Double Helical September 2018 by doublehelicaldesign

RNI No.: UPENG/2014/59232

CO M PL E T E

H E A LT H

J O U R N A L

September 2018

Volume IV • Issue X • `100

Lethal

Intoxication REMOVING THE STIGMA

TOWARDS TB FREE INDIA

COVER STORY

Contents 20

Lethal Intoxication

6 Get rid of eczema, naturally

12 Towards TB Free India

Manisha Yadav

40 Recovery from stroke

46 Stay Clean and Healthy

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Editorial

Think before you drink! D ear readers,

Thank you for your constant support and patronage to Double Helical. It is deeply satisfying to see your favourite magazine making further strides as a credible publication on health, well-being and holistic living. The current issueâ&#x20AC;&#x2122;s cover story focuses on the increasing trend of alcohol consumption worldwide. Globally, an estimated 237 million men and 46 million women suffer from alcohol-use disorde rs with the highest prevalence among men and women in the European region (14.8% and 3.5%) and the Region of Americas (11.5% and 5.1%). Alcohol-use disorders are more common in high-income countries. Alcohol consumption can have an impact not only on the incidence of diseases, injuries and other health conditions, but also on the course of disorders and their outcomes for individuals. Despite some positive global trends in the prevalence of heavy episodic drinking and number of alcohol-related deaths since 2010, the overall burden of disease and injuries caused by the harmful use of alcohol is unacceptably high, particularly in the European Region and the Region of Americas. With growing awareness of the impact of alcohol consumption on global health and an increase in international frameworks for action, the demand for global information on alcohol consumption and alcohol-attributable and alcohol-related harm, as well as related policy responses, has increased significantly. The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on

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levels and patterns of alcohol consumption, alcohol-attributable health and social consequences and policy responses at all levels. Achieving reduction in the harmful use of alcohol is in line with the targets included in the SDG 2030 agenda and the WHO Global Monitoring Framework for Non- Communicable Diseases. The goal requires concerted action by countries, effective global governance and appropriate engagement of all relevant stakeholders. By effectively working together, the negative health and social consequences of alcohol can be reduced.

As part of Special Story, we focus on recent implementation of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017. We welcome such path-breaking initiative to eliminate social stigma pertaining to HIV infected people. As per constitutional provisions, everyone has a right live with great respect. No one should be mocked and humiliated for having any type of diseases including HIV infection. India has the third largest HIV epidemic in the world. Although overall prevalence remains low, even relatively minor increases in HIV infection rates in a country of more than one billion people translate into large numbers of people becoming infected. With an aim to prevent discrimination against individuals diagnosed with HIV/ AIDS, the Ministry of Health and Family Welfare has recently issued a notification for bringing the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017 in force from 10th September, 2018. The Act, safeguards the rights of people living with HIV and affected by

HIV. The provisions of the Act address HIV-related discrimination, strengthen the existing programme by bringing in legal accountability, and establish formal mechanisms for inquiring into complaints and redressing grievances. The Act seeks to prevent and control the spread of HIV and AIDS, prohibits discrimination against persons with HIV and AIDS. The Act stipulates that every HIV- infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household. The Act also prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them. As per provisions of the Act, a person between the age of 12 to 18 years who has sufficient maturity in understanding and managing the affairs of his HIV or AIDS affected family shall be competent to act as a guardian of another sibling below 18 years of age to be applicable in the matters relating to admission to educational establishments, operating bank accounts, managing property, care and treatment, amongst others. As per the provisions of the Act, every person in the care and custody of the state shall have right to HIV prevention, testing, treatment and counseling services. Besides, the issues carries many more informative, analytical and interesting stories with new perspectives. Happy reading!

Amresh K Tiwary Editor-in-chief

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Get rid of eczema, naturally

Eczema is associated with a blend of genes and environmental triggers. It may also be caused if the bodyâ&#x20AC;&#x2122;s immune system responds too aggressively to an allergen or irritant By Vishal Duggal

he other day, you noticed a red, itchy patch on your neck and scratched the affected region continuously, only to leave it more irritated and inflamed. You got scared and rushed to a skin specialist to know if you are suffering from some serious skin problem. Many people like you have to grapple with similarly flared-up skin -- this condition is commonly called eczema. In the U.S. alone, nearly 32 million Americans display symptoms of eczema and approximately 20% of children worldwide have some form of eczema. Did you know that eczema, also known as dermatitis, can be healed with proper precautions and timely treatment? You read that right â&#x20AC;&#x201C; in order to heal eczema or at least make it less painful, you must first know the causes, symptoms, triggers, and natural

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SKIN DISEASE – Eczema

In Ayurveda, eczema is known as vicharchika and it occurs when the immune system becomes imbalanced. This condition is often associated with other allergic conditions such as asthma, hay fever, etc.

Courtesy: The Royal Children’s Hospital

treatment options for this skin ailment. What is eczema? Eczema is a condition that causes the skin to become red, itchy, inflamed, dry, and infection-prone. Etymologically, eczema is derived from the Greek word ekzein that means ‘something thrown out by heat.’ The name is well-justified - when one suffers from eczema, the skin flares up or literally ‘boils’. What causes eczema? While researchers are still unable to share the exact cause of this skin disease, it’s thought to be associated with a blend of genes and environmental triggers. It may also be caused

if the body’s immune system responds too aggressively to an allergen or irritant. Research also suggests that some people suffering from eczema experience a transformation of the gene responsible for creating filaggrin -a protein that helps preserve a healthy and protective barrier on the topmost layer of our skin. So, if your body doesn’t have sufficient filaggrin, moisture on your skin can escape,allowing viruses, bacteria, and germs to enter your skin and cause eczema. While that is one of the explanations causing the problem, there can be other reasons for it.

Eczema can also be caused by blood disorders,delicate and sensitive nature of the skin, malfunction of the digestive tract, and hereditary reasons such as a history of allergies or asthma in families. In fact, allergies, immunity problems, and environmental factors such as exposure to toxic substances, high levels of pollution, and extreme climate are also factors in the occurrence of eczema. This disease is also attributable to eating disorders and poor hygiene.

Eczema triggers

You might have, by now, identified potential triggers of eczema; but you should also be mindful that the itching and inflammation can take some time after exposure to flare up. Also, different people may have different triggers of eczema and it affects every individual differently. However, you might notice eczema symptoms at a specific time of the year or on different parts of your body. Mentioned below are some of the known triggers of eczema:

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SKIN DISEASE – Eczema

In order to heal eczema or at least make it less painful, you must first know the causes, symptoms, triggers, and natural treatment options for this skin ailment. • Dry Skin If you have extremely dry skin, it can

easily become rough, tight, scaly, or brittle, leading to eczema.

• Irritants

There are various everyday products or natural substances that may cause your skin to itch, burn, or become red and dry. You need to be cautious of the products that you apply on your body such as shampoo, hand, and dish soap; body wash, bubble bath, and cleaning products such as floor cleaners, laundry detergents, and disinfectants. Overuse or poor quality of these products may trigger eczema. Examples of other allergic reactions include excessive exposure to polyester or nylon synthetic fabrics. Some people also develop eczema from watch chains, shoes, sandals, necklaces, nail polish, shaving creams, and allergens found in other cosmetics.A lot may have been shared about the causes of eczema, but for most forms of eczema, researchers and doctors believe that combinations of genes and triggers are the most common reasons for skin irritation and inflammation.

• Stress

While there is no logical explanation for this, some researchers suggest that emotional stress can also trigger eczema. Eczema symptoms are known to deteriorate when the person feels stressed or depressed. Others may simply get upset over the fact that they have eczema,eventually making the problem worse. Other risk factors include age, ethnicity, environment, medical conditions, genetic factors, immunity levels, climate, and psychological factors.

Best Ayurvedic suggestions to reduce Eczema In Ayurveda, eczema is known as vicharchikaand it occurs when the immune system becomes imbalanced. This condition is often associated with other allergic conditions such as asthma, hay fever, etc. According to Ayurveda, eczema or vicharchika is caused by a faulty diet and lifestyle, due to which digestion is impaired and the pitta dosha is aggravated. Pitta (the fiery element or bile that governs all heat, metabolism, and transformation in the human mind and body) manifests in the skin and causes the accumulation of heating toxins known as ama. These toxic substances are accumulated in body tissues, contaminating them over time to cause eczema. Ayurveda advocates a balance of body, mind, and soul in sync with the patient’s unique body constitution.An individualized treatment plan is recommended in Ayurveda, comprising a proper diet and specialized herbal compounds. Eczema is healed by enhancing digestion, expelling toxins, and calming the pitta. While the Ayurvedic treatment requires a highly disciplined approach to diets, massages, schedule of herbs, hygiene, and baths, the biggest challenge is following the entire Ayurvedic protocol while managing everyday activities. It also requires the

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SKIN DISEASE â&#x20AC;&#x201C; Eczema

utmost patience and persistence, especially in the beginning, but it certainly ensures positive results after a period of time.

Ayurvedic remedies to treat eczema Milk

Use of milk on eczema affected skin is beneficial in reducing the problem of swelling, redness and itching. Use cold milk for good results. Leave a clean cotton cloth after dipping it in a bowl of cold milk for two minutes. Now place this cloth at the place of eczema-affected part for 30 minutes. You can use it as often as you want.

Honey

Honey is used for skin care and beauty since ancient times. Honey protects skin from dryness. Honey contains anti-inflammatory and anti-microbial properties. Apply honey to the eczema-affected area and leave it for 30 minutes and then wash it. Do this twice daily.

Neem

Neemâ&#x20AC;&#x2122;s anti-inflammatory properties are very effective in eczema symptoms. In addition, its anti-microbial properties work to eliminate germs that can further aggravate the eczema problem. To use it, you can paste neem leaves or use neem leaves in water or you can apply neem oil on the affected areas. You can use it every day.

Oatmeal

Chamomile is rich in anti-inflammatory and anti-microbial properties. To use it first you have to prepare a cup of chamomile tea. Now leave it to be cold and take a clean cotton cloth and leave itin chamomile tea for two minutes. Now apply this cloth for 20 minutes at eczema, and then wash it.

Coconut oil Add coconut oil to the place of eczema. Leave it for several hours before washing it. It is also used to treat skin infections and provide soft and smooth skin. It also reduces swelling and itching.

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SKIN DISEASE â&#x20AC;&#x201C; Eczema

An individualized treatment plan is recommended in Ayurveda, comprising a proper diet and specialized herbal compounds. Eczema is healed by enhancing digestion, expelling toxins, and calming the pitta. 10

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Aloe Vera

Aloe vera is a beneficial plant that is used in the treatment of many types of skin disorders. It has anti-inflammatory properties that help reduce pain and itching of the skin. For use in eczema, remove the aloe vera gel from fresh leaves of aloe vera and leave it on eczema for 5-6 hours. Do this every day.

Basil or Tulsi Anti-inflammatory properties present in tulsi provide relief from inflammation, itching and pain. With the anti-microbial properties present in it, your skin gets rid of infection and trouble. You can drink basil tea twice a day or let the tea cool downand immerse one clean cotton cloth for two minutes in it and place this cloth on eczemafor 20 minutes, and then wash it.

Linseed The seed of linseed is known as a herb. For the treatment of eczema, mix its paste in equal quantity of lemonade to the affected area. You can also use linseed oil daily to

massage the affected areas.

Turmeric

Anti-inflammatory and anti-bacterial properties in turmeric are beneficial in reducing the problem of redness, swelling and itching. It is one of the herbs that control eczema symptoms. To use turmeric, take turmeric according to the use and prepare its paste. Now add cold milk or rose water in the paste and apply this paste to the affected areas, leave it for 20 minutes, and then clean it.

Use of Brahmi

Brahmi is a good herb for the treatment of eczema. Regular use of this herb helps you gets rid of skin swelling, redness and itching. Boil five Brahmi leaves in water, prepare the paste and leave it on the area affected for 20 minutes. Do this three times a week.

Sage Sage herbs are used to reduce inflammation and redness in eczema problems. For this, boil the leaves of sage for 5 minutes in a glass

SKIN DISEASE – Eczema

of water, now you should consume this decoction. To get rid of the swelling of the skin, take it twice daily. Don’t stress out if you have noticed any of the symptoms or risk factors for eczema. Though it can be challenging to manage eczema initially, don’t let fear bog you down. If you really want to get rid of the disease, adopt a more holistic and methodical approach to your treatment so that your skin can eventually balance itself on its own.

