Diarrhoea and Oral Rehydration Therapy

Diarrhoea or acute gastroenteritis is a universal problem. The most frequent cause of acute gastroenteritis is an infection of the intestines. Such an infection results in an outpouring of fluid and electrolytes (sodium, potassium, chloride and bicarbonate) from the intestinal epithelial cells into the intestinal lumen, which is then purged out as diarrhoeal stool. Diarrhoea has been defined as passing of three or more loose or watery stools in a day. If there is vomiting along with loose stools; loss of large amount of body water and salts is imminent and would lead to dehydration. Infants and young children develop dehydration faster than adults especially in hot climates, when diarrhoea is also associated with fever. So the most significant harmful effect of diarrhoea is major loss of fluid and electrolytes. However during the infective diarrhoea the intestinal ability to absorb of glucose, salts, water and nutrients remain well preserved. Since the absorptive ability of intestines is not altered by diarrhoea, so the management of diarrhoea or acute gastroenteritis is possible with oral rehydration therapy (ORT).

For ORT, a standard solution of oral rehydration salts (ORS) prepared under the recommendations of World Health Organization (WHO) is administered through mouth in small amounts (50 to 100 ml) depending on the age of patient at regular intervals of time. For preparing a standard solution of ORS, the powder is dissolved in known quantity of boiled cooled or purified drinking water as mentioned on the packet of ORS. With oral rehydration therapy the death rate of people dying of severe dehydration due to diarrhoea has significantly come down and the requirement of intravenous drips has become almost negligible.

A packet of ORS contains 27.5 grams of essential salts to be dissolved in a litre of boiled cooled or purified drinking water. An ORS packet contains 20 grams of glucose, 3.5 grams of sodium chloride (common salt or table salt), 2.5 grams of sodium bicarbonate (backing soda) and 1.5 grams of potassium chloride. Packets of ORS are supplied free of cost at Primary Health Centers and Government Hospitals and dispensaries. Low salt content home-made fluids are equally good in emergency if a packet of ORS is not available immediately. Children with diarrhoea should be treated with ORS without loss of time.

The solution of ORS should be kept covered and used within 20 hours. If need be, fresh ORS solution should be prepared after 20 hours. Adults and older children should drink as much as they like from a cup or tumbler of ORS. A child under two years of age should be given half to one cup of ORS solution after each stool to compensate the loss of water and salts. Older children and adults should drink at least one to two cups after each stool. Easily digestible solid food such as boiled rice, soups, porridge, banana shake, curd, eggs, fish and well cooked meat are allowed even during diarrhoea. Treatment in hospitals and health centers depends on the degree of dehydration and other complications like fever and shock.

Potato & Mushroom Poisoning

If you study the botanical origin of potato, you would find that it belongs to the group of plants, the stems and leaves of which contain toxic agents termed as solanines. The botanical name of potato is Solanum tuberosum and it belongs to the family Solanaceae. Solanines are known to cause poisoning in cattle eating the potato plant. The tuber (potato) itself also contains small amounts of poisonous material called solanines in its peels. You must have seen that storage of potatoes leads to greening and sprouting. Both these processes lead to the production of poisonous material around the 'sprouting eyes' and also inside the flesh of potatoes. Sprouting and green potatoes taste bitter due to the presence of solanines and should not be consumed. Sometimes, people who are unaware of the poisonous nature of green and sprouting potatoes; eat these and develop poisoning symptoms. The onset of potato poisoning symptoms occurs some 4 to 12 hours after its consumption. The abdominal pain, vomiting and diarrhoea are predominant symptoms of potato poisoning. Mild headache and fever have also been reported in some cases. Severe potato poisoning may also lead to a state of coma.

Be cautious while eating potato products. The treatment of potato poisoning is always symptomatic; loss of fluids and electrolytes have to be replaced orally with oral rehydration powder dissolved in water or intravenously in cases of severe dehydration. Use of antibiotics should be avoided in known cases of potato poisoning. An average general practitioner may miss the diagnosis of potato poisoning and pass of the case as a common case of 'gastroenteritis'. The potato poisoning may be severe form of food poisoning in students eating midday meal from the common kitchen at schools, as the kitchen staff generally overlook the quality of potatoes received by them.

