What is CBC?
CBC stands for- complete blood count. This is a group of tests that evaluate the blood components, including
- Red blood cells (RBCs),
- white blood cells (WBCs), and
- platelets (PLTs).
The CBC can evaluate your overall health and detect various diseases and conditions, such as infections, anemia, and leukemia.
Blood cells and disorders
Red Blood Cells or RBC.
Red blood cells contain hemoglobin. Hemoglobin transports oxygen throughout the body. In anemia, you have fewer RBCs and thus less hemoglobin, count. An anemic person feels tired as the body gets insufficient oxygen.
White Blood Cells or WBCs.
White blood cells are an essential part of the body’s natural defense system, or immune system. There are five different types of WBCs: neutrophils, lymphocytes, basophils, eosinophils, and monocytes. WBCs protect against infections and also have a role in inflammation and allergic reactions. For example, if you have a viral or bacterial infection, the body producers higher WBCs to fight the infection.
In the case of leukemia, abnormal white cells may rapidly multiply.
Platelets or thrombocytes.
Platelets are essential for normal blood clotting. It helps stop bleeding in case of an injury. There is a risk of excessive bleeding if platelets are less in number. In contrast, a higher platelet number can cause excessive clotting.
What is included in a CBC?
A standard CBC includes:
- Red blood cell (RBC) count.
- Hemoglobin measures.
- Hematocrit measures.
- MCV-Mean corpuscular volume.
- MCH-Mean corpuscular hemoglobin.
- MCHC-Mean corpuscular hemoglobin concentration.
- Red cell distribution width.
- White blood cell (WBC) count
- the number of neutrophils, lymphocytes, monocytes, eosinophils, and basophils.
- Platelet count.
- Mean platelet volume.
- Platelet distribution width.
A CBC may be useful for
- Screening a wide range of conditions and diseases, such as anemia, infection, inflammation, bleeding disorder, or leukemia.
- Monitoring the effectiveness of treatment.
- Monitoring treatments such as radiation therapy or chemotherapy.
What diseases can CBC detect?
A CBC can help detect many conditions, like:
- Nutritional deficiencies of iron, B-12, or folate.
- Autoimmune disorders.
- Bone marrow disorders.
- Hemoglobin abnormalities.
- Low platelets.
- Cancer that has spread to the bone marrow.
Autism: does your child have ASD?
Autism is also referred to as Autism Spectrum Disorder (ASD). It is a complex developmental disability that impacts an individual’s ability to perceive and socialize with others, mainly causing social interaction and communication issues. Let us understand few points regarding Autism Spectrum Disorder.
- The term “spectrum” in autism spectrum disorder refers to the wide array of varying severity symptoms.
- Autism spectrum disorder incorporates previously viewed conditions as separate diseases like autism, childhood disintegrative disorder, and Asperger’s syndrome.
- The disorder additionally comprises limited and repetitive patterns of behavior. It begins in early infancy and, in time, causes problems with social interaction and communication skills, for example, in school, and at work.
- Children usually manifest symptoms of autism within the first year itself. While few children also appear to develop ordinarily in the first year but then between 18 and 24 months of age go through a regression period when they develop autistic symptoms.
Autism Signs and Symptoms
Each child with autism spectrum disorder is likely to manifest a unique behavior pattern and severity ranging from low to high functioning.
Some common signs:
- lacks facial expression and seems to avoid eye contact with people
- Does not respond to his or her name or appears not to hear you at times.
- Repeats words, phrases, or verses but doesn’t really know how to use them in meaningful ways.
- The child Doesn’t express emotions or feelings and appears ignorant or rather indifferent to others’ feelings.
- Do not start a conversation or isn’t able to continue an ongoing one.
- Withdrawal from society is noticed quite often. The child prefers playing alone and retreats into their own world.
- Children with ASD Resists cuddling and holding don’t want to be approached by others.
In addition to the above-mentioned manifestations, people with ASD may show limited, repetitive patterns of behavior, interests, or activities like:
- Continuous spinning, rocking, or hand flapping
- Cause self-harm, such as biting or banging their head.
- Unusually sensitive to sound, light, or touch, yet maybe insensitive to pain or temperature.
- Fixate on an object or an activity with abnormal intensity or focus.
- Has problems with coordination and patterns of odd movements like walking on toes might be noticed.
- Develop a specific and fixed routine or ritual and become anxious at the slightest change of routine.
Autism Treatment: How can ASD patients be helped?
There is currently no cure for ASD. However, early intervention can improve a child’s development. It is essential to consider speech therapy for language delays at the earliest. Know about Top 10 Children’s Hospitals in Mumbai
Supporting people with ASD begins at home, at school, and workplace by providing structure and safety. Below mentioned are some ways in which this can be done:
- Enhance your knowledge: Knowledge is indeed the key! The more you try to gather information and learn about autism spectrum disorder, the better equipped you’ll support them.
- Be ready for challenges: It might seem quite difficult at times to deal with autistic They, at times, have a hard time trying to explain what they’ve learned to others. For example, a child with ASD may use sign language to communicate at school but never do so at home. So, it is essential to be consistent in how you interact with the child and deal with challenging behaviors.
- Sticking to a schedule: Children with ASD tend to do best when they have a highly-organized routine or schedule.
- Rewards bring happiness: Praising them when they act appropriately or learn a new skill can go a long way with children with ASD.
- Understand the unsaid: Observe the kinds of sounds they make, their facial expressions, and the gestures they use when they’re hungry, tired, or want something.
Each child with ASD is unique, and it must be understood that no single treatment works for everyone. A good treatment plan will
- Target towards building the child’s interest.
- Provide a consistent schedule.
- Make sure to teach day-to-day tasks as series of simple steps.
- Offer regular reinforcement for good behavior.
- Involve the parents, guardians, teachers, and caregivers.
Eczema: Causes, Symptoms, Risk Factors, and Prevention
Eczema is a generalized term used for itchy red rashes that initially extrude or oozes serum which later forms a crust or thickened or sometimes gets scaly. The eczematous rash may be caused due to many factors, including allergies, irritating chemicals, drugs, scratching or rubbing the skin, or sometimes exposure to the sun. It can be chronic or acute. The rash can sometimes be secondarily infected, causing dermatitis or inflammation of the skin.
- Asteatotic eczema or winter itch is a mild form of eczematous dermatitis mostly seen in older adults’ lower extremities, especially during the dry seasons. This skin has fine cracks with redness. Especial care to keep your skin moisturized and hydrated helps to prevent this condition.
- Dyshidrotic eczema or pompholyx is marked by blistering, itchy rash found on hands and feet, which are episodic and exhibit deep-seated vesicles or bullae. It is usually seen in summer or spring in young adults or teenagers.
- Did you have a pinkish discoloration with ill-defined edges often associated with burning and itching along with slight swelling? Then it could be Erythematous eczema. This condition tends to spread and sometimes even merge with another type of eczema on the skin. It can develop anywhere on the body, causing roughness and dryness of the skin and branny scaling.
- Eczema herpeticum causes large corps of pustular vesicles in persons affected by Herpes simplex virus, mostly in infants with eczema.
- Lichenoid eczema is observed with thickened skin.
- Nummular eczema affects people with dry skin and gets worse in dry weather. It appears either round or oval.
- Pustular eczema causes redness, Glazed surface, Little oozing of serum.
- Eczema madidans is a Raw, Red, Covered with moisture.
- Eczema fissum shows the thickness of skin, Dryness, Inelastic skin, Dryness, and fissure on the skin.
- Squamous eczema is mostly chronic in nature, On soles, legs, scalp, Multiple and circumscribed, Thin, dry scales.
- Seborrheic eczema has excessive secretion from the sebaceous glands.
- Environmental factors
- Allergens like dust, pollen, mold, or dandruff
- Irritants like shampoo, soap, disinfectant, juices, vegetables, fruits, etc.
- Microbes certain bacteria, virus or fungus
- Hot and cold temperature
- Stress can make symptoms worse.
- Hormones in women: eczema develops due to hormonal changes during pregnancy or during a certain time of the menstrual cycle
- Certain food like dairy products, nuts, eggs, soy products, or wheat
- Redness, swelling, and itching
- Irritant contact dermatitis is painful
- Small raised bumps
- Maybe moist or have fluid oozing out
- Thickened, cracked skin.
- Raw and sensitive skin
- Dry skin
People with the following conditions are at risk
- Family history of eczema
- People having asthma or Hay fever
- Hay fever or asthma
- Dry, itchy skin and scaly skin
- Skin infections
- Irritant hand dermatitis
- Allergic contact dermatitis
- Difficulty to fall asleep.
- Keep the skin moisturized and hydrated by applying moisturizers and drinking enough fluids
- Identify the factors that cause or worsen the symptoms. Avoid the factors that aggravate the condition
- Do not take a bath or shower for a long time. Avoid using hot water use lukewarm water instead
- Take a mild bleached water bath as a bleach bath prevents the growth of bacteria
- Use soap that is gentle on your skin
- Dry yourself properly after the bath
- Wear soft cotton clothes washed in mild detergents
- Keep nails trimmed to reduce damage while scratching
- Use a humidifier to keep yourself moist in the dry winter season
Diabetes- Detection, Prevention and Management
Diabetes Mellitus refers to an elevated blood sugar level along with metabolic disturbances. Our body produces insulin, the pancreatic hormone which is responsible for the utilization of glucose by the cells. It helps in glucose uptake by the cells and thus reduces the blood glucose levels.
Diabetes mellitus is classified as
Type 1 is also known as Insulin-dependent or Juvenile Onset Diabetes Mellitus. It is characterized by the destruction of pancreatic cells by the body’s own white blood cells (autoimmune destruction). There is an absolute deficiency of insulin, leading to hyperglycemia. It thus requires treatment with insulin administration.
Type 2, is referred to as Insulin independent or Adult Onset Diabetes Mellitus. It is characterized by loss of tissue receptor sensitivity to insulin. Despite adequate insulin being produced by the pancreatic cells, the body’s cells do not respond to insulin.
Thus, despite an adequate amount of circulating insulin, due to the non-responsiveness of tissue receptors, hyperglycemia develops. It is treated with various oral anti-diabetic medications.
Tests and Diagnosis
- The normal blood sugar level is in the range of 70-110 mg/ dL. A fasting blood glucose level of more than 140 mg/dL or a post-prandial (1 hour after a meal) level of more than 200mg/dL is diagnostic of diabetes.
- Another good indicator is HbA1c also known as glycated hemoglobin. It is a marker of glycaemic control over the past 3 months. The normal range is 4-6 gm% (excellent control). Pre-Diabetes is 6-8 gm% (good control) and Diabetes is defined as above 8 gm% (poor glycaemic control).
- An oral glucose tolerance test may also be performed. A sugary solution is provided after 8 hours of fasting. Periodic blood glucose levels are checked at every half an hour for 3 hours)
(Pre-Diabetes refers to a blood glucose level between 120-140 mg/dL and Gestational Diabetes refers to hyperglycemia during pregnancy as a result of anti-insulin hormones from the placenta. The blood glucose level returns to normal after delivery.)