Though it can be challenging to manage eczema initially, don’t let fear bog you down. If you really want to get rid of the disease, adopt a more holistic and methodical approach to your treatment so that your skin can eventually balance itself on its own. www.doublehelical.com September 2018

KEEPING TRACK – TB

Towards TB Free India

TB Free India is only possible if we ensure that our panchayat and blocks are declared TB free. For that, the Government has adequately provisioned drugs and diagnostic in every part of the country… By Abhigyan/Abhinav

B and under nutrition can cause a vicious cycle of worsening disease and under nutrition. Under nutrition is linked to a number of serious outcomes related to TB disease….

What is TB?

TB is an abbreviation of the word tuberculosis and is how people often refer to the disease. TB is caused by bacteria called Mycobacterium tuberculosis (M.tuberculosis). Most individuals with active TB experience weight loss. Weight loss among people with TB can be caused by several factors, including reduced food intake due to loss of appetite, nausea and abdominal pain. Just a few years ago it was believed that TB was an old disease, and that it was no longer a problem in humans. But now because of such issues as drug resistance and HIV, it has become a major worldwide problem again. Globally, more people die from the disease than from any other infectious disease.

How do you get TB?

TB is spread from one person to another through the air. You get TB by breathing in TB bacteria that are in the air. Bacteria get released into the air by someone who already has the bacteria in their body. For a long time it has been known that there is a link between TB and malnutrition. There is a two-way link between TB & malnutrition.TB makes malnutrition worse, and malnutrition makes TB worse.

TB and malnutrition

Malnutrition is often considered to refer to people having an insufficient intake of food.

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KEEPING TRACK – TB welcome these findings.”

The three tools – Data for Action

Framework for Key Populations, Gender and Legal Environment Assessment developed by the Stop TB Partnership provided the guiding framework for undertaking rapid assessments of the three different dimensions. An increased focus on these aspects has the potential to not just increase case detection and treatment outcomes but also improve the overall quality of care.

But it strictly refers to people having either under nutrition or equally people who have too much food, that is, people who are obese. So, in the context of TB it is usual to refer to under nutrition, which is people getting insufficient nutrients from their food. Equally under nutrition weakens the

There is increasing evidence that under nutrition in patients with active TB is associated with an increased frequency and severity of disease and indeed a two to four fold increase in mortality.

body’s ability to fight disease. So under nutrition increases the likelihood that latent TB will develop into active TB disease. Although there is a clear link between active TB and under nutrition, in no way does malnutrition or under nutrition cause TB on its own. TB is only ever caused by TB bacteria. Food insecurity and malnutrition in people who are in close contact of a patient with active TB increases their risk of developing TB. Persons with TB should aim to have three meals and three snacks each day to increase the amount of food they eat. There is increasing evidence that under nutrition in patients with active TB is associated with an increased frequency and severity of disease and indeed a two to four fold increase in mortality. There is also a five fold risk of drug induced liver damage. A less than ideal weight gain during TB treatment also increases the risk of long term relapse even after initial cure. Under nutrition has also been associated with malabsorption of key anti TB drugs.

Consultative Meeting on TB

Consultative Meeting discussed three dimensions of the response to TB - key and priority populations, law and human rights and gender - and released assessment reports on the same in New Delhi recently. The meeting was organised by REACH and supported by the Stop TB Partnership. Speaking at the meeting, Deputy Director General (TB), Dr. K. Sachdeva said, “The person-centred approach to TB is already in the new National Strategic Plan (NSP) for TB elimination. We take cognizance of these dimensions that need to be addressed and

TB affects an estimated three million women every year and remains among the top five leading causes of death among adult women globally. Although more men are affected by TB, women experience the disease differently, and gender disparities could play a significant role in how men and women access healthcare in the public and private sectors. The Gender Assessment Tool is a guiding framework to undertake a gender analysis of the existing TB epidemic and response. Through this framework, existing data and information about TB in India will be collated and analyzed through a gender lens Dr Sundari Mase, WHO and Expert Advisory Group Member, CRG Assessments, said, “Globally, one-third of the people diagnosed with TB are women. Gender and TB is an area where India can take the lead. When women are dying of TB, there is a cascading impact on children, families and society.” The National Strategic Plan (NSP) for TB elimination 2017-2025, for the first time, included a separate chapter on Priority Populations, who are primarily vulnerable, underserved or populations at risk of TB infection and illness due to various factors. In this context, the data framework tool provides an opportunity to understand better how TB impacts key and priority populations in terms of both burden and access to services. “For the vulnerable populations, steps should be tailor made. One size does not fit all. Certain things need to be fixed as per the needs of a community – whether they are miners, slum dwellers or people living with HIV,” Mona Balani of Touched By TB said. The right to health from a human rights perspective is indivisible and interdependent on other rights such as the right to food, housing, right to a healthy environment, right to work and rights at work, right to education etc. The Legal Environment Assessment tool reviews existing legislations and policies that affect rights from a health perspective, www.doublehelical.com September 2018

KEEPING TRACK – TB and the existing legislations and policies that could possibly create barriers for access to TB services.

Health Ministry’s new initiatives to combat TB According to Preeti Sudan, Secretary (Health) Govt of India,we are already aligned with world TB treatment protocols. India has a mission to end TB by 2025, through community participation, involving civil societies and other stakeholders.

She further stated that the global target to end TB is 2030 but we will end it by 2025. “This is a tall order but I am confident that if we all work together, if all the partners combine together and we ensure full treatment is given on regular basis we can show the world this can be achieved. I am confident of this and my confidence is backed by our success in eradicating Polio.” At a recently held function, the Health Secretary also released the TB INDIA 2018 Report and National Drug Resistance Survey Report. She also launched the NikshayAushadi Portal and shorter regimen for Drug Resistant TB. Preeti Sudan commended the TB warrior, Shri Suman, a graduate student who narrated his experience living with TB. The Health Secretary stated that early identification and complete treatment of TB is a key to achieving our goal of TB elimination. We need many TB warriors like Suman to fight against this disease and spread positive message across the communities to burst the

myths and misconceptions around TB. Addressing the participants, the Health Secretary further stated that the Prime Minister has called for ‘TB Mukth Bharat’ which can only possible if we ensure our panchayat and blocks are declared TB free. “For that Government has adequately provisioned drugs and diagnostic in every part of the country,” she added. Also present at the event were Dr B D Athani, DGHS, Sanjeeva Kumar, Additional Secretary (Health), A. K. Jha, Economic Advisor, Ministry of Health & Family Welfare, Vikas Sheel, Joint Secreatry, Dr. Sunil Khaparde, DDG(TB), and other senior officers of the Health Ministry, representatives of WHO and other development partners. In addition to the well-known risk factors contributing to the rise of tuberculosis cases in India, like human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS), poor nutritional status, and young age, realization that other emerging factors like diabetes mellitus, indoor air pollution, alcohol abuse, tobacco smoke are also fuelling the epidemic, adding more complexities to tuberculosis control and making the task onerous. Individually and in combination, risk factors tend to increase the burden two to three times. Unless addressed concurrently, these numbers are likely to overwhelm the tuberculosis control programme and annul its efforts. The eight states of the North Eastern region characterized by hilly, forested area, sparsely inhabited mainly by tribal

The National Strategic Plan (NSP) for TB elimination 20172025, for the first time, included a separate chapter on Priority Populations, who are primarily vulnerable, underserved or populations at risk of TB infection and illness due to various factors. populations also share high prevalence of emerging risk factors for tuberculosis. India has set itself a target of elimination of tuberculosis by 2025. To achieve the target in the North Eastern states, special resources would be needed to be put in place for controlling these risk factors as well. A comprehensive integrated approach taking help of other departments in health sector and beyond is critical. There are two risk factors like diabetes mellitus and tobacco smoking which impact a larger section of North-Eastern population and accelerate progression of tuberculosis disease. Some of the states here have highest prevalence of HIV in India, notably Manipur (1.15%), Nagaland and Mizoram (0.7–0.8%).

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KEEPING TRACK – TB

In addition to the well-known risk factors contributing to the rise of tuberculosis cases in India, poor nutritional status, and young age, realization that other emerging factors like diabetes mellitus, indoor air pollution, alcohol abuse, tobacco smoke are also fuelling the epidemic India has an average of 0.26%. People with HIV have a 20–30 times higher risk of developing active tuberculosis, which is more of the extra pulmonary type and throws up challenges of diagnosis and management. Tobacco consumption is highest in this region of the country. On an average people in NE smoke more tobacco than the rest of India. Mizoram and Meghalaya have a prevalence of over 60%, Tripura follows at 40%. India’s average is around 26%. One in four Mizo women smokes, whereas average for India is 1 per hundred. Smokers are two-three times at higher risk of developing tuberculosisthan non-smokers. The disease is more severe. A regular smoker has twice the risk of getting the disease again, recurrences are more often. If an HIV infected individual also smokes, the risk increases three folds. Diabetes is the third risk factor. Results

of an India-wide show high prevalence of pre-diabetes especially amongst the urban poor in the states of Arunachal Pradesh, Manipur, and Meghalaya which is of major concern. Diabetes again increases the risk of tuberculosis to three folds and the risk of multi drug resistant (MDR) among diabetics who get TB is 2–8 times higher. The progression of the disease is rapid. And it develops more frequently when the diabetes control is poor. What does all this mean to the tuberculosis elimination programme? Elimination of TB means stopping transmission. That is reach every person suspected to have tuberculosis, get diagnosis confirmed, and if positive put on appropriate treatment and help to complete the therapy. Given the difficult terrain and hard to reach population, more resources would be needed. Health workers may have to travel long

distances to bring one patient under treatment successfully. Finding TB cases is critical. Modelling studies have shown that if the case detection is increased by 25%, it can translate in to about 40% reduction in mortality, the prevalence decreases by about 30% and the reduction of incidence cases is by more than 20% in 10 years. For persons with chest symptoms, sputum examination for acid-fast bacilli (AFB) is the recommended test. Acid fast staining of sputum for AFB performs poorly as a screening test. Its sensitivity is poor. The cartridges based nucleic acid amplification test (Cartridge Based Nucleic Acid Amplification test, CB-NAAT) is now available at the district level as it needs a controlled temperature and dust free environment. A nucleic acid amplification test (True Nat www.doublehelical.com September 2018

KEEPING TRACK – TB

Diabetic tuberculosis patients have a higher risk of treatment failure, death, and recurrent tuberculosis as compared to non-diabetic tuberculosis patient. MTB), a chip based test has been developed by an Indian company. It is reported to have good sensitivity and specificity. It has recently been validated in 100 designated microscopy centres in 50 districts in 10 states in which 18,000 samples have been tested. This battery operated test takes around an hour to give the result whether a sputum sample is positive for TB, for positive samples resistance can be determined in another hour’s time. It does not require dust proof air-conditioned environment. It is projected as a test to be used at primary health centre (PHC) level. If it is found to have an acceptable sensitivity and specificity, this test should be deployed in the NE states on a priority basis. Relying on symptoms-screen alone may be contributing to delayed diagnosis of tuberculosis. Using chest X-rays (CXR) as a pre-screen test can reduce numbers needed to test for each case of tuberculosis. Abnormal CXRs could, therefore, be key to active case finding by identifying cases that otherwise would have not have been diagnosed by conventional, passive case finding, Today, CXR is becoming more accessible in remote settings due to technological advances such as digital imaging instead of film-processed images. The sensitivity of CXR has been shown to increase if computer-

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aided diagnosis (CAD) software is used to analyse digital images. It gives a probability percentage consistent with TB. It could possibly be used as a ‘filter’ in TB screening to identify that gets tested by CB NAAT (GeneXpert). We need a locally available and economic version of the CAD4TB which would help in improving diagnosis especially in areas where a radiologist is not available to interpret the CXR. Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will further burden the TB elimination programme. An epidemiological model in Indiaindicates that diabetes mellitus may account for 15% of TB cases. The International Diabetes Federation has predicted an increase in diabetes prevalence to 10% world wide by 2035. Modelling exercises have predicted that if such an increase does happen it could undercut the decrease in new cases of tuberculosis by about 3%. Some believe that increase in the prevalence of diabetes in India has contributed in part to a negligible reduction in new cases oftuberculosis between 1988 and 2008. Diabetic tuberculosis patients have a higher risk of treatment failure, death, and recurrent tuberculosis as compared to

non-diabetic tuberculosis patient. Poorly controlled diabetes increase the risk of tuberculosis and leads to unfavourable tuberculosis treatment outcomes. Researchers have long known that diabetes patients have higher blood sugar levels making their disease difficult to control and putting them at greater risk of developing complications. A bidirectional screening for tuberculosis and diabetes mellitus at hospital and community level has been shown to be feasible and effective. Such a screening should be piloted at hospital and community level and scaledup. This presents a unique opportunity to capture persons presenting with either of these two conditions as potential targets for screening and treatment. Patients with diabetes often present with atypical symptoms and pose hurdles in diagnosing tuberculosis. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher of drug toxicity than tuberculosis patients without diabetes. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. Modelling study analysed the

