Link between air pollution and still birth – Bangladesh should be careful

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“There are more than 3,600 stillbirths every year in the UK, which means that 11 babies are stillborn every day. Worldwide, there are an estimated 2.6 million stillbirths each year.

To date, two reviews of the published evidence have suggested a possible link between stillbirths and air pollution. However, further evidence has since emerged, prompting a team led by the University of Oulu in Finland to conduct a systematic review of research published up to 2015.

They say that the 13 studies found an association between exposure to air pollution and a heightened risk of stillbirth. This association was strongest during the third trimester of pregnancy.

Specific findings show that a 4 ug/m3 increase in exposure to small particulate matter of less than 2.5 microns is associated with a 2% increased risk of stillbirth. Also that exposure to nitrogen dioxide, carbon monoxide, fine particulate matter of 10 microns or less, and ozone are all linked to higher risk”.

Source: Medscape

Now, this is the picture of UK where environmental pollution is thought to be less. If I start thinking about only Dhaka city, let alone the whole of Bangladesh then, the picture will not be a chummy one. In Dhaka, the level of environmental pollution is quite massive and people are heavily exposed to various toxic pollutants every day. If this study about the link between still birth and air pollution proves its worth in future, then, I am sure, the pregnant women of Dhaka city will be at greater risk.

Environmental pollution is a disease which can’t be cured, but can be prevented. So far, I don’t think none of us have taken effective initiatives to prevent this disease. Along with the population-boom, environmental pollution is a major issue to create headaches for Bangladesh. But sadly, we always deny to notice the major issues.

 

Thank You

Faisal Caesar

World Hypertension Day 2016 – The young adults in Bangladesh should be careful

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Once upon a time, the communicable diseases triggered massive headaches among the scientists and medical practitioners. As the time progressed, the population of the world is gradually becoming a victim of non-communicable diseases (NCDs). Among the NCDs, hypertension or high blood pressure is regarded one of the heavyweights among others and is regarded one of the most feared customers because of its nature of inviting adverse outcomes.
 
Hypertension is one of the major non-communicable diseases (NCDs) in the world, which significantly contributes to the burden of cardiovascular diseases (CVDs), stroke, kidney failure, disability and premature death. It is also identified as a global disease burden and is ranked third as a cause of disability-adjusted life-years (DALYs).
 
According to the World Health Organization (WHO), about 17 million deaths occur worldwide due to CVDs, of which hypertension alone accounts for 9.4 million deaths, and 80 % of the CVD-related deaths occurred in the developing countries. The global prevalence of hypertension is projected to increase from 26 % in 2000 to 29.2 % by 2025, which will be approximately 29 % of the world’s population.
 
Although hypertension is more prevalent in developed countries like USA, its prevalence is increasing in the low and middle-income countries. Countries in Asia, especially Southeast Asia, are having an increasing burden of hypertension including CVDs. According to the WHO, hypertension has become a significant health concern in the Asian region, affecting more than 35 % of the adult population. The two fast-growing economies, India, and China, have a huge burden of hypertension and are projected to proliferate by 2025.
 
In Bangladesh, the concern for the communicable disease have always been taken more seriously rather than the NCDs. But day by day, this developing country in the South Asian region is becoming a victim of high blood pressure.
 
In recent years, rapid urbanization, increased life expectancy, unhealthy diet, and lifestyle changes have led to an increase in the rate of CVD including hypertension in Bangladesh. According to the National Guideline for Hypertension, about 11-18% of adults (mostly the middle-aged adults) and 40 to 65% of elderly populations suffer from hypertension.
 
According to The National Center for Biotechnology and Information, the prevalence of hypertension was first reported as 1.10 % in 1976 in Bangladesh. A systematic review and meta-analysis of the prevalence of hypertension in the country among 6,430 adults for the period 1995 to 2009 was estimated to be 13.5 %. Moreover, there was a wide range of variation in the prevalence of hypertension reported by several studies ranging from 11 to 44 %.
 
Due to the lack of representative data, these studies were small-scale, confined to urban – rural communities or some other specific groups (e.g. slum residents), which cannot provide sufficient information for Bangladesh at large. Also, a substantial proportion of the population with hypertension remains undiagnosed and not treated properly due to lack of access to health care and high treatment costs.
 
Even though, many still regards hypertension to be a disease of the elderly groups, but now a days, the age groups above 25 years are also being affected by hypertension. In India, one in 4 individuals aged above 25 years has hypertension and it is increasing at an alarming rate.
 
