Dengue fever: Why do you need to stick to Paracetamol? Painkillers increase the risk of internal bleeding and affect the liver

The Indian Express | 1 week ago | 23-09-2022 | 07:45 pm

Dengue fever: Why do you need to stick to Paracetamol? Painkillers increase the risk of internal bleeding and affect the liver

There has been an increasing trend in dengue cases across the country with the disease map now spreading pan-India, way up to Jammu and Kashmir. In fact, there is no State or Union Territory left with zero cases. According to data from the National Vector Borne Diseases Control Programme (NVBDCP) till August end, there have been more than 30,627 cases and 12 deaths. Karnataka (5,392) Maharashtra (2,927)and Kerala (2,007) have the maximum cases. The new additions in the dengue map are Jammu and Kashmir (96) and Nagaland (two). In 2021, there were 1.93 lakh dengue cases and 346 deaths across the country while 2020 had seen a dip, probably because the focus was on treating COVID 19. What’s worrisome this year is the emergence of unusual symptoms in focal areas, resulting in a quick descent to dengue haemorrhagic fever.WHAT ARE UNUSUAL SYMPTOMS THIS YEAR?This year, there have been some patients with complications. In Delhi, where cases have surged over the last two weeks, people are coming to hospitals with internal bleeding, shock (sudden drop in blood pressure) and liver complications. Dr Rommel Tickoo, Director of Internal Medicine, Max Healthcare, said, “Although the numbers are not as high as what Delhi saw in 2015 and 2016, we are seeing more people with complicated dengue. Those with liver involvement show symptoms of jaundice, but these cases are self-limiting.”Some patients in Maharashtra have reported severe complications. According to Dr Sanjay Pujari, infectious diseases expert, we should be worried if the rate of complications is higher than previous years. Dr Rajesh Gadia, consulting physician at KEM hospital, who has been involved in the management of dengue viral fever for over two decades, says that largely cases have a mild presentation. However complications can occur due to the prevalent serotype and in some cases, which are mainly from Baramati and Phaltan, patients have come in with shock and fluid in their lungs. “Clinical manifestations vary from undifferentiated fever to florid haemorrhage and shock. The clinical presentations depend on age, immune status of the host and the virus strain,” Dr Gadia noted.Among some of the rare complications are Hemophagocytic Lymphohistiocytosis (HLH), which is an inflammatory state that can be triggered by infections or other immune disorders, usually among those with an underlying genetic predisposition. It is not only seen in dengue but other infections as well, Dr Pujari said. “Capillary fluid leak from the blood goes into the interstitial compartment and can lead to fluid accumulation in the lung or abdomen – once the fluid goes into extra blood space, there is a drop in blood pressure and hence shock occurs,” explained Dr Pujari. Which means all the body’s blood cells get affected, causing liver and heart injury, a drop in platelet count, abnormal clotting system, massive drop in blood pressure. This leads to a refractory shock in the patient.A specific rare case of dengue-induced Acute Respiratory Distress Syndrome (ARDS) was spotted in Arush Wandhekar, a four-year-old boy from Maharashtra’s Ahmednagar. His breathing became difficult and his oxygen levels dipped.SEEK HEALTHCARE EARLY“By and large, there is no reason for panic. However, it is extremely important to seek healthcare early,” says Dr Parikshit Prayag, infectious diseases expert at Deenanath Mangeshkar Hospital. When the hidden dengue virus gets diagnosed at the very end, it inevitably ends up causing other health problems.The onset involves an acute febrile illness between two and seven days, with symptoms like headache, retro-orbital pain, myalgia, arthralgia, rash and haemorrhagic manifestations. These need to be monitored carefully. The phase of febrile illness is one where fever can last for a week after which most people recover. There will be post-viral convalescence and the patient has weakness and fatigue.Given that COVID-19 and dengue are circulating in the city simultaneously, Dr Tickoo warned against people popping any pain-killers without consulting a doctor. “With COVID-19, many people do take painkillers without consulting a doctor, but that can be dangerous if they have dengue. Combiflam and painkillers such as Diclofenac can increase the risk of internal bleeding and affect the liver. Paracetamol is the only medicine they should take for the fever,” said Dr Tickoo.HLH is a life threatening condition and its diagnosis can be challenging because the initial symptoms may mimic other problems such as persistent fevers, rash, enlarged liver, low platelet count and altered mental functions.There are four virus serotypes that are designated as DENV-1, DENV-2, DENV-3 and DENV-4. Infection from any one serotype confers lifelong immunity to the virus serotype.WHY YOU NEED TO WATCH RAINFALL PATTERNSWith researchers and studies finding a link between dengue and rainfall patterns, experts like Dr Gadia have cautioned that monsoon and post-monsoon months are crucial for the vulnerable lot. The Aedes Aegypti mosquito has an average adult survival of 15 days. During the rainy season, when survival is longer, the risk of virus transmission is greater. The dengue mosquito is a day time feeder and can fly up to a limited distance of 400 metres. Aedes Aegypti breeds almost entirely in domestic, man-made water receptacles found in and around households, construction sites and factories. Natural larval habitats are tree holes, leaf axils and coconut shells. Unused tyres, flower pots and desert coolers are among the most common domestic breeding sites.