Diabetes Mellitus Symptoms
The general symptoms include:
- Increased hunger
- Increased thirst
- Increased frequency of urination
- Non-healing sores
- In men, there may be associated loss of sexual drive, erectile dysfunction, and poor endurance.
- In women, there may be frequent urinary tract infections, candida infections, and dry skin.
Diabetes Mellitus Causes and Risk Factors
Diabetes is caused by multiple factors that interact with each other. They are broadly divided into non-modifiable risk factors and modifiable risk factors.
For Type-1 disease, having a parent/sibling with diabetes and younger age are the major risk factors.
For Type-2 disease, the factors include:
- Increasing age: Age more than 45 years
- Race: Indian Americans, African Americans, Latino-Americans are at a greater risk
- Obesity: Characterized by an increased BMI (above 23 in the South Asian population and above 25 in the Pacific-West)
- Smoking and Alcoholism
- Physical inactivity
- Family History
- Gestational Diabetes Mellitus and Pre-Diabetes
Diabetes Mellitus Complications
Complications include wounds that do not heal, gangrene of the lower foot or extremities, nephropathy, neuropathy, and vasculopathy.
It may lead to optic nerve damage, heart disease, and dementia as well.
Diabetes Mellitus Treatment
Type 1 diabetes
Insulin therapy is the main treatment for type 1 diabetes.
There are four types of insulin that are used based on the onset and duration of action.
- Rapid-acting insulin starts to work within 15 minutes and its effects last for 3 to 4 hours.
- Short-acting insulin starts to work within 30 minutes and lasts 6 to 8 hours.
- Intermediate-acting insulin starts to work within 1 to 2 hours and lasts 12 to 18 hours.
- Long-acting insulin starts to work a few hours after injection and lasts 24 hours or longer.
Type 2 diabetes:
It involves treatment with oral antidiabetic drugs if exercise and dietary control fail to maintain blood glucose. Fruits, vegetables, whole grains, polyunsaturated fatty acids, lean meat (fish, poultry), are to be promoted. Saturated fatty acids, refined carbohydrates are to be avoided.
What is Child Abuse?
According to the World Health Organization, child abuse refers to an injury, sexual abuse, sexual exploitation, negligent treatment, or child maltreatment. The aforementioned abuse may be physical, emotional, mental, or psychological and result in the child’s exploitation and neglect.
Though the physical impacts of abuse may be instantly visible, young minds’ psychological trauma often has a long-term consequence. It not only harms the child but the family as well and, by extension, the society at large. Child abuse in India can be found across the spectrum, blurring the lines of rural vs. urban divide, the rich vs. the poor gap, and in schools as well, both private and government.
This article deals with Child abuse- what is it? Indian scenario? How is it dealt with in India? What laws to protect it? Psychological issues in these children? How to help these kids to overcome problems? Are any NGOs functional in this? Where to ask for help?
India has roughly 400 million children (defined by the United Nations Convention on Rights of Child as a person below 18 years of age), constituting roughly 25% of the entire population. A vast majority of children cannot exercise their right to education, right to dignity, and freedom from exploitation and oppression.
The 5 broad categories of child abuse include Physical abuse, Sexual abuse, Neglect, Exploitation, and Emotional abuse.
Besides the physical scars of corporal punishments, drug abuse, and violence, the psychological impact of the abuses has been shown to impair the child’s normal growth and development, affecting the children’s emotional stability and mental status. Such children are more likely to engage in anti-social activities with a feeling of vengeance and injustice and thus, have a higher rate of juvenile delinquency (A juvenile according to the Protection of Children from Sexual Offences Act is a child below 18 years of age. Delinquency refers to a juvenile who is found doing something criminal or illegal according to the law.)
The requirement for a Multifold Approach
A multi-stakeholder approach is required to tackle the menace of child abuse. Schools, governments, and non-governmental organizations all have a critical role in ensuring children’s safety and security.
Several governmental and non-governmental organizations (NGOs) have initiated prevention programs to prevent child abuse, embark upon various abuses, and ensure their safety and security. The Government of India is becoming more and more sensitive and conscious about children’s statutory and constitutional rights.
Two statistical pieces provide insight into the magnitude of child abuse in India. According to the Ministry of Women & Child Development (2007) survey, the prevalence of all forms of child abuse is extremely high (physical abuse (66%), sexual abuse (50%), and emotional abuse (50%). A study by the National Commission for Protection of Child Rights (NCPCR), con-ducted amongst 6,632 children respondents in 7 states, revealed 99% of children face corporal punishment in schools.
Thus, one of the major hurdles in identifying and recognizing child abuse is the inability and the hesitancy of children to respond from children. It can be attributed to two reasons. Firstly, many children cannot comprehend the dimensions of abuse, e.g., between good touch and bad touch. Secondly, they fear reprisal from their parents or guardians and thus do not report it to the concerned authorities.
Child Abuse: Physical, Sexual and Mental Impact
The three domains of visible impact in an abused child include:
Physical: Unexplained bruises, burns, fractures, contusions, and at times, bite marks. The child is generally secluded and is apprehensive of contact with other humans. He may also show a changed behavior every time he meets the abuser or may cry while going home.
Sexual: The WHO defines Child Sexual Abuse (CSA) as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. It includes but is not limited to fondling, improper sexual touch, forcing a child into prostitution, exhibitionism, and intercourse. The child may have visible marks of perineal injury and may present with bleeding.
Mental: The mental health issues arising from child abuse include psychotic disorders, neurotic disorders, substance abuse, and personality disorders. The age at first abuse, the extent, and severity of abuse, affect the magnitude of clinical disorders that affect later life.
The Juvenile Justice Act of 1986 defines child sexual abuse as the interaction between a child and an adult. The child is being used for the sexual stimulation of the perpetrator or another person. Sexual abuse is not often identified through physical indicators alone. A child can confide in a trusted person that she /he has been sexually assaulted.
There are some physical signs of sexual abuse like difficulty walking or sitting, pain or itching, bruises or bleeding, venereal disease, and pregnancy in early adolescence. The sexually abused child may appear withdrawn or retarded, have poor peer relationships, be unwilling to participate in activities, and indulge in delinquent behavior.
Policy and Legislation:
The present National Policy on Children 2012 has replaced the earlier version of 1974. It emphasizes children’s role as a paramount asset and a demographic dividend while placing further importance on their rights.
However, there remains a huge gap between planning and program implementation, primarily due to the government’s piecemeal approach concerning child rights.
While there is a nodal agency, the Ministry of Women and Child Development, to look after the formulation of rules and regulations, another Labour Ministry checks against child labor and exploitation. The Ministry of Health and Family Welfare looks into children and young adolescents’ health under the Reproductive, Maternal, Neonatal, Child, and Adolescent (RMNCH+A) program. Additionally, the Mid-Day Meal Programme is administered by the Ministry of Human Resource and Development.
Thus there are multiple centers, and the holistic development of the child is not taken into consideration. Thus, there is a need for laying down standard and uniform protocols at the grass-root levels while defining the role and responsibility of designated entities. The services provided should be comprehensive and must include preventive, diagnostic, therapeutic, and rehabilitation services for children.
Juvenile Justice Act,2000:
It deals with the crimes committed by a juvenile under 18 years of age.
A juvenile in conflict with the law is the one who is alleged to have committed an offense. The Juvenile Justice Board hears such cases. It consists of a Judicial Magistrate 1st class and involves two social workers, one of whom must be a female.
It specifically deals with the care and protection of children who are in conflict with the law and provide humane interventions while at the same time ensuring that they meet the developmental requirements of the juvenile. Recourse is sought, which would better help the juvenile integrate into society upon his release and not indulge in illegal acts.
Laws On Preventing and Dealing with Child Abuse:
Protection of Children Against Sexual Offences Act of 2012
(POCSO) deals with sexual crimes committed against children, including rape, assault, pornography, etc. Its main aim is to protect children from sexual abuse.
It does not define rape but includes penetrative sexual assault, thus encompassing protection against various crimes. It provides for both punishment and fine to the offender, and a more severe degree of punishment for persons in a position of authority, e.g., a police officer, public servant, etc.
The definition for the various offenses enlisted are comprehensive and have a wide ambit of possible scenarios. These provisions have been made, keeping in view the greater vulnerability and innocence of children. It also includes cybercrimes like sexting and bullying of children by cyber predators and punitive action against proven intent + abetment to commit a crime (irrespective of the act being committed or not).
It encompasses child-friendly measures for protecting the child’s identity and submission and recording of evidence. National and State Commissions for Protection of Children have been designated to oversee the implementation of the Act.
However, there are many pitfalls concerning implementation and enforcement: Lack of district courts and special judges, nearly 90% pendency, and a dismal conviction rate. Also, state governments’ specialized training to the judges lacks justice in a child-friendly atmosphere.
The Immoral Traffic (Prevention) Act has also been strengthened to protect against child-trafficking.
Preventing children abuse and where to ask for help:
Parental Role: Promoting discussion about healthy growing, good-vs- bad touch. Frank communication regarding issues of sexuality and gender and the physiology of growing up.
Schools: Providing sex education in an age-appropriate manner and fostering healthy discussions regarding bodily and emotional changes while growing up.
NGOs: Facilitate the communication concerning Sexual and Reproductive Health amongst the parents, children, and teachers.
Reporting: To the police authorities by the first informant. Anonymous online reporting to the website of the Ministry of Women and Child Development to take action accordingly.
Outreach and Support Services:
Often, the perpetrator of child abuse happens to be a close family member or an acquaintance. Thus, a victim of abuse requires various services: professional psychological help, medical aid, and legal support with police intervention.
Childline, India’s first 24-hours emergency service, helps in the rehabilitation of the rescued children. Their number is 1098. It works with various NGOs and in sync with the Ministry of Women & Child Development.
The Case of Missing Children:
Running away from abusive families or searching for a job, or due to trafficking, children may go missing. Tracking them and implementing the existing mechanisms to prevent their abuse and helping in their rehabilitation must be done. Kailash Satyarthi, the Nobel Peace Prize Winner, is the founder of Kailash Satyarthi Children’s Foundation. It is a noteworthy example of an NGO that works in preventing child trafficking.
Thus, a multi-disciplinary approach is needed involving all the stakeholders (government, justice delivery mechanisms, and medical fraternity) to implement the law better and provide teeth to the provision mentioned in it in compassionate, empathetic manner well-being of the child at its core.
- Defining violence and children protection rights 1, 2, 3
- child abuse and laws in India
- neglect towards child abuse
- child protection
Ageing or senescence is a physiologic process. Generally, senior citizens’ cut-off age is considered to be 65 years (the age of retirement from work). The bright glow and charm of youth gradually give way to the wizened face, greying hair, and frontotemporal hair loss in men and central/parietal hair loss in women. The skin wrinkles, owing to the elastic collagen fibers’ tensile strength, due to the loss of elasticity.
At the molecular level, it has been shown that free-radical mediated injury accelerates the process of ageing (thus, anti-oxidants like Vitamins A, C, and E, Selenium, and Zinc are promoted as anti-ageing agents, however with little therapeutic utility proven by evidence). Also, telomeres’ shortening on chromosomes limits cellular replication: Dead cells cannot be replaced, and differentiated cells no longer replicate. Thus, there is a gradual overall decrease in functional abilities.
