Our Life & Health

12/02/2023

18/01/2023

Pacemakers

INTRODUCTION

A Pacemaker is a small device that made up of computer chips and long lived battery in a sealed case. It can recognize irregularities of your heart rhythm and send out its own electrical impulse to make your heartbeat regularly.
Your heart muscle has its own electrical impulses generating mechanism which causes heart to contract and relax in proper timing sequence and that mechanism helps to pump blood throughout the body. When the electrical signals are blocked or irregular, heartbeat becomes too slowly. Pacemaker provides electrical stimulation when heart does not beat or beats too slowly.
The pacemaker is implanted in the surgically created cavity of upperchest. It is connected to the heart muscle by special type of wires called leads. Those leads transport the impulse that generated by the pacemaker to the heart muscle and also help the pacemaker to sense the heart rhythm.

WHY DO YOU NEED A PACEMAKER

If you have following symptoms, contact your doctor
Slow, abnormal heart rate
Dizziness
Tiredness
Shortness of breathing
Palpitations
Loss of consciousness
After several investigations, your doctor will decide the necessity of a pacemaker.
Types of Pacemakers
The first pacemaker is discovered at 1950s and it was the size of hockey puck. Its battery was lasted less than a year. Present, pacemakers become smaller in size and their batteries last between 5 to 10 years.
Single chamber Pacemakers
The simplest type of pacemakers and they are connected to one chamber of the heart using one lead, usually the right ventricle.
Dual Chamber Pacemakers
Dual chamber Pacemakers have two leads. One in right atrium and one is the right ventricle.
Some Pacemakers have three leads. One in the right atrium, one in the right ventricle and another one in the left ventricle.
BENEFITS OF HAVING A PACEMAKER
When your heart does not beat or beats too slowly, Pacemaker provides electrical stimulation to the heart muscle and makes your heart beat regularly and on time.
Relieve symptoms such as light-headedness, dizziness and faintishness.
Help to improve the quality of life as to live happier, longer, more productive and healthier lives
RISKS OF HAVING A PACEMAKER
Some people have to face complications after the surgery.
Post operative infections
Allergic reaction to a drug used in surgery.
Blood loss during surgery
Damage to the blood vessel or the heart wall or other premise.
In addition to above facts, the leads can be shifted / disconnected from the heart muscle and device may slip out of the pocket in the chest.
SURGERY FOR THE PACEMAKER
1.PRE OPERATIVE MANAGEMENT
Some medications (Anticoagulants, Antiplatelets) will be stopped by your doctor as they increase the risk of bleeding during the surgical procedure.
You have to continue fasting (not to drink or eat) for several hours before the surgery.
You may have an intravenous line (cannula) in your arm. (Usually non dominant hand)
Your operation area will be shaved by a health care worker.
Your consent will be obtained by the doctor before surgery.
2.INTRA OPERATIVE MANAGEMENT
BEFORE SURGERY
You are taken within the operation theatre.
You will be connected to the cardiac monitor (to monitor your vital signs and oxygen level of the blood)
ECG electrodes will be placed on several parts of your body. (monitor your pulse and rhythm )
Your operation area will be cleaned with an antiseptic solution (usually povidone iodine) by the Nurse.
Except your operation area, other parts of your body will be covered by operation sheets.
DURING SURGERY
Local anaesthesia will be given to your operation area by the doctor.
The doctor makes a cut through the skin (about 1-2 inches) and then finds a vein (usually the subclavian vein) and threads the lead directly into the heart using fluoroscopic guidance.
Then the doctor makes a small pocket under the skin and inserts the pacemaker into the pocket and connects it to the lead.
AFTER SURGERY
You will be taken to the place called recovery room where you stay until transfer to the ward.
You may feel some pain at the site of surgery and analgesics will be prescribed by the doctor as necessary.
You will be transferred to the ward after some time.
POST OPERATIVE MANAGEMENT
After 1-2 days after surgery you will be discharged from the hospital. But you will need first few days or weeks to get recovery. Wound may be healed gradually and antibiotics may be prescribed by the doctor. At very first days you may be aware of the pacemaker but after a while you will not notice it.
After the surgery, you should
Keep your wound clean and dry. If you notice the redness, warm, swelling, severe pain and draining fluids from the wound meet your doctor immediately.
Follow the instructions about bath and cut dressing.
Limit movements with the arm closest to the pacemaker. Avoid stretching, lifting, and sudden jerky movements. You can gradually increase the use of your arm.
Do not move the pacemaker by fingers.
Keep your follow up visits.
Follow your doctor’s advises to resume your normal activities.
Imitate your doctor’s instructions about your medications.
FOLLOW UP VISITS
During your follow up visits the doctor will put a device over your pacemaker. The device tells about the battery status, reports your heart rhythms since your last follow up as well as the doctor can alter setting of your device. It id very important to keep your follow up visits regularly and be sure to tell your doctor about any problems having with your pacemaker.
PRECAUTIONS AND WARNINGS
1.EMI
EMI means electromagnetic interference. Certain devices that linked with electrical and magnetic energy can interfere with your pacemaker. Therefore you are better to avoid some major causes of EMI as follows .
Electrical paraphernalia in poor condition or not grounded correctly.
Metal detectors and security systems. When you enter or exit a place with a security system, walk through the entrance or exit at a normal pace.
Communication instruments such as microwave transmitters, linear power amplifiers or top power amateur transmitters.
Therapeutic radiation antecedent cancer radiation therapy.
Magnetic Resonance Imaging (MRI) -MRI is a test that can make images of the soft tissues inside your body using a large machine. But to create images, the machine generate very strong magnetic fields and they can be very harmful to metallic implantable devices like your pacemaker. But nowadays some pacemakers are designed to withstand the forces of most MRI scanners. So ask your doctor that what kind of pacemaker are you having?
Cellular phones can interfere with your pacemaker. You can take simple precautions such as not carrying the phone in the pocket over your pacemaker and holding it to the ear of side away from the pacemaker.
2.Medical Procedures
If u have to undergo following medical procedures, talk to your doctor
Electrosurgery
Lithotripsy
Diathermy
MRI
Radiation therapy
MEDICATIONS
Pacemaker does not replace your medications. So do not stop your routine medications without the advice of your doctor.
FOOD AND NUTRITION
It is better to have a diet high in fiber, low in fat, cholesterol and sodium. High fat, high cholesterol foods such as whole milk dairy products, red meats and junk foods contribute to hardening of arteries causing heart attacks and strokes. High fiber foods make you satisfied with fewer calories.
OTHER HEALTHY HABITS
AVOID SMOKING AND TO***CO USE
REGULAR EXERCISES
AVOID ALCOHOL