KEEPING TRACK – TB

potential effect of diabetes on tuberculosis epidemiology in 13 countries with high TB burden. The study estimated the tuberculosis burden that can be reduced by alternative scenarios of diabetes lowering the prevalence of diabetes by an absolute level of 6.6–13.8% could accelerate the decline of tuberculosis incidence by an absolute level of 11.5–25.2% and tuberculosis mortality by 8.7–19.4%. If interventions reduce diabetes incidenceby 35% by 2025, 7.8 million tuberculosis cases and 1.5 million tuberculosis deaths could be averted by 2035. The evidence for an regular tobacco smoking increases risk of TB in active smokers is well established. There is alsosome evidence that second hand smoking (passive smoking) is a risk factor for developing tuberculosis especially in children 0–5 years. When exposed to second hand smoke, household/ environmental factors (crowding, biomass fuel burning) may increase risk for developing tuberculosis. In addition, smoking has been associated with cavitary lesions, bacillary load, smear conversion delay, and high risk of reactivation and death during or after treatment. Smoking rates are high among men in North Eastern states, and, together with rising rates of diabetes, the risk of progression totuberculosis disease will also increase. Interventions like smoking cessation and early screening for tuberculosis can be advocated, but the impact of interventions in reducing TB risk remains negligible at

population level. Both active and passive smoking increase susceptibility to TB infection, progression to active TB disease and the risk of adverse anti-TB treatment outcomes. Systematic reviews suggest that the risk of TB disease among smokers is increased two to threefold compare with people who have never smoked. Tobacco control and smoking cessation among people with diabetes and tuberculosiscan therefore play an important role in limiting the burden of TB. It is also known that diabetic smokers have more than 5-fold increased risk of pretreatment positive smears than do nondiabetic non-smokers. This is a remarkable joint effect of diabetes and smoking that increased risk of tuberculosis transmission. Against the background of risk factors fuelling the epidemic of tuberculosis in India, a critical assessment of the tuberculosiscontrol programme (like strengths, weaknesses, opportunities and threats (SWOT) analysis) especially in the North-Eastern region would be helpful in identifying the areas that need strengthening to deal with these risk factors, and the resultant possible increase in number of active tuberculosis patients. From a health systems point of view, issues such as delays in diagnosis, initiation of appropriate treatment and its successful completion would be crucial. Experience from the combating combined HIV/TB disease would be helpful. But more operational research would be needed to tackle diabetes and tobacco smoking.

Exposure to second hand smoke, household/ environmental factors (crowding, biomass fuel burning) may increase risk for developing tuberculosis. In addition, smoking has been associated with cavitary lesions, bacillary load, smear conversion delay, and high risk of reactivation and death during or after treatment. The Revised National Tuberculosis Control Program (RNTCP) would need to solicit assistance from other programmes within and outside the health sector to develop integrated comprehensive approach in meeting the targets of tuberculosis elimination in the North Eastern region.

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Lethal Intoxication

According to a recent WHO report, more than 3 million people died as a result of alcohol abuse in last two years. Countries need to effectively work together to reduce the negative health and social consequences of alcohol consumption By Amresh K Tiwary

global phenomenon, alcohol consumption is now getting worldwide attention due to its harmful impact on the society. Alcohol is classified as psychoactive substance which produces dependence. It has not only grave implications on health but also social and economic aspects. There are a number of factors which determine alcohol consumption in a society. Alcohol consumption is a causal factor in more than 200 diseases and injury conditions.

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Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major non communicable diseases such as liver cirrhosis, cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions. Age group, gender, socio-economic factors, education, certain occupation, familial tendency, peer pressure etc are individual determinants of alcohol intake.

Early age of initiation of alcohol intake leads to higher rates of diseases due to abuse, accidents and injuries. A significant proportion of the disease burden attributable to alcohol consumption arises from unintentional and intentional injuries, including those due to road traffic crashes, violence, and suicides, and fatal alcohol-related injuries tend to occur in relatively younger age groups. A variety of factors have been identified at the individual and the societal level, which

Cover Story - Alcoholism

Alcohol consumption is a causal factor in more than 200 diseases and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major non communicable diseases such as liver cirrhosis, cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions.

affect the levels and patterns of alcohol consumption and the magnitude of alcoholrelated problems in populations. Environmental factors include economic development, culture, availability of alcohol, and the comprehensiveness and levels of implementation and enforcement of alcohol policies. For a given level or pattern of drinking, vulnerabilities within a society are likely to have similar differential effects as those between societies. Although there is no single risk factor that is dominant, the more vulnerabilities a person has, the more likely the person is to develop alcohol-related problems as a result of alcohol consumption. Conceptual causal model of alcohol

consumption and health outcomes The chronic and acute health outcomes of alcohol consumption in populations is largely determined by two separate but related dimensions of drinking: â&#x20AC;˘ The total volume of alcohol consumed, and â&#x20AC;˘ The pattern of drinking. The context of drinking plays an important role in occurrence of alcohol-related harm, particularly associated with health effects of alcohol intoxication, and, on rare occasions, also the quality of alcohol consumed. Alcohol consumption can have an impact not only on the incidence of diseases, injuries and other

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Cover Story - Alcoholism

There are gender differences in alcohol-related mortality and morbidity, as well as levels and patterns of alcohol consumption. The percentage of alcoholattributable deaths among men amount to 7.7 % of all global deaths compared to 2.6 % of all deaths among women.

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health conditions, but also on the course of disorders and their outcomes in individuals. There are gender differences in alcoholrelated mortality and morbidity, as well as levels and patterns of alcohol consumption. The percentage of alcohol-attributable deaths among men amount to 7.7 % of all global deaths compared to 2.6 % of all deaths among women. Total alcohol per capita consumption in 2010 among male and female drinkers worldwide was on average 19.4 litres for males and 7.0 litres of pure alcohol for females. According to Prof (Dr) Nimesh G Desai,

Professor of Psychiatry and Director, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, â&#x20AC;&#x153;Alcohol is a psychoactive substance with dependence-producing properties that has been widely used in many cultures for centuries. The harmful use of alcohol causes disease, and social and economic burden in societies.It can also result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, reckless consumption of alcohol results in a significant health, social and economic burden on society at large.â&#x20AC;? Dr A K Agarwal, Professor of Excellence, Medical Advisor (Innovation)

Cover Story - Alcoholism

Apollo Hospital, New Delhi, said, “The latest causal relationships are those between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the incidence and course of HIV/AIDS. Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications.” Dr Suneela Garg, Director Professor,

Department of Community Medicine, Maulana Azad Medical Institute, New Delhi, said, “Social factors like cultural practices, level of development, alcohol production, distribution and marketing strategies are important factors. In India, alcohol consumption in social gatherings and on some religious occasions is an accepted norm. Similarly, consumption of alcoholic beverages is prevalent in many tribal and

The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on levels and patterns of alcohol consumption, alcoholattributable health and social consequences and policy responses at all levels.

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Cover Story - Alcoholism village societies around the world. Individual factors also play a role in the pattern of alcohol consumption.”

• Regulating the marketing of alcoholic beverages (in particular to younger people);

Ways to reduce the harmful use of alcohol

• Regulating and restricting the availability of alcohol;

The health, safety and socioeconomic problems attributable to alcohol can be effectively reduced and require actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health.

• Enacting appropriate drink-driving policies;

Countries have a responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Substantial scientific knowledge exists for policy-makers on the effectiveness and cost-effectiveness of the following strategies:

Key facts

• Reducing demand through taxation and pricing mechanisms; • Raising awareness of public health problems caused by harmful use of alcohol and ensuring support for effective alcohol policies; • Providing accessible and affordable treatment for people with alcohol-use disorders; and • Implementing screening and brief interventions programmes for hazardous and harmful drinking in health services.

• Worldwide, 3 million deaths result from harmful use of alcohol, this represent 5.3 % of all deaths. • The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions. • Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs). • Alcohol consumption causes death and disability relatively early in life. In the age group 20–39 years approximately 13.5 % of the total deaths are alcohol-attributable. • There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, other noncommunicable conditions as well as injuries. • The latest causal relationships have been established between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS. • Beyond health consequences, alcohol abuse brings significant social and economic losses to individuals and society at large.

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Prof Ramesh K. Goyal, Vice Chancellor, Delhi Pharmaceutical Sciences & Research University (DPSRU), said, “The market forces which are promoting alcohol should be brought under legislative control. Regulating the marketing of alcohol is essential since it has important impact on younger population. Restricting the availability of alcohol can be effective. Legislations should be made and strictly enforced. Taxation policies can have huge impact on alcohol demand and supply system. Raising public awareness about the harmful effects of alcohol is essential. Innovative strategies should be used including mass media campaigns for the same. More and more counselling and rehabilitation centres should be opened for those in need, all over the country. Those

who recover should be integrated within the society without stigma and discrimination. All healthcare workers, social workers should be trained in counselling alcohol users.”

WHO Response The harmful use of alcohol is one of the leading risk factors for population health worldwide and has a direct impact on many health-related targets of the Sustainable Development Goals (SDGs), including those for maternal and child health, infectious diseases (HIV, viral hepatitis, tuberculosis), non-communicable diseases and mental health, injuries and poisonings. Alcohol is specifically mentioned under health target 3.5: “Strengthen the prevention and treatment of substance use, including narcotic drug abuse and harmful use of alcohol”. The WHO aims to reduce the health burden caused by the harmful use of alcohol and, thereby, to save lives, prevent injuries and diseases and improve the well-being of individuals, communities and society at large. It emphasizes the development, implementation and evaluation of costeffective interventions for harmful use of alcohol as well as creating, compiling and disseminating scientific information on alcohol use and dependence, and related health and social consequences. The “Global strategy to reduce the harmful use of alcohol”, negotiated and agreed by WHO Member States in 2010, represents international consensus that reducing the harmful use of alcohol and its associated health and social burden is a public health priority. The strategy provides guidance for action at all levels, including 10 recommended target areas for policy options and interventions for national action to reduce the harmful use of alcohol and the main components for global action to support and complement activities at country level. The update of the evidence on costeffectiveness of policy options and interventions undertaken in the context of an update of Appendix 3 of the Global Action Plan for the Prevention and Control of n Non communicable Diseases 20132020 resulted in a new set of enabling and focused recommended actions to control the menace of alcohol. The most cost-effective actions, or “best buys”, include increasing taxes on alcoholic beverages, enacting and enforcing bans or comprehensive restrictions on exposure to alcohol advertising across

Cover Story - Alcoholism

multiple types of media, and enacting and enforcing restrictions on the physical availability of retailed alcohol. With growing awareness of the impact of alcohol consumption on global health and an increase in international frameworks for action, the demand for global information on alcohol consumption and alcohol-attributable and alcohol-related harm, as well as related policy responses, has increased significantly. The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on levels and patterns of alcohol consumption, alcohol-

attributable health and social consequences and policy responses at all levels. Achieving reduction in the harmful use of alcohol in line with the targets included in the SDG 2030 agenda and the WHO Global Monitoring Framework for Non communicable Diseases requires concerted action by countries, effective global governance and appropriate engagement of all relevant stakeholders. By effectively working together, the negative health and social consequences of alcohol can be reduced.

Current trends and projections point to an expected increase in global alcohol per capita consumption in the next 10 years, particularly in the SouthEast Asia and Western Pacific Regions and the Region of the Americas.

Footnotes 1. Based on the Global Status Report on Alcohol and Health 2018. 2. The Global Strategy refers only to publichealth effects of alcohol consumption, without prejudice to religious beliefs and cultural norms in any way. The concept of “harmful use of alcohol” in this context is different from “harmful use of alcohol” as a diagnostic category in the ICD-10 Classification of Mental and Behavioural Disorders (WHO, 1992). 3. The disability-adjusted life year (DALY) extends the concept of potential years of life lost due to premature death to include equivalent years of “healthy” life lost by virtue of being in states of poor health or disability.

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Cover Story - Alcoholism

A Frightening Picture

ccording a report released recently by the World Health Organization (WHO), more than 3 million people died as a result of alcohol abuse in last two years. This represents one in 20 deaths. More than three quarters of these deaths were among men. Overall, the harmful use of alcohol causes more than 5% of the global disease burden.

communities suffer the consequences of the harmful use of alcohol through violence, injuries, mental health problems and diseases like cancer and stroke,” said “It’s time to step up action to prevent this serious threat to the development of healthy societies.”

