Urgent need to dispel myths surrounding Vitiligo in India

Health Care, Heart Care Foundation of India, Medicine, Social Health Community Comments Off

Stress-busting techniques and a diet rich in copper and B12 beneficial in this condition

New Delhi, 25 June 2018: About 2% to 5% of the Indian population is affected by vitiligo, a condition which has deep social stigma attached to it. This is primarily because in people affected by vitiligo, white spots or patches appear on the skin. On World Vitiligo Day, there is a need to create awareness on the fact that although it is a medical condition, vitiligo is not contagious. There is an urgent need to remove such myths and accord equal respect and help to those with this condition.

Vitiligo is a skin disease that occurs when pigment-producing cells (melanocytes) in skin die or lose their function. Due to this, the normal skin color is lost, and the person develops pale, depigmented skin patches that can affect any part of the body, including the mouth, hair and eyes. It is more noticeable in people with darker skin.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, Heart Care Foundation of India (HCFI), said, “Vitiligo results from an autoimmune process directed against the melanocytes and is often associated with other autoimmune disorders, including autoimmune thyroid disease, pernicious anemia, systemic lupus erythematosus and Addison disease. People with this condition are looked down upon in India, thinking that any kind of contact can result in them acquiring this condition. Hundreds of those with vitiligo are subjected to bullying, social stigma, disability, and psychological trauma. What exacerbates this problem further is that the condition is progressive. Treatments are available that may improve the appearance of the skin but presently there is no cure.”

Vitiligo has six sub-types: generalized (most common and characterized by widespread macules and patches that are often symmetrically distributed); acrofacial vitiligo (involves areas surrounding body orifices and extensor surfaces); segmental; focal; mucosal; and universal.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “The diagnosis for vitiligo is based upon the clinical presence of depigmented patches of skin. Examination with a Wood lamp is useful for highlighting areas of pigment loss on light skinned patients. Treatment is based upon re-pigmentation therapies, which include topical and oral corticosteroids, topical calcineurin inhibitors, ultraviolet light (PUVA and narrowband UVB), and skin grafting techniques.”

Some tips from HCFI

  • Apply sunscreen and cover your body parts whenever venturing out in the sun between 10 a.m. to 4 p.m. However, the early morning sun rays can help in stimulating skin pigment cells and benefit patients.
  • While bathing, use mild soaps and gently scrub the skin. Sometimes friction can trigger the onset of new patches.
  • Avoid chemical-based products like deodorants or perfumes directly on skin. A good alternative is to use them on clothes instead.
  • Yoga and meditation can help you in overcoming the mental and emotional burden of this disease.
  • A diet rich in copper inclusive of spinach, mustard greens, and sesame is good. One can also drink water stored in copper vessels. Also ensure that your diet has enough of Vitamin B12, folic acid, and pantothenic acid.

Loneliness and isolation are just two side effects of constant smartphone usage

Health Care, Heart Care Foundation of India, Social Health Community Comments Off

Take a social media holiday and keep phones away unless absolutely needed

New Delhi, 11th June 2018: Overuse of smartphones is akin to substance abuse and addiction, as per a recent study. People who use phones a lot seem to suffer from increased levels of feeling isolated, lonely, depressed and anxious. People who are extreme smartphone users constantly switch between activities and find it hard to focus. There is a need to create awareness that such an addiction can leave us with little time to relax and rejuvenate, particularly mentally.

Addiction to social media technology can have a negative effect on social connections. The accompanying loneliness is partly a consequence of replacing face-to-face interaction with a form of communication where body language and other signals cannot be interpreted.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Push notifications, vibrations, and other alerts on our phones and computers make us feel compelled to look at them constantly. This, as per research, seems to trigger the same kind of neural pathways as during an imminent attack by a predator or in the face of some danger. This further means that our brain is constantly active and alert, albeit in a way that is not healthy for its functioning. We constantly seek that activity, and in the absence of it feel restless, agitated and lonely. There are certain other side effects of constant smartphone use. Ringxiety is the anxiety resulting due to not receiving a call in the last 30 minutes. It is present in the 30% of the mobile users. Phantom ringing is present in 20% to 30% of mobile users. You can feel that your phone is ringing but when you check, it is not.”

Smartphone is also a cause for parent-child conflict in 30% of the cases. Often children get up late and end up going to school unprepared. On an average, people spend 30 to 60 minutes in the bed playing with the smart phone before sleep.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Having access to so many different streams of information through gadgets has been found to decrease the brain’s grey matter density, which is responsible for cognition and emotional control. In this digital era, the key to good health should be moderation i.e. moderate use of technology. Most of us have become slaves to devices that were really meant to free us and give us more time to experience life and be with people. And we are leading our children in the same path as well.”

Some tips from HCFI
• Electronic curfew means not using any electronic gadgets 30 minutes before sleep.
• Facebook holiday: Take a Facebook holiday for 7 days every three months.
• Social media fast: Avoid use of social media once in a week for the entire day.
• Use your mobile phone only when mobile.
• Do not use computer for more than three hours in a day.
• Limit your mobile talk time to more than two hours in a day.
• Do not recharge your mobile battery more than once in a day.
• Mobile can also be a source of infection in the hospital setup; therefore, it is disinfected every day.