Senior citizens account for 13-14 % of the population today, and by 2050, they’d account for 22-25% of the population.
The branch of medical science which deals with the health problems and solutions of old-age persons is called Geriatrics. The main focus of Geriatrics is to emphasize Healthy-Ageing, as one advances through the years of life.
Senior citizens: Some of the problems include:
1. Chronic Non-Communicable Diseases:
Cardiovascular diseases are the most common cause of morbidity and mortality worldwide and have a disproportionate impact on senior citizens.
Heart attacks (myocardial infarction), Paralytic attacks (stroke), Hypertension, endocrine diseases like Diabetes mellitus, and Thyroid diseases are some of the most common diseases. Diseases like hypertension and diabetes require lifelong medications for preventing and reducing their progression.
Also, respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD) may emerge and seriously impair breathing and oxygenation.
The incidence of most cancers increases with increasing age. With changing lifestyles, obesity is emerging as a risk factor for multiple chronic conditions in later life.
Reducing the number of processed foods, reducing salt and sugar and saturated fat intake, and increasing the consumption of fresh fruits, vegetables, and moderate exercise, reduces the risk of developing the above conditions.
2. Gradual Cognitive Decline
Cognition refers to the brain’s higher functions: Generation of thoughts, emotions, the ability to analyze and remember things. Dementia, specifically Alzheimer’s dementia, is in common parlance, termed as memory loss is the most common neurocognitive disorder in the elderly.
Co-morbid conditions such as hypertension, obesity, depression, and smoking habits have been shown to increase the risk of developing dementia. No definitive treatment exists for dementia since it is characterized by neuronal loss (neurons are brain cells that cannot replicate). However, drug therapies intend to retard the progression of the disease.
Other diseases include Parkinsonism, characterized by tremors and a shuffling gait, making it difficult for the person to co-ordinate his daily life activities. It is caused by the absence of a neurotransmitter called dopamine, and thus, drug therapy is aimed at increasing the brain’s dopamine levels. Know more: Parkinson’s Disease-Symptoms and Management
3. Mental Health Conditions:
Older people have their fair share of mental health problems, especially neurotic diseases like depression. Nearly 15% of the elderly have some form of mental health condition or the other. A vast majority are, however, undiagnosed or insufficiently treated.
Providing social support in terms of age-old friends, laughter clubs, senior-citizen forums, and love from family members can help treat and prevent many depressive and mood disorders in the elderly. Read about Mental Health: Stop Exclusion, Dare to Care
4. Increased risk of injury due to trauma:
With increasing age, the joints become stiff, and the bone mass (predominantly calcium stores) decreases. Thus the bone strength is reduced, and the joint mobility is also restricted. The elderly thus have an increased risk for osteoporosis and osteoarthritis.
The elderly are more prone to losing their balance and have a propensity to fall. It can lead to severe injuries, such as fractures (which take more time to heal), a joint tear, or muscle injury.
Calcium and Vitamin D3 supplementation (especially in post-menopausal women), moderate exercise for strengthening the bones, and modifications (such as a handlebar at the lavatory for support) go a long way preventing traumatic injuries.
5. Immunocompromised States:
With age, the immune system of the body gradually weakens and is more susceptible to infections. If the person suffers from HIV-AIDS, there is general immunosuppression, which further weakens the immune system. Thus, they are more prone to developing opportunistic infections like candidiasis, sexually transmitted infections, and other viral and bacterial infections. Know about Genital Infection in Men: Symptoms and Treatment
Use of barrier contraceptives like condoms, regular health checkups like annual screening for diseases helps in early diagnosis and prompt treatment of the conditions.
Also, senior citizens with rheumatologic problems like osteoarthritis may be on long-term medications like corticosteroids. They lead to a compromised immune status as well, further predisposing to opportunistic infections in them.
Urinary Tract infections are the most common cause of nosocomial/ hospital-acquired infection among senior citizens. They have more chances of developing pneumonia (due to bacterial or viral infection) as the body’s defense mechanisms cannot ward off the offending agent.
6. Senior citizens and Malnutrition
Malnutrition includes both: Overnutrition-obesity and undernutrition- resulting in muscle weakness and a weakened immune response.
While lifestyle habits like smoking and alcoholism severely affect nutrition by causing liver diseases (which synthesize body proteins), cognitive disorders like dementia may forget about his meals. Also, financial constraints may limit the serving portion and nutritional intake.
Healthy food options (as mentioned above, including nuts and fresh fruits and vegetables) can help with nutrition.
7. Visual and Auditory Impairments
A cataract is the most common cause of treatable blindness in the elderly. Regular cataract camps are held, which, through cataract surgery, offer a new lease of vision to the patient. Also, hypermetropia (far vision) or difficulty in reading nearby lines can be corrected using appropriate spectacles.
Glaucoma, with increased intra-optic pressure or age-related macular degeneration, may also predispose the senior citizens to develop vision loss.
Hearing impairments due to sensorineural hearing loss or other reasons can be problematic. Hearing loss assessment and the provision of suitable hearing aids enhances the quality of life.
8. Neglect of Oral Hygiene in Senior citizens
Oral Hygiene and health are often neglected among the elderly. Thus toot caries, tooth extraction, root canal procedures, or dentures are fairly common in the elderly. Years of tobacco abuse can manifest as oral cancer in later life, which may be distressing.
They are associated with a decreased sense of self-esteem and can also complicate other health conditions by compromising nutrition.
Regular dental checkups and care of dentures go a long way in promoting good oral hygiene.
9. Drug and therapeutic misuse
Substance abuse mainly involves the excessive consumption of alcohol and smoking. They have deleterious effects on the body by exacerbating conditions like hypertension, liver cirrhosis, and substantially increase the risk of cancers in senior citizens.
At times, the elderly may take medications prescribed to their spouses or family members for similar treatment. However, this has deleterious consequences since they may be suffering from renal or hepatic impairments which require dose readjustments. Thus, drugs should never be interchanged except on the advice of a medical professional.
10. Bladder and Bowel Problems:
Senior citizens often complain of the urge to pass urine more frequently (urge incontinence) and post-voiding urine dribbling. Also, the incidence of benign enlargement of the prostate, which may cause similar symptoms, increases with age. Read Prostate Enlargement: a cause of concern in Men
Constipation is another important problem in the elderly, leading to bloating and straining. It may also increase the chances of a hernia since the increased abdominal pressure can push the contents out of the abdomen.
Medical and surgical treatment modalities with excellent results are available, which help the senior citizens to lead a healthy life later.
Helping senior citizens with social support:
By volunteering for activities, such as at a nursing home, one can help the elderly. Also, everyone needs a break. Their mood is uplifted by helping them engage with moderate outdoor activities like a walk or some games like carom or chess.
Helping them with using electronic devices is another way in which we can help them with simplifying their tasks, like contacting their friends and distant relatives.
Helping them with their household chores or a simple gesture like buying groceries for them when you go out to buy your own is one of the simple yet profound altruism acts.
Also, helping them manage their finances (light bills, medication bills, grocery, etc.) and mapping out a schedule (daily routine activities like meditation, spiritual activities, going for a walk) will help them remember better and prevent a cognitive decline.
Thus, for healthy ageing, a holistic view needs to be taken: Overcoming and preventing health problems while simultaneously improving the quality of life via allied activities.
Several NGOs, including HelpAgeIndia, ManavLok, and Abhoy Mission, work in various fields related to the needs and challenges of the elderly in India. However, those of us who have grandparents, taking good care of them and providing them with our time and attention would be the best gift! For those who do not have grandparents, adopting a senior citizen is another viable alternative.
Coronavirus or COVID-19 Protective Measures
The COVID-19 epidemic is currently declared by the WHO as a global emergency. The viral outbreak originated in the Chinese city of Wuhan in the Hubei Province and has since spread to a number of countries. Read more about Coronavirus- How to protect yourself and your family
Common human coronaviruses are known to cause mild to moderate upper-respiratory tract illnesses, like the common cold. It might be quite surprising to know, that most of the people, get infected with coronaviruses, at least once in their lifetime. These illnesses only last over a short amount of time. Know about Human Coronavirus: Outbreak and Prevention
Check here: COVID-19: Helpline Numbers in India
Breastfeeding vs. bottlefeed
Health experts around the world are unanimous concerning infant nutrition in the first few months of life. Breast milk is a complete and wholesome food for infants. Exclusive breastfeeding for at least 6 months is advised to all expectant and new mothers. Exclusive breastfeeding implies no other nutrition (not even water or liquids like honey) to the newborn for the first 6 months of life. Post 6 months, gradual weaning is advised so that the baby can tolerate foods other than breast milk. (gradual weaning means complementary foods and breastfeeding such as cow’s milk, porridge)
Parenthood and especially motherhood, can be challenging for first-time mothers. While the joy of delivering a new life is immense, the challenges of sustaining it and helping it grow also loom on the horizon. Newborn nutrition is one of the most widely debated topics in such households. Besides, it is among the biggest decisions that can impact the child in later life.
From the maternal perspective, breastfeeding (for at least one year) is protective against breast cancer development later in life. It also helps develop a bonding between the mother and the baby and is shown to relieve stress and the incidence of post-partum depression. Besides, it empties the breast, prevents lactational breast abscess due to pent-up secretions, and prevents breast engorgement and mastitis.
For the infant, besides the nutritional advantages of breast milk, there are immune benefits as well. Breast milk for the initial few days is termed as colostrum. It contains preformed immunoglobulins (antibodies which protect against infections), which provide immunity to the infant against pathogens. It also decreases the incidence of diabetes and obesity in children in later life.
While it is clear from the above points that breast-feeding has undeniable benefits, it might not always be possible for all women. Depending upon mothers’ lifestyle, commitments, and priorities, they may take an independent decision to breastfeed or bottle-feed, as it suits them.
Bottle feed or formula feed provides the baby with the nutrients for normal growth and development. They contain a mix of micronutrients (Zinc, potassium) and macronutrients (proteins, fats, and carbohydrates) to replicate or imitate breast milk composition.
While it is a viable alternative to conventional breastfeeding for mothers who cannot breastfeed (e.g., post-chemotherapy or certain surgical procedures), feeding is ultimately the one taken by the mother. Comparing and contrasting the advantages and challenges of breastfeeding and bottle feeding may help mothers make an informed decision regarding the same,
As mentioned above, breastfeeding/nursing is the gift of life a mother can give to her baby. It is the ideal food for the infant and promotes bonding between the two.
According to the Indian Association of Pediatrics and the World Health Organization, breast milk has a 3 pronged advantage: Nutritional, Immunological (against allergies and infections), and Protection against chronic conditions (Obesity and others).
Breastfeeding involves several reflexes by the mother and by the baby. The mother’s side includes galactopoiesis (milk production stimulated by prolactin) and galactokinesis (milk ejection reflex stimulated by oxytocin). From the baby’s side, it involves the coordinated actions of rooting, sucking, and swallowing.
It is thus pertinent to elaborate on these proven benefits of breastfeeding:
Breast milk is referred to as the perfect food for the newborn’s immature digestive system. It contains about 67 kcal/100 ml of breast milk.