Mushroom poisoning is also presented with abdominal pain, vomiting and profuse diarrhoea after latent phase of around 12 hours or more. Severe mushroom poisoning may also lead to liver and kidney failure within 3 to 4 days after the development of vomiting and diarrhoea. Some of the mushrooms, e.g. Amanita phalloides are so poisonous that consumption of one mushroom is sufficient to cause severe poisoning and three mushrooms could be considered a fetal dose. With the cultivation of mushrooms being taken up by the trained personals, the cases of mushroom poisoning have come down. Only those who collect and eat wild mushrooms fall prey to mushroom poisoning due to lack of knowledge about the identifying features of poisonous mushrooms. Knowledge is the key to care and maintenance of health. Never eat green or sprouting potatoes and wild mushrooms to save yourselves from potato poisoning or mushroom poisoning.

Cholera: Prevention is better than cure

Cholera is a diarrhoeal disease caused by the bacteria known as Vibrio cholerae. The infection leads to a form of diarrhoea in which the patient passes the so called rice-water stool instead of the usual formed faeces. The cause of such stools is now well understood. On entering the human intestine through contaminated food or water, the Vibrio cholerae lodges itself in small intestine. Here it secretes certain proteinaceous substances (known as enterotoxins), which attach to the specific receptors (Gm ganglioside)on the intestinal cell surface. A part of enterotoxin then enters the intestinal epithelial cells and activates the metabolic pathway in them leading to a profuse outpouring of fluids from them into the intestinal lumen. The bacteria themselves, however, do not invade the tissue. The disease had been endemic in India down the centuries, mainly in the Ganges and Brahmputra deltas in Bengal. The record of spread of Cholera throughout the world is available only after 1817 when the first pandemic occurred.  Since then six such pandemics are on record showing that the disease affected millions of people all over the world with high rate of mortality and morbidity. The seventh pandemic spread from the Sulwesi Island in Indonesia in 1961 that was caused by a biotype el Tor of Vibrio cholerae.

The man is the only source of the disease. The spread occurs through a contaminated environment. An infected patient excretes around 10⁷ to 10² bacteria per ml of stool which may further contaminate drinking water through sewage pollution. Wells and reservoirs of surface water (lakes and ponds) can get contaminated easily.  Food is another source of infection. All people in the endemic area should use boiled cooled water for drinking. Food handlers can also act as transmitters of infection. Flies act as mechanical transmitters of Cholera infection. Sanitation staff should be alerted to decontaminate the water-bodies with permitted chemicals.

The clinical picture may range from an asymptomatic carrier state to the fulminant disease. The most characteristic feature is rice-water stool and a precipitate vomiting. Dehydration may develop due to fluid loss and if not treated, the patient may collapse within 24 hours. Tentative diagnosis of disease can be made by the microscopic examination of stool, where a hanging drop preparation on a slide would show darting mobility of the bacteria. The specific diagnosis is made by growing the bacteria on artificial media in the laboratory and by serotyping of bacterial colonies grown on media.

The disease is treated by replacing the lost fluids and electrolytes, intravenously if the patient is admitted to a hospital or orally through oral rehydration powder. Tetracycline is the drug of choice. Sulphonamides, furazolidne and cotrimethoxazole have also been found to be useful. Drugs should never be taken without medical consultation. Cholera is one of the diseases which can be prevented by vaccination controlled by sanitation. The source of infection being man alone and the commonest vehicle of transmission is the water. Special attention should therefore be paid to the purity of water and the ice made from it for human consumption. The disposal of human excreta and garbage should be safe and soiled clothes of the patient must be disinfected. The isolation and treatment of Cholera patients is must. The outbreak of cholera should be notified at national level immediately for adequate prophylactic vaccination of people traveling to that area. The cholera vaccine (vaccine developed from attenuated Vibrio cholerae) is given by intramuscular injection provides effective protection for two to three months in around 89% of vaccinated population. However, oral vaccines of cholera are also available with variable protective efficacy.