WHO’s Global status report on alcohol and health 2018 presents a comprehensive picture of alcohol consumption and the disease burden attributable to alcohol worldwide. It also describes what countries are doing to reduce this burden.

Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions.

Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, said, “Far too many people, their families and

Despite some positive global trends in the prevalence of heavy episodic drinking and number of alcohol-related

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deaths since 2010, the overall burden of disease and injuries caused by the harmful use of alcohol is unacceptably high, particularly in the European Region and the Region of Americas. Globally an estimated 237 million men and 46 million women suffer from alcohol-use disorders with the highest prevalence among men and women in the European region (14.8% and 3.5%) and the Region of Americas (11.5% and 5.1%). Alcohol-use disorders are more common in high-income countries. Global consumption predicted to increase in the next 10 years An estimated 2.3 billion people are current drinkers. Alcohol is consumed by

Cover Story - Alcoholism more than half of the population in three WHO regions – the Americas, Europe and the Western Pacific. Europe has the highest per capita consumption in the world, even though its per capita consumption has decreased by more than 10% since 2010. Current trends and projections point to an expected increase in global alcohol per capita consumption in the next 10 years, particularly in the South-East Asia and Western Pacific Regions and the Region of the Americas.

How much alcohol are people drinking? The average daily consumption of people who drink alcohol is 33 grams of pure alcohol a day, roughly equivalent to 2 glasses (each of 150 ml) of wine, a large (750 ml) bottle of beer or two shots (each of 40 ml) of spirits. Worldwide, more than quarters (27%) of all 15–19-year-olds are current drinkers. Rates of current drinking are highest among 15–19-year-olds in Europe (44%), followed by the Americas (38%) and the Western Pacific (38%). School surveys indicate that, in many countries, alcohol use starts before the age of 15 with very small differences between boys and girls. Worldwide, 45% of total recorded alcohol is consumed in the form of spirits. Beer is the second alcoholic beverage in terms of pure alcohol consumed (34%) followed by wine (12%). Worldwide there have been only minor changes in preferences of alcoholic beverages since 2010. The largest changes took place in Europe, where consumption of spirits decreased by 3% whereas that of wine and beer increased. In contrast, more than half (57%, or 3.1 billion people) of the global population aged 15 years and over had abstained from drinking alcohol in the previous 12 months.

More countries need to take action Dr Vladimir Poznyak, Coordinator of WHO’s Management of Substance Abuse Unit, said, “All countries can do much more to reduce the health and social

costs of the harmful use of alcohol. Proven, cost-effective actions include increasing taxes on alcoholic drinks, bans or restrictions on alcohol advertising, and restricting the physical availability of alcohol.” Higher-income countries are more likely to have introduced these policies, raising issues of global health equity and underscoring the need for greater support to low- and middle-income countries. Almost all (95%) countries have alcohol excise taxes, but fewer than half of them use other price strategies such as banning below-cost selling or volume discounts. The majority of countries have some type of restriction on beer advertising, with total bans most common for television and radio but less common for the internet and social media. “We would like to see Member States implement creative solutions that will save lives, such as taxing alcohol and restricting advertising. We must do more to cut demand and reach the target set by governments of a 10% relative reduction in consumption of alcohol globally between 2010 and 2025,” added Dr Tedros.

Reducing the harmful use of alcohol will help achieve a number of health-related targets of the Sustainable Development Goals (SDGs), including those for maternal and child health, infectious diseases, non-communicable diseases and mental health, injuries and poisonings. Global status report on alcohol and health 2018 The report provides an overview of alcohol consumption and harms in relation to the UN Sustainable Development Goals (Chapter 1), presents global strategies, action plans and monitoring frameworks (Chapter 2), gives detailed information on: the consumption of alcohol in populations (Chapter 3); the health consequences of alcohol consumption (Chapter 4); and policy responses at national level (Chapter 5). In its final chapter 6, the imperative for reducing harmful use of alcohol in a public health perspective is presented. In addition, the report contains country profiles for WHO Member States and appendices with statistical annexes, a description of the data sources and methods used to produce the estimates and references.

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Tete-A-Tete

Removing The Stigma Significantly, to end discrimination against HIV patients, the Ministry of Health and Family Welfare has recently issued a notification for bringing the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017 in force from 10th September, 2018 By Amresh K Tiwary

ndia has the third largest HIV epidemic in the world. However, although overall prevalence remains low, even relatively minor increases in HIV infection rates in a country of more than one billion people translate into large numbers of people becoming infected. With an aim to prohibit discrimination against individuals who are diagnosed with HIV/AIDS, the Ministry of Health and Family Welfare has recently issued a notification for bringing the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017 in force from 10th September, 2018. The Act, safeguards the rights of people living with HIV and affected by HIV. The provisions of the Act address HIV-related discrimination, strengthen the existing programme by bringing in legal accountability, and establish formal

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mechanisms for inquiring into complaints and redressing grievances. The Act seeks to prevent and control the spread of HIV and AIDS, prohibits discrimination against persons with HIV and AIDS. The Act lists various grounds on which discrimination against HIV positive persons and those living with them is prohibited. These include the denial, termination, discontinuation or unfair treatment with regard to: (i) Employment, (ii) Educational establishments, (iii) Health care services, (iv) Residing or renting property, (v) Standing for public or private office, (vi) Provision of insurance (unless based on actuarial studies). The requirement

Special Story - AIDS for HIV testing as a pre-requisite for obtaining employment or accessing health care or education is also prohibited. Every HIV infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household. The Act also prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them. As per provisions of the Act, a person between the age of 12 to 18 years who has sufficient maturity in understanding and managing the affairs of his HIV or AIDS affected family shall be competent to act as a guardian of another sibling below 18 years of age to be applicable in the matters relating to admission to educational establishments, operating bank accounts, managing property, care and treatment, amongst others. As per the provisions of the Act, every person in the care and custody of the state shall have

The number of people who inject drugs (sometimes referred to as PWID) living with HIV in India is rising. The prevalence rate remained steady at around 7% between 2007 and 2013, but was estimated at 9.9% in 2015.

right to HIV prevention, testing, treatment and counseling services.

What is AIDS

AIDS (Acquired Immuno Deficiency Syndrome) is a syndrome caused by a virus called HIV (Human Immuno Deficiency virus). The disease alters the immune system, making people much more vulnerable to infections and diseases. This susceptibility worsens if the syndrome progresses.HIV is found throughout all the tissues of the body but is transmitted through the body fluids of an infected person (semen, vaginal fluids, blood, and breast milk).

What is HIV?

HIV is a virus that attacks immune cells called CD-4 cells, which are a subset of T cells. AIDS is the syndrome, which may or may not appear in the advanced stage of HIV infection. HIV infection can cause AIDS to develop. However, it is possible to contract HIV without developing AIDS. Without treatment, HIV can progress and, eventually, it will develop into AIDS in the vast majority of cases HIV is a retrovirus that infects the vital organs and cells of the human immune

system.The virus progresses in the absence of antiretroviral therapy (ART) - a drug therapy that slows or prevents the virus from developing. The rate of virus progression varies widely between individuals and depends on many factors.These factors include the age of the individual, the body’s ability to defend against HIV, access to healthcare, the presence of other infections, the individual’s genetic inheritance, resistance to certain strains of HIV, and more.

How is HIV transmitted?

Sexual transmission — it can happen when there is contact with infected sexual fluids (rectal, genital, or oral mucous membranes). This can happen while having sex without a condom, including vaginal, oral, and anal sex, or sharing sex toys with someone who is HIV-positive. Perinatal transmission — a mother can transmit HIV to her child during childbirth, pregnancy, and also through breastfeeding. Blood transmission — the risk of transmitting HIV through blood transfusion is extremely low in developed countries, thanks to meticulous screening and precautions. However, among people who inject drugs, www.doublehelical.com September 2018

Special Story - AIDS

If left untreated, HIV weakens the ability to fight infection. The person becomes vulnerable to serious illnesses. This stage is known as AIDS or stage 3 HIV.

sharing and reusing syringes contaminated with HIV-infected blood is extremely hazardous.

Symptoms

For the most part, the later symptoms of HIV

infection are the result of infections caused by bacteria, viruses, fungi, and/or parasites. These conditions do not normally develop in individuals with healthy immune systems, which protect the body against infection.

Early symptoms of HIV infection

Some people with HIV infection have no symptoms until several months or even years after contracting the virus. However, around 80 percent may develop symptoms similar to flu 2â&#x20AC;&#x201C;6 weeks after catching the virus. This is called acute retroviral syndrome. The symptoms of early HIV infection may include fever, chills, joint pain, muscle aches, sore throat, sweats (particularly at night), enlarged glands, a red rash, tiredness, weakness, unintentional weight loss and thrush. It is important to remember that these symptoms appear when the body is fighting off many types of viruses, not just HIV. However, if you have several of these symptoms and believe you could have been at risk of contracting HIV in the last few weeks, you should take a test.

Asymptomatic HIV

In many cases, after the initial symptoms disappear, there will not be any further symptoms for many years. During this time, the virus carries on developing and damaging the immune system and organs. Without medication that stops HIV replicating, this process of slow immune depletion can continue, typically for an

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Special Story - AIDS

average of 10 years. The person living with HIV often experiences no symptoms, feels well, and appears healthy.

of breath (dyspnea), swollen glands lasting for weeks, unintentional weight loss and white spots on the tongue or mouth

For people who are taking antiretroviral and are rigidly compliant, this phase can be interrupted, with complete viral suppression. Effective antiretroviral arrest on-going damage to the immune system.

During late-stage HIV infection, the risk of developing a life-threatening illness is much greater. Serious conditions may be controlled, avoided, and/or treated with other medications, alongside HIV treatment.

Late-stage HIV infection

If left untreated, HIV weakens the ability to fight infection. The person becomes vulnerable to serious illnesses. This stage is known as AIDS or stage 3 HIV. Symptoms of late-stage HIV infection may include blurred vision, diarrhea which is usually persistent or chronic, dry cough, fever of above 100 °F (37 °C) lasting for weeks, night sweats, permanent tiredness, shortness

HIV and AIDS myths and facts

There are many misconceptions about HIV and AIDS. The virus cannot be transmitted from shaking hands, hugging, casual kissing, sneezing, touching unbroken skin, using the same toilet, sharing towels, sharing cutlery, mouth-to-mouth resuscitation or other forms of casual contact.

Status of AIDS in India

The HIV epidemic in India is driven by heterosexual sex, which accounted for 87% of new infections in 2015. However, the epidemic is concentrated among key affected populations such as sex workers. India has the third largest HIV epidemic in the world. In 2016, HIV prevalence in India was an estimated 0.3%. This figure is small compared to most other middleincome countries but because of India’s huge population (1.324 billion) this equates to 2.1 million people living with HIV. In the same year, an estimated 62,000 people died from AIDS-related illnesses. Overall, India’s HIV epidemic is slowing down, with a 32% decline in new HIV infections (80,000 in 2016), and a 54% decline in AIDS-related deaths between 2007 and 2015. The HIV epidemic in India is driven by heterosexual sex, which accounted for 87% of new infections in 2015.However, the epidemic is concentrated among key affected populations such as sex workers. The vulnerabilities that drive the epidemic are different in different parts of the country. The three states with the highest HIV prevalence (Manipur, Mizoram, Nagaland) are in the east of the country. Some states in the north and www.doublehelical.com September 2018

Special Story - AIDS criminalised adult consensual same-sex sexual conduct, after the Delhi High Court had decriminalised it in 2009. This raised fears about access to HIV prevention and treatment for men who have sex with men. However, in February 2016, India’s Supreme Court announced a review of the 2013 decision.

People who inject drugs (PWID) and HIV The number of people who inject drugs (sometimes referred to as PWID) living with HIV in India is rising. The prevalence rate remained steady at around 7% between 2007 and 2013, but was estimated at 9.9% in 2015.

northeast of the country have also reported rising HIV prevalence. Among key affected populations, sex workers and men who have sex with men have experienced a recent decline in HIV prevalence. Prevalence among people who inject drugs was previously stable but has been rising in recent years. Transgender people are also emerging as a group at high risk of HIV transmission, despite all four of these groups being prioritized in the Indian national AIDS response since its inception in 1992.