The components include:
- Carbohydrates: Breast milk is rich in carbohydrates. Lactose is the predominant carbohydrate. It is broken down to glucose and galactose and ( also contains lactoferrin and lactobacillus gut bacteria).
- Proteins: They are relatively low in breast milk. The predominant protein is the whey group of protein, which includes lactalbumin and lactoglobulin. It is easier to digest (compared to formula feeds and animal milk) and is essential for brain growth. (Cow milk, on the other hand, has casein as the predominant protein and is difficult to digest and has increased chances of constipation and allergy.)
- Fat: Breast milk is rich in polyunsaturated fatty acids (docosahexaenoic acid and arachidonic acid), which aid in brain growth.
- Deficiencies: Breast milk is deficient in vitamin K and vitamin D. In strict vegetarian mothers, vitamin B12 is often absent. However, in term babies, sufficient stores are available as a reserve. However, in pre-term babies, supplementation is advised.
At birth, vitamin K injection is given to infants. Also, vitamin D supplementation is given during the first 2 months and continues until 1 year.
Thus, human milk is personalized nutrition for the baby and differs from one human to the other as opposed to formula feeds (one-size-fits-all composition)
It has been shown that infants who have been breastfed had fewer infections and hospitalizations than infants who were not. The immunoglobulins and vitamins in the colostrum (in the initial 3 days) protect against many pathogens and preterm infants (who are at an increased risk of hypothermia and infections). The mother’s milk naturally has increased concentrations of calories, ions, and immunoglobulins. Thus the protection is provided against the following diseases:
- 1. Ear infections (otitis media)
- 2. Gastrointestinal infections (manifest as diarrhea)
- 3. Respiratory infections (pneumonia)
- 4. Nervous system infections (meningitis)
Protection against chronic diseases
They result due to an interaction between genetic factors and environmental triggers. They include:
- 1. Hypersensitivity Reactions (Allergies and Asthma)
- 2. Metabolic Abnormalities ( Obesity and Diabetes)
- 3. Sudden Infant Death Syndrome (when no other cause is attributable)
- Cost: Breast milk is free, as the mother’s body ensures nutrition to the infant even at her own cost. Besides, supplies such as bottle pumps and the formula-feed mixture are costly and still not accessible to a wide range. As an extension, it also saves the medical (consultation and drugs) expenses since breastfed babies are less likely to fall ill and contract a disease.
- Cultural Acclimatization: A breastfeeding mother requires additional calories to the tune of 500kcal per day. Invariably, the breast milk of each mother tastes different since it is derived from maternal food preferences. This exposes the baby to different foods, which help in weaning later and help them accept solid foods with relative ease.
- Convenience and Availability: Paediatricians across the spectrum support ‘on-demand’ feeding to the infants, as and when the baby desires. Thus it is always fresh and readily available (as opposed to formula feeds, which need to be purchased, constituted, and then fed in bottles.
- Intellectual Development: The proteins and fats mentioned above stimulate brain growth. Thus, breast-fed babies have been shown to have slightly higher Intelligence Quotient than those who were bottle-fed.
- Kangaroo-Mother Care and Skin to Skin Contact: Especially in low birth weight babies, close skin to skin contact provides warmth to the babies and enhances bonding. This prevents hypothermia and other complications.
- Maternal Benefits: Breastfeeding helps burn calories and helps accentuate the return of body physiology to pre-pregnancy states. It also reduces the risk of ovarian, breast, and uterine cancer and hypertension, and diabetes.
Challenges Associated with Breastfeeding
Breastfeeding must be a routine practice, and as with any other routine, it can be difficult for both the mother and the baby to get used to it.
Some of the common concerns during the first few weeks and months include:
- Improper Technique: There are various positions advised by professional bodies for proper latching of the newborn, exposing the nipple and allowing the baby to crawl on to the breast. Latch-on pain in the first week or so generally subsides. However, nipple cracking and dryness may be experienced by some females, along with persistent pain. Thus, it is important to consult a pediatrician regarding the proper-technique and rule out other causes like an infection, an abscess, or an inefficient milk let-down.
- Frequency of Feeds: Initially, the babies feed often, and there is no particular feeding time. Thus, it might become difficult for working moms or professionals to provide on-demand feeding. Besides, breast-feeding infants also have a higher frequency of feeding since breast milk is easy to digest, and it also promotes gastrocolic reflex (promotes peristalsis). Thus, such babies might even require feeding every 2-4 hours, which may not always be feasible.
- Monitoring one’s diet: Inevitably, the mother’s nutrition affects the baby’s nutrition via breast milk. Thus, special care needs to be taken to consume seafood (risk of contamination with mercury- Minamata disease in Japan). Social stimulants like alcohol should also be avoided to prevent lethargy and dullness in children and an increased risk of developing liver diseases later in life. Conversely, excitants like caffeine and tea should be consumed in moderation to prevent restlessness and irritability.
Maternal medical conditions, medicines, and surgery
A mother on chemotherapy or radiotherapy and the baby diagnosed with lactose intolerance or galactosemia are absolute contraindications for breastfeeding.
Medical conditions like HIV, TB, Herpes, or Varicella infection are relative contraindications. A decision must be taken after an appropriate cost-benefit ratio.
In women with breast surgery such as reduction, it may not be easy to feed the baby. Breast-milk expression and feeding with Paladai can help. It is always advisable to consult one’s doctor regarding the medications one can or cannot take while breastfeeding and other specific concerns.
Bottle feeds, or formula feeds, have emerged as an alternative to breastfeeding and contain the supplements that are generally lacking in breast milk and need to be provided from outside.
The formulation is complex, managing the right mix of nutrients to match the mother’s milk’s nutritive content. However, it is not custom made (like breast milk) but may help women who find breastfeeding stressful or too difficult. Other positives for formula feed include:
- The convenience of Feeding: Once constituted, either the parent or the caregiver or the other partner can provide the bottle feed to the baby. If the milk is expressed in a bottle, the mother can also feel involved. It also helps to promote bonding between the feed giver and the baby.
- Flexibility: The necessity for frequent feeding is reduced, as it may become uncomfortable for the mother to nurse in public spaces. Thus, there is no need to reschedule work or other obligations as the feeding is taken care of bottle feeding.
- Frequency: As opposed to breastfeeding, formula feeds take more time to digest, and hence, they feed less frequently.
- No-Diet Monitoring: The mother’s nutrition would not affect the composition of the breast milk provided to the baby.
Formula Feeding Challenges
The challenges associated with bottle feeds include:
- No immunological function: The maternal pre-formed antibodies and bioactive substances (for the maturation of the gut) are absent in formula feeds, and thus, the infant is at a higher risk of infections (immediate and late complications)
- Composition: Breast-milk is tailor-made by the mother to suit the baby’s demands. It evolves according to the baby’s feeding patterns, which cannot match in complexity.
- Constitution and Feeding: Unlike breast milk available in the right form at the right temperature, formula milk must be properly prepared, with planning and organization to ensure that it is always handy when the baby needs it. The accessories like bottles and nipples must also be clean and readily available. For babies who feed frequently, this routine can become overwhelming and time-consuming.
- Cost: It comes as no surprise that ready-to-feed foods are expensive. (Powdered feeds are relatively less expensive). Thus, it may not be affordable to families who are the most in need of them. Special feeds (which don’t have soy or other processing substances) may even cost higher.
- Diarrhea, Constipation, and Bloating: There is a slightly increased chance for diarrhea due to infections by water. Also, formula-fed babies have more bloating and constipation, as the feeds are relatively difficult to digest.
Making a Choice: Breast vs. bottle
Undoubtedly, breastfeeding must be encouraged with feeding in public spaces; it might not always be the answer to a mother’s work and lifestyle. It is natural for many women to switch choices after the baby is born, continuing breastfeeding and bottle feeding, considering their family and lifestyle.
Talking to the pediatrician or, better, a lactation consultant helps make the mother an informed choice regarding her options and the relative benefits-challenges of both.
Today, the world is referred to as a global village. There is an information overload but a dearth of genuine knowledge and wisdom. According to studies, fake news spreads up to 10 times faster than genuine news, which fans anxiety, hatred, and even violent crimes. It is even more important to verify news articles and received forwards before forwarding them to others. This article highlights the impact of social media on mental health.
The world has come a long way from the gold economy to the oil economy and, currently, the attention and data economy. Data is the new gold. And, social media companies jostle to gain our attention. If something is offered free, then we are the product that is being sold. Social media behemoths like Google, Facebook, and Twitter earn billions of crores of revenues via advertising campaigns and targeted displays of goods and services based on our internet browsing history, including YouTube, LinkedIn, Quora, etc. However, it has been shown that social media usage, over some time, can lead to addictive behaviors that are very similar to those occurring from drug and alcohol abuse.
Excessive usage promotes dependence and a sense of virtual reality bubble. Whereas even a temporary break fuels anxiety, depression, and the fear of missing out (FOMO).
In times of COVID-19
However, we have been going through an unprecedented pandemic of a scale that has never been seen in the last 100 years. The Covid-19 pandemic caused by the Sars-Cov2 has forced the world to change its ways. With numerous lockdowns and social distancing measures, the world has moved to virtual forums. So what is the relationship between social media and mental health?
Mobile data consumption has seen a three-fold rise among users, newer web series and movies released on Over-the-television platforms have replaced cinemas, live physical education classes have been substituted by online classes on virtual platforms such as Zoom. Sports events are played on empty platforms, being broadcast to our mobiles and televisions.
Thus, social media has proved invaluable in keeping in touch with friends, family, and long-distance acquaintances. However, it exacerbates stress and anxiety, which are signs that one must limit the usage.
Social media and mental health
Humans are genetically wired to be social animals. We look out for companionship and connections for our sense of happiness, self-worth, achievement, and life perpetuation. Thus, it has a huge impact on the mental aspect of health. Healthy social interactions promote joy, longevity, and well-being while easing stress, anxiety, depression, loneliness. As a corollary, lacking meaningful relationships accentuates the opposite and poses a mental and emotional health hazard.
It is important to realize that such social media apps can never substitute for real-world interactions, which require in-person contact. They are shown to release endorphins and other hormones, which alleviate stress and make one feel positive about life.
Paradoxically, social media technologies have been shown to make people less-social and lonelier, and more isolated while fuelling guilt and depression.
It is important to balance the virtual and real world by adapting habits that promote well-being over negative emotions.
Like any breakthrough-invention, there are both positive and negative aspects of social media.
The positive aspects include:
- Keeping in touch with friends and family
- Finding long-lost friends or distant networks with common interests.
- Promoting worthwhile causes
- Offering/ Anonymously seeking emotional support in hard times.
- Bridging the rural-urban connect
- Promoting one’s creativity and artistic abilities while learning valuable skills at the same time.
The negative aspects include:
The advent of this disruptive technology has outpaced the human abilities of thought and expression. Innumerable studies have shown a strong link between heavy, passive usage of social media and mental health problems mentioned above, including self-harm and suicidal ideation.
The negative emotions include:
Feeling of worthlessness: The number of filters and manipulation of experiences, photos, and videos is a mirage to one’s real self. They have promoted an entire generation of young adults who feel that they lack something or are just not up to the mark. Often, only the brighter side is displayed, while failures and rejections are seldom put up.
