Dr. sabloks' medical centre

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Quality of drinking water and associated health risks

A new NIH study links arsenic in drinking water from private wells to bladder cancer

The quality of water has an important impact on public health. Presence of contaminants, either microbial or chemical, puts health of people at risk. Water-borne diseases such as diarrhea, cholera, dysentery, typhoid, worm infestations are well-recognized and constitute a major cause of mortality and morbidity worldwide.

It’s not only the surface water in rivers and lakes that is susceptible to contamination, groundwater or water in wells too is susceptible to contamination through poor management of industrial or agricultural waste. Groundwater may also be contaminated by naturally occurring chemicals. Drinking water requires appropriate treatment to remove the hazardous contaminants before it is fit for drinking.

Water sources that are unprotected are at a great risk of contamination and become unfit for drinking.

Arsenic is naturally present at high levels in the groundwater in many parts of the world. It is the only contaminant that has been shown to be the cause of human cancers following exposure through drinking water. In addition to occupational exposure, other important routes of arsenic exposure are oral intake of food and drinking-water. The goal for amount of arsenic in drinking water is usually less than 10 µg/L. But, in those areas in which drinking water contains arsenic levels greater than this, it becomes the major source of arsenic.

Findings from a recent NIH study further support an association between low-to-moderate levels of arsenic in drinking water and bladder cancer risk in Maine, New Hampshire and Vermont in the United States, where most people use private wells for their drinking water.

In the study published May 2, 2016, in the Journal of the National Cancer Institute, increasing cumulative exposure was found to be associated with an increasing risk of bladder cancer. Among study subjects who had used private wells, particularly wells that were dug during the first half of the last century, those who drank the most water had a 2-fold higher risk. These private wells are outside jurisdiction of federal regulations and are not maintained by municipalities. The water in these wells may contain low to moderate levels of arsenic due to use of arsenic containing pesticides.

Dug wells are less than 50 feet deep, and potentially susceptible to contamination from man-made sources.

   Over a month ago
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Controlling cholesterol levels can help regress heart disease
High blood cholesterol itself does not cause symptoms; so many people are unaware that their cholesterol level is too high.
Cholesterol lowering is important for everyone--younger, middle age, and older adults; women and men; and people with or without heart disease.
Lipid profile means measuring total Cholesterol, Triglycerides, LDL, HDL, VLDL and Non HDL Cholesterol. VLDL cholesterol is calculated by dividing value of triglycerides by five. LDL cholesterol is calculated by total cholesterol – HDL cholesterol – VLDL cholesterol
A standard serum lipid profile consists of total cholesterol, triglycerides, and HDL-cholesterol and rest are calculated values.
Foods of plant in origin contain no cholesterol. Almonds and nuts contain no cholesterol.
Food liquid at room temperature contains unsaturated fat. Food solid at room temperature is either saturated or a transfat.
Transfat increases bad cholesterol and reduces good cholesterol. Saturated vanaspati ghee increases bad cholesterol but does not reduce good cholesterol levels in the body.
A 1% rise in cholesterol leves can raise the chances of heart attack by 2%. 1% reduction of good HDL cholesterol increases the chances of suffering from a heart attack by 3%.
One yellow of an egg contains cholesterol equivalent to 10 tea spoon full of butter.
Regular exercise can increase the levels of good cholesterol in your body
Keep your total cholesterol lower than 160mg%. LDL is bad cholesterol and should be kept as low as possible, keep it lower than 80 mg/dl. HDL is good cholesterol, keep it more than 40mg%
Lipid profile is done on 8 -12 hours fasting (no calories) to minimize the influence of postprandial hyperlipidemia. Fast for 12 hours to get accurate readings of LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglyceride levels. Avoid drinking alcohol for at least 24 hours before the test.
Serum total and HDL-cholesterol can be measured in fasting or nonfasting individuals. There are only small clinically insignificant differences in these values when measured in the fasting or non-fasting state. So for calculation of Non HDL cholesterol no fasting is required.
Having suffered from a flu or another illness shortly before the blood test can have a dramatic effect on ones cholesterol levels.
High levels of alcohol or carbohydrates taken in the last week can raise triglyceride
An underactive or overactive thyroid can affect cholesterol levels.
If there is a strong family history of heart disease, first Lipid profile should be done at the age of 5. If lipid profile is normal, is should be repeated every 5 years.
Blood lipid levels may exhibit mild seasonal variation with a peak in total cholesterol level in the winter and a trough in the summer. Amplitude of seasonal variation of total cholesterol concentration is 3.9 mg/dL in men and 5.4 mg/dL in women.
The total cholesterol can vary by 4 to 11 percent within an individual due to multiple factors including stress, minor illness, and posture.