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Changing City: Cable-stayed flyover to improve road connectivity in Mumbai’s western suburbs
The Indian Express | 2 hours ago | 07-10-2022 | 11:45 am
The Indian Express
2 hours ago | 07-10-2022 | 11:45 am

The Brihanmumbai Municipal Corporation (BMC) has come up with a project to build a cable-stayed flyover in a bid to improve the road connectivity between Versova, Malad and Marve regions in the western suburbs of Maharashtra’s Mumbai city.A look at the project: The cable-stayed flyover will connect Versova jetty with Madh island.Location: The bridge will originate from near the Versova jetty and end near the wharf adjoining the Madh island jetty, passing over the Versova Creek.Specifications: The bridge will be 1.5 kilometers long and 27.50 meters wide.Objective: The primary objective of this project is to improve road connectivity between Versova, Malad and Marve region in the western suburbs, which currently has patches of mangroves, mudflats and creeks between the locations. This bridge is expected to bring down the travel time between Versova and Madh island to 10 minutes. It currently takes at least one hour through SV Road and Link Road. The travel time during peak hours can go as high as two hours.Significance:– This project will improve the road connectivity till the extreme end of the western suburbs. Since there is no direct road network right now, the people are mostly dependent on a ferry service that runs between Versova and Madh.– The bridge will lead to uninterrupted transport system for 365 days. Since the ferry services often become non-operational during monsoon, the people are compelled to take the longer route of travel though bus, taxi or local train via Malad, which increases the travel time by several fold.– The bridge will also play a key role in uplifting the economy of the Madh and Marve area, which mainly houses the fishing community that travels to the fish markets in Andheri and Dadar areas and are mainly dependent on ferries. This bridge will open more travelling options for them, thus creating better connectivity.– With the Mumbai Coastal Road Project (MCRP) coming up and also with the Versova-Bandra Sea Link (VBSL) project being on pipeline, this flyover will create a smooth corridor for the north-south bound traffic that will be travelling from the extreme end of western suburbs to the island city or vice-versa.Present status:– The BMC had finalised a consultant for this project back in 2020 and recently an Environment Impact Assessment (EIA) and a survey on the mangroves have been completed.– The BMC had submitted the reports and a proposal for the final alignment of this bridge to the Maharashtra Coastal Zonal Management Authority (MCZMA) for final clearance of this project and is awaiting the clearance.– The civic officials are hopeful that the clearance certificate would come in next two months following which a tender will be floated.Cost: Approximately Rs 400 croreConstruction time: 12 months (excluding the monsoon) after the day of issuing work order.Authority speak: “The project has been in the pipeline for more than a decade and has been deferred for multiple reasons. The flyover will pass through a mangrove zone and coastal area, therefore we have already submitted our proposal to the MCZMA for clearance. They had provided some inputs in the previous application that we had made and have submitted a fresh proposal on the same. After the project gets cleared, tenders will be floated and contractor will be appointed for the project,” said an official from civic bridges department.Citizen speak: “The proposed Versova-Madh bridge is supposed to be a pivotal linkage between Versova and Madh island and with the coastal road nearing its deadline, this bridge is need of the hour. Since, not only it will declutter the traffic movement but also will save time, fuel and money for thousands of Mumbaikars every day,” said Dhaval Shah, a local resident and co-founder of the Lokhandwala Oshiwara Citizen’s Association (LOCA).

