Why is Nipah virus more deadly than Covid-19?

 About Nipah

Like Covid-19, Nipah virus is a highly contagious virus.  It is transmitted from animals to humans.  The first case was seen in Malaysia.  Cases of the virus have since been confirmed in Singapore and Bangladesh.  The virus is spread from pigs and sheep to humans.


It can range from mild to severe.  If a pig is infected, it can be passed from one person to another.  Similarly, the fruit on the tree is eaten by an infected goat.  It moves even if it comes in contact with a person.  Also, it is more likely to be transmitted through the urine of a goat.  How to distinguish between Nipah virus and Covid-19 virus?  It is not easy to separate Covid-19 and Nipa.  Because some of its symptoms are similar.  A person infected with both viruses develops a fever, headache, and lung problems.  It has slightly less respiratory problems than Covid-19.  However, the mortality rate from Nipah virus infection is higher than that from Covid-19.  Nipah infection has a 50 to 75 percent mortality rate in people with headaches.  This means that 3 out of 4 infected people die.  Symptoms appear 4 to 14 days after infection with the virus.  People with respiratory problems have a higher risk of moving from one person to another.  Primarily, it causes more damage to the scalp.  So far, the infection has not been seen in Nepal.  However, once it is confirmed in neighboring India, it cannot be said that it will not be seen in Nepal.  As the border will be opened in the approaching Dashain Tihar, there is a strong possibility that the infection will spread in Nepal.

Survival measures

1.  To avoid scurvy and sick pigs, pig keepers should also pay attention to personal hygiene.

2.  Public taps, pond water should not be consumed and used as much as possible.  Because, Chamero may have eaten that water.

3.  Do not eat false fruit eaten by any bird or fruit that has fallen on the ground.

4.  Residents living near Chamero's residence should be more vigilant.

5.  A person with symptoms of infection should be examined immediately and isolated as much as possible.  Is it possible to cure it?  The diagnosis of this virus has not been found yet.  Rivavirin was once thought to be effective against the virus.  However, so far it has only been tested in the laboratory.  Humans have not been tested.  In 2020, work has begun on a vaccine against it.  Which is being studied and researched.  Before coming to Nepal, the government should raise awareness among the people and make necessary preparations for its control and prevention.  For this, it seems necessary to make a separate unit like Covid-19.  Because, the mortality rate of Nipah virus is very high.  As it is seen that up to 3 out of 4 infected people will die, it is necessary to prepare for it in every possible way.

SIX FOODS THAT CONTROL CHOLESTEROL LEVELS

Walnut

Cholesterol is essential for a healthy life.  The fat found in the blood is called cholesterol.  It helps keep every cell in the body alive.  Cholesterol reaches various parts of the body through blood plasma.  However, sometimes the amount can increase.  When the amount of cholesterol in the blood is high, there is a risk of causing heart problems.  Even with regular exercise, if the diet is not healthy, the amount of bad cholesterol in the body increases.  It is important to pay special attention to food to control it.

1. Walnut

Finally, omega-3 and monounsaturated fatty acids are abundant.  Cholesterol can be controlled up to 15 percent by eating walnut.  It also cures inflammation of the body, which improves blood circulation in the body.  In addition to omega-3, vitamin-B complex and vitamin-E are also found in abundance.

2. Olive oil

This oil is the best source of monounsaturated fats.  It also helps reduce inflammation in the body and lowers cholesterol levels.  Olive oil intake is important if you are concerned about heart-healthy foods.  It can be eaten not only for cooking but also as a salad.

3. Red wine

Alcohol consumption is harmful to health.  But scientific research has shown that red wine helps control cholesterol.  Red wine is made from a special type of grape, known as tempranilo red grape.  It lowers cholesterol levels.  For this you can drink a glass of wine at night.  But, if you drink more than that, it will have the opposite effect.

4. Orange juice

Orange juice is also a special type of cholesterol-controlling superfood.  Orange juice can be taken for breakfast in the morning.  It is the best source of vitamin C.  In addition, it is rich in magnesium, vitamin B complex, vitamin A and potassium.  According to a research, regular consumption of orange juice can control cholesterol levels.

5. Dark chocolate

The antioxidants in dark chocolate help control cholesterol.  Researchers at San Diego State University found that dark chocolate had a positive effect on lowering blood sugar and bad cholesterol.  It also plays a role in raising good cholesterol.  In addition, it was found to have the benefits of helping to keep the skin healthy, tightening the brain, regulating blood circulation, and improving vision.

6. Green tea

The antioxidant element in green tea is useful in lowering cholesterol.  According to research published in the Journal of the American Dietetic Association, people who regularly consume green tea have lower cholesterol levels.  Green tea helps to lower the total amount of cholesterol and LDL levels by 5 to 6 points.

Eight Habits That Damage Your Kidneys

 

Fig. Kidneys 

Knowingly or unknowingly, our daily habits may also be affecting the kidneys.  Negligence is also a major factor in the impact on the kidneys, which is often concerned with human health.

Which are as follows:

1. The habit of consuming too much salt

Eating too much salt or other salty foods can also damage the kidneys.  Salt raises sodium blood pressure, which affects the kidneys.

2. The habit of holding back urine

When you stop urinating, the urine bag fills up.  Urine fills up and reaches the kidneys.  Bacteria in the urine damage the kidneys.

3. The habit of drinking less water

Drinking more or less water The body needs to drink 8 to 10 glasses of water daily.  Disorders that accumulate in the body even after drinking a small amount of water affect the regular functioning of the kidneys.  Drinking too much water also affects the kidneys.

