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Chief Editor : Dr. Aniruddha Malpani, M.D. Health News Drug Information

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Improving Patient & Family Health Literacy Disease Prevention Disease Information

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Editorial

Oct’ 2012 3

Side effectS of Soda NY takes Lead

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Phosphoric Acid - Weakens bones and rots teeth Excessive artificial sweeteners makes you crave more Carmel Color - Made from the chemical caramel, is purely cosmetic, it doesn't add flavour yet is tainted with carcinogens.

Formaldehyde - Carciogen, it is not added in soda but when you digest aspartame, it will break down into 2 amino acids and menthanol formic acid formaldehyde (diet sodas) High Fructose Corn Syrup is a Concentrated Form of sugar fructose derived from corn. It increases body fat, cholesterol and triglycerides and it also makes you hungry.

Potassium Benzoate preservative that can be broken down to benzene in your body. Keep your soda in the sun and benzene = Carcinogen Food Dyes = impaired brain function, hyperactive behavior, difficulty focussing, lack of impulse control.

On September 13 the New York City Health Department became the first in the USA to ban the sale of sugared beverages larger than 16 oz. at restaurants, mobile food carts, sports arenas and movie theaters.

It’s a bold experiment in the antiobesity campaign, and while it’s widely supported by health professionals, it’s not popular with food retailers or most city residents.

China Closes 147,000 fake food and drug sites

Police in China has closed 147,000 sites that manufactured or sold counterfeit food or drugs in the past year, the government says. According to newly released figures from the Chinese Ministry of Public Security police have shut down 147,000 sites involved in the fake food and drug trade since August 2011.

Over the same period the police have reportedly resolved 185,000 criminal cases linked to counterfeiting.

Information from the public played a big role in the anti-counterfeiting cases. The Ministry says the police paid 12,000 informants $4,4 mill for helping

to identify and solve cases of fake food and drugs.

Cases investigated by police over the past year include the use of reprocessed cooking oil.

In this case police reportedly shut down manufacturers of the illegal product - known as 'gutter oil' - and closed off supply channels.

Data on the success of anticounterfeiting efforts comes as China tries to show publicly that it is taking control of the situation.

From October the State Food and Drug Administration (SFDA) will blacklist manufacturers of fake drugs as part of the intensified anti-counterfeiting push.

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COCONUT OIL COULD COMBAT TOOTH DECAY Scientists found that coconut oil which had been treated with enzymes stopped the growth of Streptococcus bacteria - a major cause of tooth decay.

Tooth decay affects 60% to 90% of children in industrialized countries.

Speaking at the Society for General Microbiology's conference, the Irish researchers say that coconut oil also attacks the yeast which causes thrush.

The research team from the Athlone Institute of Technology in Ireland tested the impact of coconut oil, vegetable oil and olive oil in their natural states and when treated with enzymes, in a process similar to digestion.

The oils were then tested against Streptococcus bacteria which are common inhabitants of the mouth.

Coconut oil attacks the bacteria behind tooth decay and Only the enzyme-modified coconut oil showed an ability could be used in dental care products, according to re- to inhibit the growth of most strains of the bacteria. search.

MoNsooN rEDucEs tHE IMMuNIty of tHE boDy Monsoon is welcome by all but it comes with lots of diseases as the immunity of the body is reduced. The diseases associated with monsoon are malaria, dengue, Chikungunya, jaundice, gastrointestinal infections like typhoid and cholera, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal, President, Heart Care Foundation of India.

Apart from these, viral infections like cold and cough are also common.

Patients with Chikungunya, typically have joint pains, which will get relieved by flexing the limbs. Dengue, if not adequately managed, can be fatal in 1–4% of cases. Chikungunya, though not fatal, can cause chronic debilitating joint pains lasting for years.

Management of dengue involves fluid resuscitation and not platelet resuscitation. If enough fluids are given, mortality can be reduced. The mortality period usually starts when the fever subsides. Inappropriate misuse of anti fever medicines can precipitate bleeding in dengue patients.

The water that gets collected due to rain becomes a breeding ground for mosquitoes. Contamination of drinking water is common. It is important to drink clean and

Hand wasHing

pure water to prevent diarrhea and gastrointestinal infections.

Walking in dirty water during rainy season leads to numerous fungal infections, which affect toes and nails. Diabetic patients have to take care of infections, which affect toes, and nails. Diabetic patients have to take a special care about their feet.

Always keep the feet dry and clean.

Avoid walking in dirty water. Keep the shoes, socks and raincoats dry and clean.

Precautions have to be taken to prevent dampness and growth of fungus (mold) on and around the house were asthmatic patients are living. Avoid fumigation in case of asthmatic patients.

Worms from underground comes to the surface and contaminate the surface vegetables. In the presence of weak digestive fire, this can cause gastric disturbances. It is because of this reason that community lunches and marriage are prohibited in this season.

One should eat light foods. Consuming barley, rice and wheat is good. Water should be boiled before use. Adding ginger and green in daily diet is helpful. Eating warm food is the rule.

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Many diseases and conditions can be spread through inadequate hand hygiene as a result of not washing hands.

