SYMPTOMATIC STONES: MONITOR KIDNEY FUNCTIONING AFTER FORTY YEARS.

The increased use of CT scans and ultrasounds are helping to identify kidney stones that are symptomatic in nature. Symptomatic kidney stones are those which are not painful but slowly develop inside the kidney. An individual who has stones will not have any symptoms of pain or recurrent urinary tract infections or even difficulty while urinating. Dr. G.P. Srinivas, urologist, explained that symptomatic kidney stones are identified in those who come for health check ups or patients with co-morbid conditions such as diabetes and hypertension. "These people are being identified with the disease early. There is still a vast majority of patients who some to the clinics only when there is pain or problems of infections in the urinary tract", he said. The prevalence of chronic kidney disease is a shigh as 10 percent in India. With screening being seen as a tool to check and prevent the development of stones and also failure of the kidney, experts state that early diagnosis can go a long way. 

The functioning of kidney has to be monitored after 40 years of age where research has found that its functioning slows down by one percent in every advancing year. Dr. R. Shekar, nephrologist, explained that higher intake of calcium supplements are found to cause kidney stones. "The condition was earlier seen between 30 to 50 years of age in adults. But now we are seeing it as early as in 20 years also. These are patients who are identified with the disease during health check-ups are counselled and later evaluated", he said.  

Kidney stones are formed due to:

--Diets that are very high in protein and sodium. 

--Obesity.

--High blood pressure.

--Issues with calcium absorption in the body after gastric bypass surgery or due to inflammatory bowel disease.

--Long term use of Vitamin D and calcium supplements.

-Challapalli Srinivas Chakravarthy-

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EIGHTY PERCENT NEWBORN DEATHS CAN BE AVOIDED: REPORT.

The number of new-born deaths in India is 25 per 1,000 live births, which constitutes nearly a quarter of the new-born deaths globally, according to 'Being Alive', a report released by UNICEF on20th February, 2018 (Tuesday). The report also stated that almost eighty percent of the deaths of new-born children could be avoided if proper medical care, nutrition during pregnancy for mothers, and facilities were available. India is ranked 12th of the 52 lower middle income countries when it comes to new born mortality rates. Gynaecologist Dr. T.S. Akshara, says, "We have been ranked higher than our less prosperous neighbours because most programmes implemented by the government for child safety and women's welfare are spread diversely with a few places reaping the benefit. We should ensure that new-born babies get the best of treatment while in the womb and outside".

Poor new-born mortality rate linked to lack of mother's education: As part of the Being Alive Campaign, UNICEF has asked all countries to up the cooperation between governments, healthcare providers and patients by ensuring the 4 P's: Power, i.e., ensuring community based health care facilities, followed by People, i.e., trained health staff, and Products, which is equipment and drugs needed for delivery. Another important aspect raised in the report is the 'quality' of services, i.e., not whether the resources or services exist, but how they are deployed. 'Quality is also about health workers believing that the life of every mother and baby is worth saving, regardless of income, age ethnicity, religion and social or cultural norms', states the report.

Dr. V.P. Jyotsna, a gynaecologist, says that according to WHO standards, basic minimum level of care must be provided to every woman. "People often avoid hospitals because of the stigma against C-sections but can a housewife or an untrained professional guarantee safety of the mother or baby when there is a mishap? Irrespective of caste, creed or economic condition pre-natal complications can arise. Just because of social differences, no woman should be denied medical care, treatment or facilities". The report also states that the poor new-born mortality rate is likely to lack of mother's education and economic background.

Gynaecologist S.K. Shilpi Reddy says, "The intention to access health care should firstly be present even in rural areas. Despite the government providing money for institutional deliveries and providing vaccines and protein powders free, people from rural areas do not visit hospitals until a complication arises. With proper check-ups and nutrition for the mother and screening of the foetus, we can ensure a healthy child. The neo-natal outcome will be successful only if ante-natal care is given". Another important aspect raised in the report was breastfeeding. The report states that some health-care workers do not have the time, knowledge or skills to overcome mis-conceptions about breast-feeding. Experts say that unless the benefits of breast-feeding are taught to mothers - that it contains antibodies to fight viruses and bacteria - the practice will not be widely followed.

UNICEF Report:   

--2.6 million babies die before they are one month old.

--2.6 million babies are still-born - 1.3 million babies out of this are alive at the start of labour.

--7,000 new-borns die on a daily basis.

--35% of health facilities in 54 countries, including India do not have water and soap for hand washing in hospitals.

New-born mortality rate / Deaths per 1,000 live births. 

