dr. Gita Mathai

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Last week (August 1-7) was breast feeding week, and the entire world was involved in the great “latch on” — a word that best describes the way mammalian babies find their mothers and derive nutrition. Mothers gathered in public places and demonstrated that it was possible to breast feed babies, in public, discreetly and elegantly, and there was nothing “indecent” about it.

Breast feeding, though natural, is a failing art. It needs to be actively promoted, and not just for one week a year.

Breast milk is rich in fat and omega 3 fatty acids. It also contains the fat digesting enzyme lipase, so that all the fat is digested and absorbed. It also contains immunoglobulins (IgA), which protect the child against common viral, bacterial and gastrointestinal diseases. The composition and quantity of milk changes and regulates itself as the child grows older.

All mammals produce milk and the composition for each species is specific. Cow’s milk is best for calves and goat’s milk for kids. Human milk cannot be replicated in a factory, despite best efforts by the infant formula industry. The companies have tried various nutritious additives but it is not the “real thing.”

Manufacturers have tried to base the composition of formula milk on a human mother’s milk, analysed at approximately one to three months postpartum. Still, there are significant differences in the nutrient content of these products. For formula, purified cow’s milk, whey and casein are used as the  protein source, a blend of vegetable oils as the fat source and lactose for carbohydrates. Each manufacturer tries to add different vitamins and minerals to claim superiority over other products. None contain trace elements and immunoglobulins. It does not protect the child against disease. The fats are also not digested well and the stools of formula fed babies are foul smelling.

WHO (World Health Organization) recommends that infants  be exclusively breast fed for the first six months. To do this efficiently, the mother should be given a peaceful environment, an adequate diet and plenty of fluids. Drinking a glass of water before and after feeding ensures adequate flow of milk.

The baby has to search for the nipple, find it and latch on. Placing the nipple against the baby’s cheek can do this. Pushing the nipple into the mouth is counterproductive. The baby should be held at an angle of 45 degrees. Lying down and feeding the  baby is not a good idea.

Breast milk is always available on demand, it is sterile and at the right temperature. Our Indian clothes, with dupattas and sari pallus make breast feeding discreet.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in·    

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