Hands should always be washed: • Before, during, and after preparing food • Before eating food • Before and after caring for someone who is sick • Before and after treating a cut or wound • After using the toilet • After changing diapers or cleaning up a child who has used the toilet • After blowing your nose, coughing, or sneezing • After touching an animal or animal waste • After handling pet food or pet treats • After touching garbage Hand hygiene is critical to interrupt the spread of infectious diseases, such as the common cold, influenza, and gastrointestinal illnesses

A difference is only A difference if it mAkes A difference.

Social injustice has everything to do with illnesses. Poverty is the mother of all diseases from common cold to cancer. A child born to a poor mother will have a very small hippocampus major, small pancreas, small vessels etc making that child get all killer diseases in the 30s; in addition, the small hippocampus unfits the mind for any intellectual pursuits.

It is not prevention that should be our motto but health promotion. Disease is failed health promotion. Prevention brings in screening in its wake which promotes disease mongering. Every human body is built to last as long as it can, thanks to the immune system.

No one should try to be here for ever, as s/he will certainly not succeed, doctors and medicines notwithstanding.

The immune system needs boosting on a regular basis to keep the person

disease free. Modern medicine is not doing that. Clean water, air and food are of vital importance. One third of the world population lives on less than one meal a day. Nutritional immune deficiency syndrome (NIDS) is the biggest killer of children in poorer countries, deadlier than AIDS. Poverty economics has to be learnt not in Oxbridge but in the slums of the poor countries. Then only one gets the true picture. It is akin to doing Dictator experiments of John List in real life situations which showed that mankind is not altruistic, unlike the controlled experiments of the 2002 Nobel winning work of Vernon Smith and Daniel Kahneman, showing humankind to be hard wires to be altruistic.

The medical profession, like all other professions, has become homo eco-

“Literacy is a bridge from misery to hope.- ― Kofi Annan Health Literacy is a bridge from illness to wellness. Leaps in medical advances has left the common man far behind. He seems lost in the maze of complex medical terms and systems.Why is he unable to understand the names of diseases and medical conditions and associated issues which afflict him? These so-called ‘complexities’ come in way of of his receiving high quality medical care or to simply look after his general wellbeing. We cannot

assume that he is not interested in being healthy. The answer is simple – there is a severe shortage of the best medicine called Health Literacy. Studies have shown that around 50% of the world’s population is ‘health illiterate’.

This means that one out of 2 persons is unable to obtain, process, understand and to use that information to make good decisions about his health and medical care.

Doctor’s have no time. Patients Questions are not getting answered to resolve this problem we have created groups in the following websites. We request you to join and share your Experiances.

ay Jo in Tod

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s ’ r o t i d E Desk M.D. ha Malpani, Dr. Anirudd ctor, Founder Dire n Library for atio Health Educ P) L People (HE

SubSCRIbE TODAY for 12 Issues Just Rs. 100 Soft Copy by email Rs. 150 for Hard Copy including postage

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nomicus. We, doctors, are not concerned with poverty eradication lest we should break our own rice bowl!

Doctors can never survive without patients while patients could survive without doctors!

Hospitals and doctors have very little to do with health of the populace.

More doctors and less health has been the finding of the 14 industrialised countries’ study. (JAMA 2000; 284: 483-485) Civil engineers, politicians, social workers, philanthropes, and the altruistic social organizations should be able to do something in keeping the health of the public. Food, shelter and water with a clean environment, coupled with economic empowerment and ethical education should do the trick to keep our immune system at its peak. Will the powers that be wake up to this reality please?

Professor BM Hegde, hegdebm@gmail.com Padmabhushan Awardee’2010

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Drug Information Ofloxacin Instructions or counseling for the patient prescribed with Tablet Ofloxacin.

Ofloxacin Type of medicine: Fluoroquinolone antibiotic Use: Used to treat certain infections that are caused by bacteria. It works by killing the bacteria which cause the infection. Infections includes chest/lungs, urinary-tract and skin infections. before taking ofloxacin Before taking ofloxacin make sure your doctor knows: • If you are pregnant, trying for a baby or breast-feeding.

• If you have ever experienced tendon (a tissue that connects muscle to bone) problems after taking any other quinolone antibiotic such as ciprofloxacin, levofloxacin, moxifloxacin, nalidixic acid or norfloxacin.

• If you have a history of kidney or liver disease.

• If you have a history of diabetes or heart diseases • If you have a history of epilepsy/seizure.

• If you have ever had mental health problems.

• If you have myasthenia gravis (a muscle weakening disease).

• If you know you have glucose 6-phosphate dehydrogenase (G6PD) deficiency.

• If you are taking other medicines, including those available to buy without a prescription, herbal and complementary medicines.

• If you have ever had an allergic reaction to this or any other medicine.

How to take ofloxacin • Take ofloxacin exactly as prescribed by your doctor.

It is usually taken once or twice a day depending on the infection being treated.

• If you have been told to take ofloxacin twice a day, space your doses out evenly throughout the day.

• You may take this medicine with or without food.

• Keep taking this antibiotic until the course is finished unless you are told to stop. This is important in order to prevent the infection from coming back.

• Do not take indigestion remedies (antacids) or medicines containing iron or zinc, in the 2 hours before or after you take ofloxacin. This is because they interfere with the way ofloxacin is absorbed by your body and stop it from working fully.