Aborting or Preventing an Attack of Asthma by Relaxation Exercises

The conventional treatment of asthma with drugs has extensively been changed during the last 20 years. Modern therapy of asthma is fully reliable to prevent or to abort an attack of asthma but we should not ignore the ancillary advice of yoga experts. It is eminent to mention here that customized breathing exercises propagated by yoga experts are also a reliable method to abort or to prevent an attack of asthma. It is more important to learn that how to relax respiratory muscles and thereby make it easier for lungs to overcome an attack of asthma. In fact, general relaxation of all voluntary muscles of the body, practised daily, also helps.

The essential abnormality in asthma is the narrowing down of the bronchi (the breathing tubes of the lungs). The patient feels uncomfortable when passage of air through these narrowed bronchi becomes difficult. The patient should not panic at this time of distress rather try to relax. Our respiratory process has two components: 1) Inspiration and 2) Expiration. Inspiration is an active process, the chest muscles expand the chest and the air is sucked in. The expiration is achieved by allowing the chest muscles to relax like gently deflating an air filled balloon. In normal health we do not have to force the air out during expiration.

In the case of asthma, the inspiration (breathing in) needs palpable and visible effort due to narrowing of bronchi but greater difficulty arises in expiration (breathing out). An asthmatic, therefore tries to force the air out and in this process the bronchi get even more narrowed. The asthmatic has thus to put in even more vigorous effort to empty out the lungs. This explains why in case of asthma the lungs stay inflated. The struggle involved in breathing in during an attack of asthma, brings into action all the respiratory muscles that stay relaxed during the normal breathing. The tension spreads to the upper abdominal muscles (muscles of the tummy) causing abdominal distension during an attack of asthma. The muscles of the bronchi are involuntary muscles that do not obey orders like voluntary muscles of our limbs, chest wall and elsewhere. The drugs used to treat asthma have a powerful action on the involuntary muscles that have constricted the lumen of bronchi (the breathing tubes). So, the secret of treating an attack of asthma is to open up the narrowed breathing tubes by relaxing their muscles.

Relaxation Exercises:

1. One should avoid tension by thinking away from asthma and thus try to relax the mind. Intended relaxation of mind by sitting calm with closed eyes for 10 minutes twice daily would be beneficial. After relaxation exercise one should gradually and peacefully shift to routine assignments.
2. One should not try to breathe rapidly but try to slow down the process and take deeper breaths. Your deliberate effort to regulate the process of breathing would bring you relief from unpleasant symptoms of over-breathing.
3. One should allow the lungs to relax before taking the next breath in and should not try to force emptying of the lungs during an attack of asthma.
4. One should learn to breathe with the chest muscles and also use the upper part of abdomen. If you distend your tummy along with your chest during inspiration and pull in tummy during expiration, that would exercise your diaphragm muscles and make you feel more comfortable. As one tries to take a long breath, one should try to keep the upper chest muscles relaxed and gently distend the abdomen (tummy). If an asthmatic practises this technique during asymptomatic periods, it would minimize the severity of an attack.
5. Relaxation techniques should be learnt and practised when one is symptom free.
6. Yoga offers excellent 'asanas' (sitting postures) to achieve relaxation of muscles.
7. If the attack of asthma is eminent in spite of your best efforts to prevent or abort it, immediately take a dose of drug prescribed by your treating physician.

Amoebiasis: Bowel amoebiasis and spread of infection to liver and lungs

The organism that causes amoebiasis is a unicellular parasite called Entamoeba histolytica. A variety of clinical presentations are seen. Though the disease is not a major health problem but in serious forms of amoebiasis, significant morbidity and mortality is unavoidable. We may have asymptomatic carriers of amoebic infection. On the other hand Entamoeba histolytica infection may result in fulminant dysentery with fever, diarrhoea, bleeding and even perforation of intestine. The organism can be identified in wet slide preparation of stool specimen obtained from infected patient.