The study about the prevalence of hypertension among the young adults are not satisfactory as because, about 32.9% or even more percentage of this age group doesn’t measure their blood pressures. Keeping in mind the changes in lifestyle and food habit among the young adults in Bangladesh, the possibilities of hypertensive cases can’t be ruled out among this age group.
 
They should be careful enough as because the majority of the young adults in Bangladesh can develop a high blood pressure because of the following reasons:
 
 
1. Sedentary lifestyle.
 
2. Lack of interest in doing exercises, walking and running.
 
3. More habituated to eating junk foods and drinking soft drinks.
 
4. Smoking and alcohol intake.
 
5. The habit of taking unnecessary stresses.
 
6. Lack of proper sleep.
 
7. In Bangladesh, adulteration of food products, fruits and vegetables must have taken the top spot by now.
 
If the young and adult age group of Bangladesh becomes hypertensive at such an early stage of their life, then how can this country progress? In that sense, these age groups should be very cautious about their health and check their blood pressure at least once in a six month and it should be done by a registered physician.
 
Above all, you can prevent secondary hypertension, which is not dependent on genetic factors, by modifying your lifestyle:
 
1. Shun sedentary lifestyle and build the habit of regular exercises, walking and running either outside or on a treadmill so that you don’t gain extra weight.
 
2. Eat healthy foods such as vegetables, fish, fruits and meat according to the need of your body.
 
3. Avoid junk foods and soft drinks.
 
4. Avoid smoking and alcohol intake.
 
5. Reduce salt intake.
 
6. Avoid taking unnecessary stresses.
 
7. Build the habit of taking a sufficient amount of sleep.
 
8. Women should avoid taking Oral Contraceptive pills as much as possible.
 
9. Build the habit of undergoing a thorough health check up at least once in a year to keep updated about your health.
 
On this World Hypertension Day, please, do check your blood pressure via a registered physician, shun all the bad habits, eat healthy foods and lead a healthy life.
 
Stay healthy, stay safe.
Thank You
Faisal Caesar

We need to be cautious enough, while prescribing the fluoroquinolones

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The US Food and Drug Administration (FDA) said today, until and unless other treatment options are  available, patients with uncomplicated infections should not receive fluoroquinolones, given the risk for disabling and potentially permanent adverse events.

Fluoroquinolones are very productive antibiotics with better coverage against the Gram Negative organisms. It is active against the Gram positive organisms as well. But with the progression of time, the adverse effects related with fluoroquinolones outweigh their beneficial effects.

Fluoroquinolones cause adverse effects like, tendonitis, tendon rupture, central nervous system effects, peripheral neuropathy, exacerbation of myasthenia gravis, QT prolongation and torsades de pointes, phototoxicity, and hypersensitivity. These adverse events can also occur together.

In Bangladesh, we use fluoroquinolones like: Ciprofloxacin, Levofloxacin, Ciprofloxacin Extended release and Ofloxacin quite effectively. I have also seen the pharmaceutical companies to promote fluoroquinolones like Gatifloxacin, Sparfloxacin, Gemifloxacin and Moxifloxacin. Frankly speaking, I have not seen the adverse effects associated with these drugs to crop up in an ugly fashion. But we physicians, always keep ourselves updated about the recent studies of diseases and medicines and follow the new guidelines available. In that sense, we should be cautious enough regarding the use of fluoroquinolones.

These antibiotics have been proving their worth for more than twenty years in Bangladesh, but at the moment, I guess we need to be careful about using these antibiotics until and unless we don’t have any other options left.

Thank You

Faisal Caesar

Asthma symptoms exacerbate in the summer season as well

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There is a common perception among many people that, asthma symptoms only exacerbate during the winter season. But as a matter of fact, the symptoms of asthma can show up during the summer season as well. Many patients rush into the Cardiac Emergency of the hospitals in Bangladesh during this hot and humid condition with breathlessness thinking that, they have a cardiac problem. But after an appropriate physical examination and ECG reading, the doctor at the emergency confirms that, he or she is suffering from Bronchial Asthma or Chronic Obstructive Pulmonary Disease (COPD) and not any cardiac diseases.

The patient and their attendants get surprised by the remark of the physician and don‘t want to believe as because, at the back of their minds, they firmly believe that, the symptoms of asthma don’t exacerbate during the summer season. The physicians then, explain them about the reason behind the sudden onset of breathlessness. Some of the patient party agrees, while the rest disagrees.

