Kerala battles its worst floods in 100 years: Acute health effects of floods

Floods waters not only take a toll of human life, they also leave an aftermath of illnesses. The health effects of floods can be immediate as well as long-term.  Today we discuss the immediate or acute health effects of flood.

Drowning

Floods create an immediate risk of drowning for everyone. It has been postulated that two thirds of flood-related deaths worldwide are from drowning and one third from physical trauma, heart attacks, electrocution, CO poisoning or fire.

Drowning may occur by falling into fast-flowing water, at times of unknown depth, including open manholes, crossing flooded rivers or streams, standing on bridges that might be washed away or driving through flood-water. Driving through floodwater is risky. Vehicles do not provide adequate protection from flood waters. They can be swept away or may stall in moving water. As per the CDC, people in vehicles are at greatest risk for drowning, while according to the UK health protection agency, 6 inches of fast-flowing water can knock over an adult, and 2 feet of standing water will float a car.

Injuries

Walking through floodwater is dangerous. Sharp objects submerged in the water can cause injury. Standing waters can hide open manholes and drains, or holes in the roads or other trip/fall hazards. Flood waters can displace vehicles, trees and other material, which can cause injury. Building collapse or damage may also cause injury. Chances of injuries are more when people are trying to evacuate and move away from the fast approaching water. Types of injuries include wounds caused by sharp objects and fractures.

Electrocution

There is a risk of electrocution if water is present anywhere near electrical circuits and electrical appliances. Submerged fallen power lines or live wires can electrically charge the standing water.

Communicable diseases

Although in the short term, there is limited risk of transmission of communicable diseases, floods can potentially increase the transmission of:

• Water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis A
• Vector-borne diseases, such as malaria, dengue, yellow fever, Zika

The major risk factor for water-borne diseases is drinking from potentially contaminated water sources. Leptospirosis, a zoonotic bacterial disease can also be transmitted directly from contaminated water and may cause epidemic. Infection may be acquired by wading in floodwater or contaminated fresh water, especially if there is open wound or scratch.

Direct contact with polluted waters can cause wound infections, dermatitis, conjunctivitis and ear, nose and throat infections.

Hypothermia may occur, particularly in children, if trapped in floodwaters for long periods of time.

Chemical contamination

Industrial chemical leaks, gasoline and diesel spills from vehicles, fuel supplies, pesticides, including household items can contaminate flood water. Carbon monoxide poisoning may occur due to the use of portable generators or pumps to remove collected water.

Stress

Psychological stress manifesting as tearfulness, numbness, tearfulness, numbness, lethargy, low mood is common.

Other health effects

• Trench foot, also known as immersion foot, caused by prolonged exposure of the feet to wet, unsanitary, and cold conditions.
• Animal and insect bites may occur as flood waters can displace animals, insects, and reptiles from their home.

In addition, health risks are also associated with the evacuation of patients to safer grounds, loss of health workers and/or health infrastructure including essential drugs and supplies and damage to equipments.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Emedinews Inspiration: Everything I need to know about life

Everything I need to know about life, I learned from Noah's Ark...

One: Don't miss the boat.
Two: Remember that we are all in the same boat.
Three: Plan ahead. It wasn't raining when Noah built the Ark.
Four: Stay fit - When you're 600 years old, someone may ask you to do something really big.
Five: Don't listen to critics; just get on with the job that needs to be done.
Six: Build your future on high ground.
Seven: For safety  sake, travel in pairs.
Eight: Speed isn't always an advantage. The snails were on board with the cheetahs.
Nine: When you're stressed, float a while.
Ten: Remember, the Ark was built by amateurs; the Titanic by professionals.
Eleven: No matter the storm, there's always a rainbow waiting.
Twelve: You may want to leave the woodpeckers off the ark.

(Source:http://www.inspire21.com/stories/lifestories/EverythingIneedtoknowaboutlife)

(Contributed by Dr Maj. Prachi Garg)

Emedinews Inspiration: VIKRAMADITYA'S JUDGEMENT

Once upon a time, there lived a pious old man, renowned for his honesty. One day his neighbor, a rich merchant came to him with a request. The merchant was leaving on a voyage and wanted the old man to safeguard his wealth, until his return. The old man agreed, and with God as his witness promised to protect and safeguard the merchant’s wealth.

The old man then entrusted the safekeep of the merchant’s wealth to his son, from whom he only takes an oath of propriety and honesty.