4. The habit of smoking

Cigarettes or tobacco smokers or smokers accumulate toxins in the body which can damage the kidneys.  Smoking raises blood pressure and ultimately affects the kidneys.

5. When drinking more cold drinks

According to a study done in Japan, people who drink a lot of cold drinks or cold drinks are also more likely to have kidney damage.  The orthophosphoric acid in cold drinks can cause serious damage to the kidneys.

6. Excessive eating habits

People who eat more than normal people also have kidney problems.  Eating more increases weight.  Even if you are overweight, there are various problems related to the kidneys.

7. The habit of eating too much

Eating a lot of non-vegetarian meat contains enough protein.  Too much protein increases the metabolic load on the kidneys and causes kidney stone problems.

8. The habit of not sleeping late at night

People who do not sleep for 7 to 8 hours a day tend to have high blood pressure and heart problems.  Blood pressure and heart disease cause kidney problems

Sources of essential minerals

About 4 percent of the body weight is made up of essential mineral elements. They are calcium, phosphorus, potassium, sulphur, sodium, chlorine, chlorine, iron, zinc, copper, iodine, magnesium, manganese, molybdenum, selenium and chromium .

Essential minerals required by the body

On the basis of the daily requirement for good health, minerals can be grouped into macrominerals: calcium, phosphorus, potassium, sulphur, sodium, chlorine, and magnesium ; and trace minerals: iron, zinc, copper, iodine, manganese, molybdenum, selenium and chromium. Macrominerals are required in amounts of g/day for healthy life while trace minerals are required in amounts less than 100 mg/day for healthy life.

Macrominerals are present principally in body fluids as electrolytes and tissues as structural components. And trace elements are present in tissues.

All these minerals have diverse and critical functions in human metabolism, so they are called essential minerals that should be included in diet.

Essential trace minerals (elements) have vital roles in enzymatic reactions. They functions as part of enzyme reactions, either as a constituent part of the enzyme or as activators of enzyme systems. They have also a structural and catalytic role in gene expression.
Another function of trace minerals include the storage and transport of substrates as metalloproteins, for example zinc and insulin in secretory vesicles in the beta cells in the pancreas.

Cobalt is also required only as preformed vitamin B12, fluorine is not essential but is beneficial as fluoride.

Let's discuss details about essential materials required by the body:

Calcium

Calcium is a essential structural component of the bones where 99 percent of calcium is found.

Function of calcium

Calcium also plays important role in the coagulation of blood and mechanism of muscle contraction.

Dietary sources of calcium

Calcium can be got abundantly from milk ,cheese, eggs, fish, green vegetables.

Daily requirement of calcium

Normally  daily requirements of calcium are 700 mg for normal adults and are higher in pregnant women and growing children .

Calcium deficiency may occur usually due to deficiency of vitamin D because absorption of calcium from intestinal tract is vitamin D-dependent.

Phosphorus / phosphate

Phosphorus is another essential element required for normal growth and development of the body. It is non metallic and highly reactive element which is present in the nature only in combined forms, predominantly with calcium in rock or bone. The common form of phosphorus in the nature is phosphate.

At  normal condition, human body contains approximately 0.6 to 1.1 % phosphorus of total mass of the body. About 85 percent of phosphorus is found in bones and teeth in phosphate form. And rest of phosphorus is in the soft tissues where it takes part in metabolic reaction. Half to two third of the phosphorus in blood is in red blood cells ( erythrocytes).

Function of phosphorus

The main function of phosphorus is to build and repair bones and teeth, help nerves function, and  make muscle contract.

It in association with calcium and vitamin D helps hardening bones and teeth.

In serum, phosphate ion has important role in acids /base  balance (buffering).

In cells,  phosphorus is important in the structure of nucleic acids (DNA, RNA) and phospholipids in cell membranes.

In cell energy metabolism,  it involves in production of ATP (Adinosine triphosphatase) , which is source of energy.

Dietary sources of phosphorus/phosphate

All natural foods like milk, cheese, liver, kidneys, meat, oat meal, nuts, legumes,  fish, bread are the richest dietary sources of phosphorus.

Daily requirement of phosphorus/phosphate

Normally daily requirements of phosphorus/phosphates are 550 mg for normal adults and are higher in pregnant women and growing children .

As phosphates are present in all natural foods, deficiency of phosphate is rare except starvation.


Deficiency of phosphorus causes hypophosphataemia and consequent cellular dysfunction which manifests as anorexia, muscle weakness, bone pain, rickets, osteoporosis, osteomalacia, debility, increased susceptibility to infection, paraesthesia (abnormal sensation of skin), ataxia (neurological signs which lacks voluntary coordination of muscle movement),confusion, and ultimately death.

Sodium

Sodium is key element in human body.  It is most commonly occurring extracellular cation and is associated with:
- contraction of muscles
- transmission of nerve impulses along axons
- maintenance of the electrolyte balance in the body.

A normal blood sodium level is 135 to 145 mEq/L. When blood sodium level comes below 135 mEq/L , hyponatremia occurs .

Dietary sources of sodium

Most of foods, especially fish, meat,eggs, milk, artificially enriched bread and as cooking and table salts are dietary sources of sodium.

Daily requirement of sodium

Daily requirement of sodium is 1.6 grams.

Potassium

Potassium is an important mineral or element that functions as an electrolyte in the body. It  mostly occurs as intracellular cation to regulate fluid balance, involves many chemical activities within cells and concisely to say, it is associated with :
- contraction of muscles
- transmission of impulses
- maintenance of the electrolyte balance in the body.