• Drink extra fluids so you will pass more urine while you are using this medicine. This will keep your kidneys working well and help prevent kidney problems.

•

If you forget to take a dose, take it as soon as you remember and then continue as before. Do not take two doses together to make up for a forgotten dose.

Getting the most from your treatment • Do not take non-steroidal anti-inflammatory painkillers (NSAIDs) such as ibuprofen while you are being treated with ofloxacin.

• Ofloxacin may cause your skin to become more sensitive to sunlight than normal. Protect your skin particularly if you are exposed to strong sunlight for long periods during the day.

• Ofloxacin may impair your ability to concentrate.

Make sure your reactions are normal before driving, operating machinery or doing other jobs which could be dangerous if you were not sufficiently alert.

• If you have diabetes, you may need to check your blood glucose levels more regularly as ofloxacin may affect the levels of sugar in your blood.

• If you still feel unwell after completing your course of this antibiotic, make another appointment to see your doctor.

• Some people develop thrush (redness and itching in the mouth or vagina) after taking a course of antibiotics. If you think you have thrush, speak with your doctor.

Possible Side Effects While using Ofloxacin: Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor if any of the following side-effects continue or become troublesome.

Important Note: If you develop any of the following rare symptoms, contact your doctor for advice straight away: • Swelling of your tongue, mouth or face or any problems with your breathing.

• A severe rash.

• Pain or inflammation in your joints (particularly in your hips, knees or ankles).

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor and seek advice.

How to store ofloxacin • Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

Side-effects - these affect less than 1 in 100 people who take this medicine

What can I do if I experience this

Feeling or being sick, indigestion, abdominal pain

Eat little and often. Stick to simple or bland foods

Diarrhoea

Drink plenty of water to replace lost fluids. If the diarrhoea is severe or continues to be a problem, speak with your doctor

Headache

Try to manage with a suitable painkiller. If the headache continues, speak with your doctor

Dizziness

If affected, do not drive or operate machinery

Difficulty in sleeping, eye irritation, cough and skin itchiness

If any of these become troublesome, speak with your doctor

Reference: 1. www.thomsonhc.com, Micromedex (R) 2.0, 20022012, Thomson Reuters (Healthcare) Inc. 2. http://www.cimsasia.com/ 3. Product Information: FLOXIN(R) oral tablets, ofloxacin oral tablets. Ortho-McNeil, Raritan, NJ, 2011.

Attended by: Samson P.G., Drug Information Pharmacist, DIRC, KSPC Disclaimer: Information provided by the center is authentic and should be used judiciously by the healthcare professionals only. The center will not accept any responsibility of liability arising on using the provided information and it rests entirely on the user.

Karnataka State Pharmacy Council Drug Information & Research Centre 514/E, I Main, II Stage, Vijayanagar Club Road, Bangalore – 560 104 PH: 23383142; 23404000,9900032640 Fax: 23202345 E-mail: kspcdic@gmail.com; Web: www. karnatakadruginfo.com P T N

A Guide to SAfe uSe of PAin Medicine f you've ever been treated for severe pain from surgery, an injury, or an illness, you know just how vital pain relief medications can be.

Pain relief treatments come in many forms and potencies, are available by prescription or over-the-counter (OTC), and treat all sorts of physical pain—including that brought on by chronic conditions, sudden trauma, and cancer.

Pain relief medicines (also known as "analgesics" and "painkillers") are regulated by the Food and Drug Administration (FDA). Some analgesics, including opioid analgesics, act on the body's peripheral and central nervous systems to block or decrease sensitivity to pain. Others act by inhibiting the formation of certain chemicals in the body.

Among the factors health care professionals consider in recommending or prescribing them are the cause and severity of the pain.

TYPES OF PAIN RELIEVERS OTC Medications These relieve the minor aches and pains associated with conditions such as headaches, fever, colds, flu, arthritis, toothaches, and menstrual cramps.

There are basically two types of OTC pain relievers: acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen is an active ingredient found in more than 600 OTC and prescription medicines, including pain relievers, cough suppressants, and cold medications.

NSAIDs are common medications used to relieve fever and minor aches and pains. They include aspirin, naproxen, and ibuprofen, as well as many medicines taken for colds, sinus pressure, and allergies. They act by inhibiting an enzyme that helps make a specific chemical.

Prescription Medications Typical prescription pain relief medicines include opioids and non-opioid medications.

Derived from opium, opioid drugs are very powerful products. They act by attaching to a specific "receptor" in the brain, spinal cord, and gastrointestinal tract. Opioids can change the way a person experiences pain.

Types of prescription opioid medications include • morphine, which is often used before and after surgical procedures to alleviate severe pain • oxycodone, which is also often prescribed for mod-

erate to severe pain codeine, which comes in combination with acetaminophen or other non-opioid pain relief medications and is often prescribed for mild to moderate pain • hydrocodone, which comes in combination with acetaminophen or other non-opioid pain relief medications and is prescribed for moderate to moderately severe pain FDA has recently notified makers of certain opioid drugs that these products will need to have a Risk Evaluation and Mitigation Strategy (REMS) to ensure that the benefits continue to outweigh the risks.