Sex workers and HIV

In 2016, an estimated 2.2% of female sex workers in India were living with HIV, although this figure varies between states. For example, one 2013 study cited HIV prevalence among sex workers in Maharashtra at 17.9%, Manipur at 13.1%, Andhra Pradesh at 9.7% and Karnataka at 5.3%.Although sex work is not strictly illegal in India, associated activities such as running a brothel are. This means authorities can justify police hostility and brothel raids. Stigma and discrimination against sex workers restrict their access to healthcare. A 2011 study in Andhra Pradesh indicated a significant association between police abuse and increased risk of HIV transmission and inconsistent condom use. Sex workers are one of the high-risk groups targeted by India’s National AIDS Control Organization (NACO)

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with peer-to-peer HIV interventions (when individuals from key affected populations provide services to their peers or link them to services within healthcare settings). In 2015, NACO reported reaching 77.4% of sex workers with HIV prevention activities of this kind. Male sex workers are particularly vulnerable to HIV. A study of men who have sex with men (sometimes referred to as MSM) who attended STI clinics at Mumbai and Hyderabad, two large cities in India, found that 70% of them engaged in sex work. Of those who engaged in sex work, HIV prevalence was found to be 43.6%, compared to 18.1% among all men who have sex with men attending the clinics. Around 4.3% of men who have sex with men in India are living with HIV, with just over a third aware of their status. A 2015 study of men who have sex with men, conducted across 12 Indian cities, found that 7% tested positive for HIV. Just under a third (30%) of those who reported having anal or oral sex with a man in the past 12 months were married to a women and engaging in heterosexual sex.19. The study also found evidence of emerging epidemics among men who have sex with men in urban areas not previously recognised as having high HIV burdens. The legal status of same-sex conduct in India has fluctuated in recent years. In December 2013, India’s Supreme Court re-

Injecting drug use is the major route of HIV transmission in India’s north-eastern states. HIV prevention efforts in the north-east have been effective in reducing the number of new infections. However, there is evidence that the number of people who inject drugs is growing.30 The same study found HIV prevalence to

In 2016, HIV prevalence in India was an estimated 0.3%. This figure is small compared to most other middle-income countries but because of India’s huge population (1.324 billion) this equates to 2.1 million people living with HIV

Special Story - AIDS

be three times higher for women who inject drugs than men who do so. HIV prevention activities for people who inject drugs in India include needle and syringe exchanges and opioid substitution therapy (OST), with the former intervention more common. NACO reports the number of clean needles and syringes distributed as 16.5 million as of September 2015, a figure that is rising year on year. OST was incorporated into the harm reduction programme in 2008. As of 2014, there were around 150 OST centres supporting nearly 18,000 people who inject drugs. Plans to increase the number of OST centres has been slow and coverage as of 2016 remains low, with only 213 OST centres nationwide.

Migrant workers and HIV

Research worldwide has linked migration to increases in HIV transmission. There are an estimated 7.2 million migrant workers in India, of whom 0.19% are living with HIV much higher than the national prevalence of 0.26%.34. NACO categorises migrants as a â&#x20AC;&#x2DC;bridge populationâ&#x20AC;&#x2122;, as they form a link between urban and rural areas, and between groups that are at high and low-risk of HIV transmission. HIV testing among this group remains low, standing at 11.32% in 2016. Despite being an important driver of the HIV epidemic in India, data on migrant sexual behaviour is limited. In 2014, UNAIDS reported that 75% of women testing positive in India have a husband who is a migrant

labourer. Moreover, 0.9% of people who have migrated from a rural to an urban area are HIV-positive.

Key highlights of the HIV and AIDS (Prevention and Control) Bill, 2017

Prohibition of discrimination against HIV positive persons: The Bill sets various grounds on which discrimination against HIV positive persons is prohibited. These include the denial, termination, discontinuation or unfair treatment with regard to employment, educational establishments, health care services, residing or renting property, among others. Informed consent and disclosure of HIV status: The Bill requires that no HIV test, medical treatment, or research will be conducted on a person without his informed consent. Role of the Union and State Governments: The Union and State Governments shall take measures to prevent the spread of HIV or AIDS, provide anti-retroviral therapy and infection management for persons with HIV or AIDS, facilitate their access to welfare schemes especially for women and children, and others. Role of the Ombudsma n: An ombudsman shall be appointed by each state government to inquire into complaints related to the violation of the Act and the provision of health care services.

Male sex workers are particularly vulnerable to HIV. A study of men who have sex with men (sometimes referred to as MSM) who attended STI clinics at Mumbai and Hyderabad, two large cities in India, found that 70% of them engaged in sex work. 12 to 18 years who has sufficient maturity in understanding and managing the affairs of his HIV or AIDS affected family shall be competent to act as a guardian of another sibling below 18 years of age. Court proceedings: Cases relating to HIV positive persons shall be disposed off by the court on a priority basis. In any legal proceeding, if an HIV infected or affected person is a party, the court may pass orders that the proceedings be conducted (a) by suppressing the identity of the person, (b) in camera, and (c) to restrain any person from publishing information that discloses the identity of the applicant.

Guardianship: A person between the age of

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Health - News

Health Minister J P Nadda offers Shramdaan

P Nadda, Union Minister of Health & Family Welfare offered Shramdaan along with senior officers of the Health Ministry and staff members at Nirman Bhawan, New Delhi, recently.. The Health Minister along with officers and staff viewed the live telecast of the Prime Minister as he launched the Swachchta Hi Sewa activities through live video conference with various stakeholders, Swachchta champions and volunteers across the country. Nadda and senior officers including Preeti Sudan, Health Secretary inspected various offices and divisions at Nirman Bhawan and urged the officers and staff members to maintain cleanliness and hygienic working environment.

Health Minister Shri J. P. Nadda

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He stated that under the leadership of the Hon. Prime Minister, sanitation has become a mass movement where widespread awareness has been created among the people towards keeping their surroundings clean. Sanitation is a key determinant of health, he said, and a clean and hygienic environment shall hugely contribute to preventing many diseases. Nadda reiterated the importance of preventive and promotive health.

Nadda stated that the central government hospitals are also launching such fortnight activities, and senior officers from the Health Ministry shall visit the central government hospitals to be part of these efforts. The Kayakalp initiative, he stated, has been launched to encourage every public health facility in the country to work towards standards of excellence to help the facilities stay clean and hygienic.

The Swachhta hi Sewa movement, which aims at generating greater public participation towards Swachhta, is being organized in the run up to the fourth anniversary of the Swachh Bharat Mission, on 2nd October 2018, which will also mark the commencement of the 150th year celebrations of Mahatma Gandhi.

This does not apply only to physical cleanliness, but to develop and put in place systems and procedures for activities such as bio-waste disposal or protocols etc. The initiative towards total â&#x20AC;&#x153;Swachchtaâ&#x20AC;? in public health facilities is aimed towards building confidence of the users in public health facilities, provide quality service and encourage team work, he said.

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Health Ministry goes digital with Budget Dashboard The Ministry of Health and Family Welfare has made a new Budget Dashboard on Budget, Expenditure and Bill Payment position. The Budget Dashboard also incorporates Ministry of AYUSH and Department of Health Research. Budget and expenditure is available in a snapshot and also drilled down details in various categories, such as flagship schemes, Central sector expenditure, North East, SC/ST, Centrally Sponsored Schemes, etc. Various related presentations, Demand for Grants and all relevant budget circulars are also available on the dashboard. The dashboard has the

unique feature of Bill Position for All India Pay Accounts Offices (PAOs) of this Ministry and also reason for return of bills. It is another step in transparency. The dashboard has SMS facility of information on demand and can be accessed on mobile. SMS alerts to concerned officers are also being introduced for shortfall in expenditure. The Health Ministry team lead by Vijaya Shrivastav, SS and FA and Smt. Bharati Das, CCA made a presentation on the Digital Budget Dashboard to A N Jha, Secretary (Expenditure), recently.

Kayakalp parameters of hygiene and cleanliness

Encouraged by the achievements of Kayakalp Scheme, National Accreditation Board for Hospitals & Healthcare Providers (NABH) has decided to consider assessment of healthcare facilities in the private sector on the lines of parameters of ‘Kayakalp’ Scheme. This is also an initiative as part of the ‘Swachhta hi Sewa’ cleanliness and sanitation campaign being undertaken across various parts of the country.

Cleanliness and hygiene in hospitals besides being critical for preventing infections also provide the patients and visitors with a positive experience and encourages moulding behaviour related to cleanliness and sanitation at their homes and work-place. Clean & bright environment where patients are received with dignity & respect,

along with delivery of prompt care go a long way in promoting faster healing and enhanced satisfaction of patients. To complement this effort, the Ministry of Health & Family Welfare, Government of India has launched “Kayakalp” in the year 2015 with initiative to recognise such efforts under ‘Swachh Bharat Abhiyaan’. With above initiative of the Government, the healthcare facilities in the public sector have been competing with each other to attain highest levels of cleanliness and hygiene in their respective facilities. The initiative has resulted in bringing significant improvement in the sanitation and hygiene, patient satisfaction, behavioural change in the staff & employees of the hospitals/institutions, patients and their attendants towards cleanliness. Public perception towards cleanliness & hygiene in public healthcare facilities has also been changing. Besides, public healthcare facilities have also given focused attention on promoting activities like Green Initiatives to reduce carbon footprint by encouraging public sector hospitals to undertake Energy Conservation, Corporate Social Responsibility (CSR) activities, horticulture & landscaping, optimal skill based training of sanitation employees and capacity building, celebration of Swachhta Pakhwada, Swachhta hi Sewa Campaign across all public sector health care facilities every year. The health ministry will recognise the outstanding work done by the private hospitals on an annual basis. www.doublehelical.com September 2018

Health - News

National Dissemination Workshop held in New Delhi the concept of energy density) with optimum food, and information and awareness regarding early childhood development. The Anaemia Mukt Bharat - intensified Iron-plus Initiative - aims to strengthen the existing mechanisms and foster newer strategies for tackling anaemia, focused on six target beneficiary groups, through six interventions and six institutional mechanisms; to achieve the envisaged target under the POSHAN Abhiyan. The strategy focuses on testing & treatment of anaemia in school going adolescents & pregnant women using newer technologies, establishing institutional mechanisms for advanced research in anaemia, and a comprehensive communication strategy including mass/mid media communication material. A web-portal anemiamuktbharat.info has also been developed as part of the monitoring mechanism of the strategy, which would provide survey data on anaemia across beneficiary groups, target prevalence of anaemia as per POSHAN Abhiyan and quarterly HMIS based reporting of programme implementation coverage up to the district level. Ashwini Kumar Choubey, Minister of State for Health and Family Welfare, inaugurated the two-day National Dissemination Workshop on Anaemia Mukt Bharat and Home-Based Young Child Care (HBYC), recently. Dr V K Paul, Member (Health), NITI Aayog was also present at the inaugural function. The objective of this workshop was to orient the state programme managers for rolling out these interventions. Speaking at the function, Choubey stated that under the dynamic leadership of Prime Minister Narendra Modi, both these programmes epitomise the government’s commitment to the ‘Poshan Abhiyaan’ in improving the nutritional outcomes in the population. Highlighting the achievements of the Health Ministry, Choubey spoke about the huge strides taken by India in reducing Maternal Mortality Ratio (MMR) and achieving MDGs with a view to addressing the burden of anaemia and under-nutrition among children in the country. “With an average prevalence of 40 percent across all age groups, anaemia still is a challenge which needs attention,” he said and called for a people’s movement for nutrition and survival and healthy development of every new-born of future India. The minister also released the Toolkit for Anaemia Mukt Bharat & Home-Based care for Young Child programmes. Addressing the participants, Dr V K Paul said that under Poshan Abhiyaan, and as part of Anaemia Mukt Bharat, there is everything that technically should be there to address anaemia in the country. “These interventions will make a difference. We have ingredients for all that can be done to make sure that no one is left behind,” Dr Paul added. He further stressed that during the increased contacts/ home visits by the ASHAs, importance should be given to nutrition, including breastfeeding, how often a child should be fed (bringing in

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The HBYC programme has an objective to reduce child mortality and morbidity by improving nutrition status, growth and early childhood development of young children through structured and focused home visits by ASHAs with the support of Anganwadi workers (AWWs). The programme is envisaged to be implemented as an extension to the existing HBNC programme and will be rolled out in a phased manner. In the first phase (F.Y 2018-19) the programme will be rolled out in all the identified aspirational districts. In the second phase, all the remaining districts under Poshan Abhiyan will be included and in the third phase programme this shall be expanded to cover all the districts in the country. Under the HBYC programme, five additional home visits (in every three months) by ASHAs are proposed after the last visit on 42nd day, as in the existing HBNC programme. Thus, the contact of new-born with the health system is extended till 2nd year of birth. ASHA will ensure exclusive breastfeeding till 6 months of life, adequate complementary feeding after 6 months, Iron and Folic Acid supplementation, full immunization of children, regular growth monitoring, appropriate use of ORS, appropriate hand washing practices and age appropriate playing and communication for children during each home visit. Dedicated skill building, additional incentives, provision of additional commodities and additional home visits for SNCU discharged & sick-new-borns are also included in the programme. The participants of this workshop include senior officials from key Ministries (MoHFW, MWCD, MHRD, MoTA, MoRD) and State Nodal officers for both the programmes, representatives of various UN agencies and development partners.