The symptoms of bronchial asthma show up during the summer season as well. People with mild asthma may discover that when the temperature rises along with the humidity levels, their asthma symptoms begin to act up. According to the asthma experts, the exacerbations of summer asthma are due to heat stress, which leads to various changes in the human airway passage and trigger asthma.

Again, increase level of humidity itself can trigger asthma as well and when the temperature rise along with humidity, it becomes a fertile breeding ground for allergens such as dust mites. Mold thrives in moist, warm, dark environments. During the summer season, we see an increase in mold. These allergens also worsen the impact of environmental pollutants, such as exhaust fumes and ozone.

For some, summer heat and humidity may be complicated by seasonal irritants such as smoke from fires.

So, the symptoms of asthma also exacerbate during the summer season. Studies suggest, the effects of hot air saw asthma symptoms occur within as little as four minutes of inhaling the hot and humid air.

Now, what should a patient do when his asthma symptoms worsen during the summer season

1. As soon as you experience cough, wheeze and breathlessness, try not to inhale hot air as much as possible. It’s a tough task to do for those who work in outdoors, but consider avoiding outdoor assignments

2. If you experience that you are allergic to a summer trigger, such as mold or grass pollen, consult with your physician immediately about getting tested and necessary measures. This will prevent an asthma exacerbation caused by an undiagnosed allergy.

3. Always keep an eye on the weather news and get an idea about the temperature,                  humidity and air quality index. If the conditions are not suitable, avoid outdoor works          and if you are driving a car, always close the window.

4. Try to finish your important outdoor tasks as early as possible in the morning  before the uncomfortable situation sets in.

5. Swimming is a recommended exercise for asthmatics, and in the summer it reduces your chances of becoming overheated. However, some people find that their summer asthma symptoms are triggered by the chlorine added to most pools for water safety. If chlorine triggers symptoms in you, find another activity or exercise program, such as an indoor fitness class.

6. Keep indoor humidity low. Even if you can’t control the weather, you can control your home environment. Set your indoor humidity to 50 percent or lower to cut down on dust mites, mold, and humidity-related allergens that grow in warm, moist environments.

Above all, for any problems, always consult with your physician.

Stay healthy, stay safe.

Thank You

Faisal Caesar

Warning signs of stroke – You need to know to save a life

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Your father had just finished his routine walk after dinner and sat with you and other members of the family to have a candid talk before going to sleep. All of you are having a wonderful family time, but suddenly, a certain panic gripped you and other family members. It was a bolt from the blue.

You could notice that, your father started to sweat profusely and was having difficulty in talking. His vision was beginning to blur and he was unable to lift his left arm. All of your family members were perplexed by this sudden incident and rushed towards the old man to hold him as he was about to lose his consciousness and fall to the floor.

Your father settles down after a while.

Your family members decide to keep your father at home and consult with a doctor the next day. The next day, your physician confirms you that, your father has suffered a stroke and needed immediate hospitalization. Neither you nor your family members could even realize, your father could suffer such an ischaemic event in the brain as your father has always a health conscious patient and his diabetes and hypertension have always been under control.

But in an elderly patient, Ischaemic or Haemorrhagic strokes can show up any time and when the patient is diabetic and hypertensive, the risk is always there.

Many family members fail to recognize the warning signs of stroke and thus, get panicked rather than taking drastic measures. When the patient settles down a bit, they decide not to rush to the hospital immediately. Such an act has invited many adverse outcomes for many families.

It’s very important to know about the warning signs of stroke:

  1. Sudden numbness or weakness of the face, arm or legs on the one side of the body.
  2. Sudden confusion, sweating, trouble speaking and understanding.
    3. Sudden trouble in seeing or blurred vision in one or both eyes.
    4. Sudden trouble with walking, dizziness, loss of balance or coordination.
    Sudden severe headache with known cause.
    5. Sudden severe headache with known cause.

If the patient has vomited, then the possibilities of a haemorrhagic stroke should be kept in mind.

When you notice the above signs evident among one of your family members, friends or near and dear ones, don’t panic, but keep calm and take him or her to the hospital as soon as possible.

You might save a life.

Thank You

Faisal Caesar

 

About fever and common cold – Just keep things simple

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The climate of Dhaka is very unstable at the moment. At times, the weather is extremely exhausting while at other times, it’s quite wet due to rainfall. Dhaka’s pollution and dense population have already put a question mark over its hygienic status and now, this sort of weather makes Dhaka’s hygienic status quite critical. Such sort of weather gives rise to various health problems and among many, fever and common cold are a common phenomenon and at the moment, many of the residents of Dhaka are suffering from such a health problem.