Changing City: Cable-stayed flyover to improve road connectivity in Mumbai’s western suburbs
Post-Covid complications not being addressed: Expert
Times of India | 10 hours ago | 07-10-2022 | 03:53 am
Times of India
10 hours ago | 07-10-2022 | 03:53 am

MUMBAI: Neither the government nor the private sector was doing enough to address post-Covid complications that people are grappling with, said Dr Sanjay Oak, head of the Maharashtra Covid-19 taskforce, on Thursday. He also said it would be “preposterous” to think that the pandemic was over, although there is certainly a decline in its severity. “Such a declaration can only come from the World Health Organisation. However, our current numbers are not alarming and are infinitely less than the last two years. The morbidity is less, and patients are no longer dying in front of our eyes,” said Dr Oak. Cautioning that health systems cannot take their eyes off the pandemic, he said the emerging variants have to be closely followed. Members of the state Covid taskforce and former additional municipal commissioner Suresh Kakani spoke at a panel discussion over the future of the pandemic and lessons learnt by the health systems. The event saw the launch of Kakani’s book on Covid-19 titled Mumbai Fights Back. Elaborating on post-Covid complications, Dr Oak said a rise in young cardiac deaths and orthopaedic problems is being reported from the world over. “We are not suggesting that Covid or vaccination is leading to more deaths in the young, but it surely needs to be studied and addressed,” he said. The doctors added that the incidence of hip replacements due to avascular necrosis, a known Covid complication, has seen a tremendous rise in youngsters. “People have become oxygen dependent for life. All these begs the question if we are doing enough post-Covid,” said Dr Oak. Intensivist and taskforce member Dr Rahul Pandit said the mental health toll of the pandemic is seldom talked about. “Now that we are in a lull phase, we must look into its scale,” he said. A Covid survivor himself, Dr Pandit said all health workers lived aloof for 8-9 months during the first wave despite their loved ones staying under the same roof. “Common people saw extreme events, including job losses to paying inflated hospital bills, which has taken a toll,” he said, adding that mental health checks have to be normalised like cardiac check-ups in the post-Covid world.

Post-Covid complications not being addressed: Expert
Moderate rainfall warning for Pune and surrounding areas for next two days
The Indian Express | 10 hours ago | 07-10-2022 | 03:45 am
The Indian Express
10 hours ago | 07-10-2022 | 03:45 am

PUNE AND its neighbouring areas will receive moderate rainfall during the next two days, the India Meteorological Department (IMD) said on Thursday. Since October 1, the city has received 58.5mm of rainfall.Maharashtra is currently experiencing the influence of cyclonic circulation, which lay over coastal Andhra Pradesh. A trough from this system is running through Telangana, Vidarbha and west Madhya Pradesh extending till Uttar Pradesh.“Due to this cyclonic circulation, moisture-laden winds are being pulled from the Arabian Sea and Bay of Bengal over Maharashtra. Rainfall activity over Maharashtra will increase during the next two days,” said Anupam Kashyapi, head of the weather forecasting division at IMD, Pune.Rainfall will mostly be seen during the afternoon or evening with one or two intense spells with the potential to cause flash flooding, inundation of roads and windy conditions resulting in the uprooting of trees, the IMD said.Palghar, Thane, Raigad, Ratnagiri, Sindhudurg, Dhule, Pune, Nandurbar, Nashik, Ahmednagar, Sangli, Satara, Solapur, Beed and Osmanabad districts will also witness thunderstorms, lightning and rainfall till October 8, the forecast said.Another fresh cyclonic circulation is expected to develop off the Gujarat coast further strengthening the westerly winds blowing in from the Arabian Sea over Maharashtra, Kashyapi added.Meanwhile, the withdrawal of the Southwest monsoon continues to remain slow. As of Thursday, the withdrawal line passed through Uttarkashi, Nazibabad, Agra, Gwalior, Ratlam and Bharuch.Due to the presence of the cyclonic circulation over UP, which remains on ‘red’ alert till Friday any further withdrawal of monsoon is not expected till the weekend. Uttarakhand will receive heavy rainfall during the next four days, according to the forecast.