Potassium is third most  abundant mineral in the body. About 98 percent of potassium in body is found in cells. Of this,  80 percent is found in muscle cells, while 20 percent of potassium is found in bones, liver and red blood cells.

Dietary sources of potassium

Vegetables, fruits, juice, milk and meat are the dietary sources of potassium.

Note that potassium rich diet may reduce blood pressure and water retention, protect from strokes and help prevent osteoporosis and kidney stones.

Daily requirement of potassium

At normal condition daily requirement of potassium is 3.5 g which is excess in comparison of sodium.

How do sodium and potassium maintain electrolyte balance in body ?

Representative diagram of extracellular fluid compartments and intracellular fluid compartments 

At normal condition,  a 70 kg weight adult man's body contains about 42 litres water(fluid), ie total body water is 60 percent of the body weight. The percentage of water(fluid) in the body depends on the age , gender and degree of obesity.

Nearly 28 of the 42 litres of fluids in the body are inside the cells and are collectively called intracellular fluids (ICF). So, the intracellular fluids constitutes nearly 40 percent of the total body weight of in a normal person.

The remaining 14 litres of 42 liters of fluids are in the outside of the cells and are collectively called extracellular fluids (ECF). Thus extracellular fluids constitutes nearly 20 percent of the total body weight.

There are two largest compartments of the extracellular fluid: Interstitial fluid comprises 11 litres and ; the plasma comprises 3 litres.

It is very crucial to keep normal distribution of fluids between the intracellular and the extracellular compartments of the body.
The normal distribution of this fluids between the different body compartments is achieved and tightly controlled through several interlinked factors. Among these factors, sodium and potassium are important factors to regulate fluid balance between extracellular and intracellular compartments of the body.

The amount of fluids in the intracellular fluid compartments and extracellular fluid compartments is affected by their concentration of electrolytes, especially potassium and sodium.

Potassium is the main electrolyte in the intracellular fluids,  and it determines amount of water inside cells.  Conversely sodium is the main electrolyte in the extracellular fluids, and it determines the amount of water outside the cells.

Number of electrolytes per litre of fluid is called osmolarity of that fluid. Under normal conditions, the osmolarity is same inside and outside of the cells.

Total osmalarity of plama  is 299.8 mOsm/L, that of interstitial fluid 300.8 mOsm/L, and that of Intracellular fluid is 301.2 mOsm/L.  At 37°C, the total osmotic pressure (mmHg) of plasma is 5441 mOsm/L ,of interstitial fluid is 5423 mOsm/L , and of intracellular fluid is 5423 mOsm/L.

When osmalarity becomes unequal between two compartments, water from the side with fewer electrolytes will move into the side with more electrolytes to equalize electrolyte concentrations of fluid.

The movement of too much water from cells may cause them to shrink and the movement of too much water into cells may cause them to brust. 
That's why , it's very important to consume right amount of sodium and potassium containing foods.

It is very important to maintain good fluid balance for optimal health. Poor fluid balance may cause dehydration or oedema in the body. Dehydration ultimately affects the heart and kidneys.
Adding a potassium rich food stuffs in diet and  staying hydrated can help maintain good fluid balance

Iron

Iron is an essential element for the formation of red blood cells. It is also essential for the oxidation of carbohydrate and in the synthesis of some hormones and neuro transmitters.

Deficiency of iron causes anemia. In normal adults about 1 mg of iron is lost from the body daily.

Dietary sources of Iron

Liver  kidney, meat ,egg yolk, wholemeal bread, green vegetables, potatoes are the main dietary sources of iron.

Daily requirement of Iron

The daily requirement of iron is 8.7 mg for men and 14.8 mg for women.
Menstruating women and pregnant women needs more iron due to their physiological causes.

Iodine

Iodine is only one mineral element that is essential component for formation of thyroid hormones; thyroxine (T4) and triiodothyronine (T3).

Dietary sources of Iodine

Salt water fish, meat, milk,seafood and vegetables grown in the soils containing iodine are dietary sources of iodine.

Daily requirement of iodine

Daily requirement of iodine is 140 micrograms.

Deficiency of iodine causes goitre, swelling of neck resulting from enlargement of the thyroid gland.

Zinc

Zinc is essential transnational element exists in biology Zn++ cation  and is cofactor more than 300 different enzymes in all branch of metabolism.

Zinc is also a stabilizing structural component of several of several proteins.
Zinc also functions as antioxidant and plays important role in the immune system. It is also beneficial for wound healing.
Zinc supplementation may improve growth and development development of infants and children and improve immune response.

Daily requirement of zinc

Daily requirement of zinc is 9.5 mg for men and 7 mg for women.

Dietary sources of zinc

Widely variable foods are dietary sources of zinc.

How deadly is the overuse of antibiotics?

How deadly is the overuse of antibiotics?

Antibiotics drugs 

Antibiotics are chemical substances that have the ability to kill only the bacteria in the body.  Antibiotics are drugs that have the ability to kill certain elements in the cells of bacteria.

Simply put, antibiotics are drugs that have the ability to kill certain bacteria in the body.

When to use?

Antibiotics should be used only when it is determined that the physical problem is caused by bacteria.

When antibiotics are used indiscriminately, bacteria develop the ability to fight them.  Due to which the effect of medicine does not remain in our body.  When the bacteria change their cells, antibiotics don't work for us and the problem gets worse.