The infection is transmitted by the faeco-oral route. The infection can be an asymptomatic one, that is, the victim could be in good health in-spite of harboring the Entamoeba histolytica infection. In severe cases of infection, Entamoeba histolytica can result in full-fledged frank dysentery along with colonic ulceration. Uncommonly, Entamoeba histolytica can invade organs other than large intestine. Liver is the second common site followed by lungs. The brain, genitals and the skin are other possible sites if infection by the amoeba. The majority of patients do not develop frank-dysentery, i.e. they do not develop diarrhoea with blood or mucus. Vague symptoms, such as discomfort in the tummy, irregularity of bowels, constipation, diarrhoea, griping and tenesmus occur in various combinations. In some cases, low grade fever, loss of weight, pallor, generalized non-specific aches and pains are common. The patient usually carries on his day-to day duties with sub-optimum health and efficiency.

The diagnosis of asymptomatic bowel amoebic infection can be established through repeated fresh stool microscopic examination. The sigmoidoscopic examination of ulcerative lesions of colon and microscopic examination of direct smears obtained from the ulcers would further confirm the diagnosis of amoebic ulcers. Invasion of liver by Entamoeba histolytica is the second commonest form of amoebiasis. The onset is usually insidious but an exceptionally rapid course can be seen during endemics of bowel amoebiasis. The presenting symptoms of liver amoebiasis are pain in the upper right quadrant of tummy, or fever or both. The presence of jaundice is very rare in patients with liver amoebiasis. Fever of uncertain origin is a common problem in many developing countries. One of the causes of the fever of uncertain origin could be amoebic infection of the liver.

The diagnosis of amoebic infection of the lungs and brain requires a high degree of expertise on the part of physician/clinician. The amoebic infection of brain is usually diagnosed at the operation table. Amoebic ulceration of skin is not very rare. Sophisticated techniques like serology and radio-isotopic scan can be of great help in establishing the diagnosis of amoebic abscess of liver, lung or brain. The treatment of amoebiasis is highly effective once a correct diagnosis has been made. Eradication or prevention of amoebiasis in any locality can be achieved only if there are optimum ways of sewage disposal and personal hygiene.

Effect of Alcohol on Fetus

Thousands of research papers have been published to highlight the hazardous effects of alcohol on the fetus in the womb of drinking mothers. It has been estimated that 60-70% of pregnancies of mothers having 5 to 6 drinks a day may have an abnormal outcome. Even moderate levels of drinking during pregnancy would be detrimental to the fetus. Excessive drinking during pregnancy may lead to fetal alcohol syndrome (FAS). The fetal alcohol syndrome (FAS) includes failure of growth before and after birth, various physical defects and neuro-developmental disorders. The FAS has an incidence of around one percent in live births from such women. The healthcare of alcohol damaged children (ADC) would need extra spending by individuals as well as by governments. Psychiatrists recommend total abstinence from alcohol during pregnancy.

The alcohol abuse and drink trade are subjects of the interest of governments worldwide. Majority of the governments are interested in the wealth than health. The average consumption of alcohol has doubled during the last decade in many developing countries. You would find increased number of outlets of liquor in your area. The alcohol seems to be an ever-expanding scourge, taking a heavy toll of health and wealth due to lack of social alcohol discipline. The drinking habits of female population need to be reliably surveyed to ascertain the damage caused to their infants.

Children’s health, growth and immunization: Our role in preventing preventable diseases

Unless we look after our women and children in a programmed manner in the field of health, we cannot have a happy world around us. Children are still killed or disabled each year by diseases that could have been prevented by immunization. The World Health Organization (WHO) is doing its best to eradicate/eliminate a variety of infectious diseases, but involvement of every citizen of the world is must for compliance of various programs of the WHO. The measles, mumps and rubella triple vaccine (MMR) should be included in the EPI (Expanded Preventable Immunization) program of every country. We should not ignore the facts that measles and mumps can cause considerable morbidity and mortality which could be prevented with optimum immunization. Optimum immunization means full course of vaccination schedule without missing any booster dose.