The fear of missing out (FOMO): Social media exacerbates the previous point while falsely implying that if we fail to do something, we miss out on the stuff in vogue and may be left behind. It can impact one’s self-esteem while promoting compulsive behaviors that may not be in-sync with our interests: Checking the phone first in the morning, responding to notifications, prioritizing virtual interactions over physical contacts.
Isolation and Loneliness: As mentioned above, ironically quitting social media or reducing usage makes one feel connected and ensures well-being and not the opposite.
Mood Disorders: Anxiety, compulsive behaviors, depression are all higher in those who are heavy social media users.
Cyberbullying and Hate Speech: Almost up to 15% of users have reported some form of social media bullying and hate-attacks and threats. Twitter, in particular, with top trends and hashtag features, has been found to spread rumors, unverified truths, and threats which can leave indelible marks on young minds.
Narcissism: Sharing anything and everything on social media, from relationship status to intimate experiences, can create an unhealthy egoistical life in which we live in our virtual bubble, detached from the reality of a filter-less world.
Drivers of Social Media Use:
The apps are designed in a way to keep us hooked to them for as long as possible so that we continue receiving notifications and devote our maximum time to screens of mobiles, tablets, and computers. Thus, it affects our ability to focus and concentrate, disturbs our sleep, and keeps us addicted via the reward pathways of dopamine. And it perpetuates a self-rewarding cycle of triggers, wanting to keep it using and experiencing more of the same.
The mirage of FOMO promotes impulsive behaviors while making one feel miserable and left out at the same time, constantly comparing our lives with the lives of others. Besides, to ward off social anxiety, we turn to unlock our phones and login to social media. But, it denies us the opportunity for real face-to-face conversations, which could have eased the same. More importantly, when we turn to social media to mask problems such as stress, depression, or boredom, we deny our bodies to feel those emotions and make peace with them and thus do not find a healthy outlet for our pent up feelings. Over time, social media’s use progresses to a negative vicious cycle that feeds on mental health issues like uncertainty and other negative emotions.
Social media: When does it become problematic?
While there is no fixed limit to the hours one must/must not spend on social media, the threshold depends on its impact on our everyday living, mood, and how it makes us feel. Using it to ward off boredom or making others jealous is a sign that one must use it wisely. Some of the indicators, as mentioned, include:
- Substituting real-world friends and conversations with online friends and chats.
- Unrealistic comparisons of oneself and having poor perceptions of self. It includes body-morphic disorders such as over-eating/ eating less.
- A feeling that one is not in control of one’s life with the stuff people put up online about oneself.
- Constant distractions at work and succumbing to peer pressure.
- Lack of time and efforts to engage with oneself and one’s emotions.
- Risky behavior and compulsive posting to gain more attention.
- Sleep and eye problems are arising out of blue light from mobile phones.
The way out:
The following modifications in daily life can help:
1. Reducing online screen-time
2. Focusing on things which matter
3. Spending one’s time in the real world
4. Expressing gratitude and practicing mindfulness
Social media and mental health: Striking the balance
1. Reducing online screen-time
Limiting social media usage to less than 30 minutes a day has been shown to have several positive effects, from reducing anxiety, loneliness, and depression to promoting mood and focus. Also, being mindful of what content one consumes helps in being in control of one’s life. Thus a reduction in smartphone usage by the following tips helps.
Using an app-tracker such as Your Hour or App Block to monitor one’s time spent and setting realistic goals for reducing it.
Switching off phones at certain times of the day when we are with friends and family. Practicing ‘No-mobile’ zones by not taking the mobile to bathroom, bed, or while driving.
Disabling app notifications helps one focus while preventing ourselves from being distracted as we focus on our work.
Limiting one’s checks of the phone by unlocking it frequently. Again, certain apps can help.
Uninstalling the majority of social media apps while occasionally logging in from one’s browser rather than the app.
2. Focusing on things which matter
Being mindful of one’s motivations to log in to social media (either to kill time or learn a new skill) can help us be aware of our usage patterns and reduce the time we spend mindlessly scrolling. Actively using social media for forging better relations and checking on family members is indeed different from its addictive usage for short term gains or pleasure.
If a feeling of loneliness creeps in, we might call a friend or go for brunch. If feeling depressed, we could go for a walk of fresh air, putting our favorite songs or channeling that time towards learning a new hobby.
Success and failures are part of daily life. Rather than being bogged down by disappointments and inferiority complex by looking at others’ supposed perfect lives, we deny ourselves the chance to be our authentic selves. Not every restaurant outing, not every trek needs to be shared online. Enjoy your personal space and privacy.
3. Spending one’s time in the real world
Social media should facilitate rather than replace relationships. Setting aside dedicated time for interacting with closed ones, keeping electronic distractions away is a sure way to make you feel good. Reaching out to old friends, arranging get-togethers, or exercising together also promotes bonding and kinship.
Shunning reservations while engaging with like-minded people, also boosts confidence and leads to new ideas and creative endeavors. Building friendships helps overcome insecurity and shyness while breaking the ice. A simple courtesy greeting or a warm smile to the next-door neighbors or strangers on a bus goes a long way in promoting positivity.
4. Expressing gratitude and practicing mindfulness
Feeling and expressing thankfulness for the things which we have in life is a great way to attract more abundance and joy in our lives. It gives a break from the hatred, discontent, and insecurity generated by social media at times.
Private reflections, maintaining a diary, keeping track of happy memories reinforce the positivity in one’s life. When we have time to count our blessings, we seldom have the time to vent out negative emotions or anger.
Practicing present-moment awareness, as an extension, helps ward off the feelings of FOMO. Dwelling in the uncertainties of the future prevents us from realizing our full potential. Mindfulness helps one to live in the present moment and improves our mental peace. Volunteering for community services also aids in practicing empathy, which enriches our self and our community.
social media and mental health: in children
For parents to help their children in formative years
The young minds are like wet clay, which can be molded by giving their attention to things. There have been rising cases of anxiety, cyberbullying, depression, and self-worth doubts among teenagers. Confiscating phones or a blanket ban on the child’s social media use might backfire as they may be separated from their friends and other positive aspects of internet use.
Monitoring the child’s social media usage while being partners rather than spying on their activities would better address the problem. Adjusting parental control and privacy settings limits the exposure to useful things while limiting exposure to bullies.
A recent behavior change and decreased academic or social performance warrants an open and frank discussion with the child to unmask deeper problems. Sometimes, teenagers refer to online web sources to understand sexuality and consume a lot of misinformation. Read about: Sex education for teenagers and Its Importance.
Maintaining ‘mobile-distancing’ and ‘social media breaks’ and switching off phones before sleeping helps cut down usage and over-dependence on social media.
Lastly, stressing that social media is an inaccurate description of one’s life is important. Having fewer virtual friends, fewer likes, or shares should not be equated with popularity or lower self-esteem. It is important to engage in physical activities and lifestyle changes like healthy eating and reading to be fit, aware, and make the best out of life.
Modern medicine has come a long way in terms of diagnostic and therapeutic advances. Earlier, patient safety was not one of the primary concerns today, where the thrust is on a patient-centric approach. Medical errors are a serious healthcare challenge and one of the leading causes of death in India and worldwide. Recognizing the causes and finding viable, long-lasting solutions to prevent their recurrence is important for patient safety.
Rather than individual responsibility, it is a collective challenge for the entire hospital-team to implement viable solutions that will help decrease the errors. Thus, the morbidity and the mortality associated with it, along with healthcare workers’ safety.
Medical Errors Types
The classification of medical errors (acts of commissions or omissions) includes:
- Error or delay in diagnosis
- Failure to employ indicated tests
- Use of outmoded tests or therapy
- Failure to act on results of monitoring or testing
- Error in the performance of an operation, procedure, or test
- Error in administering the treatment
- Error in the dose or method of using a drug
- Avoidable delay in treatment or in responding to an abnormal test
- Inappropriate (not indicated) care
- Failure to provide prophylactic treatment
- Inadequate monitoring or follow-up of treatment
- Failure of communication
- Equipment failure
- Other system failures
SOURCE: Leape, Lucian; Lawthers, Ann G.; Brennan, Troyen A., et al. Preventing Medical Injury. Qual Rev Bull. 19(5):144–149, 1993
Medical Errors Definitions
Medical errors are not homogenous. Thus, it has been difficult to define them. They depend upon various factors, the availability of trained personnel in a given geographic time and place, and the standard of care prevalent in similar circumstances. Thus, due to the lack of a clear definition, medical errors do not have a uniform yardstick of measurement.
Thus, the absence of a definition and the lack of measurement have led to inadequate data collection, processing, and analysis of the data.
Medical errors can be real or perceived. It leads to a deep impact on treating physicians and surgeons’ physical, mental, and social well-being. It has been shown to lead to anger, guilt, depression, and suicide as the doctors encounter the triad of worthlessness, hopelessness, and helplessness.
Compounded with the threat of possible legal action, besides the ethical disciplinary action, at times, they may lose confidence and self-esteem. When entering practice, the clinicians abide by the Hippocratic Oath and the principle of primum-non-nocere (Do no harm). However, medical errors can lead to the feeling of inflicting harm, with self-blame.
Code of Ethics
Medicine is governed by dual things: The law of the land and the Code of Ethics. Violation of the latter leads to disciplinary actions by the associated state or regional medical councils with which the doctor is associated. Whereas, violation of the former (In Indian Penal Code section 320 IPC deals with criminal negligence) leads to legal action in a country’s courts.
There is often a dilemma between the fear of punitive action and the concern of patient safety, which holds them back from reporting errors due to self or due to others.
Often at times, due to strict and rigid workplace-errors policy, medical staff do not report or document an error while hushing it up under the carpet. However, a failure to report leaves the problem unaddressed and further compromises patient safety. Thus, the cycle of errors, non-structured attempts to minimize them, and recurrence keep going unless the root causes are identified and corrective steps are taken.
However, when such errors come to the fore (as they inevitably do), the doctors and the hospital’s reputation is at stake. The emergent negative public opinion can have a devastating effect on healthcare workers’ reputation and health.
Medical Errors: Perspective
Medicine is not a perfect science, and hence, some errors are inevitable due to inherent variations in the biology of individuals and the limits of medical technology. Thus, the term ‘error’ may, at times, refer to a negative connotation that pins the blame on the medical professional when the cause might not even be attributable to the healthcare worker. Consequently, he may be less efficient at work, which will inevitably affect patient outcomes.
However, the term ‘medical error’ has become an integral part of medical jurisprudence, and over time, its definitions and scope have evolved. As with modern afflictions, medical errors are multifactorial in origin. According to the WHO, the most common cause of medical errors is miscommunication. Thus, an ineffective or lack of communication is the starting event in a chain of events that may result in an adverse patient outcome—for example, a wrong-side limb surgery or exchange of patient identity.
The margin of acceptability for medical errors is almost nil, as it deals with human beings’ lives and warrants the highest degree of caution and standard care.
Identifying and acknowledging errors is the first step in the list of improvement strategies.
Fixing an Accountability
The blame for systemic inefficiencies should not be pinned on individuals as soft targets. Thus, punitive actions are considered counter-productive, which does not lead to better future outcomes. Contrarily, it promotes a culture that would be hesitant to admit mistakes and genuine errors.