16/01/2023

Diabetes Mellitus

Diabetes Mellitus is a disorder that the body does not produce enough insulin or does not response to insulin causing blood glucose levels to be higher than normal range.
DM is mainly categorized as Type 1 and Type 2. Type 1 diabetes is also known as Juvenile diabetes or Insulin Dependant diabetes. In this condition your pancreas produces either little or no insulin. This is occurred due to autoimmune destruction of beta cells (the cells involved in insulin synthesis ) in pancreas. The onset is frequently occurred in childhood or adolescence. But this disease also can be developed in adults. Type 1 diabetes has no cure and needs insulin therapy throughout their life.
Type 2 Diabetes Mellitus
In type 2 diabetes, hyperglycaemia is occurred primarily due to two problems.
1.Your pancreas does not produce enough insulin.
2.Your body cells become resistant to insulin.
Symptoms
Signs and symptoms of type 2 diabetes are developed slowly through long period. You may be living with type 2 diabetes for several months/ years without knowing about it. If symptoms are presently, they may include
Increased thirst
Frequent urination
Increased hunger
Unintended weight loss
Fatigue
Blurred vision
Slow healing sores
Frequent infections
Tingling in the hands and feet.
Some Areas of dark skin, generally in the armpits and neck.
Risk Factors
Factors that may increase your risk of type 2 DM include:
Weight – Being overweight or obese increase your risk of diabetes.
Sedentary life style – Physical activity helps to control your weight by using glucose as energy and make your cells more sensitive to insulin. If you are less active, your risk is greater.
Family history – If your parents and siblings have diabetes you have more chance to develop diabetes.
Race and Ethnicity – Black, His, Native Americans and Asian people are more likely to develop type 2 DM than white people.
Age – The risk of type 2 DM is increased when you are older than age 45.
Fat distribution – storing fat in your abdomen rather than your hips and thigh indicates greater risk.
Blood lipid levels – low levels of HDL (High Density Lipoprotein) and high levels of triglycerides are associated with occurrence of type 2 DM.
Prediabetes – If your blood glucose level is higher than normal although not high enough to be classified as diabetes, it is called as prediabetes. With unhealthy life style prediabetes can be progressed to type 2 DM
Pregnancy related risks – Your risk of developing type 2 DM is increased if you have gestational diabetes or if your baby is weighing more than a pound at birth.
Diagnosis
Diabetes can be identified after testing your glucose level in the blood. Mainly there are 3 tests.
Fasting blood sugar – This test is usually done in the morning after 8-10 hours of fasting.
Random blood sugar – This test can be done at any time of the day. No need to keep fasting.
HbA1C test – This is also called as glaciated haemoglobin test. This test shows your average blood glucose level over the past two or three months. This test measures the amount of glucose correlated to haemoglobin. You don’t need to stay fast before this test.
Oral glucose tolerance test ( In pregnant mothers )- In this test you may kept overnight fasting. Then your blood glucose level to be measured and as far you may drink a sugary drink. Blood glucose level is checked again after one, two and three hours.
Complications
If your blood glucose levels remain high over a long period, your body cells, tissues and organs can be seriously damaged.
Cardiovascular issues including high cholesterol, artherosclerosis, coronary artery disease, stroke and hypertension.
Neuropathy ( Nerve damage ) – Numbness and tingling of your toes and fingers and then spreads.
Nephropathy ( Kidney damage ) – This can lead to Chronic Kidney Disease (CKD ) that need to haemodialysis or kidney transplant.
Retinopathy ( Eye damage ) – It may lead to blindness. ( Cataract, Glaucoma )
Foot damage – due to poor blood flow, poor healing of cuts and sores can be occurred.
Skin infection
Erectile dysfunction
Hearing loss
Dementia
Dental problems
Prevention