India / 25.4; China /5.1; Pakistan / 45.6; Bangladesh / 20.1; Afghanistan / 40.

--41% deaths occur in cases where the mother has no education.

--31% where the mother just has no education.

--22% when the mother has secondary or higher education.

Causes of new-born deaths:

--Premature.

--Complications.

--Infections such as sepsis, meningitis and pneumonia.

--Stiil-born babies do not receive an official birth or death certificate.

Improvement:

--Under-five deaths in India reduced by 66% between 1990 and 2015.

--Under-five mortality in India dropped below one million for the first time in 2016 - 1.2 lakh fewer children below the age of five died in the country in 2016 than the previous year.

--Development goals target for under-five mortality of 25 per 1,000 live births by 2030.

-Challapalli Srinivas Chakrvarhy-

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SHOULD I BE CHECKED FOR IRON LEVELS?

If you are older, you may be accumulating excess iron without knowing it. This condition is called Iron Overload. That's why a Serum Ferritin Test is so important. The healthy range for Serum Ferritin is 20 to 160 NG/Ml. The ideal range is 40 to 60. If you are below 20, you are iron deficient.

-Challapalli Srinivas Chakravarthy-

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RHEUMATOLOGY AND ITS SCOPE.

A Rheumatologist is a physician who has undergone further specialised training in the management of diseases related to bones, joints, soft tissues and auto-immunity. A rheumatologist differs from orthopedicians in that trauma related cases and surgeries are managed exclusively by orthopedicians. Auto-immune diseases are those where the body's defence mechanism which should normally protect the body from external infections and insults, attacks the body itself. These diseases commonly affect the joints also and hence the umbrella term arthritis may refer to auto-immune diseases.

Rheumatologic diseases commonly affect women more than men. However some diseases may be more common in men. Children may also be affected by these diseases, so no age or gender is immune from these conditions. There may be a genetic component in some diseases so a history of a family member suffering from similar complaints is an important clue to the diagnosis. In general, a rheumatologist should be consulted when there is joint pain, swelling or deformity, without preceding trauma history. As any organ can be affected by these diseases, other common symptoms include skin rashes, hair loss, fever, weight loss, decreased blood cell counts or in more severe cases, eye involvement, breathlessness, chest pain, numbness or weakness, seizures, loss of consciousness.

As females are prone to these diseases, pregnancy and rheumatologic diseases require special care and management by a rheumatologist and obstetrician. Common diseases which are managed by a rheumatologist include rheumatoid arthritis, lupus or SLE (Systemic Lupus Erythematosus), Systemic Sclerosis, Sjogren's Syndrome, Dermatomyositis, Vasculitis, Spondyloarthritis including Ankylosing Spondylitis, Psoriatic Arthritis, Reactive Arthritis, Gout, Crystal Deposit Diseases, Juvenile Idiopathic Arthritis, Sarcoidosis, Osteoporosis and other Metabolic Bone Diseases. On the first meeting with a rheumatologist, a detailed history and physical examination will be done to look at all possible symptoms and organs involved. Based on these and any available previous reports, a clinical diagnosis will be reached.

To confirm the disease, the rheumatologist may ask for specialised tests like rheumatoid factor, ANA, HLA B27, apart from other blood tests like blood counts, urine examination, liver and kidney tests. Required radiographs or other imaging may be done to confirm the disease and assess the extent of joint damage. The rheumatologist will then give a clear picture of the disease, the organs involved, the complications, plan of management and prognosis of the disease. Regular review is important for proper management and for early detection of complications of the disease or drugs and prevention. 

Drugs used in the management of rheumatologic diseases are commonly pain killers (NSAIDs), steroids (like prednisolone), and immuno-suppressive drugs like methotrexate, cyclophosphamide, azathioprine, etc. These drugs should be used under medical supervision only and require regular clinical review and regular clinical review and regular blood tests to assess the efficacy and possible adverse effects. A new class of drugs called biologicals are now available which have improved the treatment and prognosis of those diseases which have not responded to the initial medication. A healthy diet, regular exercise and stress management all help in improving disease control and quality of life.

As the cause of these diseases is not completely known, rheumatologic diseases do not have a definite cure. However with early diagnosis and appropriate management, they can be well controlled and people suffering with these diseases will be able to have no or minimal impact on their activities. Untreated, these diseases vary in their severity and the damage may be restricted to joints, leading to difficulties in daily life activities or may be organ threatening leading to permanent compromise in function or in more severe cases, may be life threatening.

Contact a rheumatologist early if you have any of the above mentioned symptoms. The earlier the disease is identified and treatment begun, the better the prognosis.

-Challapalli Srinivas Chakravarthy-

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