But, slowly the son starts dipping into the merchants wealth. People noticed this and warned the old man of his son’s misdeeds. The old man asks his son to explain, and reminds him of his oath on following the right path. The son rubbishes the accusations as rumours and the idle gossip of jealous people, who cannot bear to see his prosperity. The old man accepts the son’s explanation and things go on as before.

The merchant returns and demands his wealth. The old man calls his son, who hands over a quarter of the merchant’s wealth saying that is all there was. The merchant realizing that he has been cheated approaches the King. The King listens to the merchant’s complaint and summons the old man. The old man comes to the court with his son and handing him over to the King, and says “Your majesty, the merchant is right. My son has confessed to the crime. Please punish him !”

The king has the son flogged and imprisoned. He then praises the old man’s honesty and dismisses the case.
But the merchant insists that the old man should be punished, saying, “Your majesty, I have still not received justice. I had entrusted my wealth to the old man, which he swore by God to safeguard. The old man’s integrity is intact, but what about me, I have been robbed of most of my life’s savings, and made a pauper. It was the old man’s decision to entrust my wealth to his son for safe keeping that has caused this loss. As far as I am concerned the old man is the real culprit, and should be punished.”

The king is astounded by this demand. The old man, was neither a party to the son’s theft, nor did he benefit from it. In fact, he had sent his son to jail. Yet, the merchant was asking for the old man punishment ?!
...The Betal asked Vikramaditya : “What should be the Kings decision ?!”

Vikramaditya’s replied : “Though the old man is innocent of the actual theft, he is guilty of dereliction of duty. The son’s crime was a straightforward one, the old man’s was a graver crime. He did nothing to protect the merchant’s wealth. Far from being vigilant, he failed to take action even when he was warned of his son’s misdeeds. Because of the old man’s laxity, the trusting merchant is now condemned to a life of penury. So, he should be punished !”

Contributed by Dr Anupam Malhotra

Should we measure carotid intima media thickness in any cardiac risk assessment?

Measuring maximum intima-media wall thickness of the internal carotid (neck) artery may boost the predictive power of Framingham risk scores as per Dr Joseph Polak, of Tufts University, and colleagues who reported their findings in the New England Journal of Medicine.

1. Thickening in both arteries is used as a surrogate measure of atherosclerosis.

2.   In the common carotid it manifests as diffuse arterial wall thickening

3.    In  the internal carotid artery, it's a surrogate for focal atherosclerotic plaque

4.   Both are recognized tools for cardiovascular risk assessment

5.   To clarify the issue, Polak and colleagues analyzed data from 2,965 patients in the Framingham Offspring Study who were followed for an average of 7.2 years, and 296 of them had a cardiovascular event during that time.

6.   Plaque is defined as an intima-media thickness of more than 1.5 mm in the internal carotid artery. Plaque in ICA is a significant predictor of cardiovascular events.

7.    Recent American College of Cardiology and American Heart Association guidelines give common carotid artery intima-media thickness a level IIa recommendation for risk evaluation -- the same level as ankle-brachial index and coronary artery calcium scoring.

8.    Intima-media thickness of the internal carotid artery should be measured in addition to the thickness of the common carotid artery for purposes of cardiovascular risk assessment.

Doctors too should respect the prefix ‘Dr.’ before their name

Go and wish your doctor “Happy Doctor’s Day”

July 1 is Doctor’s Day.  Call your doctor or your doctor friends and wish them a Happy Doctor’s Day.  Medicine is a noble profession. Among all professions, medicine is the only profession which can be regarded as next to God.

 “Doctors treat, but God heals” is a well-known saying. Doctors thus serve as the messengers of God. A doctor cannot refuse treatment. It is a doctor’s duty to attend to a patient in emergency regardless of caste, creed, race or the financial status of the person.

This principle has been very well-personified in our mythology too. Ramayana cites the story of Vaidya Sushen, who treated Lakshmana with the famed Sanjivani booti. He was called to see the unconscious Lakshmana during the war between Lord Rama and Ravana. Despite the fact that he was a royal physician in the kingdom of Ravana, Sushen made the decision of treating Lakshmana. This illustrates the ethical duties of a physician.  Likewise, if a person sentenced to death by hanging falls ill, it is the duty of a physician to treat him until the day of his hanging.

 The concept of Family Physician or the General Practitioner of the olden times is fast vanishing in this age of super specialization. Every day new specialties are coming up. What was once the domain of a family physician has been now divided among different specialties. This has created a gap in communication between patient and doctor often leading to litigations. To avoid this, look for a Family Physician, who will be your guide in all health matters and also coordinate your care when specialists are involved.