Urgent need to formulate a national policy on compulsory screening of Critical Congenital Heart Diseases (CCHD) in India

Health Care, Heart Care Foundation of India, Medicine, Social Health Community Comments Off

• Relevant stakeholders from the medical fraternity discuss the why and how of screening newborns for heart defects in a panel discussion in New Delhi
• The Government of Kerala is already working towards making CCHD screening mandatory in all their state-run hospitals

New Delhi, May 29, 2018: According to the National Family Health Survey, the infant mortality rate (IMR) in India stands at 34 per 1000 live births. About 10% of these infant deaths can be attributed to congenital heart diseases (CHD) alone. About 1.5 lakh infants are born with CHD in the country every year, a condition which can be detected with timely screening. Considering this, relevant stakeholders from HCFI, NNF and other institutions had come together to launch a campaign for formulating a national policy on making CCHD screening mandatory in all healthcare establishments in India. Dr Anne de-Wahl Granelli, a specialized biomedical scientist visiting India to raise awareness about CCHD screening was also part of the discussion.

The campaign followed a high-level meeting with Shri Manoj Jhalani, Additional Health Secretary, Ministry of Health and Family Welfare, Government of India. Masimo, a global leader in innovative non-invasive patient monitoring technologies is the technology partner for the initiative.

Current screening methods that include physical examination, fetal scan or a combination these two can only detect 72% of the cases. Various clinical studies have shown that addition of reliable pulse oximetry to screening protocols can potentially increase the detection rate to 92% which in the Indian context can approximately save about 52,000 babies. This will further have a direct impact on IMR.
Speaking during the discussion, Dr K K Aggarwal, President, Heart Care Foundation of India (HCFI), said, “Many newborns with critical CHD are symptomatic but not identified or diagnosed until after discharge. Such a delay in diagnosis increases the chance of frequent hospitalization and can cause mortality in the longer term. Newborn screening is thus an important strategy to ensure that no babies die due to lack of a proper screening mechanism. This issue requires the formulation of a national policy that will make screening for CCHD a priority even in primary healthcare establishments in the country. This can be made a reality if all relevant stakeholders join hands and support the cause.”
CCHD screening can also detect other birth defects including sepsis, respiratory disorders/lung pathology, persistent pulmonary hypertension, and transitional circulation. Countries that already have mandated and/or have adopted this screening methodology include USA, UAE, Saudi Arabia, Sweden, Norway, Sri Lanka, China, and Australia. USA already boasts of a 33% decline in infant deaths from CCHD in eight states due to timely screening.

Adding her inputs, Dr Anna Granelli, Head of Cardiology, NU Hospital Group, Trollhättan, Sweden said, “Pulse oximetry is a proven technology in detecting critical heart defects in infants. However, during my research, I gathered that not all pulse oximeters are the same. Institutions launching CCHD programmes should therefore choose a reliable technology after considering all aspects. Infants affected by CCHD can have poorer outcomes if there is a delay in diagnosis and treatment. Diagnosing these conditions before infants leave the hospital can prevent complications and more importantly, mortality. The time is appropriate and by sharing our experiences, I am sure we can bring about a positive development in this area in India as well and put in place a national policy for mandatory screening.”

Some signs of CCHD in infants include loss of healthy skin color; Cyanosis (a bluish tint to the skin, lips, and fingernails); rapid or troubled breathing, swelling or puffiness in the face, hands, feet, legs, or areas around the eyes; shortness of breath or tires easily during feedings; sweating around the head, especially during feeding; and poor weight gain.

“The current scenario in terms of the number of infants that die due to CCHD is grim. It further necessitates the need to implement a policy at the national level at the earliest. A pulse oximetry screening is not only inexpensive but takes less than 2 to 3 minutes per baby, with the benefits far outweighing the costs. The screening can even be carried out by an ASHA health worker with basic training. We are sure that this high-level meeting and discussion among relevant stakeholders will help us reach a consensus and get positive results,” said Dr BD Bhatia, President, The National Neonatology Forum.

Commenting on the subject, Dr Sitaraman Radhakrishnan, Director & HOD, Fortis Escorts Heart Institute, said “Pulse oximetry is a very simple and inexpensive tool to screen babies who are born with some critical CHD associated with low oxygen levels. Meticulous attention should be paid while analysing the oxygen readings taken by the instrument. Clear guidelines are available for this. However, there are many critical congenital heart diseases which may be associated with normal pulse oximetry results and screening should not be a substitute for a thorough clinical examination of the baby at the time of discharge from the nursery. It is also important that screening is also done during the infant’s first visit to the Paediatrician.”

“The primary benefit of newborn screening for CCHD with pulse oximetry is timely identification of infants with the condition prior to discharge from the hospital. Universal screening with Pulse Oximetry is better at detecting infants with critical CHD compared to physical examination alone. There is much to be gathered from the experience of other countries in making CCHD screening a priority.” opined Dr Smita Mishra, Pediatric Cardiologist, Jaypee Hospital.

The state of Kerala, few hospitals under the Government of Tamil Nadu, and other healthcare institutions such as the Manipal Group of Hospitals, St Martha’s Hospitals, Bangalore and CloudNine Hospitals have successfully adopted the screening mechanism. Others such as the Ram Manohar Lohia Hospital have recognized the importance of newborn CCHD screening and are working towards adopting it as a policy. All this makes it imperative to take it up on a national scale in India.

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