Affected opioid drugs, which include brand name and generic products, are formulated with the active ingredients fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone.

FDA has authority to require a REMS under the Food and Drug Administration Amendments Act of 2007.

Types of non-opioid prescription medications include ibuprofen and diclofenac, which treat mild to moderate pain. uSE AS DIRECTED Pain medications are safe and effective when used as directed. However, misuse of these products can be extremely harmful and even deadly.

•

Consumers who take pain relief medications must follow their health care professional's instructions carefully.

If a measuring tool is provided with your medicine, use it as directed.

Do not change the dose of your pain relief medication without talking to your doctor first.

Also, pain medications should never be shared with anyone else. Only your health care professional can decide if a prescription pain medication is safe for someone.

Here are other key points to remember.

With acetaminophen (Paracetamol) : • Taking a higher dose than recommended will not provide more relief and can be dangerous.

• Too much can lead to liver damage and death. Risk for liver damage may be increased in people who drink three or more alcoholic beverages a day while using acetaminophen-containing medicines.

• Be cautious when giving acetaminophen to children.

Infant drop medications can be significantly stronger than regular children's medications. Read and follow the directions on the label every time you use a medicine. Be sure that your infant is getting the infants' pain formula and your older child is getting the children's pain formula.

With NSAIDs: • Too much can cause stomach bleeding. This risk increases in people who are over 60 years of age, are taking prescription blood thinners, are taking steroids, have a history of stomach bleeding or ulcers, and/or have other bleeding problems.

• Use of NSAIDs can also cause kidney damage. This risk may increase in people who are over 60 years of age, are taking a diuretic (a drug that increases the excretion of urine), have high blood pressure, heart disease, or pre-existing kidney disease.

With opioids: • Use of opioids can lead to drowsiness. Do not drive or use any machinery that may injure you, especially when you first start the medication.

• The dose of an opioid pain medication that is safe for you could be high enough to cause an overdose and death in someone else, especially children.

KNOW THE ACTIVE INGREDIENTS A specific area of concern with OTC pain medicines is when products sold for different uses have the same active ingredient. A cold and cough remedy may have the same active ingredient as a headache remedy or a prescription pain reliever.

To minimize the risks of an accidental overdose, consumers should avoid taking multiple medications with the same active ingredient at the

same time.

All OTC medicines must have all of their active ingredients listed on the package. For prescription drugs, the active ingredients are listed on the container label.

Talk with your pharmacist or another health care professional if you have questions about using OTC medicines, and especially before using them in combination with dietary supplements or other OTC or prescription medicines.

MISuSE AND AbuSE Misuse and abuse of pain medications can be extremely dangerous. This is especially so in regard to opioids.

These medications should be stored in a place where they cannot be stolen.

According to the National Institutes of Health, studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction.

But the abuse of opioids is a significant public safety concern. Abusers ingest these drugs orally, and also crush the pills in order to snort or inject them.

Commonly abused opioid pain medicines include prescription drugs such as codeine, and the brand-name products Oxycontin (oxycodone), Vicodin (hydrocodone with acetaminophen), and Demerol (meperidine).

Addiction is just one serious danger of opioid abuse. A number of overdose deaths have resulted from snorting and injecting opioids, particularly the drug OxyContin, which was designed to be a slow-release formulation. uSE OPIOIDS SAFELY: 3 KEY STEPS 1. Keep your doctor informed.

Inform your health care professional about any past history of substance abuse. All patients treated with opioids for pain require careful monitoring by their health care professional for signs of abuse and addiction, and to determine when these analgesics are no longer needed.

2. Follow directions carefully. Opioids are associated with significant side effects, including drowsiness, constipation, and depressed breathing depending on the amount taken. Taking too much could cause severe respiratory depression or death. Do not crush or break pills. This can alter the rate at which the medication is absorbed and lead to overdose and death.

3.

Reduce the risk of drug interactions. Don't mix opioids with alcohol, antihistamines, barbiturates, or benzodiazepines. All of these substances slow breathing and their combined effects could lead to life-threatening respiratory depression.

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Causes, incidence, and risk factors Atopic dermatitis is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to longterm swelling and redness (inflammation) of the skin.

People with atopic dermititis may lack certain proteins in the skin, which leads to greater sensitivity.

Atopic dermatitis is most common in infants. It may start as early as age 2 to 6 months.

Many people outgrow it by early adulthood.

People with atopic dermatitis often have asthma or seasonal allergies. There is often a family history of allergic conditions such as asthma, hay fever, or eczema. People with atopic dermatitis often test positive to allergy skin tests.

However, atopic dermatitis is not caused by allergies. The condition tends to get worse when the person is exposed to certain triggers.

The following can make atopic dermatitis symptoms worse: • Allergies to pollen, mold, dust mites, or animals • Cold and dry air in the winter • Colds or the flu • Contact with irritants and chemicals • Contact with rough materials, such as wool • Dry skin • Emotions and stress • Exposure to too much water, such as taking too many baths or showers and swimming too often • Feeling too hot or too cold, as well as sudden temperature changes • Fragrances or dyes added to skin lotions or soaps Symptoms Typical skin changes may include: • Blisters with oozing and crusting • Dry skin all over the body or areas of bumpy skin on the back of the arms and front of the thighs • Ear discharge or bleeding • Raw areas of the skin from scratching • Skin coloring changes -- more or less color than the normal skin tone (See: Skin abnormally dark or light) • Skin redness or inflammation around the blisters • Thickened or leather-like areas, called lichenification, which can occur after long-term irritation and scratching Both the type of rash and where the rash appears can depend on the age of the patient: • In children younger than age 2, skin lesions begin on the face, scalp, hands, and feet. They are often crusting, bubbling, or oozing rashes that itch.