Moderate rainfall warning for Pune and surrounding areas for next two days
Maharashtra: New beginning awaits 25 differently-abled patients at Karjat rehab centre
The Indian Express | 20 hours ago | 06-10-2022 | 05:45 pm
The Indian Express
20 hours ago | 06-10-2022 | 05:45 pm

It is going to be a new dawn for the 25 differently-abled patients from government-run mental hospitals and other private healthcare facilities in Chennai who have travelled all the way to a Karjat-based rehabilitation centre, near Pune in Maharashtra.As they alighted from the train at Pune railway station Wednesday a bus from Shraddha Rehabilitation Foundation was waiting outside to welcome the patients, who are on the recovery path. After a nearly two-hour drive, the patients, along with five social workers and support staff, reached the centre at Karjat.They will be reunited with their families soon, Dr Bharat Vatwani, founder trustee of Shraddha Rehabilitation Foundation and Magsaysay award winner told The Indian Express.The foundation, set up in 1988, has reunited at least 9,000 differently-abled persons with their families in the last 15-16 years, said Dr Vatwani who added that this was for the first time a large group of patients have been shifted from a mental hospital to our rehabilitation centre.The centre was started to deal with differently-abled destitute persons wandering on the streets. Hence, the foundation does not admit patients brought by family members. It set up the Karjat project in 2006. Services at the foundation are free of charge.“These are unfortunate men and women whom you often see wandering on roads, lost in their own world, laughing and talking to themselves, with dirty long matted hair, half naked and skinny in appearance. They survive on gutter water and leftovers of food thrown at them by passers-by. With no one to look after them they are on the roads for weeks and months together,” Dr Vatwani said.The foundation has tied up with various mental institutions across the country. The latest batch of 25 patients is mainly from north India and they find it difficult to communicate due to limited knowledge of the language.“These patients were selected from different institutions in Tamil Nadu, including the government-run Institute of Mental Health Chennai and Emergency Care and Recovery Centre, Chennai, and others like Anbagam NGO Tamil Nadu and St Giuseppe Moscati Psycho-Social Rehabilitation Centre Tamil Nadu by our team. The social workers in Tamil Nadu find it a challenge to communicate with them due to language barriers. However, they are on their path to recovery and we will now try to reunite the 25 patients with their families,” Dr Vatwani said.Mental Health Day programmesMeanwhile, several organisations in Pune will host a series of programmes on the occasion of World Mental Health Day which falls on October 10 to create awareness about mental health. Dr Mridula Apte, a clinical psychologist who heads Vidula Psychological Consultancy, said her firm will conduct an awareness programme in association with the Pune Metro Rail to inform citizens of the facts related to mental health.World failing in ‘our duty of care’, says reportThis year’s theme of the World Health Organisation’s (WHO) is to make mental health and well-being a global priority. A recent report shows that the world is failing in ‘our duty of care’ to protect the mental health, and well-being of healthcare workers. ‘Our duty of care’ is a global call for action to protect the mental health of health and care workers. It examines the impact of the Covid pandemic on the mental health of the health and care workforce and offers 10 policy actions as a framework for immediate follow-up by employers, organizations and policy-makers.A report by the Qatar Foundation, World Innovation Summit for Health (WISH), in collaboration with the WHO finds that at least a quarter of health and care workers surveyed have reported anxiety, depression and burnout symptoms.The report found that 23 to 46 per cent of health and care workers reported symptoms of anxiety during the Covid pandemic and 20 to 37 per cent experienced depressive symptoms. Burnout among health and care workers during the pandemic ranged from 41 to 52 per cent in pooled estimates as per the report.