   Over a month ago
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According to International guidelines, unless a patient’s platelet count is below 10, 000, and there is spontaneous, active bleeding, no platelet transfusion is required. The outbreak of dengue in the City and Hospital beds are full and families are seen running around in search of platelets for transfusion. However what most people do not realize is that the first line of treatment for dengue is not platelet transfusion. It, in fact, does more harm than good if used in a patient whose counts are over 10, 000.

The primary cause of death in patients suffering from dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multi-organ failure. At the first instance of plasma leakage from the intravascular compartment to the extravascular compartment, fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the difference between the upper and lower blood pressure is over 40 mmHg, or the patient passes adequate urine. This is all that is required to treat the patient. Giving unnecessary platelet transfusion can make the patient more unwell.

“While treating dengue patients, physicians should remember the ‘Formula of 20' i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP of less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high-risk situation and the person needs immediate medical attention.”

Dengue fever is a painful mosquito-borne disease. It is caused by any one of four types of dengue virus, which is transmitted by the bite of an infected female Aedes aegypti mosquito. Common symptoms of dengue include high fever, runny nose, a mild skin rash, cough, and pain behind the eyes and in the joints. However, some people may develop a red and white patchy skin rash followed by loss of appetite, nausea, vomiting, etc. Patients suffering from dengue should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.

The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided.
DENGUE NS1-Best test is NS1
Cannot be false +ve
Is + from day 1 to 7 ideally.
If on day 1 is -ve, repeat it next day.
Always ask for ELISA based NS1 tests as card tests are misleading.

Value of IgG & IgM dengue-
In a pt with reduced platelets and looking "sick" on day 3 or 4 of illness, a very high titre of IgG with borderline rise in IgM signifies secondary dengue. These pts are more prone to complications.
In primary dengue IgG becomes + at end of 7 days, while IgM is + after day 4.

Immature Platelet fraction/IPF
A very useful test in Dengue for pts with thrombocytopenia.
If IPF in such a pt is > 10%, despite a pl count of 20, 000 he is out of danger & platelets will rise in 24 hrs
If its 6%, repeat the same next day. Now if IPF has increased to 8% his platelets will certainly increase within 48 hrs.
If its less then 5%, then his bone marrow will not respond for 3-4 days & may be a likely candidate for pl transfusion.
Better to do an IPF even with borderline low platelet count.

A low Mean Platelet volume or MPV means platelets are functionally inefficient and such pts need more attention.**

   Over a month ago
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75% of Indians suffer vitamin deficiency
Chennai: More than seven out of ten Indians lack in vitamins, and most of them suffer from vitamin D deficiency that is linked to Alzheimer's disease, prostate cancer, erectile dysfunction and schizophrenia. Chennai-based Metropolis Healthcare studied 14, 96, 683 samples over three years and found an increasing trend of deficiency in vitamin D, vitamin B12 and vitamin B9 (Folic Acid) among all age groups of Indians. The samples tested across four zones showed that 75% of the population was deficient in three vital vitamins. While 21.02% were deficient in vitamin B12 and 15.06% deficient in vitamin B9, 81.28% of all samples were deficient in vitamin D. Dr Sonali Kolte of Metropolis said symptoms of vitamin D deficiency can be vague, with muscle or joint pain, weakness, and depression. "Vitamin deficiencies usually show slowly. Nowadays, it is observed that people deficient in Vitamin D are more likely to have diabetes, regardless of how much they weigh, " Dr Sonali Kolte said… Lack of Vitamin B12 is so staggering that it is the culprit behind the suboptimal blood levels of nearly half the Indian population, said consultant nutritionist Dr Deepa Agarwal of Asian Bariatrics… The study found that Vitamin B9 or folic acid was deficient especially in the 20-40 age group. Vitamin B9 is vital for pregnant women to prevent anaemia and major birth defects in the baby… The study indicated that the majority of the population had poor practices and were ignorant of vitamin sufficiency… (Source: Times of India - Janani Sampath)

   Over a month ago
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Simple Dengue Fever:

Over ninety-five percent people suffer from simple dengue fever, which is not as threatening as severe dengue fever.
In simple dengue fever there is no capillary leakage, the person requires only oral fluids, 100 ml per hour, and is advised to visit a local doctor
Additionally, the patient is recommended to drink 500 ml water at the time of diagnosi Only those patients with dengue fever who have vomiting should consume intravenous fluids
Severe Dengue Fever:

Those suffering from severe dengue develop capillary leakage and intravascular dehydration. Also, they suffer from a rapid fall in the platelet count along with rapid rise in their hematocrit levels They will have rapid fall in platelets along with rapid rise in hematocrit levels
Persistent vomiting, nausea, extreme exhaustion and lethargy are some of the symptoms of dengue. Along with these symptoms, a victim might suffer unrelieved abdominal pain and mental irritability and confusion.
These people require close daily observation.
Dengue patients are kept under close observation and are recommended to consume 1500 ml fluids (20 ml per kg) immediately
And in case, when they cannot consume liquids orally, then intravenous fluids are a must

Formula of 20 to identify high-risk cases of Dengue fever:

If there is a rise in pulse by 20
Fall in upper blood pressure by 20
Rise in hematocrit by 20 percent
Rapid fall in platelets to less than 20, 000
Petechiae (red spot) count of more than 20 in one inch after tourniquet test
If the difference between upper and lower blood pressure is less than 20, then such cases should be given 20 ml of fluid per kg immediately and then shifted to nearest medical center for medical assistance
What you need to do in case symptoms are prevalent?

The follow-up tests are required to witness the rise in hematocrit and significant fall in the level of platelets.
The tests are required to be screened simultaneously.
Platelets transfusions are not required unless there is active bleeding and platelet count is less than 10, 000
Keep a tab on hematocrit levels are crucial as their count decides the adequate requirement of fluids required by the body
It is important to remember the following:

Capillary leakage only occurs when the fever is on the verge of subsidin
In the initial 48 hours, including 24 hours after fever is over, are crucial, and the patient requires plenty of fluids as a sub-treatment
Signs of itching or rash usually occur post the capillary leakage period is over
When is urgent admission required?

If the patient is unable to consume or tolerate the consumption of liquids
Pregnant women Underlying comorbid conditions
Infants or elderly people
Patients suffering from uncontrolled diabetes...

   Over a month ago
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20 min of sunlight and a glass of milk can keep osteoporosis at bay
Osteoporosis and vitamin D deficiencies are the two new epidemics of the society.

Drinking less milk, avoiding sunlight exposure and omitting the traditional aerobic indoor games are few reasons for these new epidemics. Most young professionals now remain confined to their offices or workplace, with practically no exposure to sunlight. This is especially true for the medical residents.

Here are a few tips for preventing osteoporosis and strengthening the bones.
Stop smoking as it increases bone loss.
Eat a calcium-rich diet: The aim should be to get 1, 500 mg of calcium a day in postmenopausal woman or a man over age 65. Good dietary sources of calcium include dairy products, tofu and other soy products, orange juice fortified with calcium, canned salmon with the bones, and cooked spinach. The alternative is to take calcium supplements.
Get enough vitamin D: Vitamin D levels are influenced by how much sunlight one gets. Levels tend to decrease in older adults, especially in winter and in people who are unable to leave their home. Consider taking a supplement to ensure intake of the recommended daily amount.
Get exposure to sunlight of at least 20 min per day. The exposure should be for duration of 20 min every day for a month in a year.
Get enough protein in diet: An adequate intake of protein in diet, combined with an adequate intake of calcium helps increase bone density. One should aim for about 12% of calories to come from proteins such as legumes, poultry, seafood, meat, dairy products, nuts and seeds. However, too much protein with too little calcium can be harmful.
Weight-bearing exercise: These are activities such as walking, jogging and climbing stairs that one should do on the feet, with your bones supporting your weight. They work directly on the bones of the legs, hips and lower spine to slow mineral loss.
Weightlifting exercises: These exercises, also called resistance training or strength training. They strengthen muscles and bones in the arms, chest and upper spine. They can work directly on the bones to slow minerals loss.
Get adequate vitamin K: This vitamin may be helpful in enhancing bone strength. Green leafy vegetables are the best sources of vitamin K. If one is taking a blood thinner, he or she should check with the doctor.
Avoid excessive alcohol: Women should limit alcohol consumption to less than one ounce a day and men should limit it to less than two ounces.
Limit cola drinks: People who have high cola intake often have lower bone density.

   Over a month ago
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