Multifactorial problems require multimodal involvement and integration across various administration lines: Legal, Medical, and Governmental. Besides being viewed as a defect in the medical services provision, errors should be seen as an opportunity to reform the education and delivery concerning healthcare services.
While accountability must be assigned, and periodic audits must be carried out by an independent third-party, it is equally important to set targets for improvements.
A common goal of hospitals the world over is to offer maximal care with minimal adverse events. A collective effort at streamlining the services with appropriate context-specific protocols will lead to decreased morbidity, mortality, and decreased healthcare costs (including insurance premiums and out-of-pocket expenditures).
Medical Errors Prevention
To check the medical errors, a Joint Commission on Patient Safety Goals was established. It has set various protocols, standards, and goals to have a safe working environment for the healthcare professionals and a positive hospital-visit for the patient.
These measures include:
The doctor is responsible for the safety and well-being of the patients under his care. In a medical team, the treating physician is compared to the Captain of the Ship. Thus, the liability of the deeds of the entire team rests on the doctor.
However, many errors are not directly attributable to the doctor, and thus, it becomes difficult to fix accountability. Thus, to prevent adverse events, there is a WHO Surgical Safety Checklist, for example, in surgery. It encompasses all the factors from patient identification, consent, and site marking for the surgery to procedural steps and the reporting of surgery and equipment malfunctioning steps.
As described earlier, punitive action discourages reporting and leads to humiliation and a negative vicious downward spiral. The administrators and the hospital’s review boards must not humiliate the physician and rather focus on preventing future incidents. This serves dual purposes: Acknowledging deficiencies and new learnings and improvement efforts that are free from the fear of retribution. This will lead to constant improvement towards an ideal administration.
The healthcare provider must be aware of the patients’ rights and duties and the physician’s rights and duties. It is all the more important in today’s era as a stress-free post-operative period, and outcome dependent treatment with a patient-centric approach takes the front seat.
Rather than justifying certain preventable errors as inevitable in a hospital setting, it is important to reduce the infections resulting from, for example, instrumentation and catheterization: Surgical site infections, adverse drug reactions, central-line associated bloodstream infections, and hospital-acquired infections (urinary tract infection and ventilator-associated pneumonia). A commitment to achieving the set targets for decreasing the above-mentioned infection rates goes a long way.
These result from the first line contact between the patient and the members of the treating team, such as doctors or nurses. Development of bedsores or thrombophlebitis of the vein secondary to an IV injection are examples of active errors.
An adverse event refers to an unanticipated surgical or medical complication in the course of treatment. It occurs when the set standards by professional bodies are not followed through. However, some adverse events may be non-preventable. For example, if a ceiling falls on a patient who is admitted to a post-operative ward. Never events are a special subset, which, as the name suggests, should have never happened at all—for example, a wrong-side surgery.
Latent Errors Avoidance
These refer to those errors which are waiting to happen in the absence of due care and precaution. For example, malfunctioning equipment and poor maintenance can result in an adverse event coupled with active human errors.
Root Cause Correction
It refers to a deficiency or decision that, if corrected or avoided, will eliminate the undesirable consequence. They include Poor hierarchical communication, inadequate knowledge or training, blame game, etc.
Pet’s Companionship- A Great Stress Buster
Pet’s Companionship, especially a dog or a cat, can be a great energy source and motivation for their owners. But how does a pet impact our life?
“Happiness is a warm puppy.”
– Charles M. Shulz
- A pet offers you a sense of belonging. They constantly remind you: you are not alone.
- Their unconditional love has a soothing effect on you.
- Pets are more connected; people may not.
- If you are distressed, they know how to calm you down.
- Research has proved that stroking your pet can elevate your mood.
- An emotional connect with a pet helps to release oxytocin: the mood enhancer.
- Depressed people feel less lonely in the company of pets.
- Pet owners tend to exercise more, as pets are dependent on them for daily routine.
- Interacting with your pets often has therapeutic effects, like decreasing cholesterol and Triglyceride level.
- Feelings of loneliness and isolation are prevalent among seniors. Having a pet certainly benefits the elderly to reduce stress.
Wow! Did you know so many benefits of having a Pet’s Companionship?
Even if we learn their quality of unconditional love and devotion, the world will be a better place to live. So, what’s on your mind?
Factors affecting sexual health- Do’s and don’ts
Sexual Health and Sexual Dysfunction
Sexual health is a state of complete physical and mental well-being concerning sexual maturity and sex organs. Thus, besides healthy sexual organs, a correct attitude regarding sexual practices and sound mental health is equally important. Thus, sexual dysfunction is a vague term, which includes a multitude of reasons: physical, social, and psychological, among others. Thus, it is a multi-factorial disorder with varying genetic susceptibility and environmental triggers upon a person’s sexual health.
While occasional disturbances and lack of adequate satisfaction are fairly common, the problem arises when the stress is prolonged. Often it causes long-term distress, which progresses to dysfunction and sexual disorder. It is thus, important to ask for professional help when the dysfunction leads to distress, which affects one’s daily life.
Often, sexual disorders are a manifestation of a physical or mental illness. For example, premature ejaculation, bedwetting is common in persons suffering from depression and other mood disorders. Consequently, the first-line drugs for such conditions are tricyclic anti-depressants or TCAs. Thus, it is important that secondary causes, if present, must be identified and treated to relieve sexual dysfunction associated distress.
Some of the other risk factors and warning signs associated with the first manifestation of sexual disorder are as follows:
Post-chemotherapy for perineal cancers (cervical, vaginal, bladder, rectal), women experience sexual side effects such as a reduction in sexual drive, vaginal dryness, and, as a result, painful coitus, which reinforces negative emotions associated with sex.
In men with pre-existing heart disease, a chronic inability to maintain an erection of the penis during sex (erectile dysfunction) may be the first sign. The corporal vessels of the penis, having a smaller lumen, are more vulnerable to damage by lipids, hypertension, and atherosclerosis than the other vessels. Thus, before the cardiac manifestations become apparent, erectile dysfunction may be the first presenting signs of impending heart disease.
The stigma associated with sexual health and its disorders is immense. A significant percentage of the population suffers from some of the other kinds of sexual distress. Thus, it is important to shun the taboo and ask for professional help, to prevent consequences and early diagnosis of disorders when they are amenable to treatment.
Sexual Health: Physical, Mental and Social well-being The World Health Organization (WHO) defines sexual health as a state of physical, mental and social well-being in
Sexually Transmitted Diseases: Risks and Prevention Sexually transmitted diseases (STDs) or otherwise known as sexually transmitted infections (STIs) are generally acquired by sexual contact. The
Sex education for teenagers- How to deal with adolescent issuesWhy study sex education in adolescence?Adolescence is the transition from childhood to adulthood. It is accompanied by hormonal changes, which also manifest themselves in physical changes in the bodies of boys and girls (Growth of genitalia, the appearance of axillary and pubic hair, a change in the pitch of voice, attraction towards the opposite sex, etc.). Also, there is impulsiveness and curiosity to indulge in acts, which are considered forbidden, without the adequate wisdom to control these impulses. Alarmingly, they have given rise to the following consequences, which can be controlled. Imparting sex education can lead to
- Prevention of teenage pregnancies and unsafe abortions
- Increased accessibility to methods of contraception and safer sexual practices
- Control of sexually transmitted diseases such as AIDS, gonorrhea, and pelvic inflammatory disease may contribute to infertility later in life.
What is Sexual Health?According to the World Health Organisation,Health is a state of complete physical, mental, and social well-being and not just an absence of disease or infirmity to lead a socially and economically productive life.Sexual health is an integral part of healthy living, starting from teenage and right to parenthood and beyond. However, many teenagers are unaware of the right kind of information concerning sexual organs, sexual maturity, the practice of sex, and the various kinds of contraception.Owing to a large amount of misinformation and, at times, legitimate information void, the youngsters, out of curiosity, refer to online web sources to understand sexuality and its varied aspects. However, there is no certainty that these may be authentic, and thus, they fall prey to misconceptions. These misconceptions at a young age might lead to catastrophic consequences later in life.
Current Status of Sex Education in IndiaIn India, there is no uniform policy about sex education. It has faced many ups and downs after the NCERT implemented it. Currently, government institutions do not teach sex education to the students regarding good touch, bad touch, safe-sexual practices, and the medical and legal recourse in cases of emergencies. Private schools and institutions are, however, not covered under the restriction order from the government. They are free to conduct weekly or monthly lectures and seminars on sex education or not conduct them.According to recent government guidelines, sex education, under the revised Human Resource Development Ministry guidelines, operates on a pilot basis in select districts across India. However, uniform policy for implementation and roll-out is still lacking.
What exactly is sex education? What are the myths associated with it?Sex education mainly comprises the skills, knowledge, and development of thought processes to make healthy and informed decisions related to all matters concerning sex.Before discussing them, parents themselves need to bust the myths while imparting sex education to their children.Some of the common myths of teenage sex education are as follows:Myth: Sex education will lead to teens indulging in sex more frequentlyTruth: Sex education does not promote promiscuity. Contrarily, it helps teenage children make more informed decisions regarding their sexual health and generate a feeling of being-in-charge. Also, comprehensive sex education reduces risky behaviors and promotes trust with a single partner. Myth: There is no need for comprehensive sex education. Abstinence alone is sufficient.Truth: This is incorrect. Abstinence-only programs fail to realize the biological urges among teenagers. A comprehensive sex education program channelizes teenagers’ energy and concerns more productively and rationally, such that they take charge of their own sexual health. Myth: Sex education will lead to an increased incidence of teenage pregnancies.Truth: Sex education provides female teenagers with more options and promotes safe sexual behavior using contraceptive methods. Thus, investment in sex-education will reap rich dividends for the future generation in terms of the individual’s overall health status and the community as a whole. It needs to be liberated from the bedroom’s confines to the dining and living room, where there can be free-flowing open-ended discussions where all stakeholders can participate and feel cherished, valued, and confident.
By whom and when?Sex education is best provided by trained health professionals in schools and teachers. However, to come into action and have meaningful action, a healthy discussion with parents back at home is equally important.The social environment is filled with subtle cues related to sex: Horrific news of rapes and sexual perversions, intimate scenes in movies and other entertainment shows, and advertisements ranging from condoms to sanitary pads and iPills. It is important to build upon conversations that stem from such events, which act like springboards.Rather than thinking of sex education as an independent entity per se, it is important to consider it a part of an ongoing discussion that affects all the spheres of life: Personal, social, and cultural.
- Initiating the Conversation: Casual moments such as a drive-through or a late-night walk provide much-needed privacy and opportunity to discuss the issues (which might have been raised during an advertisement or a news debate) kickstart a conversation regarding the complexities involved in the same.
- Being honest and candid: At times, the children are uncomfortable to break the ice with the parents for fear of being judged adversely or simply feeling awkward. Reciprocally, the parents may feel the same if they are averse to the idea of discussing them with the child. What is required is an acknowledgment of the discomfort and being honest. If you don’t know the answer to a question, there is no harm in admitting so. One can always revert after looking up for a legitimate answer or jointly find it and then discuss it.