• In older children and adults, the rash is more commonly seen on the inside of the knees and elbows, as well as the neck, hands, and feet.

• During a severe outbreak, rashes may occur anywhere on the body.

Itching, which is sometimes intense, almost always occurs.

Itching may start even before the rash appears. Atopic dermatitis is often called the "itch that rashes" because the

itching starts, and then the skin rash appears from the scratching.

Signs and tests A physical exam will be done.

A skin biopsy can be done to confirm the diagnosis or rule out other causes of dry, itchy skin.

Diagnosis is based on the: • Appearance of the skin • Personal and family history Allergy skin testing may be helpful for people with: • Hard-to-treat atopic dermatitis • Other allergy symptoms • Skin rashes that form only on certain areas of the body after exposure to a specific chemical SKIN CARE AT HOME Taking care of your skin at home may reduce the need for medications.

Avoid scratching the rash or skin: • Relieve the itch by using a moisturizer, topical steroid cream, or other prescribed cream and taking antihistamines to reduce severe itching.

• Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.

Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions 2 - 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals. A humidifier in the home will also help.

Avoid anything that makes your symptoms worse. This may include: • Foods such as eggs in a very young child (always discuss with your doctor first) • Irritants such as wool and lanolin • Strong soaps or detergents, as well as chemicals and solvents • Sudden changes in body temperature and stress, which may cause sweating and worsen the condition • Triggers that cause allergy symptoms When washing or bathing: • Keep water contact as brief as possible and use gentle body washes and cleansers instead of regular soaps.

Short, cooler baths are better then long, hot baths.

• Do not scrub or dry the skin too hard or for too long.

• After bathing, it is important to apply lubricating creams, lotions, or ointment on the skin while it is damp. This will help trap moisture in the skin.

Complications • Infections of the skin caused by bacteria, fungi, or viruses • Permanent scars Prevention Studies have shown that children who are breast-fed until age 4 months are less likely to get atopic dermatitis.

If the child is not breast-fed, using a formula that contains processed cow milk protein (called partially hydrolyzed formula) may decrease the chances of developing atopic dermatitis.

ATOPIC DERMATITIS

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Diabetes - eye care

Diabetes can harm your eyes. It can damage the small blood vessels in your retina, the back part of your eye.

This is called diabetic retinopathy. Diabetes also increases your risk of having glaucoma, cataracts, and other eye problems.

You may not know there is any damage to your eyes until the problem is very bad. Your doctor can catch problems early if you get regular eye exams.

If your doctor finds eye problems early, drugs and other treatments may help prevent them from getting worse.

You Need Regular Eye Exams Every year, you should have an eye exam by an eye doctor. Choose an eye doctor who takes care of people with diabetes.

The eye exam may include: • Dilating your eyes to allow a good view of the entire retina. Only an eye doctor can do this exam.

• At times, special photographs of the back of your eye Your eye doctor may ask you to come more or less often than every year.

How to Prevent Eye Problems Control your blood sugar levels. High blood sugars increase your risk of having eye problems.

Control your blood pressure. Blood pressure less than 130/80 is a good goal for people with diabetes.

• Have your blood pressure checked often and at least twice per year.

• If you take drugs to control your blood pressure, take them as your doctor told you to.

Gingivitis is inflammation of the gums.

Causes Gingivitis is a form of periodontal disease. Periodontal disease is inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets (alveolar bone).

Gingivitis is due to the longterm effects of plaque deposits on your teeth. Plaque is a sticky material made of bacteria, mucus, and food debris that develops on the exposed parts of the teeth. It is a major cause of tooth decay.

If you do not remove plaque, it turns into a hard deposit called tartar (or calculus) that becomes trapped at the base of the tooth. Plaque and tartar irritate and inflame the gums. Bacteria and the toxins they produce cause the gums to become infected, swollen, and tender.

The following raise your risk for gingivitis:

Do not smoke. If you need help quitting, ask your doctor or nurse.

If you already have eye problems, ask your doctor if you should avoid some exercises that can strain the blood vessels in your eyes. These exercises may make eye problems worse: • Weight lifting and other exercises that make you strain • High-impact exercise, such as football or hockey Make It Easier for Yourself at Home Make sure your home is safe from falls.

If you cannot read the labels on your medicines easily, these tips might help you make sure you are taking the correct medicine and the correct dose: • Use felt tip pens to label medicine bottles so you can read them easily.

• Use rubber bands or clips to tell them apart.

• Ask someone else to give you your medicines.

• Always read labels with a magnifying lens.

• Use a pill box with compartments for days of the week and times of the day, if you need to take medicines more than once a day.

Never guess when taking your medicines. If you are unsure of your doses, talk with your doctor, nurse, or pharmacist.