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Health - News

New evidence released on the trends of NCDs and Suicide across India

The India State-level Disease Burden Initiative, a joint initiative of the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and Institute for Health Metrics and Evaluation (IHME) in collaboration with the Ministry of Health and Family Welfare, Government of India, along with experts and stakeholders associated with over 100 Indian institutions,

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has recently released a comprehensive analysis of several non-communicable diseases (NCDs) and suicide for every state in India, based on analysis of all identifiable epidemiological data from India since 1990 as part of the Global Burden of Disease study. These findings are reported in a series of five research papers published in The Lancet Global Health, The Lancet Public Health,

and The Lancet Oncology, along with a commentary in The Lancet. Highlighting crucial policy-relevant points in these papers, Professor Balram Bhargava, Secretary to the Government of India, Department of Health Research, Ministry of Health & Family Welfare, and Director General, ICMR, said, â&#x20AC;&#x153;These papers through detailed analysis have elucidated

Health - News disease and risk factor trends of major NCDs and suicides in every state over 26 years. While it is known that NCDs have been increasing in India, a major finding of concern is that the highest rate of increase in ischemic heart disease and diabetes is in the less developed states of India. These states already have a high burden from chronic obstructive lung disease and from a range of infectious and childhood diseases, so the control of NCDs in these states has to be boosted without delay. The proportional contribution of cancers to disease burden in India has doubled since 1990, but the incidence of individual cancers varies widely between the states, the reasons for which need to be understood better to guide prevention and control of cancer. Another important finding is the very high contribution of India to the total suicide deaths in the world, especially among women. The ten-fold variation between the states in the suicide death rate for women emphasises the need to better understand the reasons behind these suicides and make concerted efforts to reduce this avoidable loss of predominantly young lives.” Dr Bhargarva also informed about the working of ICMR, its national priorities, new initiatives, major events that took place at ICMR this year and the role ICMR has been playing in the field of health research in India since the past century. Giving pre inputs on the release of this data, Professor Lalit Dandona, Director of the India State-Level Disease Burden Initiative informed that the detailed analyses reported

in these papers have been possible because of the valuable contributions of highly qualified collaborators from India over the past three years. Dr Richard Horton, Editor-in-Chief of The Lancet, observed, “The papers in the Lancet journals reveal a rapid epidemiological transition in India. While the country is engulfed in an emerging epidemic of non-communicable disease, it is also facing the challenge of a significant burden of suicide. Findings of the studies:• Detailed estimates of the trends of cardiovascular diseases, diabetes, chronic

respiratory diseases, cancer, and suicide in every state of India from 1990 to 2016 published in The Lancet family of journals. • Prevalence of ischemic heart disease and stroke has increased by over 50% from 1990 to 2016 in India, with an increase observed in every state. • The number of persons with diabetes in India has increased from 26 million in 1990 to 65 million in 2016. • The rate of increase in the burden of ischemic heart disease and diabetes has been the highest in the less developed states of India, where the burden of chronic obstructive lung disease and infectious conditions is already high. • The number of chronic obstructive lung disease cases in India has increased from 28 million to 55 million from 1990 to 2016, and death rate among these cases is twice as higher in the less developed states than in the more developed states. • The proportional contribution of cancers to the total health loss in India has doubled from 1990 to 2016, but the incidence of different types of cancers varies widely between the states. • Suicide is presently the leading cause of death in the 15-39 year age group in India, 37% of the total global suicide deaths among women occur in India, and suicide death rate among the elderly has increased over the past quarter century.

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Health - News

www.doublehelical.com September 2018

Health - News

Symposium organised on “Recent Advancement in Physiotherapy” at DPSRU W

orld Physiotherapy Day takes place every year on 8th September. The day is an opportunity for physical therapists from all over the world to raise awareness about the crucial contribution the profession makes to keeping people well, mobile and independent. Keeping this in mind, a symposium on “Recent Advancement in Physiotherapy” was recently organized by School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University (DPSRU). The symposium was inaugurated by Vivek Sehgal, Chief Guest, Ajay Dutt, Guest of Honour; Dr. (Prof) S.S Aggarwal, Founder and Ex-VC of DPSRU; Dr. (Prof) R.K. Goyal, Vice Chancellor (DPSRU); Dr. Narkeesh Arumugam, Head Physiotherapy (Punjabi University), Dr. (Prof) Raman Dang, Registrar (DPSRU); Dr. D.P Pathak, Director DIPSAR, and Dr. (Prof) Harvinder Popli, Dean and Principal (DPSRU). During inaugural address Chief Guest, Vivek Sehgal, Principal of PHD Chamber of Commerce and Industries, emphasized on the role of Physiotherapist, Sports Physiotherapy and Neurophysiotherapy with special mention of requirement of Physiotherapy for geriatrics. He also mentioned the importance of moral science education. Guest of Honour, Ajay Dutt, MLA, Ambedkar Nagar Constituency assured the support of various government hospitals of New Delhi for School of Physiotherapy, DPSRU. He also emphasised on the role of physiotherapist in the welfare of society. Vice Chancellor, Dr. (Prof) Ramesh K. Goyal in his address emphasized on the profession of Physiotherapy and their role in healthcare practices. During delivering the talk he mentioned the importance of collaboration of School of Physiotherapy, DPSRU with the government hospitals for

providing the best healthcare services to the society while Dr. Harvinder Popli with her team announced about Health Hack 2. The renowned keynote speakers from physiotherapy field included Dr. Harpreet Singh (AIIMS, New Delhi), Dr. Kavita Behal (Sub Editor, IJPOT Journal), Dr. Arun Mozi (Assoc. Prof. SBSPGI, Dehradun), Dr. Abha Sharma (H.O.D., Holy Family Hospital, New Delhi), and Dr. Narkeesh Arumugam ( Professor, Punjabi University, Patiala). A workshop on Manual Therapy of Lumbar Spine was also successfully organized by well-known resource person Dr. Naveen Ganer. The main objective of two-day Symposium/Workshop was to provide a professionally rewarding experience to all the delegates from the medical fraternity in addition to socializing with colleagues from other institutions. This event was an excellent platform for various organizations to get updated information on key issues like Lumbo-sacral dysfunction, cardiopulmonary

diseases or disorders and sports injuries. The event allowed delegates to have issues addressed on the specified topics by recognized experts who are up-to-date with the latest developments in their own field. The participants learned new manual therapeutic techniques by renowned resource person Dr. Naveen Ganer who shared his expertise for the clinical examination of lumbosacral spine along with selective lumbopelvic manipulations through practical sessions. He taught latest mobilization techniques for treatment of lumbopelvic dysfunctions and back pain so that the delegates got more updates with the latest therapeutic manoeuvres for the treatment of various joint dysfunctions and any pathology underlying the joint. The learning environment encouraged delegates to exchange experiences, ideas and practice from their own fields. Dr Madhu Gupta, Dr. Rajiv Tonk, Dr Jyoti Kataria, Dr. Parul Sharma, Dr. Shilpa Jian, Dr. Siddharth Sen, Dr. Varsha Chorsiya were also present on this occasion.

Recovery from stroke There is life after a stroke.You need to approach each day with fresh enthusiasm to significantly increase your ability to perform activities of daily life, as part of stroke rehabilitation By Shubham Singh

troke affects everybody differently. Many stroke survivors continue to improve over a long time, sometimes over a number of years. Recovery from stroke involves making changes in the physical, social and, emotional aspects of your life. You will make changes to prevent additional strokes as well as to facilitate your lifelong recovery. It is normal to feel angry, anxious or even depressed after a stroke. You may feel worried about work, finances and relationships, and the tiredness caused

www.doublehelical.com September 2018

by stroke can make things even worse. Rehabilitation is all about getting back to normal life and living as independent a life as possible. It involves taking an active approach to ensure that your life goes on. This can mean learning new skills or relearning the old ones. It may involve adapting to new limitations and post-stroke conditions. Or it can mean finding new social, emotional, and practical support to live your best life post-stroke.The stroke rehabilitation literature suggests that the first three to six months are typically when most spontaneous

functional motor recovery will occur. This first recovery mechanism is essentially a resolution of harmful local factors, which generally account for early spontaneous improvement post stroke. These processes include resolution of local edema, resorption of local toxins, improvement of local circulation, and recovery of partially damaged ischemic neurons. But even after this time, please don’t let anyone tell you ‘that’s it’; ‘that will be all’, because you then have the potential to restore significant function at whatever point from injury you

Stroke-Rehabilitation happen to be, whether it is in months or even years. Because now you can take the advantage of the second major recovery mechanism: neuroplasticity, which can take place early or late. Neuralplasticity in simple terms means the ability of the nervous system to modify its structural and functional organisation. The two most important forms of plasticity are collateral sprouting of new synaptic connections and the unmasking of neural pathways and synapses that are not normally used, but that can be called upon when the dominant system fails. CIMT (constraint-induced movement therapy) is a magnificent example of intensive, ultra-focused repetitive work to drive plasticity. This simple but powerful ‘forced-use paradigm’ can be modified for use in your home rather than a clinical setting.

So, my advice is that it is useful to wave goodbye to the naysayers. Forget about any 6 months or 1-year rule. In fact, time to forget ‘the rules’… and rather blindly following them without asking why they are there or who made them up. Recovery can continue over a long period of time if you have partial return of voluntary movement, especially in the upper limb. A systematic review of various studies confirms the most important predictive factor for upper limb recovery following stroke is the initial severity of motor impairment or function. Furthermore, who says that you cannot be the exception to the ‘rule’? Potential is a difficult word. I personally have the potential to become an engineer or a scientist. I know probably

The Effects of Stroke on the Body

Dr Shubham

Neuralplasticity in simple terms means the ability of the nervous system to modify its structural and functional organisation. The two most important forms of plasticity are collateral sprouting of new synaptic connections and the unmasking of neural pathways and synapses www.doublehelical.com September 2018

Stroke-Rehabilitation

The stroke rehabilitation literature suggests that the first three to six months are typically when most spontaneous functional motor recovery will occur.

Stroke-Rehabilitation

A systematic review of various studies confirms the most important predictive factor for upper limb recovery following stroke is the initial severity of motor impairment or function.

won’t happen! But recovery potential? Don’t let anyone tell you that you aren’t going to make as good a recovery as possible. The reason is that there is ALWAYS something you can do to try to improve your lot. If all else fails, you’ll at least be keeping the ‘plastic template’ open and available for applications of current or future cutting-edge

innovations. That’s why every repetition you do counts. More on this in a later post. For now, I can tell you for certain that time-rules and the ‘nay-sayers’ can be ignored. Importantly, you can significantly increase your ability to perform activities of daily life from anypoint in time after your injury.