The full dose should be taken after using antibiotics.  Otherwise bacteria attack in another form.

Antibiotics are not the only cure for the disease.  After taking antibiotics, it destroys the infected bacteria in the body.  Depending on the type of bacteria, antibiotics should be used.  Its quantity, duration, time should all be taken care of.

However, in any case, you take antibiotics.  This type of use increases the body's defenses against bacteria.  Changes cells.  This is called 'drug resistance'.

This is a big complication.  When the bacteria in the body change their cells, the effect of the drug decreases.  The disease flares up again.  And, that gets even louder.

We are not aware of the use of antibiotics.  After taking antibiotics, a certain dose must be completed.  But, we buy drugs indiscriminately.  Use arbitrarily.  Once your problem is cured, we leave without completing the dose of medicine.

Another important thing is that antibiotics should be started as soon as it is determined that the problem is caused by bacteria.  If this is not done, the bacteria will change their cells, which we do not have the medical ability to fight.

When antibiotics are developed, it is estimated how long they can work in the body.  The amount of the drug in the body is checked.

That is why you should take antibiotics as prescribed by the doctors, because the body cannot get the amount of antibiotics below or above that time.  When the body does not get the medicine it needs, it may lose its ability to do the job or kill the bacteria.

So if you take antibiotics once a day, you have to take it twice or thrice a day.

Advantages and disadvantages of antibiotics

Antibiotics, also known as 'magic bullets', are a miraculous gift in the medical field.  Properly covered, it will withstand a great deal of adverse conditions.  Such antibiotics can cause any bacterial infection.  It can shorten the long-term treatment and cure it in a short time.

Since it can be used in various diseases, the benefits of antibiotics are many.

But if it is not used properly, it can be very useless.  Moreover, it is seen to have a great impact on future generations.  E.g.,

Do not take antibiotics on time

Do not complete the dose

Also, when using antibiotics, it affects some of the cells in the body, so it has a lot of side effects.

Side effects caused by antibiotics

- Diarrhea, direction

- Affecting the kidneys

- Effect on the ears

- Decreased immunity in the body

Nipah Virus | Nipah virus outbreak in India

 

Nipah Virus Test 

History of Nipah Virus

In 1997, a new disease of pigs with respiratory problems and encephalitis appeared in Malaysia. The encephalitis like disease also  appeared in workers on affected pig farms soon afterwards of new disease of pigs. Over a two year period several hundred people got infected and more than 100 deaths occurred. In 1999 scientists succeeded to isolate a new virus from the brain of one of the patients who had died from encephalitis like disease. The virus was a paramyxovirus with similar characteristics to Hendra virus and it was named Nipah virus.

A research was conducted to find out details of Nipah virus including its possible reservoirs of infection. Research found  fruit eating bats of the genus Pteropus to be reservoirs of Nipah virus infection. Infectious virus was isolated from bat's urine and virus-specific antibodies were found in their blood.

Research found routes of transmission of Nipah virus as :
[  ] Bat to pig and pig to human transmission
[  ] Bat to human transmission
[  ] Human to human transmission

Nipah virus outbreak also occurred in Bangladesh and India in few years ago. In this outbreaks there was no evidence of transmission from pigs to human and it is also believed that transmission may have occurred from bats to humans. There was also evidence of human-to-human of the virus.

Nipah virus infection

Nipah virus , a bat borne virus causes Nipah virus infection in humans and other animals. So, Nipah virus infection is a zoonotic disease that transmitted to humans from animals and can also be transmitted through contaminated food or directly from person-to-person. It causes asymptomatic illness to acute respiratory illness and fatal encephalitis in infected people.

Although Nipah virus has caused only few outbreaks in Asia, it causes disease with high mortality rate. It infects wide range of animals and causes severe disease and death in people.

In 1997, the first recognized Nipah virus infection outbreak in Malaysia, which also affected Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to be occurred through unprotected exposure to secretions from the infected pigs or unprotected contact with the tissue of a infected animal.

In second Nipah virus infection outbreaks in India and Bangladesh, it was found that infection occurred by consuming fruits or fruit products contaminated with urine or saliva from infected fruit bats (Pteropus).

Human to human transmission of infection of Nipah virus has also be found to occur among family and care givers of infected people. So it is necessary to isolate infected persons as soon as possible.

Symptoms of Nipah virus infection

The symptoms of the infection range from asymptomatic illness to acute  respiratory infection, seizures and fatal encephalitis.

Infected people in early stage of illness mostly develop systems like fever, headache, myalgia, vomiting, sore throat. As infection become more severe, patients feel dizziness, drowsiness, altered consciousness, neurological signs that indicate encephalitis. Patients can also experience pneumonia and acute respiratory distress.  In severe conditions of patients, encephalitis and seizures result to coma within 24 to 48 hours of seizures.

Generally incubation period of illness is 4 to 14 days but in some  cases 45 days has been reported.
The case fatality rate of virus is estimated 40 to 75 percent which far more deadly than SARS-COV-2.

Treatment of Nipah virus infection

Currently there are neither drugs nor vaccine against Nipah virus infection. Intensive supportive care is recommended to treat severe respiratory distress and neurologic complications.

Nipah Virus Outbreaks in India in 2021

The death of a 12- year old boy on 5th  September, 2021 sparked worries of a Nipah virus outbreak in India. According to news papers published from Delhi, a twelve year old boy died of Nipah virus infection in Kozhikode, Kerala state, India, on 5th September, 2021. The  government of state is quickly ramping up efforts to stop a potential outbreak of the  deadly Nipah virus.