Apart from vaccination child nutrition and general health must be taken care of. The child health reminds me the efforts of Mr. James P Grant, the Director of United Nations' Children's Fund (UNICEF, 1984), who in 1984 brought out a Report on the State of World's Children, and forwarded a mnemonic GOBI-FFF to remember the techniques which could reduce sadness of the world. In GOBI-FFF, "G" stands for growth monitoring, "O" stands for oral rehydration therapy, "B" stands for breastfeeding, and "I" stands for immunization. The three Fs (FFF) stand for 'family spacing', food supplements and female education. The methods represented by GOBI-FFF are the simplest methods which could help us in tiding over the state of health of children and preventing diseases and saving lives. Consequent upon the compliance of GOBI-FFF, lives of millions of children are saved every year and the health and growth of millions more is protected. Still there is need to protect the children from episodes of common childhood diseases like measles, respiratory infections and diarrhoeal infections.

Various infections also interfere with physiological and psychological development of children. The malnutrition and infections perpetuate each other and may lead to suboptimum brain development. The GOBI methods are not so expensive. Community health workers can be assigned the responsibility of growth monitoring through periodic recording of weight and height of a child. The oral rehydration salts (ORS) should be supplied at cost price to prevent the dehydration caused by diarrhoea. The breastfeeding should be encouraged since it provides ideal nourishment to the child and saves from the infectious hazards of bottle feeding. Immunization against tuberculosis, diphtheria, pertusis (whooping cough) tetanus, polio, measles, mums and rubella protects the child against these serious as well as disabling diseases. Attention should also be given to the health education of mothers. Awareness about the child's health in mothers would definitely make all the healthcare and immunization programs successful. It is well established fact that proper spacing between child births decreases the risks to the heath of the mother and the infant. Food supplements should regularly be supplied to the mothers during pregnancy and vaccination against tetanus should be done. We must put in our best efforts to prevent the preventable diseases since prevention is better than cure.

Role of Fruits & Vegetables in Averting Strokes

Cardio-vascular disease (CVD) causes stroke in majority of patients with chronic hypertension. Fruits and vegetables have a variety of natural ingredients/nutrients, which act as protecting factors against strokes. Raised blood pressure along with tobacco smoking is a major risk factor in patients with CVD. It is well documented that fresh fruits and vegetables have a considerably high potassium content and low sodium content. Fresh fruits are very rich source of vitamin-C also. It is evident that fresh fruits and vegetables influence the sodium-potassium ratio and thus help in lowering the blood pressure in hypertensive people. It is advisable that hypertensive patients should restrict the salt (sodium chloride) intake only then intake of fresh fruits and vegetables would be helpful.
Many countries have reported a decline in stroke rates and mortality with a change in the eating habits of their people. One should stay normotensive (normal blood pressure) for prolonged survival. Avoid smoking and eat fresh fruits & vegetables to keep a check on your blood pressure to avoid strokes and heart attacks. Live Healthy, Live Long.

Bioenergy Conservation and Diabetes mellitus

Diabetes mellitus (DM) is related to common metabolic disorders and is expressed by hyperglycemia (i.e. elevated level of glucose in blood). There are a variety of DM and are caused by complex interactions of genetics and environmental factors. In fact DM is a sort of lifestyle associated metabolic disorder. Sedentary lifestyle, over indulgence in alcohol and excessive consumption of fatty fast-food laced with preservatives are the cause of excessive conservation of bioenergy in human body. One should be calorie conscious and take balanced diet to avoid getting obese and over weight. Obesity is an invitation to metabolic disorders.
Non-insulin dependent diabetes mellitus (NIDDM) is also known as diabetes-II (or Type-II Diabetes, where as Diabetes-I is insulin dependant) and is characterized by variable degree of insulin resistance and pancreatic beta cell dysfunction. Loss of metabolic control is probably associated with neuroendocrine control system that effect hepatic glucose output. Computerization and automation in industrial units is the cause of bioenergy conservation in workers, leading to metabolic disorders like diabetes mellitus. Low energy expenditure due to leisure-way lifestyle and reduced sensitivity to peripheral insulin further complicate the case. Vascular complications associated with DM lead to morbidity and mortality in patients with diabetes mellitus. Energy expenditure needs to be increased in diabetics by way of exercise; brisk walking and cycling.  Optimum energy expenditure in diabetics can act as adjunct to reduce the level of hyperglycemia.