CIMT (constraint-induced movement therapy) is a magnificent example of intensive, ultra-focused repetitive work to drive plasticity. This simple but powerful ‘forceduse paradigm’ can be modified for use in your home rather than a clinical setting. People often say that motivation doesn’t last. Well, neither does bathing – that’s why we recommend it daily… right?? Staying motivated on the daily basis can change your recovery process by banishing negative thinking. When you remind yourself every day that there is life after stroke, you’ll approach each day with fresh enthusiasm. (The author is Physiotherapist, Institute of Human Behaviour and Allied Sciences, (IHBAS), Delhi)

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Advertisements & Marketing Abhinav Kumar, Kumar Gaurav Gautam Email: sales@doublehelical.com All material printed in this publication is the sole property of Double Helical. All printed matter contained in the magazine is based on the information of those featured in it. The views, ideas, comments and opinions expressed are solely of those featured and the Editor and Publisher do not necessarily sub-scribe to the same. Double Helical is owned, printed and Published monthly. It is printed at Polykam offset, Naraina Industrial Area Phase 1, New Delhi-110028, and published from G-1, Antriksh Green, Kaushambi, Ghaziabad-201 010. Tel: 0120-4219575, 9953604965. Contact us: contact@doublehelical.com Email: editor@doublehelical.com, doublehelicaldesign@gmail.com Website: www.doublehelical.com, www.doublehelical.in

Healthcare-Viral Infections

Stay Clean and Healthy You need to on your guard with regard to diseases that spread through air or water and take steps to reduce exposure to the pathogens that cause them. If you follows preventive measures then such potentially life threatening waterborne diseases can be kept at bay. By Dr Manisha Yadav

easonality is the basic cause of many viral infections of humans, but the mechanisms underlying seasonality, particularly for person-to-person communicable diseases, remain inadequately understood. Better understanding of drivers of seasonality could provide insights into the relationship between the physical environment and infection risk,

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which is particularly significant in the context of global ecological change in general, and climate change in particular. First, we start with air borne diseases. Many such diseases affect humans. Understanding diseases that spread through the air, and how to prevent and avoid them, is important. There are several treatment

options, as well, which people need to know if they catch an airborne disease. Simple measures, such as staying home when sick, reducing contact with people who are sick, and other prevention methods, are also looked. Airborne diseases are commonly spread by sneezing and coughing, making the

Healthcare-Viral Infections

diseases difficult to control. Airborne diseases are illnesses spread by tiny pathogens in the air. These can be bacteria, fungi, or viruses, but they are all transmitted through airborne contact. In most cases, an airborne disease is contracted when someone breathes in infected air. And a person also spreads the disease through their breath, particularly by sneezing

and coughing, and through phlegm. There are frequent outbreaks of common cold and cough which also need timely attention. Due to intense humidity, skin and scalp infections are common. Often, asthma and arthritis also get aggravated. These illnesses, including colds and flu, are transmitted through the air. Many airborne

There are several treatment options, as well, which people need to know if they catch an airborne disease. Simple measures, such as staying home when sick, reducing contact with people who are sick, and other prevention methods, are also looked. diseases are common and can have mild or severe symptoms. Prevention tips include good ventilation to swap indoor and outdoor air. Ventilation methods, such as opening a window or using fans, help to exchange dirty air. Treatment for less serious airborne diseases includes rest and fluids.

Common airborne diseases Particles that cause airborne diseases are small enough to cling to the air. They hang on dust particles, moisture droplets, or on the breath until they are picked up. They are also acquired by contact with bodily fluids, such as mucus or phlegm. Once the pathogens are inside the body, they multiply until someone has the disease. Common airborne diseases include www.doublehelical.com September 2018

Healthcare-Viral Infections

The length of an illness caused by a common airborne disease can vary from a few days to weeks, but it is usually dealt with easily. Uncommon airborne diseases may require additional treatment. • Varicella zoster: This virus causes chickenpox and spreads easily among young children. The rash is typically widespread on the body and made up of small red spots that turn into itchy blisters, which scab over in time. Chickenpox is spread for about 48 hours before a rash shows, which is how it infects others so successfully. It is usually spread through the air or by touching the rash. • Mumps: This virus affects the glands just below the ears, causing swelling and, in some cases, loss of hearing. Vaccination is considered important to prevent the disease.

Influenza: The seasonal “flu” virus spreads easily from person to person. There are many strains of the flu, and it continually changes to adapt to the human immune system.

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• The common cold: The condition called “a cold” is usually caused by a rhinovirus. There are many rhinoviruses, and the strains change to make it easier to infect humans.

• Measles: This illness is caused by contact with a person who has the measles virus, or by inhaling particles from their sneezes or cough. As with mumps, vaccination is essential for preventing the spread of this disease. • Whooping cough (pertussis): This is a contagious, bacterial illness that causes

Healthcare-Viral Infections

the airways to swell. The hacking cough that results is persistent and generally treated with antibiotics early on to prevent damage.

Uncommon airborne diseases

• Meningitis: Meningitis swells the membranes around the brain and spinal cord. It is a bacterial or viral infection, but is also caused by an injury or fungal infection. Common symptoms include a persistent headache, fever, and skin rash.

• Anthrax: This is a bacterial disease that infects the body when a person inhales anthrax spores. It causes nausea and flu symptoms. Inhaled anthrax is difficult to diagnose because it resembles other diseases such as flu. Anthrax is treated with antibiotics to stop it worsening.

The length of an illness caused by a common airborne disease can vary from a few days to weeks, but it is usually dealt with easily. Uncommon airborne diseases may require additional treatment.

• Diphtheria: A rare bacterial disease, diphtheria damages the respiratory system and attacks the heart, kidneys, and nerves. Its rarity may be due to widespread vaccination. Diphtheria can be treated with antibiotics.

Many airborne diseases have symptoms similar to the common cold or influenza. They include cough chill, muscle and body aches, fatigue, congestion, sneezing, runny or stuffy nose, sore throat, slight body aches or headaches, and sinus pressure. Some

Symptoms

people also experience low fever or general sluggishness with these symptoms.

Treatment and outlook Airborne diseases are widespread and easily treatable, in most cases. Complete prevention is difficult, but there are some ways to reduce exposure to the pathogens that cause them. Regular hand-washing and other good sanitary habits will help prevent the spread of airborne diseases. Wearing a hospital mask in public, and covering sneezes and coughs with an elbow or tissue, are some of the good habits that are recommended. Regular hand-washing can also help lower the spread of bodily fluids that may contain disease-causing germs. In an unventilated area, pathogens, pollutants, and moisture can build up to unsafe levels. Cleaning the air with a filter is another part

Airborne diseases are widespread and easily treatable, in most cases. Complete prevention is difficult, but there are some ways to reduce exposure to the pathogens that cause them. www.doublehelical.com September 2018

Healthcare-Viral Infections of keeping an area as free of pollutants and pathogens as possible. It is important for people to talk to a doctor as soon as they experience symptoms to avoid any complications and to begin treatment. Symptoms of the common cold can be treated, but the illness tends to go away without treatment. The flu runs its course over a few days before someone starts to recover. In the case of chickenpox, the immune system usually deals with the virus on its own. While airborne diseases are common, serious complications are much rarer and normal vaccinations reduce the risk, substantially.

Regular handwashing and other good sanitary habits will help prevent the spread of airborne diseases. Wearing a hospital mask in public, and covering sneezes and coughs with an elbow or tissue, are some of the good habits that are recommended. 50

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Water Borne Disease According to World Health Organization, every year more than 3.4 million people die as a result of water-related diseases, Most of the victims are young children. Common symptoms include high fever, nausea and vomiting which can become life threatening if ignored. Monsoon is around the corner. The onset of monsoon brings relief from the scorching heat of summer but it also makes one susceptible to a host of waterborne diseases. The most common waterborne diseases associated with monsoon are Malaria, Jaundice (Hepatitis) and Gastro-intestinal infections such as Typhoid and Cholera. Apart from many biological reasons why these diseases flourish in monsoon, there are some other reasons you should be careful about: overflowing drains, sewage pipe bursts and mix-ups with municipal drinking water lines which contaminate your drinking water. It is rightly said that prevention is better than cure. If one follows preventive measures then such potentially life threatening waterborne diseases can be kept at bay: 1. Avoid wading in rainwater or going out during a heavy downpour. If you must, remember to wash the area of contact with soap and water as soon as possible. 2. Personal hygiene can be intensified during this period. You should keep skin clean and dry. Washing hands often throughout the day can spell the difference between prevention and

disease. 3. Stagnant water is a breeding ground for mosquitoes. Check your living space for any hotspots of contamination eg. air conditioning trays, flowerpots and vases, and choked drains. If thereâ&#x20AC;&#x2122;s a pond near your premises, then breed Gambusia fish as they reduce the chances of mosquito breeding. Alternately, call the municipal authorities for fumigation. 4. Use effective mosquito repellant while going out and cover windows with mosquito nets. 5. Our digestive system becomes weak during this season so one should avoid eating spicy, fried and junk food as these have heated thermal effect on our bodies and make us feel lethargic and sluggish. 6. Keep food covered. Flies look harmless but are carriers of serious waterborne diseases such as typhoid and cholera. 7. Drink warm water and strictly avoid untreated water, or water/ice from unknown sources. 8. Make the important decision about investing in a home water purifier for the safety of your loved ones; during the monsoon and every day. Consider a water treatment option based on your water quality. UV technology is an excellent disinfection technology and is ideal for municipal treated and supplied water. When the water is from underground sources such as bore wells and is high in salts/TDS making it hard and unpalatable,

Every year more than 3.4 million people die as a result of waterrelated diseases, Most of the victims are young children. Common symptoms include high fever, nausea and vomiting which can become life threatening if ignored.

consider RO technology. (The author is associated with Sir Ganga Ram Hospital, New Delhi)

ABCD of Cancer and its Treatment By Team Double Helical

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Treatment-Cancer

Tumour removal may be the only treatment, or it may be combined with chemotherapy, radiation therapy, or other treatments, which may be given before or after surgery.

ith advancement of latest technology surgery in cancer remains the most effective of all options available for cancer treatment. In fact, surgery has a part to play at all stages from the diagnosis to palliation. Cancer surgery is a highly specialised branch requiring years of intense training, a multidisciplinary team and good paramedical backup. Considered to be the most effective of all options available for cancer treatment, minimally invasive surgery is in increasing demand these days but it is a highly specialised technique requiring years of intense training, a multidisciplinary team and good paramedical backup Cancer is a group of several hundred entities that can begin almost anywhere in the body. It happens when normal cells in the body change from their native state and grow uncontrollably. These cells may form a mass called a tumour. A tumour can be either malignant (cancerous, meaning it can spread to other parts of the body) or benign (noncancerous). However, some cancers do not form solid tumours. These are called haematological malignancies. These include leukaemia, most types of lymphoma and myeloma (cancer of the plasma cells in the

bone marrow, the spongy tissue inside of bones).

Types of surgery Diagnostic: For most types of cancer, biopsy is the only way to make a definitive diagnosis. During a surgical biopsy, the surgeon makes a cut in the skin and removes some or all of the suspicious tissue. There are two main types of surgical biopsies. An incisional biopsy is the removal of a piece of the suspicious area for examination. An excisional biopsy is the removal of the entire suspicious area, such as an unusual mole or a lump. After a biopsy, the tissue removed is examined under a microscope by a pathologist. A pathologist is a doctor who specialises in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The pathologist provides a pathology report to the surgeon or oncologist, who makes the diagnosis. Staging: Staging surgery is performed to find out the size of the tumour and if or where it has spread. This often includes removing some lymph nodes, which are tiny, beanshaped organs that help fight infection, near the cancer to find out if it has spread there. Together with the physical examination, www.doublehelical.com September 2018

Treatment-Cancer

biopsy, and results of laboratory and imaging tests, this surgery helps the doctor decide which kind of treatment is best and predict the patient’s prognosis, that is, the chance of recovery. Tumour removal, also called curative or primary surgery: The most common type of cancer surgery is the removal of the tumour and some of the tissue surrounding the tumour. The tissue surrounding the tumour is called the margin. Tumour removal may be the only treatment, or it may be combined with chemotherapy, radiation therapy, or other treatments, which may be given before or after surgery. Conventional surgery requires large cuts, called incisions, through skin, muscle, and sometimes bone. However, in some situations, surgeons can use surgical techniques that are less invasive, which may speed up recovery and reduce pain afterwards. Debulking: When the complete removal of a tumour is not possible or might cause excessive damage to the body, surgery is used to remove as much of the tumour as possible. Other treatments, such as radiation therapy or chemotherapy may sometimes also be used to shrink the remaining cancer. Palliation: Palliative surgery is used to relieve side effects caused by a tumour. It plays an important role in improving quality of life for patients with advanced cancer or widespread disease. Surgery may be used to help relieve pain or restore physical function if a tumour presses on a nerve or the spinal cord, blocks the bowel or intestines, or creates

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pressure or blockage elsewhere in the body. Surgery may be used to help stop bleeding. Certain cancers are more likely to cause bleeding because they occur in areas with a high concentration of blood vessels, such as the uterus, or organs in which the tumours are fragile and can easily bleed when food and waste products pass through, such as the esophagus, stomach, and bowel. In addition, bleeding may be a side effect of some drugs used to treat cancer. When surgery is needed to stop bleeding, a common technique is suture ligation, which involves tying blood vessels using surgical thread. Surgery may be used to insert a feeding tube or tubes that deliver medications. If the cancer or cancer treatment has made it difficult to eat, a feeding tube may be inserted directly into the stomach or intestine through the abdominal wall. Or a tube may be inserted into a vein to deliver pain medication or chemotherapy. Surgery may be used to prevent broken bones. Bones weakened by cancer or cancer treatment can break easily and often heal slowly. Inserting a metal rod may help prevent fractures of weak bones and relieve pain during healing. Reconstruction: After primary cancer surgery, surgery may be an option to restore the body’s appearance or function. This is called reconstructive or plastic surgery. Reconstructive surgery may be done at the same time as surgery to remove the tumour. Or, it may be done later after a person has healed or received additional treatment. Examples of reconstructive surgery include breast reconstruction after a mastectomy and surgery to restore a person’s appearance and

Conventional surgery requires large cuts, called incisions, through skin, muscle, and sometimes bone. However, in some situations, surgeons can use surgical techniques that are less invasive, which may speed up recovery and reduce pain afterwards.