Kerala state of India is on high alert after a death of a boy due to Nipah virus infection. Health officials have started to do contact tracing and isolating hundreds of people who came in contact with the boy, who died at hospital in the coastal city of Kozhikode.
One health official said that more samples will be tested  and 48 people including eight people that are tested negative,  are  being monitored at a hospital. Health officials have been deployed to carry out door-to-door surveillance and identifying secondary contacts.

Kerala state of India faced with Nipah virus outbreak also in 2018. At that time more than a dozen people died from the Nipah virus.

Most Contagious and Deadly new variants of COVID-19

About covid-19 variants 

For the last one and a half years, the wave of covid-19 infection has been seen in the world. In the second wave of covid-19, its magnitude also looked quite serious. According to health experts, mutations in the virus are currently making it more deadly and contagious. So far, scientists have considered the Delta variant of covid-19 the most contagious. Meanwhile, some new variants have recently added to the concerns of experts.

Almost all the reports have shown that such a change in the new variant of covid-19 can easily deceive the body's immune system. The third wave of covid-19 is being debated around the world. Many have estimated that the wave is more serious and will affect children more.

In a recent report, scientists have suggested a variant of the covid-19 that could be even more dangerous than the delta. Scientists fear that these variants could cause serious complications in most infections.

Here are four dangerous variants listed by experts:

1. Covid's super variant - (Covid-22)

Immunologists at ETH Zurich University in Switzerland have warned people about Corona's super variant 'Covid-22'. Scientists say that depending on the nature of the variant, its infection could lead to serious health complications.

Not only that. Extremely powerful vaccines may be needed to avoid this variant. Scientists are of the opinion that the possible danger from covid-19 may be avoided in the future.

2. South African variant (C.1.2)

 Scientists have recently reported the severity of the South African variant C.1.2 of Covid. According to researchers at the National Institute for Communicable Diseases (NICD) and the KwaZulu-Natal Research Innovation and KwaZulu-Natal Research Innovation and Squeezing Platform (KRISP), the variant first appeared in May.

It has been found in some cities in South Africa and later in other countries. Experts estimate that the covid vaccine has no effect on the virus.

3. Myu variants

The World Health Organization (WHO) has announced a new variant of Myu covid-19 in its weekly epidemic bulletin. It has been classified as a 'variant of interest', according to the study. Studies are still being done to find out.

4. Lambda variant of covid-19

A team of scientists studying the Lambda variant Corona recently reported that the Lambda variant of the corona has seven mutations. This deadly variant of the corona, first found in Peru, has spread to many countries around the world, including the United States and the United Kingdom. Health experts consider it more dangerous than the Delta variant of the Corona.

Scientists say that this type of corona variant has seen many mutations in the spike protein that significantly increase its infection rate. The WHO has also classified the Lambda variant as a 'variant of interest'.

Child growth

 

Child growth 

Child malnutrition is a major public health issue worldwide.  An estimated 144 million children under age 5 are stunted, 47 million are wasted and 38.3 million are overweight or obese. Around 45% of deaths among children under 5 years of age are linked to undernutrition.

Measuring the growth of infants and children is an important part of child health surveillance. Inadequate infant growth due to poor nutrition leads to under-nutrition in children in many developing countries, which, if followed later in life by an increased intake of calories, can result in overweight or obesity.

The WHO Child Growth Standards are a diagnostic tool used to monitor and assess the nutritional status of infants and young children worldwide. By tracking children’s height and body weight, the standards detect children or populations not growing properly or under- or overweight, and who may require specific medical or public health responses.

The WHO standards have charts for boys and girls separated, covering age birth to 5 years. They are used in doctors’ offices, clinics and other health facilities, and by research institutions, child health advocacy organizations and ministries of health

What is Anemia? | How does Anemia occur ?

 

Blood taking to test anemia

About Anemia :

Anemia is an underlying health condition in which the haemoglobin concentration in blood is lower than normal values. Haemoglobin concentration for men 13 g/100 ml and for 12 g/ 100 ml is considered as normal value of haemoglobin (Hb). World Health Organization defines Anemia as a reduction of the haemoglobin concentration to less than 130 g/ litre in man or  less than 120 g/ litre in women.
Main function of the haemoglobin to bind oxygen molecule to red blood cells to transport oxygen from lungs to all body's tissues and carbondioxide from tissues to the lungs. If the blood has too few or abnormal red blood cells or not enough haemoglobin,  there will be a decreased capacity of  the blood to carry oxygen to the body’s tissues. If this situation persists for long , anemia occurs.

Prevalence of anemia

Anemia is a serious global public health problem. It is a very common problem in low and middle income countries. A data collected in 2013 showed that 27 percent of the world populations or 1.9 billion people are affected by anemia and 90 percent of them were from developing countries.
It particularly affects young children and pregnant women. World Health Organization has published a data that 42 percent of children less than 5 years of age and 40 percent of pregnant women worldwide are anaemic. This figure shows how anemia is affecting children and pregnant women worldwide. It is also estimated one third of all women of reproductive age are anaemic. Thus prevalence of anemia remains high globally particularly low income families or communities.  Anemia is also an indicator of both poor nutrition and poor health. It has impacts not only on health but has impacts also on social and economic status of family.

What are the symptoms of anemia?

The common symptoms of anemia are fatigue, weakness, dizziness and shortness of breath, pale skin and lips.

What are the  causes of anemia?