Keep medicines and other household items organized in a cabinet so you know where they are.

Use large-print cookbooks to make foods that are on your diabetes meal plan. Ask your doctor or nurse where you can get these books.

When to Call the Doctor Call your doctor if: • You cannot see well in dim light.

• You have blind spots.

• You have double vision (you see 2 things when there is only 1).

• Your vision is hazy or blurry and you cannot focus.

• You have pain in your eyes.

• You are having headaches.

• You see spots floating in your eyes.

• You cannot see things on the side of your field of vision.

• You see shadows.

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• Certain infections and body-wide (systemic) diseases • Poor dental hygiene • Pregnancy (hormonal changes increase the sensitivity of the gums) • Uncontrolled diabetes • Misaligned teeth, rough edges of fillings, and illfitting or unclean mouth appliances (such as braces, dentures, bridges, and crowns) Use of certain medications, including phenytoin, bismuth, and some birth control pills Many people have some amount of gingivitis. It usually develops during puberty or early adulthood due to hormonal changes. It may persist or recur frequently, depending on the health of your teeth and gums.

Symptoms • Bleeding gums (blood on toothbrush even with gentle brushing of the teeth) • Bright red or red-purple appearance to gums

GinGivitis

• Gums that are tender when touched, but otherwise painless • Mouth sores • Swollen gums • Shiny appearance to gums Exams and Tests The dentist will examine your mouth and teeth and look for soft, swollen, red-purple gums.

The gums are usually painless or mildly tender.

Plaque and tartar may be seen at the base of the teeth.

The dentist will use a probe to closely examine your gums to determine if you have gingivitis or periodontis.

No further testing is usually necessary. However, dental x-rays may be done to see if the disease has spread to the supporting structures of the teeth.

Treatment The goal is to reduce inflammation.

The dentist or dental hygienist will clean your teeth. The may use different tools to loosen and remove deposits from the teeth.

Careful oral hygiene is necessary after professional tooth cleaning. The dentist or hygienist will show you how to brush and floss.

Professional tooth cleaning in addition to brushing and flossing may be recommended twice per year or more frequently for severe cases of gum disease.

Antibacterial mouth rinses or other aids may be also be recommended.

Repair of misaligned teeth or replacement of dental and orthodontic appliances may be recommended.

Any other related illnesses or conditions should be treated.

Outlook (Prognosis) Some people have discomfort when plaque and tartar are removed from the teeth.

Bleeding and tenderness of the gums should lessen

within 1 or 2 weeks after professional cleaning and careful oral hygiene.

Warm salt water or antibacterial rinses can reduce gum swelling. Over-the-counter anti-inflammatory medications may also be helpful.

Healthy gums look pink and firm. Strict oral hygiene must be maintained for your whole life, or gum disease will recur.

Possible Complications • Gingivitis returns • Periodontitis • Infection or abscess of the gums or the jaw bones • Trench mouth When to Contact a Medical Professional Call your dentist if you have red, swollen gums, especially if you have not had a routine cleaning and examination in the last 6 months.

Prevention Good oral hygiene is the best way to prevent gingivitis.

You should brush your teeth at least twice a day. You should floss at least once a day.

Your dentist may recommend brushing and flossing after every meal and at bedtime. Ask your dentist or dental hygienist to show you how to properly brush and floss your teeth.

Special devices may be recommended if you are prone to plaque deposits. They include special toothpicks, toothbrushes, water irrigation, or other devices.

You still must brush and floss your teeth regularly.

Antiplaque or antitartar toothpastes or mouth rinses may also be recommended.

Regular professional tooth cleaning is important to remove plaque that may develop even with careful brushing and flossing. Many dentists recommend having the teeth professionally cleaned at least every 6 months.

Alternative Names Gum disease; Periodontal diseas P T N

India’s ’5-star’ private hospitals should be regulated: WHO New Delhi: The World Health Organization’s India representative Dr Nata Menabde has expressed the need for regulating India’s private healthcare sector represented by five star hospitals.

“The private sector in India is represented by five star hospitals. Their services need to be regulated,” Dr Menabde has said, adding, “over-diagnosis” in private hospitals

is a problem and so is “misuse of technology”.

Dr Menabde has also supported the wider adoption of the Clinical Establishment Registration Act passed by Parliament in 2010.

Only four of the states and union territories (UTs) have ratified the law so far. [Source: BS]

Delhi DDU hospital appoints bouncers to protect doctors At first sight, they pass off as just security guards at a hospital but their strong builtand tough looks indicate that they are bouncers kept to ward off agitated people.

These guards are stationed in key areas of the Deen Dayal Upadhyay Hospital from emergency tolabour room to casualty ward and one would think twice before picking up an argument with them.

Plagued by physical attacks on doctors by agitated relatives of patients, the administrators of the hospital have

hit upon the idea to protect doctors.

Such “well-built yet polite” people are on guard with the primary objective of saving doctors who are often at the receiving end.

Authorities at the Delhi Government-run hospital justify the move to resort to such a step to save the doctors from being attacked by the kith and kin of the patients and prevent professionals from going on a strike.

Why not many hospitals are opting for nABH accreditation?

Because of lack of awareness. Demand for quality healthcare should come from consumers. We need a campaign on similar lines of "Jago Grahak Jago".

