WHO study in kerala reveals Nearly half of TB patients have been found to be diabetic


A World Health Organization (WHO) study from Kerala has sent out a serious warning to the rest of India, which is home to over 60 million diabetics. Nearly half of patients suffering from the deadly air-borne disease tuberculosis (TB) in Kerala have been found to be diabetic, with approximately half of them newly-diagnosed during the survey, showing the acute lack of awareness.

Among 552 TB patients screened, 243 (44%) had diabetes — 128 (23%) previously-known diabetics and 115 (21%) newly-diagnosed — with higher prevalence among males and those above 50 years.

Dr Anoop Misra, chairman Fortis Centre for Diabetes, Metabolic Diseases and Endocrinology, said, "India should routinely start screening diabetics for TB and TB patients for high blood sugar. It is important for countries like India where numbers of both the diseases are enormous, with TB and diabetes fuelling each other. It is important to look for both these diseases and aggressively treat them."

The WHO in its World TB Report, 2012, said people with a weak immune system, as a result of chronic diseases such as diabetes, are at a higher risk of progressing from latent to active TB. One in three persons in the world is infected with latent TB. People infected with latent TB have a life-long risk of developing and falling sick with active TB. According to WHO, people with diabetes have a two-three times higher risk of TB compared to diabetics. About 10% of TB cases globally are linked to diabetes. The global health watchdog has recommended that all TB patients should be screened for diabetes.

"Screening for TB in people with diabetes should be considered, particularly in settings with high TB prevalence. People with diabetes who are diagnosed with TB have a higher risk of death during TB treatment and of TB relapse after treatment. WHO-recommended treatments should be rigorously implemented for people with TB/diabetes. Diabetes is complicated by the presence of infectious diseases, including TB," WHO said.

"A large proportion of people with diabetes as well as TB is not diagnosed, or is diagnosed too late. Early detection can help improve care and control of both," it added.

WHO has asked countries to set up a means of coordinating diabetes and TB activities, conduct surveillance of TB disease prevalence among people with diabetes in medium and high-TB burden settings, besides surveillance of diabetes prevalence in TB patients in all countries. Countries have also been asked to screen TB patients for diabetes and ensure high-quality diabetes management among TB patients. The Kerala study says that while diabetes is a known risk factor for TB, the prevalence among TB patients in India is unknown.

At present globally, more than 9 million people fall sick with TB every year while over 1.5 million die from it. On the other hand, 350 million people have diabetes with over 80% of diabetes deaths occurring in low and middle-income countries. It is predicted that global diabetes prevalence will increase by 50% by 2030.

Scrub Typhus - A new threat

Scrub Typhus, or tsutsugamushi disease is a febrile illness caused by bacter ia of the family rickettsiaceae and named Orientia tsutsugamushi. Scrub typhus is endemic to a geographically distinct region, the so-called tsutsugamushi triangle, which includes Japan, Taiwan, China, and South Korea.
It also occurs in nepal, northern Pakistan, Papua new Guinea, and the Australian states of Queensland and northern new South Wales. In India, the disease had occurred among troops during World War II in Assam and West Bengal, and in the 1965 Indo-Pak war. There was a resurgence of the disease in 1990 in a unit of an army deployed at the Pakistan border of india. It is known to occur all over India, including Southern
India and northern India. However, the reported number of cases of Scrub typhus from different parts of the country particularly from large tertiary care hospitals do not give a true picture of prevalence of scrub typhus in the country. As yet there are not many community based studies in our country.One such community based study involving several districts in Tamil nadu showed that scrub typhus and rickettsial diseases were widely distributed in the state.In this context the repor t of outbreak of scrub typhus
in Pondicherr y and in the current issue of the Journal meaningful. In this report the diverse clinical and laboratory manifestations of scrub typhus are described. The diagnosis was based on the presence of eschar and/or positive Weil Felix test with a titre of > 1:80.In scrub typhus, an eschar approximately 5 to 20 mm in diameter is formed at the site bitten by trombiculid mites, and this may be considered the most important clinical finding for the diagnosis of scrub typhus. The site bitten by chiggers is initially a papule followed by a blistered ulcer, and this is then covered with a black crust; the border of the eschar is surrounded by reddish erythema. Such a typical eschar is formed at the time when symptoms are manifested.

malaria


Malaria is a mosquito-borne infectious disease of humans caused by eukaryotic protists of the genus Plasmodium.Four species of Plasmodium can infect and be transmitted by humans. Severe disease is largely caused by Plasmodium falciparum. Malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae is generally a milder disease that is rarely fatal.




japanese encephalitis - What, Why, When and How to do approach

Japanese Encephalitis For Doctors, Health Workers & Parents
What, Why, When and How to do approach)


By
Dr.P.Nagabhushana Rao,
BSc MD (Pediatrics) DCH DM (Neurology)
Head of the Expert Medical Team for
Management of Epidemics of Encephalitis,
Govt. of Andhra Pradesh, India &
Prof. and Head,
Department of Pediatric Neurology,
Osmania Medical College / Niloufer Hospital,
Hyderabad, A.P

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