Although most common causes of anemia is the nutritional deficiencies, particularly iron deficiency, anemia occurs also due deficiencies of folate, vitamin B12 and vitamin A. Haemoglobinopathies and Infectious diseases like malaria, HIV, tuberculosis and parasitic infections also cause anemia.

It should be noted that defective production of red blood cells (erythrocytes) or an increased rate of loss of RBC, either by bleeding or premature destruction of cell (haemolysis) can cause anemia.
Besides above mentioned causes, the reduced erythropoietin production typically seen in chronic kidney disease can cause anemia.
Primary diseases of the bone marrow also develop anemic state of the body.
But it is clear that nutritional anemia is relatively common in most populations at certain periods during development and in life.
Preschool children and women of reproductive age are particularly affected by anemia and more 60 percent of anemia is caused by iron deficiency.

How does anemia affect body ?

As it develops due to the reduction of level of oxygen carrying vehicles, haemoglobin in the blood , anemia affects all most all parts of body including vital organs. As anemia reduces tissue oxygenation, it is associated with widespread organ dysfunction. It shows varied clinical picture. The  degree of organ dysfunction depends on whether anemia is of rapid or insidious onset.
In mild anemia there may be no symptoms or simply increased fatigue and slight pallor.  As anemia becomes more marked, the symptoms and signs gradually appear.
As anemia get severe cardiorespiratory symptoms and signs like exertional dyspnoea, tachycardia, palpitations, angina, night cramps, increased arterial pulsation,  capillary pulsation, a variety of cardiac bruits, reversible cardiac enlargement may occur.
Anemia also affects neuromuscular parts. Impacts on neuromuscular parts reflected by headache, vertigo, light headedness, faintness, tinnitus, roaring in the ears, cramps, increased cold sensitivity, and haemorrhages in the retina.

How does Anemia cause heart failure?

In mild anemia oxygen consumption is unchanged by shifting oxygen dissociation curve. When the haemoglobin concentration level falls below 7-8 g /100 ml , there is an increase in cardiac output, both at rest and after exercise
As oxygen supply to central nervous system, cardiac muscle and other muscle vastly cut off , hypoxia develops . Hypoxia increases the stroke rate and hyperkinetic circulation develops, characterized by tachycardia, arterial and capillary pulsation, a wide pulse pressure, and flow murmurs. The circulation time is shortened, left ventricular stroke is increased, and coronary flow is increased in proportion to the increased cardiac output. The normal myocardium ( cardiac muscle) may tolerate all these hyperactivities but patients with coronary artery disease or those with extreme anemia may impaire oxygenation oxygenation of the myocardium. In such conditions, cardiomegaly, pulmonary oedema, ascites, and peripheral oedema may occur.  And finally a state of high output cardiac failure is established.

How does Anemia affect pregnancy?

Development of anemia during pregnancy severely affects both mother and baby. It may affect proper growth of baby. If mother has anemia in first three months of pregnancy, deformed embryo may form.
Anemia during pregnancy makes mother weak and she feels tired dizziness, difficult in breathing, rapid heartbeat.

What is sickle cell anemia?

Sickle cell anemia is a type of anemia which results due to sickle cell haemoglobin (HbS). Sickle cell haemoglobin is not able to carry oxygen as other normal haemoglobin. The red blood cells with sickle haemoglobin looks like rigid sickle shaped under certain conditions.
Sickle cell haemoglobin results from single based mutation of adenine to thymine.

Pathogesis of sickle cell anemia occurs in this way:

Deoxygenated sickle cell haemoglobin  molecules are insoluble and polimerize.  The flexibility of the cell is decreased and they become rigid and take up their characteristic sickle appearance. Initially process of sickling reversible, but repeated sickling, the cells  eventually lose their membrane flexibility and become irreversibly sickled. These irreversibly sickled cells are dehydrated and dense and will not return to normal when oxygenated .
Sickling can produce a shortened red cell impaired passage of cells through the microcirculation. These rigid sickled cells causes obstruction of small vessels and tissue infarction. Sickling is precipitated by infection  dehydration, cold, acidosis or hypoxia.
Sickle cell anemia is common in Africa, India, Nepal, the Middle East, and Southern Europe.

What is aplastic anemia?

Aplastic anemia occurs due to bone marrow failure. A reduction in the number of pluripotential stem cells causes aplastic anemia.
Aplastic anemia is defined as pancytopenia with hypocellularity(aplasia) of the bone marrow. Aplastic anemia causes a deficiency of all blood cell types: red blood cells, white blood cells and platelets.

Anemia 

Afghanistan and UNICEF Role in Health Services | Health crisis amid uncertainty and instability

Children after crisis in Afghanistan 

Overview 

Recent developments or national uncertainty developed in Afghanistan have taken heavy deaths and injuries on Afghan children and their families. Long running humanitarian crisis has become triple crisis; recent escalation in conflict, covid-19 and drought has cause whole health system to fail to operate smoothly.

Afghans are experiencing a very bad psychological condition. They are feeling tremendous fear and their health condition is getting worse and and worse.

Although already Afghanistan was most dangerous places in Asia in context of health facilities, recent escalation in conflict has  intensified emergency situations of public health.

The combined impact of insecurity, internal displacement, poverty, covid-19, water scarcity is being felt by the most vulnerable: children including children with disabilities, women including pregnant women and elderly.

Baby ,child and mother are vulnerable. The access to a hospital or health facility is far beyond the reach of most of Afgans.