Doctors too should respect the prefix ‘Dr.’ before their name

Very few professions have the privilege of prefixing an honor before their name and medical profession is one of them. We, as doctors, are allowed to prefix ‘Dr.’ before our names and we must respect this honor.

Diwan, Rai Bahadur, Rotaries, Lion, Justice etc. are other sets of prefixes given by the society to distinguished people.  Even the Prime Minister of India, President of India, Member of Parliaments, MLAs, Councillors have no such privilege. Likewise, Padma Awardees too have no such privilege. They cannot write Padma Shri Dr. XYZ but can only write Padma Shri Awardee Dr. XYZ.

There is no law in India, which allows doctors to write prefix ‘Dr.’ before their names. It is a precedence which has been accepted and honored by the society. The prefixes Dr., Diwan, Rai Bahadur etc. distinguish the privileged persons from the rest of the population. These prefixes indicate that the main duty of these people is towards the welfare of the society. For example, people are aware as to whom to contact when in trouble. It can be any one with a ‘prefix’.

It is the Vedantic principle of “welfare of the society” which makes doctors special and different in the society. The day this aspect of welfare is lost, society may not accord us the same respect as they have been doing so till now.

The principles involved in acting towards the welfare of the society includes giving 10% of our time to charity; not charging any fee from those who cannot afford;  charging less from the middle class and charging normal from people who can afford and where reimbursements are available. Probably, this is the reason that in every hospital even today we have multiple systems of patients and policies starting from Free Wards, General Wards, Concessional Semi Paying Wards and Fully Paid Wards. Many hospitals have even come out with another category of Deluxe where one can charge more from people where money is not a problem. It is the rich who has to pay for the poor in the welfare system.

Let us ( we the doctors) resolve on Doctor’s Day, July 1, 2011 to commit some portion of our time for the welfare of the society.

Mayor Prof Rajni Abbi Releases Poster of Clean India

Delhi Mayor Prof Rajni Abbi released a poster with a message in a function organised to celebrate World Environment Day. Prof Rajni said "Think of metro as your personal limousine; public park as your personal farm house, city river your personal swimming pool AND keep them clean. My country clean Country"

On this occasion Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India said that all citizens of India should make efforts towards a safer and clean India.

Apart from external environment, we should also clean and look after our internal environment, he further added. He also appealed that manufacture of mercury instruments should be stopped. Environment health means not only reducing air pollution but also involves reducing the global warming, electromagnetic radiation pollution, and the noise pollution.

He said that one should switch over to CFL lamps as tube lights and bulbs consume more electricity compared to a CFL bulb. CFLs consume 75% less electricity and last 10 times longer. He recommended the use of CFL bulbs in fixtures that are kept switched on for more than two hours a day. A 23 watt compact fluorescent bulb can replace the 100 watts that a simple bulb requires. By just replacing 275 watt light bulbs that are switched on for four hours a day with 215 watt energy conservation lamps, one can save almost 18 kilowatt hours of electricity in an hour.

Mr. Satish Upadhaya Director IMCS said that one should saggregate the waste at source.

Dr. S.S. Agrawal, Professor, DIPSAR said that pollution, particularly if not tackled, may cause kidney failure and such other diseases. He also said that noise pollution not only disturbs the environment but also the ear health of a person. Experts have said that even listening to music with head phones, through iPod or a music CD player, can be harmful to the health of ear. Loudness of the sound is measured in decibels (dB) and any sound louder than 85 dB can cause hearing loss. The higher the decibel, the shorter the amount of time one is exposed to the sound before hearing loss occurs.

Eminent Kathak Dancers Ms Nalini and Ms Kamalini, said that one can be spiritually healthy only in an atmosphere of clean environment.

Acharya Dr. Sadhnaji Maharaj, President, World Fellowship of Religions, said that all the religions and dharmas talk about the importance of clean environment.

India on high alert against deadly 'Super Toxic Bug' E. coli strain 0104LH4 that causes kidney failure

1.      India is on high alert against the deadly strain of Shiga toxin-producing E coli ( STEC 0104: H4)

2.      Has infected over 1823 cases across 12 European nations (Austria, Czech Republic, Denmark, France, Netherlands, Norway, Spain, Sweden, Switzerland, Britain and the United States) including 520 cases of hemolytic uremic syndrome (HUS). Twelve HUS cases were fatal, and 6 deaths were reported among non-HUS cases. (17 deaths in Germany and I in Sweden)

3.      The Food Safety and Standards Authority of India has informed its officials to watch out for all food items, especially fruits and vegetables, coming in from Europe.