Accreditation is beneficial for everybody because it provides: A strong focus on: • Patient rights and benefits • Patient safety • Control and prevention of infections, medicine errors • Practicing good patient-care protocols e.g. special care for vulnerable groups, critically ill patients • Better and controlled clinical outcome benefits For Patients: • High quality of care • Rights are respected and protected • Understandable education and communication • Patient satisfaction is evaluated • Informed choice through counselling and the care process and maintain confidentiality • Focus on patient safety • Care of vulnerable patient

American College of Surgeons Launches Patient Education Website As the largest international organization of surgeons, The American College of Surgeons is dedicated to improving the care of the surgical patient.

This “Surgical Patient Education” website contains educational information to help you and your families become informed about your operation and surgical care. Here you will find current information about surgical procedures, diseases, tests, and medications from government and professional sources to support you in participating in your surgical care.

PATIENT & DOCTOR NOTES

Patient access to physician notes can boost patient engagement, understanding and adherence to their care plans, according to a study published in Annals of Internal Medicine.

For the study, researchers surveyed 105 primary care physicians and 13,564 patients who had access to their physicians' notes via an electronic portal over a one-year period. Of the 5,391 patients who reviewed at least one note and completed the survey, up to 87 percent reported that the open notes program made them feel more in control of their care, and up to 78 percent reported increased adherence to medications.

Nearly all (99 percent) of the patients who responded felt that the program should continue, but approximately one-third expressed concerns aboutprivay.

Physicians initially voiced concerns that open notes would increase their work load or worry and/or offend patients; however, those concerns never materialized.

When asked to describe the most difficult aspect of the open notes program, 74 percent of the 104 physicians who responded said that nothing was difficult and that they experienced no changes in their practice.

• Continuity of care benefits For the Staff: • Improves professional staff development • Provides education on consensus standards • Provides leadership for quality improvement within medicine and nursing • Increases satisfaction with continuous learning, good working environment, leadership and ownership benefits For the Health Care Organisation: • Improves care and brings in Corporate Governance • Stimulates continuous improvement • Demonstrates commitment to quality care • Opportunity to benchmark with the best Dr Gayatri Vyas Mahindroo Ms Mch Director, National Accreditation Board for Hospitals and Healthcare Providers (NABH), which is a constituent board of Quality Council of India (QCI), New Delhi.

Jago Grahak Jago

DCGI-To ConTrol oTC sales of anTIbIoTICs Amid concerns over rampant use of antibiotics and resistance developed towards them, government is set to restrict over-the-counter sale of 91 such new generation drugs through a notification which is likely soon.

The notification in this regard is in final stages with the Drug Controller General of India (DCGI) writing to the Union Health Ministry, which, in turn, will send it to the Law ministry for its nod, a Health Ministry official said.

"The classification of 91 new generation antibiotics will be labelled 'Rx' in red and also prominently display warnings that the drug is not to be administered without medical advice," the official said.

He, however, said such a notification is likely after the current monsoon session of Parliament.

The Schedule H-1 drugs will prominently carry a warning "it is dangerous to take this preparation except in accordance with medical advice" in red colour on the left corner, along with another advice of "not to be sold by retail without the prescription of a registered medical practitioner".

The Drug Controller General of India has already written to all state drug controllers for strengthening of regulatory control at retail sale outlets to ensure drugs are dispensed by retail chemists in compliance to the provisions of the Drugs and Cosmetics Rules.

The DCGI directive also seeks to ensure that drug inspectors make surprise checks on chemists in their areas so that restricted Schedule X and Schedule H drugs are not sold without medical prescription.

KNOW YOUR LAB TEST

Cholesterol is a soft, wax-like substance found in all parts of the body. Your body needs a little bit of cholesterol to work properly. But too much cholesterol can clog your arteries and lead to heart disease.

Some cholesterol is considered "good" and some is considered "bad." Different blood tests can be done to individually measure each type of cholesterol.

Total Cholesterol

bILIRubIN Alternate Names • Total Bilirubin • TBIL • Neonatal Bilirubin • Direct Bilirubin (Conjugated Bilirubin) • Indirect Bilirubin (Unconjugated Bilirubin) Bilirubin is a component of bile, which is produced by the liver, and necessary for the normal digestion of food. Jaundice is caused by high bilirubin levels in the blood, which can lead to brain damage if untreated. Bilirubin blood levels are used to diagnose gallbladder disease, liver disease, anemias, blood infection, transfusion reaction, or hemolytic disease of the newborn (where red blood cells are destroyed).

Near Best: 100 - 129 mg/dL Borderline High: 130 - 159 mg/dL High: 160 - 189 mg/dL Very High: 190 mg/dL and higher HDL (Good) Cholesterol HDL stands for high-density lipoprotein. It's also sometimes called "good" cholesterol. Lipoproteins are made of fat and protein. They carry cholesterol, triglycerides,

Understanding cholesterol A total cholesterol test measures all types of cholesterol in your blood. The results of this test tells your doctor whether your cholesterol is too high.

• Best: lower than 200 • Borderline high: 200 239 • High: 240 and higher If your total cholesterol levels are high, your doctor will want to know your LDL cholesterol and HDL cholesterol levels before deciding whether you need treatment.