Afghanistan has one of the highest infant mortality rates in the world and thousands of Afghan women die every year from pregnancy-related causes. This condition is worsen by the  current uncertainty as Taliban militants captured the country.

The current uncertainty facing nation also has made uncertainty on health facilities, immunization for children, maternity care, international projects working there to assist health and other social sectors.

Now its time to see how UNICF performs its duty during this turmoil condition. Afghanistan uncertainty pose a threat to reach every child for their immunization, their nourishment and treatment .

Role of UNICEF for child and mother health in Afghanistan:

UNICEF with its office has completed more than half century on ground of Afghanistan to assist most vulnerable, especially child and mother.

So, UNICEF is a key organ in Afghanistan’s health system. It is continuing to work with its partners to support children and their families across the country. Despite the instability of the past few weeks, UNICEF is providing its services in most affected areas. It is trucking safe water to areas affected by drought.

Despite uncertainty and instability in Afghanistan UNICEF has committed to continue its work for children and families across the nation. As the lead United Nations agency  UNICEF wants yo reach to children who needs health support in hardest area without any obstacles from conflicting parties. For its humanitarian works , UNICEF is advocating with all parties to conflict for safe and unhindered access, in line with the Core commitment for children in Humanitarian Action, so that they can deliver much needed support to the Afghan population.

UNICEF wants to strengthen health facilities by providing training and essential newborn care equipment and deploying qualified health personnels .

Millions of people are under needs os essential services, including health, lifesaving vacation against polio and measles ,nutrition, protection,shelter, water and sanitation. UNICEF therefore increasing its lifesaving programmes for children and women- including through the delivery of health, nutrition and water services to displaced families.

As a lead of United Nations, UNICF  in Afghanistan is continuing its work through conflict and COVID-19. It is also calling  to end attacks on children. It is advocating for hard-won girls rights ,including access to education. It requests all conflicting parties to establish peace and security for children.

UNICEF recently has predicted that more than 18 million people including 10 million children are under needs of humanitarian assistance.  Organization also has predicted that 1 million children under age of 5 will be severely malnourished by the end of 2021.

UNICEF has also expressed its concerns over reports of escalating grave violation, including children being recruited by armed groups.

Challenges to UNICEF to run health programme in remote villages:

Recent developments in Afghanistan has added more challenges to UNICEF. It has following challenges:

• To reach remote areas to support vacation programmes

• To assist  vaccination for pregnant women to prevent nine disease

• To run child nutrition programmes in remote areas

• To run mobile health camp in needed areas

• To support specialised maternity " waiting homes and rooms " programme among vulnerable group in remote villages. 

Thyroxine(T4) and Triiodothyronine(T3) Impacts on Health | Hyperthyroidism and Hypothyroidism

Thyroxine (T4) and Triiodothyronine (T3) Impacts on Health 

Thyroid testing 

Overview:

Thyroxine (T4) and triiodothyronine (T3) are thyroid hormones secreted by thyroid gland. Disturbance of these hormones causes wide range of health problems in the body.

Thyroid gland is one of the largest of the endocrine glands ,weighing 15 to 20 grams in adults. The gland is located immediately below the larynx on each side of and anterior to the trachea . The gland resembles a butterfly in shape, consisting two lobes one on either side of trachea.

The thyroid gland synthesize hormones that help control many vital functions of the body. It produces two major hormones, thyroxine (T4) and triiodothyronine(T3). Thyroid gland also secretes calcitonin which is important for calcium metabolism.

T3 is about four times as potent as thyroxine,but it is present in the blood in much smaller quantities and persists for a much shorter time compared with thyroxine.

Nearly about 93 % of metabolically active hormones secreted by the thyroid gland is thyroxine and  7 % triiodothyronine forms.

Both of these two hormones, T4 and T3 increase the metabolic rate of the body. The secretion of thyroid hormones is mostly controlled by the thyroid stimulating hormone (TSH) from pituitary gland. Normally level T4 and T3 remain at certain range keeping basal metabolic rate at normal level. As secretion of thyroid hormone increases or decreases , there occurs bad impacts on entire body.

Thyroxine (T4) and triiodothyronine (T3) are essential for normal growth and development of the body especially of the nervous system and skeletal. T4 and T3 hormones play vital roles byv regulating metabolism of carbohydrates,proteins and fats. So ,T4 and T3 affect most of cells of the body by increasing metabolic rate and heat production. Along with it T4 and T3  have physiological influence on the heart, skeletal muscles, skin, digestive and reproductive system.

If secretion of thyroid hormone exceed normal level, it is called hyperthyroidism. If secretion decreases and thyroid hormone levels in blood comes below normal level, it is called hypothyroidism.

Regulations of secretion of thyroxine (T4) and triiodothyronine (T3) :

Regulation of T4 and T3 

Regulation of secretion of T4 and T3 is a vital phenomenon to keep balanced stage of basal metabolism and to maintain health.

Regulation of secretion of T4 and T3 take place as following:

• Thyroid releasing hormone (TRH) produced from hypothalamus stimulates to produce thyroid stimulating hormone (TSH)

• Thyroid stimulating hormone (TSH) produced from pituitary gland stimulates to produce thyroxine (T4) and triiodothyronine (T3).

• As blood level of T4 and T3 raised above the  normal level, it passes an signal to hypothalamus to inhibit(stop) production of thyroid releasing hormone (TRH) and to pituitary gland to inhibit secretion of thyroid stimulating hormone (TSH )

• During metabolism use of hormones by most of the body cells make lower the level of T4 and T3 in the blood.