4.      The FOOD source IS organic Spanish cucumbers. cucumbers, tomatoes, and lettuce are top suspects.

5.      E coli is a common bacteria in the GI tract and part of the normal bacterial flora. However some E coli strains produces a toxin that could produce serious infection. The infection is acquired by consuming contaminated food or water.

6.      The incubation period is 3-4 days in conventional strain but in the STEC 0104: H4 strain it is 7-12 days. Most patients' symptoms resolve within 5 to 7 days. However, HUS STEC 0104: H4 can develop a week after diarrhea begins.

7.      Symptoms range from mild to severe bloody diarrhoea, mostly without fever. The strain STEC 0104: H4 is causing severe symptoms, including stomach cramps, bloody diarrhea, vomiting, and fever. However, fever is not usually high.

8.       As per WHO, this STEC 0104:H4 strain of E coli "is a unique strain that has never been isolated from patients before" and there may be "various characteristics that make it more virulent and toxin-producing".

9.      The hemolytic-uremic syndrome (HUS) is characterized by the simultaneous occurrence of a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury.

10.  Microangiopathic hemolytic anemia: Hemoglobin levels are usually less than 8 g/dL. The Coomb's test is negative and the peripheral blood smear is characterized by the large number of schistocytes and helmet cells. There is no correlation between the severity of the anemia and the severity of the renal disease.

11.   Thrombocytopenia: Platelet counts are generally around 40,000/mm3. There is no correlation between the degree of thrombocytopenia and the severity of the renal disease.

12.  Acute renal injury: The severity of renal involvement ranges from hematuria and proteinuria to severe renal failure and oligoanuria, which occur in one-half of cases. Hypertension is also frequently observed. Although as many as 50 percent of those with HUS require dialysis during the acute phase, the prognosis for recovery of renal function is generally favorable.

13.   Up to 10% of patients with this latest infection  with STEC 0104: H4 strain  may develop HUS, with a case-fatality rate ranging from 3% to 5%. 

14.   Normally HUS is the most common cause of acute renal failure in young children but this strain (STEC 0104: H4) is affecting female adults above the age of 20.

15.   It can cause neurological complications like seizure, stroke and coma in 25% of HUS patients and chronic renal sequelae, usually mild, in around 50% of survivors.

16.   Normally HUS can be Typical HUS or atypical HUS. Typical HUS is Shiga-like toxin (Stx) associated HUS and atypical HUS is non-shiga toxin (NStx) associated HUS.

17.   Typical Stx HUS occurs after a prodromal episode of bloody diarrhea. It normally affects children under the age of five years. On the other hand atypical non-shiga toxin associated (NStx) HUS is a heterogeneous disorder distinguished clinically by the absence of diarrhea or Shiga toxin-producing E. coli infection, but with microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury.

18.   Typical HUS primarily follows an infection with Shiga toxin producing strains of E coli. The most common serotype is O157:H7, which is found in 70 percent of cases. The annual incidence is 2 to 3 per 100,000 children less than five years of age. The current strain is different Shiga toxin–producing E coli O104:H4.

19.   This disorder is commonly observed during the summer.

20.  The differential diagnosis includes : other enteric infections, Henoch-Schönlein purpura, systemic vasculitis, sepsis, and disseminated intravascular coagulation.

21.   There is no known effective therapy to prevent progression from the bloody diarrheal  phase (acute infectious phase) to the post diarrheal phase of HUS.

22.   Therapy is supportive. One can give antibiotics but NOT anti motility agents. Some research has shown that administering antibiotics may in fact increase their risk of developing HUS, but the CDC recommends that clinicians ultimately determine treatment according to each individual patient. There may be indications for antibiotics in patients with severe intestinal inflammation if perforation is of concern. Of note, isolates of STEC O104:H4 from patients in Germany have demonstrated resistance to multiple antibiotics.

23.    Patients may require red blood cell transfusions when the Hb is below 6 g/dL.

24.  Platelets are transfused when there is active bleeding or prior to a required invasive procedure in patients with platelet counts less than 30,000/mm3

25.   Dehydration is corrected as per requirement.

26.   Dialysis is done as per standard indications.

27.    Hypertension is managed by fluid restriction, antihypertensive agents, and dialysis if needed.  Nifedipine is the drug of choice in initial phase to be substituted with ACE inhibitors later.

28.   Parenteral diazepam, phenytoin, and fos-phenytoin are used for seizures.

29.   One can try plasma exchange in cases with significant neurologic symptoms.

30.   Do not use antithrombotic agents or oral Shiga toxin-binding agent.

31.   In general, prognosis is excellent with mortality rates below 5 percent. 5% of patients will have significant long-term sequelae of either stroke or end-stage renal failure. In patients who require renal transplantation, recurrence of HUS is rare.