- Being Direct: Brushing contentious issues under the carpet would do more harm than good. The questions would remain, and the queries would be unresolved. It is important then, to confront the issues heads on. For example, the risks of sexually transmitted diseases such as gonorrhea and HIV, amongst others. Their association with unsafe sexual practices and the adverse health impacts must be discussed.
- Being Receptive: Discussions surrounding sex cannot be one-way. They need to be dynamic, with active participation between the parents and the child. It should not turn out to be a didactic lecture where the parent imposes his views. Rather, they should be receptive to his concerns, teenage pressures, and views regarding sexual maturity.
- Being Socio-Culturally Relevant: Often, sex education discussions revolve around well-established facts and figures. However, it is equally important to discuss them in subjective values and attitudes, which one adopts in life. A case in point being premarital sexual intercourse. Beyond the scope of legal repercussions, the questions of ethics and responsibility must be deliberated along with personal beliefs.
- Room for more: With evolving societies and globalization, there are conflicts between the older and newer generations—a case in point being sexuality. Sex is a biological concept, while gender is a social concept. With the emergence of LGBTQ movements, many teenagers are confused with regards to their sexuality. While discussing these issues might seem challenging, the conversation is the best way to deal with questions arising regarding the same. Whatever be the outcome of it, it is always prudent to express to them that you’d love them unconditionally irrespective of their choices and orientation.
Is it relevant to study sex education in developing countries?If yes, some frequently asked questions:With increasing westernization, developing countries like India face emerging issues of consent, date rape, sexual orientation, among others. Some of the questions might be:The right age for sexual activity commencement: While peer pressure, curiosity, and various challenges might steer some teenagers into sexual activity, it is important to stress that sex is an adult activity. The Indian Penal Code classifies sexual intercourse with a female less than 18 years of age as statutory rape. Also, affection can be expressed through other means such as intimate talks, hand-holding, dates, or hugging and kissing.Consent for sexual activity: The importance of consent cannot be understated. Any form of forced sex (within or outside the ambit of a relationship) amounts to rape (However, the IPC does list marital rape as an offense). As is famously stated, ‘No means no.’ Also, drugs and alcohol are likely to impair judgment and reduce inhibitions, predisposing situations where rape is more likely. It is advisable to have abstinence from these substances. Warning signs of Unhealthy relationships:Dating violence has come to the fore with increased awareness and reporting regarding the same. Parents must be vigilant to the warning signs of violence while dating/ in a relationship. They include:
- Alcohol and secretive drug abuse
- Social withdrawal from friends and family
- Excusing the partner’s unacceptable behavior
- Loss of interest in activities which were once enjoyable (anhedonia)
- Bruises, scratch marks, or other unexplained injuries
Finetuning your response to the child’s sexual behavior:While the importance of reinforcing the adult aspect of sexual activity cannot be understated, if the teen becomes sexually active, it is more important than ever to keep a vigil and to engage him in conversations. You need to state your concerns openly and imprint upon him the seriousness of the responsibilities which come along with it.Safe sex practices, barrier contraception, and exclusivity of a relationship (to avoid the risk of contracting STDs) must be communicated from time to time without being too intrusive.Once in a while, a check-up with the physician gives the child a much-needed opportunity to address his concerns in front of a medical professional confidentially and at his own comfort and leisure. Besides, the doctor’s words carry weight, which might positively influence the teen’s behavior regarding contraception and safe sex practices.Also, in teenage boys and girls, Human Papilloma Virus vaccination helps prevent genital warts and cancers of the cervix and the penis.Some worthwhile sites providing genuine information on sex and sexual health concerns include:
- IT MATTERS
- ONE IN THREE
- REACH OUT
Sexual Health: Physical, Mental and Social well-being The World Health Organization (WHO) defines sexual health as a state of physical, mental and social well-being in
Sexually Transmitted Diseases: Risks and Prevention Sexually transmitted diseases (STDs) or otherwise known as sexually transmitted infections (STIs) are generally acquired by sexual contact. The
Blood transfusion- Indications, Procedure, Cost, and ProblemsWhat is Blood Transfusion?Blood transfusion refers to transferring blood or its components into a human recipient’s vein for therapeutic purposes to replace the blood or compensate for those deficient blood components.It can be a lifesaving measure to replace the blood lost during surgery, severe traumatic injury, or burns.It can also be useful when the body cannot produce enough blood components or if the blood components produced are defective.For example, in severe anemia, when the Haemoglobin levels fall below 7gm per decilitre, blood transfusion, either whole blood transfusion or packed RBC transfusion, is advised.Similarly, in thalassemia patients, where there is defective hemoglobin chain synthesis, and as a result, there is hemolytic anemia, repeated blood transfusions are advised to prevent the delay in growth the predisposition to infections.The blood required is obtained from a donor or a blood bank. Thus, blood banks are responsible for collecting, testing, and storing blood.Normally, in most surgical and minor surgical procedures, the need for blood transfusion does not arise. One of the major focuses of modern-day surgery is to reduce blood loss and maintain the homeostasis of the body’s organ systems.However, surgical patients might require a blood transfusion, and it is better to keep the possibility in mind before consenting for surgery and planning for post-operative care. The need and indication and the risks of transfusion must be discussed with the treating physician.It is always advisable to begin the decision-making process as early as possible since there are time limitations and health restrictions.
Blood transfusion TypesThe types of blood transfusion depend upon the donor, who has donated blood to the blood bank.By far, volunteers’ blood donations are the most common type of blood donations available in the blood bank. The blood from such donors is usually readily available and, with proper screening, has little risk of adverse outcomes.However, the likelihood of contracting infections, such as Hepatitis B and HIV, remains if there is improper testing.Autologous blood transfusion refers to the transfusion of one’s own blood. It is naturally only possible in pre-planned (elective) surgical procedures and needs to fulfill certain eligibility criteria.It is the safest method with practically no risks.Directed donor blood transfusion allows the patient to receive blood from family members or friends (known donors). However, it needs to be collected several days before the transfusion’s actual need to ensure testing and screening.However, the protocols for both blood donation and transfusion are specific for the respective hospitals.As mentioned above, blood transfusion is a life-saving procedure. However, one may refuse to provide consent for the same, leading to disastrous complications and even death.However, doctors may provide emergency blood transfusion to save the recipient’s life in case of emergencies.
Prerequisites: Blood transfusionBefore transfusing the blood, the healthcare provider ensures re-confirmation of the identity, the blood group, and the amount to ensure that blood is given to the correct patient.However, if during transfusion, one has symptoms of breathlessness (dyspnea) or itching and fever or chills (blood transfusion reaction), the healthcare provider must be alerted immediately.As mentioned above, blood source can be Autologous (one’s own) or Donor (someone else’s) blood.Autologous blood transfusion is further divided into Preoperative, Intra-operative, and Post-operative donation.Hemodilution is another method in which some blood is drawn during the surgery and is replaced with IV fluids. Later, after the surgery, the blood is filtered and returned to the body. However, large amounts of blood cannot be drawn by this method.Plasmapheresis: It is another variant in which platelets and plasma are withdrawn before surgery and returned to the body when there is a need to stop bleeding. However, it has limited applications.The second type is the donor blood, which can be volunteering-based (blood banks) or by designated donors (family and friends). The blood is screened for infectious agents and other noxious substances. However, the risk of infection remains, albeit minuscule.
Blood and its components:A 60 kg human has around 5 liters of blood, which constitutes about 8% of the adult human body weight. Blood is a fluid connective tissue. It is composed of plasma (55%) and formed elements (45%). The formed elements include red blood cells, white blood cells, platelets, proteins, and coagulation factors.There are various blood groups. The blood group is determined by antigens’ presence (specialized proteins) on the red blood cells’ surface.Thus, a person with blood group A has A antigen, a person with blood group B has B antigen, and a person with blood group AB has both, A and B antigens on the surface of the red blood cells. Similarly, a person with O blood group has neither A nor B antigens on its surface.There is a presence of corresponding antibodies in the plasma of the patients. Thus, a person with blood group A will have an anti-B antibody (antibody directed against B antigen, since it is not present in the person). Similarly, a person with blood group B will have an anti-A antibody. A person with blood group AB will have no antibodies. Lastly, a person with blood group O will have both, A and B antibodies (since both the antigens are absent on the red blood cells).Another factor is the Rh factor, also referred to as the D antigen. Patients with D antigen are Rh-positive, while those who do not have the antigen are Rh-negative. Thus, an Rh-positive person can receive blood from both Rh-positive and Rh-negative persons. However, Rh-negative persons should only receive blood, which is Rh-negative. (Rh-negative blood is to be used for emergencies when there is no time to test a person’s Rh type)
Conclusion:It is clear then that a person with blood group AB positive would be the universal recipient (since he has no antibodies in his plasma, and hence he can receive blood from any blood group person)The person with O negative would also be the universal donor since his RBCs have no antigens on its surface. They can be transfused into another person without the fear of an antigen-antibody reaction in the recipient.There may be whole blood transfusion, or only a part may be transfused, such as platelets (in dengue) or RBCs (in severe anemia).
Red Blood Cell TransfusionsRBCs or Red blood cells are the most commonly transfused component of the blood. RBCs are responsible for carrying oxygen from the lungs to the tissues and carrying carbon-dioxide back from the tissues to the lungs for expiration.RBC transfusion is indicated after surgery, severe injury, hemorrhage, or anemia.Anaemia refers to the decrease in the oxygen-carrying capacity of the blood due to a decrease in RBC number or decrease in hemoglobin concentration or both, below the normal levels for that particular age and sex. (Haemoglobin in the RBCs is responsible for oxygen transport and gaseous exchange in the body).
Platelets and Clotting Factors transfusion:Both the products are useful in hemostasis to stop the bleeding (internal or external) and prevent hypovolemia and shock. They are also indicated in conditions where the body is unable to make sufficient platelets or clotting factors. E.g., In hemophilia, which is an X-linked recessive disorder, clotting factors are absent. As a result, there is excessive bleeding on minor trauma. There can be spontaneous internal hemorrhage in joints, knees, etc. Another disease in which it is indicated is thrombocytopenia, where there is a deficiency of platelets.
Plasma Transfusion:As mentioned above, plasma is the liquid part of the blood. It is composed mainly of water, proteins, clotting factors, and nutrients such as glucose, vitamins, and minerals.It is generally indicated in patients with severe burns (who have extensive loss of plasma), chronic liver failure, or a severe sepsis infection.
What to expect: Blood transfusion
Before Transfusion:You would be asked if you had something to eat before you came for transfusion. If not, biscuits and juice would be provided to maintain the blood sugar level and prevent a syncopal attack.
The technician will prick one’s finger, and the blood drops are placed on the slide. Alternatively, blood from one of the veins is dropped, and with the help of appropriate reagents, the blood group is determined, whether A, B, AB, or O, and whether it is Rh-positive or negative.Only compatible blood is provided for transfusion to prevent the risk of antigen-antibody reaction and hemolysis.Also, to prevent allergic reactions, which may be genetically determined and hard to know beforehand, medicines may be prescribed to prevent such reactions.