•  As level of T4 and T3 in the blood comes below the normal level, this condition passes signal to hypothalamus to stimulate secretion of thyroid releasing hormone (TRH) which again stimulate the pituitary gland to secret thyroid stimulating hormone (TSH). TSH stimulates to thyroid gland to secrete T4 and T3 . In this way regulation of T4 and T3 takes place as well designed mechanism.

• Exercise, stress, malnutrition, low level glucose,sleep may stimulates hypothalamus to secrete TRH which stimulates pituitary gland to produce TSH. As mentioned above TSH stimulates thyroid gland to produce T4 and T3.

In case any faults occur in this regulation of secretion mechanism, secretion of T4 and T3 whether more than normal or very lower than normal.  If secretion occurs more than need it is called hyperthyroidism and  if no secretion occurs or less secretion occurs than need it is called hypothyroidism. Commonly people say thyroid occur.

Hypothyroidism:

Thyroid problems are most occurring problems among endocrine problems. Iodine deficiency and neonatal hypothyroidism remain major challenges for public health in developing countries.  And another frequent cause of thyroid dysfunction is autoimmunity, where the follicular gland structure is destroyed by autoreactive T cells.

Primary hypothyroidism is confirmed by performing biochemical diagnosis . In primary hypothyroidism a high serum TSH and a low free T4  are found . In autoimmune hypothyroidism thyroid peroxidase autoantibodies is found along with high serum TSH and a low free T4 .

The prevalence of hypothyroidism in white populations is around 2 percent in women and 0.2 percent in man . The rate is lower in Asia and black populations.

Common effects of  decreased secretion of T4 and T3 hormones ( Hyperthyroidism):

• Decreased basal metabolic rate. Comlete lack of thyroid secretion usually causes the basal metabolic rate to fall 40 to 50 % below normal.

• Depression, psychosis, mental slowness, lethargy

•  Dry skin, brittle hair

•  Bradycardia

• Dry cold skin, prone to hypothermia

• Costipation

• Weight gain, anorexia

Causes of Hypothyroidism :

Primary causes:

• Iodine deficiency

• Autoimmune hypothyroidism

• Hashimoto's thyroiditis

• Primary myxoedema

• latrogenic treatment

• Subtotal or total thyroidectomy

• External irradiation for  treatment of lymphoma or cancer involving the neck

• Drugs like

1. lodine-containing contrast media
2. Amiodarone
3. Lithium 
4. Antithyroid drugs
5. p-Aminosalicylic acid
6. Interferon-a and other cytokines
7. Aminoglutethimide
8.  Tyrosine kinase inhibitors

• Congenital hypothyroidism

• Absent or ectopic thyroid gland

• Dyshormonogenesis

• TSH receptor mutation

• Destructive thyroiditis

• Postpartum thyroiditis

• Silent thyroiditis

• Subacute thyroiditis

•  Infiltrative disorders

•  Amyloidosis

• Sarcoidosis

• Haemochromatosis

• Scleroderma

• Cystinosis

• Riedel's thyroiditis

• Consumptive hypothyroidism due to increased type 3 deiodinase expression

Secondary causes

• Hypopituitarism

• Pituitary tumours

• Trauma (head injury)

•  Pituitary surgery or irradiation

• Infiltrative disorders

• Infarction

•  Isolated TSH deficiency or inactivity

• Hypothalamic disease

Hyperthyroidism and Thyrotoxicosis

Hypothyroidism occurs when thyroid  gland release excessive amount T4 and T3 that is more than normal level. Hyperthyroidism occurs in Graves' disease, inflammation of the thyroid or in benign tumor of thyroid.

Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone. Hyperthyroidism exists when thyrotoxicosis is caused by thyroid overactivity.  It should be noted that there are many types of thyrotoxicosis that are not caused by hyperthyroidism. It is obvious that thyrotoxicosis may occur due to administration of excessive T4.

Causes of Thyrotoxicosis

Primary hyperthyroidism

• Graves' disease

• Toxic multinodular goitre

• Toxic adenoma

• Drugs: iodine excess , lithium, amiodarone

(type 1 amiodarone-induced thyrotoxicosis)

• Thyroid carcinoma or functioning metastases

• Activating mutation of the TSH receptor

• Activating mutation of the Gsa protein

• Struma ovarii (ectopic thyroid tissue)

Thyrotoxicosis without hyperthyroidism

• Ingestion of excess thyroid hormone (factitious -thyrotoxicosis)

• Subacute thyroiditis

• Silent thyroiditis

• Other causes of thyroid destruction: amiodarone (type 2 amiodarone

induced thyrotoxicosis),  or external irradiation (acute effect), in-

farction of an adenoma

Secondary hyperthyroidism

• TSH-secreting pituitary tumour

• Chorionic gonadotropin-secreting tumours

• Gestational thyrotoxicosis

• Thyroid hormone resistance

Common effects of  decreased secretion of T4 and T3 hormones(Hyperthyroidism

• Increased basal metabolic rate . Extreme excesses of thyroid secretion may increase the basal metabolic rate to 60 to 100% above normal.

• Anxiety, physical restlessness, mental excitability

• Hair loss

• Tachycardia, palpitation, atrial fibrillation

• Warm sweaty skins, heat intolerance

• Diarrhea

• Weight loss, good appetite

• Exophthalmos in Graves' disease . Most people with hyperthyroidism exhibit some degree of protrusion of the eyeballs,

• Muscle weakness

• Tremor of the hands.

• Nervousness