32.  All stools submitted for testing from patients with acute community-acquired diarrhea should be cultured for STEC O157:H7. These stools should be simultaneously assayed for non-O157 STEC with a test that detects the Shiga toxins or the genes encoding these toxins

33.  It is often difficult to isolate STEC in stool by the time a patient presents with HUS.

34.  WHO does not recommend any trade restrictions related to this outbreak.

Cops detain IIT boy, extort money for 'porn' on phone

Piyush, after a long journey from his home in Chhattisgarh, got off at Dadar station only to be picked up by a group of railway policemen who snatched his phone and threatened to arrest him for allegedly having pornographic clips on it. They then extorted money out of him after intimidating him with handcuffs and belts inside a locked-up police chowky. This wasn't the first time the policemen had pulled a trick like this. The entire episode was perfectly set up. Such cases of extortion are common. Such policeman should be punished. Police has no powers to violate the privacy of a citizen without provocation. 

6 simple steps to keep your mind sharp at any age ( Harvard HealthBeat)

1. Keep learning: Challenging your brain with mental exercise is believed to activate processes that help maintain individual brain cells and stimulate communication among them.

2. Use all your senses: The more senses you use in learning something, the more of your brain will be involved in retaining the memory.

3. Believe in yourself: Middle–aged and older learners do worse on memory tasks when they’re exposed to negative stereotypes about aging and memory, and better when the messages are positive about memory preservation into old age.

4. Prioritize your brain use: Take advantage of calendars and planners, maps, shopping lists, file folders, and address books to keep routine information accessible. Designate a place at home for your glasses, purse, keys, and other items you use often.

5. Repeat what you want to know: When you want to remember something you’ve just heard, read, or thought about, repeat it out loud or write it down.

6. Space it out: Repetition is most potent as a learning tool when it’s properly timed. It’s best not to repeat something many times in a short period, as if you were cramming for an exam. Instead, re–study the essentials after increasingly longer periods of time — once an hour, then every few hours, then every day. Spacing out periods of study is particularly valuable when you are trying to master complicated information, such as the details of a new work assignment. 

Air ambulance crashes near Delhi, 10 killed

Ten persons, including all seven onboard a small civil chartered aircraft were killed when the medical ambulance flight to Delhi  from Patna crashed into a densely-populated residential area in bad weather near Faridabad on Wednesday.

Faridabad's SDM Pradeep said three persons on ground were among the dead when the P-12 turboprop aircraft belonging to Delhi-based Air Chartered Services India Pvt Limted crashed in Jawaharnagar locality near the IAF station at around 1035 PM shortly before landing at IGI airport in Delhi.

Two persons were also injured in the crash. The persons who lost their lives on the ground are believed to be residents of the houses hit by the plane.

According to Delhi airport sources, the airplane lost control and nosedived from a height of about 8,000 feet fifteen minutes before landing. There was strong gusty winds due to a duststorm at the time of the crash.

The plane caught fire as soon as it crashed on two houses sending up plumes of smoke.

The airplane was ferrying a critically ill patient Rahul Raj, a young Patna-based businessman, to be taken to Apollo Hospital in New Delhi for further medical management. Raj, who was in coma, was undergoing treatment in Patna's Jagdish Memorial hospital. The airplane was arranged by Apollo Hospital.

Besides the two pilots, two doctors and two medical attendants accompanying the patient were on board the ill-fated aircraft. The plane was piloted by Harpreeet with Manjeet Kataria as the co-pilot.

Dr Arshad and Dr Rajesh were the doctors while Ratnesh Kumar and Shiril the medical attendants.

The bodies of all the 10 victims were charred beyond recognition, according to Faridabad Police Commissioner P K Agarwal.

TOI adds: A small aircraft with seven on board crashed into a colony in Faridabad's sector 22 around 10.45 pm on Wednesday, killing all on board. They included the 22-year-old patient, Rahul Raj, an attendant, two doctors, one male nurse, the pilot and co-pilot. Those killed were Dr Rajesh, Dr Arshad, Captain Harpreet, co-pilot Manpreet Kataria, Ratnesh Kumar and male nurse Cyril.

Padmashri Awardee Dr K K Aggarwal, editor emedinews comments: This is a typical professional hazard with both doctors and the patients loosing their life. There should be guidelines for the safety of doctors and the nurses who travel to carry patients.