During Transfusion:A blood transfusion may occur in an in-patient ward, where the patient is admitted or during surgery in the Operation Theatre Complex or the emergency rooms.An appropriately sized needle is used to insert an IV cannula or an IV line into the blood vessels, and the other end is attached to a blood bag, from which the blood is transfused. It usually takes between 1 to 4 hours for transfusion. However, the time duration may vary depending upon the units of blood transfused and the components transfused.Throughout the transfusion, the vital signs are monitored, especially to watch out for signs of allergic reactions.
After TransfusionPost-transfusion, vital signs are checked, such as temperature, blood pressure, heart rate, and oxygen saturation. The IV cannula is taken out. There may be bruising at the site of cannulation due to thrombophlebitis and some edema. However, it resolves within a day or two.
Blood transfusion: Allergic Reactions and Transfusion-associated complicationsThe majority of blood transfusions do not have any adverse effects. However, mild edema and pain at the injection site to more severe symptoms like systemic anaphylaxis can ensue.
Allergic Reactions:They may occur even with the right type of matching blood transfusion.
- They may be mild or severe, and the symptoms include:
- Tachycardia (increase in heart rate) and palpitations
- Anxiety and perspiration
- Cold, clammy skin
- Breathing difficulties (dyspnoea)
- Nausea and vomiting
Viruses and Infectious Diseases:The screening of blood is done to prevent the following diseases.The risk of HIV infection via blood transfusion is 1 in 2 million, much lower than road traffic accidents and other morbidity causes.The risk of Hepatitis B infection is 1 in 2,00,000, while Hepatitis C infection is 1 in 2 million.Variant Creutzfeldt-Jacod Disease, earlier referred to as Kuru disease, is a prion mediated fatal brain disorder. The possibility of it remains low, via a blood transfusion, but is a documented risk.
Fever:Within a day or two of blood transfusion, one may develop a fever, which is the body’s physiologic response to the transfused White blood cells. However, it resolves over a period of 1-2 days or with over-the-counter NSAIDs such as paracetamol and diclofenac.Many times, WBCs are centrifuged and removed and not transfused. This makes the chances of a fever developing less likely.
Iron overload:Repeated blood transfusions may lead to an iron buildup in the blood. This is especially true concerning hematological disorders like Beta-thalassemia. It can lead to iron overload(siderosis) and iron deposition into the liver, heart, and other vital internal viscera.Iron chelation therapy reduces the gut’s iron absorption in the form of desferrioxamine or intake with vitamin C. This helps to maintain the blood iron levels at a normal range.
Risks and Complications: Blood transfusion
Transfusion Associated Acute Lung Injury (TRALI):Normally, during a blood transfusion, the vital parameters such as heart rate, blood pressure, and respiratory rate are monitored. In some patients, post-transfusion, there can be difficulty in breathing due to lung damage. However, it may be transient dyspnea, and the majority of patients recover.In 5-25% of those who develop symptoms, the damage may severely cause significant lung injury and death. It is more common with severely immunocompromised patients.It is postulated that plasma from women who have been pregnant might be responsible for antibodies that damage the lungs and disrupt respiration. Thus, male and female plasma is now being used differently in different centers.
Acute Immune Haemolytic Reaction:This is a result of mismatched blood transfusion. As a result, the body’s host defense mechanisms attack and destroy the transfused RBCs. Hemolysis and hemoglobinuria, which, when deposited in the kidney, leads to acute tubular necrosis and acute renal failure.The symptoms include:Fever with chillsLoin pain or pack painDark or cola-colored urine.It is an acute reaction, and blood transfusion is stopped at the first sign of acute hemolytic reaction.
Delayed hemolytic reaction:As is evident in the name, in contrast to acute hemolytic reaction, the red blood cells are destroyed insidiously over time in delayed hemolytic reactions.Both acute and chronic reactions are common in patients who have had a previous blood transfusion history.
Graft versus host disease:It is a hypersensitivity reaction in which the white blood cells from the donor plasma attack the antigens present in the recipient’s tissues and organs.Immunosuppression is a major risk factor for developing graft versus host disease.The symptoms generally start within a month of transfusion and include fever and body rash. To minimize the risk of developing GVHD, only RBCs are transfused, while WBCs are centrifuged and removed.
Alternatives to Blood Transfusions:There are no alternatives to blood; however, some recombinant substances, which mimic the endogenous substances, have been produced, making red blood cells.For example, in patients with chronic kidney disease, recombinant erythropoietin is administered. It stimulates the bone marrow to produce more red blood cells, thus requiring fewer transfusions.With minimally invasive surgeries, such as laparoscopic and endoscopic surgeries, the amount of blood loss is minimized. Also, with optimum peri-operative and post-operative care, the risk of infections is reduced, and blood transfusions are seldom required. Refer to other articles:
Allergic asthma and its Diagnostic Tests
Allergic asthma is the most common type of asthma triggered by an allergen. An allergen is any substance that causes a hypersensitivity reaction. The common allergens are inhalant (dust, pollens, fungi, smoke, perfume, or odors of plastic), and sometimes they are food, drugs, infectious agents, physical agents, or through contact with certain things. The allergens do not affect everyone but only affect hypersensitive people to the allergens that trigger a response starting in the immune system.
It is essential to see a specialist who helps to find the various allergens through conducting various tests.
What is an allergy test?
Allergy test is some test helps to decide the allergens that cause a bout of asthma. However, asthma caused due to exercise, stress, illness, or cold is not ascertained in these tests.
Several tests were done to find out the allergen for asthma, including a skin test and blood test. Once identified, it helps manage the symptoms and avoid the allergens to prevent the bouts of asthma attacks.
Allergy Skin Test:
Allergy skin test: In an allergy skin test, the skin is exposed to the suspected allergen. After exposure to the allergen, the reaction is checked for signs of an allergic reaction. This test helps to determine the allergen, be it because of ingestion, touch, or inhalation.
An allergy skin test can be conducted for people of any age group, including infants to old adults.
The indications for allergy skin test are:
- Hay fever
- Allergic asthma
- Food allergy
- Penicillin allergy
- Bee poison allergy
- Rubber/latex allergy
There are few contradictions of allergy skin tests. These are:
- Having a severe allergic reaction
- Certain skin conditions like psoriasis or eczema in large areas of the body.
- Having medicines that can differ test results
Side effects of the test:
- Swollen red lips
- Itchy bumps, which can last for a couple of days.
- Skin prick test: It is the most common type of skin prick test. This test is a time-saving test where around forty allergens are tested in one go. Tiny drops of allergens are inserted just beneath the skin with the help of a lancet. If the recipient is allergic to the specific allergen, the area surrounding it will become red. This procedure is not at all painful.
- Intradermal test: This test is indicated when skin prick tests did not show the expected result. In this test, the doctor injects the allergen intra-dermally. This test is done in cases where the allergens are either drugs or allergies because of the environment. This is usually not suitable for allergies caused because of food or latex allergy. This test is mostly correct, but sometimes false-positive results are also reported.
- Patch test: This test uses an allergen to a patch that is left for forty-eight hours. If the skin appears red, irritated with itching, it indicates the chance of being allergic to the substance.
Allergic blood test:
An allergic blood test is suited for cases where allergic skin test cannot be done. This test is done either on blood or the immunosorbent assay. The test includes the following:
- ELISA or EIA (enzyme-linked immunosorbent assay): This test helps determine the allergen-specific antibody in the blood.
- RAST or Radio allegro-sorbent test: This test helps to find specific allergen related antibodies. This test is not used these days as ELISA gives more accurate results.
Vitiligo: a Skin Disorder with Milky-white Patches
Vitiligo is a chronic skin disorder that causes patchy loss of skin pigmentation.
Vitiligo may start at any age but often appears before the age of 20 years. This condition can affect any part of your body, commonly involving the hands and feet. In addition to that, it may also make your hair turn grey or white (called leucotrichia). It tends to progress with time and, as a result, gradually involves larger areas of skin. However, this condition is neither life-threatening nor contagious.
Why does VITILIGO occur?
- It basically occurs when the cells (melanocytes) that produce melanin, the pigment responsible for skin color, cannot do so. This, in turn, leads to blotches of milky-white patches on various body parts.
- Though this phenomenon’s main cause is unknown, it has been widely linked with autoimmune etiology. With autoimmune etiology, it basically means that it is a disorder in which your own immune system attacks your body and destroys the melanocytes in the skin.
- Though not directly responsible for causing vitiligo, a positive family history may act as a risk factor.
- Genes associated with vitiligo, including NLRP1 and PTPN22 may also increase the risk.
- Triggering events such as sunburn, stress, or exposure to industrial chemicals, are also associated with the risk of vitiligo.
Symptoms- What changes does vitiligo cause?
- The most important manifestation involves patchy loss of skin color, which is usually bilateral and symmetrical.
- Depigmentation initially affects the sun-exposed areas, such as the hands, feet, arms, face, and lips.
- The white patches may, at times, have a hyperpigmented border and scalloped margins.
- Depigmentation of hair (on your scalp, eyelashes, eyebrows, or beard) is called leucotrichia and is a poor prognostic factor.
- Discoloration may involve the inside of your mouth and nose (mucous membranes) and even the eyeball’s inner layer (retina).
Hoe does vitiligo get diagnosed?
- It usually involves a proper physical examination and medical history.
- Any contributory factors such as recent sunburns, premature graying of your hair, or any autoimmune diseases, are paid attention to.
- Tracing family history is also important.
- The ultraviolet lamp (known as wood’s lamp) helps differentiate between vitiligo and other skin conditions.
What are the Possible Complications?
- More than the physical complications, it is the psychological stress that is quite commonly observed. Patients affected with vitiligo usually develop a tendency to social withdrawal and depression.
- In addition to that, these patients are at an increased risk of sunburn, skin carcinoma, iritis (inflammation of the iris), hearing loss, etc.
- Therefore, it becomes all the more important to apply a good amount of sunscreen (at least SPF 30) and wearing proper clothes for adequate protection.
Know more about Albinism
Is there any Treatment for Vitiligo?
Treatments for vitiligo mainly focus on the restoration of normal pigmentation of the skin. The treatment options usually vary according to the severity of the condition, number of patches present, locations of the depigmentation, size of these blotches, and the patient’s response to treatment. It involves both medical as well as surgical intervention. At times, it may involve a combination of both.
Medical treatments include the following:
- Topical creams– There are quite a few creams available, including corticosteroids, that can help treat cases that are still in the initial stages.
- Psoralen and ultraviolet A (PUVA) therapy: This method involves administering psoralen as a pill or its application as a cream onto the skin directly. This is followed by the exposure of skin to UVA light to activate the drugs that help restore color to your skin.
- Narrowband UVB light: This is another option or alternative to traditional PUVA therapy. It involves the exposure of skin to a more focused type of light therapy. It basically has comparatively fewer side effects.
- Depigmentation – This often is a solution when most treatments have failed in returning the normal skin pigmentation.
Surgical intervention is required when any of the above-mentioned solutions fail to yield results. It involves the following:
- Skin grafting– Transfer of pigmented skin to the affected areas. Risks of skin grafting involve infection and scarring.
- Melanocyte transplants– In this type, the melanocytes are removed and allowed to grow in a laboratory setting. These are then transplanted to the areas affected.