Treatment-Cancer function after surgery to the head and neck area. Prevention: Some surgery is performed to reduce the risk of developing cancer. For example, doctors often recommend the removal of precancerous polyps in the colon to prevent colon cancer. In addition, women with a strong family history of breast or ovarian cancers or known mutations to the BRCA1 and BRCA2 breast and ovarian cancer genes may decide to have a mastectomy, which is the removal of the breast, or an oophorectomy, which is the removal of the ovaries, to lower the risk of developing breast or ovarian cancer in the future.

Types of minimally invasive surgery As mentioned above, conventional surgery often requires large incisions. However, in some situations, surgery can be performed

Conventional surgery often requires large incisions. However, in some situations, surgery can be performed through one or more small incisions, which typically results in shorter recovery times and less pain afterwards.

through one or more small incisions, which typically results in shorter recovery times and less pain afterwards. Below are some examples of minimally invasive procedures and surgeries: Laparoscopic surgery: The doctor performs surgery through small incisions in the skin using a thin, lighted tube with a camera. For example, a laparoscopy refers to a minimally invasive surgery of the abdomen, and mediastinoscopy and thoracoscopy are terms used when the same type of procedure is performed in the chest. Laser surgery: The doctor uses a narrow beam of high-intensity light to remove cancerous tissue. Cryosurgery: The doctor uses liquid nitrogen to freeze and kill abnormal cells. Mohs micrographic surgery: Also called microscopically controlled surgery, the dermatologist shaves off a skin cancer, one

Role of Surgery Surgery is the removal of the tumour and surrounding tissue during an operation. A doctor who specialises in surgical treatment of cancer is called a surgical oncologist. Surgery is the oldest type of cancer therapy and remains an effective treatment for many types of cancer today. The goals of surgery vary. It is often used to remove all or some of the cancerous tissue after diagnosis. However, it can also be used to diagnose cancer, find

layer at a time, until all cells in a layer appear to be normal cells when viewed under a microscope. Robotic Surgery: This is the latest in minimally invasive techniques of cancer surgery in which the operating surgeon uses a robotic system to perform the surgery. The surgeon is sitting comfortably on the console at some distance while the robot is performing the operation based on the instructions of the surgeon. This system has several advantages like better magnification, degrees of movement, 3D vision and faster rehabilitation. However, the steep cost is the limiting factor. Endoscopy: The doctor inserts a thin, flexible tube with a light and camera on the tip, called an endoscope, into an opening of the body (such as the mouth, rectum, or vagina) to examine the internal organs. During an endoscopic procedure, it is possible to remove samples of potentially abnormal tissue for further examination.

out where the cancer is located, whether it has spread, and whether it is affecting the functions of other organs in the body. In addition, surgery can be helpful to restore the bodyâ&#x20AC;&#x2122;s appearance or function or to relieve side effects. The location where you have surgery depends on the extent of the surgery and how much recovery is needed. Surgery may be performed in a doctorâ&#x20AC;&#x2122;s office, clinic, surgical centre, or hospital. Outpatient surgery means that you do not need to stay overnight in the www.doublehelical.com September 2018

Treatment-Cancer

hospital before or after surgery. Inpatient surgery means that you do need to stay in the hospital overnight or longer to recover after the surgery. The diagnosis of cancer begins when a person reports any unusual symptoms. After discussing a person’s medical history and his or her symptoms, the doctor will perform various tests to find out the cause of the ailment. However, many times a person with cancer has no symptoms. Sometimes a doctor diagnoses cancer after a cancer screening test in an otherwise healthy person. Examples

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of screening tests include a colonoscopy, a mammogram, and a pap test. The results of these tests may necessitate additional tests to confirm or disprove the result of the screening test. Less often, cancer is diagnosed when a person undergoes a medical test for another reason. For most cancers, a biopsy is the only way to make a definitive diagnosis. A biopsy is the removal of a small amount of tissue for further study. The cancer treatment options that the doctor recommends depends on the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. In cancer care, different doctors often work together to create a patient’s overall treatment plan that combines different types of treatment. This is called for a multidisciplinary team.

The diagnosis of cancer begins when a person reports any unusual symptoms. After discussing a person’s medical history and his or her symptoms, the doctor will perform various tests to find out the cause of the ailment.

Children-Dental Care

Let Your Child Smile

Help your child’s teeth stay strong and healthy because the time tooth decay is noticed it may be too late and your child may suffer from long term disorders By Dr Suresh Ahlawat

here are a number of problems that affect the oral health of children, including tooth decay, thumb sucking, tongue thrusting, lip sucking, and early tooth loss. Even though baby teeth are eventually replaced with permanent teeth, keeping baby Dr Suresh Ahlawat teeth healthy is important to a child’s overall health and well-being. Picture YTC Even before the first tooth appears, use a soft, clean cloth to wipe your baby’s gums and cheeks after feeding. As soon as the first tooth appears, begin using a small, soft bristled tooth brush to clean the tooth after eating. Don’t cover the brush with toothpaste. Young children tend to swallow most of the toothpaste, and swallowing too much fluoridated toothpaste can cause permanent spots on their teeth called dental fluorosis. We recommend a first checkup of 12 months old to make certain that teeth and jaw development are normal, and even more importantly so that parents and guardians know how to help their children be healthy from the start.

Guidelines for working with children • Parents/guardians are always welcome in the room • Comfort is always our concern • Parent / guardian consent and guidance are vital, before any procedure

First Visit We recommend a first checkup by 12 months. A simple guide for when to schedule a first visit: no longer than 6 months after first tooth is erupted • No longer than 6 months after first tooth is erupted • At least by 12 months old • As soon as possible if you have any

queries.

ORAL HYGIENE FOR CHILD There is a significant value for early baby dental checkups. In particular, checkups for very young children address many concerns including teaching adults how to care for their child’s teeth and gums, how to help their children learn to care for themselves, answering parents questions and concerns, and planning for future dental health.

Checkups Education and prevention are the cornerstones of our concern for the dental health of children. In addition to teaching parents and guardians about dental care for their child, checkups are an appropriate time to comfortably and easily evaluate like how many teeth are present, are all teeth present, loose teeth if any, braces/bite evaluation, cavity check, check health of gums, habit evaluation, homecare/prevention, fluoride use, review diet. Under it, the doctor addresses adult’s concerns and teach adults how to care for child’s teeth.

Dental Care Tips It is often difficult initially to brush your child’s teeth. They can really put up a struggle, screaming, kicking, crying, running away, not opening their mouths – every kid is different. Healthy teeth and gums are so important to start out life with. We have often heard the value of choosing your battles with your children, and this is one to choose. Remember that the initial challenge you face is actually more taxing on you than it ultimately is for your child.

Common Procedures Include

About the author Dr. Suresh Ahlawat MDS, Maxillofacial Surgeon and Implantologist, BDS, DNB (USA) is an eminent Dental Surgeon (Implantologist) in Gurugram, India. He has been facilitated by former Chief Minister of Haryana, Bhupender Singh Hooda for his excellence in dentistry. Also, he has been awarded the best Implantologist in Haryana by FAMDENT Association in 2016. Adding to his list of awards, the Finance Minister (Govt of Haryana) has also awarded him for his outstanding dental services and skills. He has been a dental practitioner for more than two and half decades now. In his long career, he went on to bring sparkling smiles over his patients’ faces by his great skills and dental knowledge. He has successfully handled innumerable critical cases during his long professional tenure and provided satisfying results to his patients. From the feedback given by his patients, he is known for empathic approach and gentle hands and hence extensively respected by his patients. Dr. Suresh Ahlawat is a renowned international speaker for implantology. To keep upbeat with latest knowledge, Dr Suresh Ahlawat has travelled widely to USA, Switzerland, UK, France, Spain, S Korea, Bangkok etc. His major interest areas are IMPLANTS, COSMETIC DENTISTRY AND FULL MOUTH REHABILITATION.

• 2-MIN FLUORIDE APPLICATIONS www.doublehelical.com September 2018

Children-Dental Care (For prevention from effects of chocolates; colas; sticky foods on teeth) • PIT and FISSURE SEALS (Most recommended way of caries prevention by blocking deep pits & fissures of teeth ) • FLUORIDE FILLINGS (for correction of cavities in milk & permanent teeth) •

ORTHODONTIC ASSESMENT (opinion from specialist orthodontist whether your child needs braces?)

• HABIT BREAKING APPLIANCES (For correction of bad habits like thumbsucking; mouth breathing; tongue – thrusting) • SPACE MAINTAINERS (To allow permanent tooth to erupt in place if milk tooth shed off or extracted early.) • SCALING & POLISHING OF TEETH (to prevent any gum problem) • COLOURED GLITTERING FILLINGS (Latest Fashion Statement in fillings for kids)

Baby Bottle Tooth Decay Baby Bottle Tooth Decay, or Baby Bottle Syndrome, or Nursing Bottle Mouth are all terms used to describe a dental condition, which involves the rapid decay of many or all the baby teeth of an infant or child.

The teeth most likely to be damaged are the upper front teeth. They are some of the first teeth to erupt and thus have the longest exposure time to the sugars in the bottle. The lower front teeth tend to be protected by the tongue as the child sucks on the nipple of the bottle or the breast. Baby Bottle Tooth Decay is caused by frequent exposure of a child’s teeth for long periods of time to liquid containing sugars. When your baby falls asleep with a bottle containing formula, milk or juice, or a pacifier dipped in honey, the liquid pools around the front teeth. During sleep, the bacteria living in every baby’s mouth, turns the milk sugar or other sugars to acid, which causes the decay.

• Have regular dental visits for your child beginning when their first tooth erupts TIP: Cut back on sugary bottles by gradually watering them down until they are only water. Most children begin life with strong, healthy teeth. Help your child’s teeth stay that way. Your newborn is totally dependent upon you as a parent. The decisions you make will have a vital effect on your child’s dental future.

• Oral checks should be performed by parents to detect early signs of the disease. • Brown spots along the gumline on your child’s teeth are signs which should alert you.

Is it important to brush before bed?

• If your child prefers soft foods, frowns or cries when eating cold, sweet, or hard foods, they should be checked for tooth decay.

Yes. If you have to miss a brushing, the bedtime one is probably the worst one to miss. If you don’t get rid of the bacteria and sugar that cause cavities, they have all night to do harm. While you are awake, saliva helps keep the mouth clean. When you are asleep, there is less saliva produced to clean the mouth. For this reason it is important to brush before bedtime.

Parents may not know there is a problem until serious damage has been done:

• You can prevent this from happening to your child’s teeth by learning how to protect them. • daily

Clean your child’s teeth

• Never allow your child to fall asleep with a bottle filled with juice, milk, or formula (or when awake, sip on it for long periods of time as a pacifier) • Start bottle weaning by at least a year • www.doublehelical.com September 2018

• Make sure your child gets the fluoride needed to prevent decay

Try having your child lie down. Put your child on your lap or on the floor, keeping his/ her head steady with your legs. If your child is standing, have his/her back to you with their head tilted slightly and resting against your body. Have your child hold a mirror while you brush and floss their teeth so your child can see what is being done.

By the time tooth decay is noticed it may be too late and crowns, pulp therapy, or even extraction of the decayed teeth may be necessary. As a result, your child may suffer from long term disorders, which include speech impediments, possible psychological damage, crooked or crowded teeth, and poor oral health.

water for thirst

Give your child plain

How to brush your child’s teeth? Every day plaque forms on the inner, outer, and chewing surface of teeth and the gums. Tooth brushing is one of the most effective ways to remove the plaque. The best kind of toothbrush to use is one with soft, round-tipped bristles. A child will need a smaller brush than an adult. Young children do not have the manual dexterity to brush properly. Your child will need your supervision and help brushing until he or she is 8-10 years old to ensure a thorough brushing has been done. When the bristles become bent or frayed, a new brush is needed. Start flossing your child’s teeth when the teeth touch each other and you can no longer brush in between them.