Whenever, a patient of this country suffers from common cold and fever, he or she immediately starts taking antibiotics without the advice of a physician or they do such according to the advice of a medical-shopkeeper. Such a practice is very bad as because, this common cold and fever happens mostly due to a viral infection and in such cases, antibiotics have no role to play. By practicing such, the majority of the patients of Dhaka and outside Dhaka is  inviting a fatal problem: Antibiotic resistance.

If a patient keeps on taking antibiotics, according to their whims, they are sure to develop antibiotic resistance and there might come a time when, his or her body might not be responsive to any antibiotics in the near future.

If you are suffering from a common cold and fever then, just go for a symptomatic treatment:

1. For fever take antipyretics like paracetamol.
2. For running nose and cough, take suitable antihistamines according to the advice of your physician.

3. Drink more warm water and lemon juice.

4. Take enough rest and don’t forget to keep a napkin or tissue paper so that you can use it while sneezing and avoid the spreading of respiratory droplets which is contagious in nature.

5. Consult with your physician.
You can prevent fever, and the common cold by yourself as well:
1. Avoid drinking ice-cold water and soft drinks in hot climates.

2. Avoid smoking.

3. Avoid taking a bath while you are still sweating.

4. Avoid dust and pollution as much as you can.

5. Clean your room regularly to keep it free from dusts. 

6. Spend less time in air-conditioned room. You can switch on the AC when it’s needed. Otherwise, don’t spend too much time there as Legionella infections occur from air-conditioners.
Always consult with your physician about any health problems and make sure your physician is registered medical practitioner. Avoid treating yourself and listening to what a medical-shopkeeper says.

Thank You

Faisal Caesar

 

 

Thalassaemia

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Thalassaemia is the most common inherited gene disorder in the world and varies in different population groups in the world. With global improvement in childhood diseases, due to prevention and treatment with targeted programs to prevent mortality from malnutrition, diarrhoea & acute respiratory infections, thalassaemia will become a major issue in developing countries like Bangladesh in this millennium. World Health Organization (WHO) estimates that at least 6.5% of the world populations are carriers of different inherited disorders of Hemoglobin. It is predicted that when the world population finally stabilizes, at least 8.0% of the world population will be the carrier or trait of different types of thalassaemia syndromes & hemoglobinopathies.

The world population of carriers of beta thalassemia trait is reported to be more than 100-million worldwide and about 100,000 children with Thalassaemia major are born each year. Abnormal hemoglobin, called hemoglobin-E, which is quite common in Bangladesh no definite data regrading carrier status of the hereditary hemoglobin disorder exist.

No screening program had ever been taken in any population group. A conservative World Health Organization (WHO) report estimates that about 3.0% of populations are carriers of Beta thalassaemia and 4.0% are carriers of Hb-E in Bangladesh, which means that there are about 3.6-million carriers of beta thalassemia and 4.8-million carriers of Hb-E and affected birth per thousand of Beta halassemia is 0.106 & 3.000 of Hb-E/Beta thalassemia and affected birth per thousand of Beta thalassemia is 0.106 & 0.300 of Hb-E/Beta thalassemia. It is presumed that approximately six thousand thalassemic children are born each year in Bangladesh.

The birth of a thalassemic child could create a negative impact not only on the affected child and its family, but also to the whole community and country and the country’s economy as well, as because, without a healthy young generation, no country cannot advance forward.

All over the world, efforts are being made to prevent the birth of thalassemic children and to improve the quality of life those who are suffering. Thalassemia needs to be recognized as an important health issue in this country and necessary steps are needed to be taken to control the birth of thalassemic babies.

What is Thalassaemia?

Thalassaemia is an inherited (passed from parents to children through genes) blood disorder caused when the body doesn’t produce enough hemoglobin, which is an essential component of Red Blood Cells. When there isn’t enough hemoglobin, the function of body’s Red Blood Cells is dented  and their life span is shortened and for which,  there are fewer healthy red blood cells traveling in the bloodstream.

Red blood cells carry oxygen to all the cells of the body. Oxygen is a sort of food that the cells use to function. When there are not enough healthy red blood cells, there is also not enough oxygen delivered to all the other cells of the body, which may cause a person to feel tired, weak or short of breath. This is a condition called anemia. People with thalassaemia may have mild or severe anemia. Severe anemia can damage organs and lead to death.

 

What are the different types of thalassaemia?

When we talk about different “types” of thalassaemia, we might be talking about one of two things: the specific part of hemoglobin that is affected (usually either “alpha” or “beta”), or the severity of thalassaemia, which is noted by words like trait, carrier, intermedia, or major.