Knowing your LDL and HDL cholesterol levels will also help guide your doctor to choose the best drug for you.

LDL (Bad) Cholesterol LDL stands for low-density lipoprotein. It's also sometimes called "bad" cholesterol. Lipoproteins are made of fat and protein. They carry cholesterol, triglycerides, and other fats, called lipids, in the blood to various parts of the body. LDL can clog your arteries.

Your LDL level is what doctors watch most closely. You want your LDL to be low. Too much LDL, commonly called "bad cholesterol," is linked to cardiovascular disease. If it gets too high, you will need treatment.

A healthy LDL level is one that falls in the best or nearbest range.

Best: Less than 100 mg/dL (less than 70 mg/dL for persons with a history of heart disease or those at very high risk)

and other fats, called lipids, in the blood from other parts of your body to your liver.

You want your HDL cholesterol to be high. Studies of both men and women have shown that the higher your HDL, the lower your risk of coronary artery disease.

This is why HDL is sometimes referred to as "good" cholesterol.

A healthy HDL level should be as follows: • Men: above 40 mg/dL • Women: above 50 mg/dL An HDL 60 mg/dL or above helps protect against heart disease. Exercise helps raise your HDL cholesterol.

VLDL Cholesterol VLDL stands for very low density lipoprotein. There are three major types of lipoproteins.

VLDL contains the highest amount of triglycerides. VLDL is considered a type of bad cholesterol, because it helps cholesterol build up on the walls of arteries.

A normal VLDL cholesterol level is between 5 and 40 mg/dL. Considerations Sometimes, your cholesterol levels may be low enough that your doctor will not ask you to change your diet or take any medications.

When your levels are high, your doctor must consider other factors before deciding whether your cholesterol levels are a concern and need treatment.

SOURCE—MEDLINEPLUS

HealtH ministry pusHes for generic medicines New Delhi: In a bid to reduce healthcare costs, the union health ministry plans to bring in a legislation to make it mandatory for doctors to prescribe generic medicines.

Sources from the ministry say a bill is already being drafted to push low-cost medicine, along with an ambitious plan to provide free medicine to all.

"The out-of-pocket expense on healthcare is too high. Generic medicine will ensure that it is affordable," an official from the ministry said.

"A bill is being drafted, it will make sure that a list of generic medicines and combination drugs are available in all districts, and it is prescribed by doctors," the official said.

The official said that the bill would ensure that both generic and branded medicines are available on sale side by side.

"The aim is not to bring an end to branded medicine. They shall exist side by side. Out-of-pocket expenditure for healthcare is 78 per cent of total expenditure on healthcare. Generic medicine would reduce the burden on the common man," he said.

The official, however, cautioned that there would be need for strict monitoring and stringent quality control.

An ambitious programme for providing free generic medicines to the economically weaker sections has already been finalised, and is likely to be implemented by the year-end.

As per data available with the ministry, the government currently spends only 0.1 per cent of GDP on purchase and supply of medicine through public health centres.

Though India is one of the world's largest exporters of generic drugs, its domestic market for generic drugs is small. India exports to over 200 countries, including the highly regulated markets of the US, Europe, Japan and Australia.

Common medicines like paracetamol cost Rs 10 a strip when branded, while the generic variety costs around Rs 2.45 per strip.

At present, the government has a list of nearly 350 medicines for which generic varieties will be made available.

[Source: IANS]

Patient satisfaCtion survey We would like to know how you feel about the services provided by Doctor / Hospital. Your responses are directly responsible for improving services. All responses will be kept confidential and anonymous. Thank you for your time.

Please Tick how well you think DOCTOR / HOSPITAL are doing in the following areas:

GREAT : 5 GOOD : 4 OK : 3 FAIR : 2 POOR : 1 Ease of getting care : Ability to get in to be seen: Hours Doctor/Hospital is open: Convenience of location: Prompt return of telephone calls:

Nurses and Medical Assistants: 5 5 5 5

4 4 4 4

3 3 3 3

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1 1 1 1

5 5 5 5

4 4 4 4

3 3 3 3

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Waiting : Time in waiting room: Time in exam room: Waiting for tests to be performed: Waiting for test results:

Your Age: __________________

Staff : DOCTOR Takes enough time with you: 5 4 3 2 1 Explains what you want to know: 5 4 3 2 1 Gives you good advice and treatment: 5 4 3 2 1

Friendly and helpful to you: Answers your questions:

Sex: Male 5 4 3 2 1 5 4 3 2 1

5 4 3 2 1 5 4 3 2 1

The likelihood of referring your friends and relatives to same Doctor / Hospital : YES / NO What do you like best about Doctor / Hospital What you do not like about Doctor / Hospital Suggestions for improvement?

Name Of your Doctor / Hospital

5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Yes / No

Please Post or email

All Others: Friendly and helpful to you: Answers your questions:

Female

Payment : What you pay: Explanation of charges: Collection of payment/money: Do you feel overcharged Facility: Neat and clean building: Ease of finding where to go: Comfort and Safety while waiting: Privacy:

5 5 5 5

4 4 4 4

3 3 3 3

2 2 2 2

1 1 1 1

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