Maharashtra: New beginning awaits 25 differently-abled patients at Karjat rehab centre
India@75 looking at 100: The dream of a healthy nation
The Indian Express | 2 days ago | 05-10-2022 | 05:45 am
The Indian Express
2 days ago | 05-10-2022 | 05:45 am

“I wandered lonely as a cloud/ That floats on high o’er vales and hills/ When all at once I saw a crowd/ A host of children frail and ill…….”I woke up in a panic but felt relieved when I realised it was only a nightmare. I had gone back in time to being a young doctor, feeling helpless with the high infant and maternal mortality rates, a paediatric ward filled with children suffering from tuberculous meningitis, polio, severe malnutrition and diarrhoea.Today the scenario has vastly changed. The past 10 years especially, have seen rapid progress. We are now blessed with a growing economy and a huge, young population that is relatively healthy. The Covid-19 pandemic has shown the world our capability to handle mega problems. With good leadership and active community participation we became self-sufficient in terms of PPE, ventilators and vaccines. India@100 may see people recount Covid nightmares like the one I woke up from today.Now, new challenges await us. These include climate change, the rising aspirations of people, inequitable access to resources and the biggest challenge of all: Health. India is predicted to be the capital of non-communicable diseases, cancers and deaths due to trauma. The challenges are humongous due to the huge population of 1.4 billion, juxtaposed against a relatively inadequate public health system and the deep crevice separating the haves and have-nots. However, I envision that India@100 will have addressed all these woes humanely, efficiently and adequately. The need of the day is a revolution to make India a world leader in health. Having spent nearly 40 years in the armed forces, with the motto of my life being, “Country First and Always”, I strongly feel that this is the opportunity of a lifetime for every Indian to give back to the nation.Provided we act now, the next 25 years will witness a big change in the health indices. For this, we need to collaborate and work together as a society and as a polity. The silos of medical education in colleges, life science research in laboratories and public health in government hospitals will need to be integrated and work in close collaboration, with appropriate linkages through the opportunities lent by NEP 2020, National Digital Health Mission and most importantly, in synchronisation with the central and state governments. India@100 will then see a smoothly oiled machine where public health drives education and research.Medical education today faces numerous challenges. The most critical of these are the mushrooming of medical, nursing and AYUSH colleges, and non-availability of dedicated faculty. We can overcome these drawbacks by using digital technology to reach the unreached students quickly and effectively. We can also align medical education to India’s healthcare needs through integrated courses and creating a bigger and better pool of paramedical and nursing personnel on priority. It is also important to absorb the trained human resources into the workforce by providing adequate compensation. The aspirations of students need to be met with innovative solutions. For example, the district residency programme can be expanded to provide district PG programmes with adjunct faculty from the public hospitals. This will improve the quality of care and also meet the aspirations of the students. Simultaneously, this will enhance the faculty pool with universities training additional adjunct faculty. Learning management systems (LMS) under various universities can provide equitable opportunities to students across the country. Students will have access to knowledge at their own time and pace. Collaborations with international universities for twinning, joint degree or dual degree programmes is a big opportunity that is available today.India with its huge and young population can become a provider of healthcare personnel to the world. Another change I can see happening is a blurring of the line between engineering and medicine. While engineering and science institutions are setting up medical colleges which take longer to nurture, medical universities can effectively utilise data science, computing tools and inputs from design schools to improve on innovations and bring problems from bedside to bench in a shorter time to find solutions. Thus, India @100 may provide multiple degrees under one roof.Research will slowly move out of the laboratories to the bedside. We may need to follow a policy of reserving most of the available funds for life science research towards finding solutions for the health problems of the country for a while till we reach our goals as envisaged by National Missions. With good infrastructure and capacity building, India@100 will have Nobel Prize-winning scientists.Most clinical, preventive and primary care will be taken over by technology-based solutions and paramedical personnel. Clinicians will need to be trained to provide secondary and tertiary care or carry out research to aid policy changes. India@100 will ensure equitable and the best healthcare to every citizen of the world. People will not need to spend out of pocket or travel long distances on foot to receive healthcare. Ambulatory care (care at home) will be the order of the day and point of care devices will ensure redundancy of big laboratories for medical tests. People will be empowered to make their own decisions. This will reduce medical litigation. Healthcare will see no geographical borders. Doctors will be friends who help people make decisions with empathy and the Indian systems of medicine will be globally lauded.I will then wake up to a pleasant dream of India@100: “Where the mind is without fear and the head is held high/ Where health education is freely available/ Where healing has not been broken up into ’pathys/ Where health research springs from the depth of truth/ Where tireless striving stretches its arms towards perfection.”Lt General Madhuri Kanitkar (Retd) is Vice Chancellor, Maharashtra University of Health Sciences

India@75 looking at 100: The dream of a healthy nation