Hemoglobin, which carries oxygen to all cells in the body, is made of two different parts, called alpha and beta. When thalassaemia is called “alpha” or “beta,” this refers to the part of hemoglobin that isn’t being made. If either the alpha or beta part is not made, there aren’t enough building blocks to produce  normal amounts of hemoglobin. Low alpha is called alpha thalassaemia. Low beta is called beta thalassaemia.

When the words “trait,” “minor,” “intermedia,” or “major” are used, these words describe how severe the thalassaemia is. A person who has thalassaemia trait may not have any symptoms at all or may have only mild anemia, while a person with thalassaemia major may have severe symptoms and may need regular blood transfusions.

In the same way that traits for hair color and body structure are passed down from parents to children, thalassaemia traits are passed from parents to children. The type of thalassemia that a person has, depends on how many and what type of traits for thalassaemia a person has inherited, or received from their parents. For instance, if a person receives a beta thalassaemia trait from his father and another from his mother, he will have beta thalassaemia major. If a person received an alpha thalassemia trait from her mother and the normal alpha parts from her father, she would have alpha thalassaemia trait (also called alpha thalassaemia minor). Having a thalassaemia trait means that you may not have any symptoms, but you might pass that trait on to your children and increase their risk of having thalassaemia.

Sometimes, thalassaemias have other names, like Constant Spring, Cooley’s Anemia, or hemoglobin Bart hydrops fetalis. These names are specific to certain thalassemias – for instance, Cooley’s Anemia is the same thing as beta thalassaemia major.

How do I know whether I have thalassaemia or not?

People with moderate and severe forms of thalassaemia usually find out about their condition in childhood, since they have symptoms of severe anemia early in life. People with less severe forms of thalassaemia may only find out because they are having symptoms of anemia, or maybe because a doctor finds anemia on a routine blood test or a test done for another reason.

Because thalassaemias are inherited, the condition sometimes runs in families. Some people find out about their thalassaemia because they have relatives with a similar condition.

People who have family members from certain parts of the world have a higher risk for having thalassaemia. Traits for thalassemia are more common in people from Mediterranean countries, like Greece and Turkey, and in people from Asia, Africa, and the Middle East. If you have anemia and you also have family members from these areas, your doctor might test your blood further to find out if you have thalassemia.

How can I prevent thalassaemia?

Since it is a severe and incurable disease, emphasis must shift from the treatment of the affected child to prevention of this disease. All forms of thalassemia are transmitted hereditically. Identification of carriers of the thalassemia gene plays an important role in preventing this fatal, but preventable disease.

If you or your partner knows about family members with thalassaemia, or if you both have family members from places in the world where thalassemia is common, you can speak to a genetic counselor .

The following steps to be recommended and which are being followed in many countries :

 

  1. Creating awareness

Creating awareness via the print and electronic media can be very useful and the appropriate utilization of social media can be very helpful as well.  The government must also take steps to create awareness among the rural populations by involving thana health complexes and other different local organizations through different activities like seminars, symposium, publications etc. It is a very sad-affair that other than Dhaka, no facilities exist for the diagnosis of thalassemia in any other parts of the country.

 

  1. Population screening

Population screening  of such vast group of people is quite a hectic job, but a cheap and easily accessible screening method is available to detect the carriers.

“NESTROF {Naked Eye Single Tube Red Cell Osmotic Fragility) has been developed along with the morphology of red cells & red cell indices (MCV, MCH, RWD) for detection of beta-thalassemia trait & other hemoglobinpathies like Haemoglobin-E trait which is most common abnormal hemoglobin in Bangladesh and showed to be very effective in mass population screening.

It is done in India, Iran, Thailand and Iraq. In Iraq this screening method was applied in national survey to detect the carrier- state all over the Iraq .

This screening test for carrier detection is active in Bangladesh as well. A practical approach would be to perform NESTROF in an accessible way to the unmarried cohort of peoples like adolescents at school leaving or before starting college, or young adults starting a job or going to marry, must perform this screening HbA2 or Hb-E. By diagnosing and counseling thalassemia carriers, it becomes feasible and attractive alternative for prevention of thalassemic birth in our country.

 

  1. Genetic counseling

Genetic counseling needs to be given to thalassemia carriers and parents who have a thalassemic child. It should be not-directive and the counselor’s main role is to provide people at risk with full information; give them time for consideration and support them in making decisions.

Thank You

Faisal Caesar