1. Healthy eating – prepare your meals as follows.
-Eat foods low in sugar, fat, sodium and high in fiber. (Whole grains, non-starchy vegetables and fruits)
-Follow a regular schedule for meals and healthy snacks.

-Take meals in smaller portions.

2. Physical activity – Exercises are more important to maintain healthy weight / reduce weight. It also support to control your blood glucose levels. Involve in aerobic exercises such as walking, swimming, cycling or running at least 30 minutes per day and at least 150 minutes per week.
Limit inactivation – If you work with computers, take few minutes to stand, walk around or do some light activity every 30 minutes.

3. Weight reduction – Reduction of weight can delay the progression from prediabetes to diabetes. If you have prediabetes, reduction of weight 7%- 10% of your body weight may reduce the risk of diabetes.
Treatment
Healthy eating
Regular exercise
Weight reduction
Diabetes medication and insulin therapy
Blood glucose level monitoring
Diabetes medications
If you can’t control target blood glucose level with diet and exercise, you have to take diabetes medications according to your doctor that help to control your blood glucose levels.
1.Oral hyperglycaemic drugs
Biguanides – Metformin
Sulfonylureas
Thiazolidinedione – Pioglitazone
DPP4 inhibitors – Sitagliptin
SGLT2 inhibitors- Empagliflozin, Dapagliflozin

4. Insulin therapy

15/01/2023

HIV, human immunodeficiency virus (HIV), affects the immune system making the body vulnerable to several infections and diseases. The virus destroys the function of Immune cells ( CD4 cells), which helps fight the body against pathogens, virus, and conditions. HIV infects white blood cells and T cells by interacting with virion envelope glycoprotein (gp120) and the CD4 molecule. The infection of T cells is assisted by the viral dsDNA, which is integrated into the host genome by the viral integrase enzyme (5). During the process of integration, transcription, and maturation, HIV infects individual functional proteins. The mature virions are then able to infect another host cell. The infected individual becomes immunodeficient and later acquires AIDS, acquired immune deficiency syndrome if the virus is left untreated. A person having a CD4 count of less than 200 /Cmm is diagnosed with HIV and, ultimately, AIDS. Because healthy adults generally have a CD4 count of 500 to 1,600 per cubic millimeter. With the advance in medications and vaccinations, an individual can have an average life expectancy without living with AIDS.
SYMPTOMS
The first stage after infection is termed the acute infection stage. It is a stage of the rapid growth of the virus, with minor flue-like symptoms that are unable to detect before one month or a few weeks. These symptoms include:
⦁ Dizziness
⦁ Fatigue
⦁ Fever
⦁ Chills
⦁ Nausea
⦁ Skin rash
⦁ Enlarged nodes or lymph( neck region)
⦁ Joint pain
After the acute stage, the individual could last asymptomatic for a year and reach another stage, the clinical latency stage. In an asymptomatic stage, the virus continues to affect CD4 cells and harm the immune system for more severe conditions until the individual reaches the stage of Acquired immune deficiency syndrome. The host body shows these symptoms :
⦁ Diarrhea
⦁ Dyspnea( Shortness of breath)
⦁ Blurred vision
⦁ Confusion
⦁ Body imbalance
⦁ Dry cough
⦁ Sweats
⦁ Purplish spots on the tongue
⦁ TB( Tuber clauses), Meningitis
⦁ Kidney disease
On-time treatment and medications can help guard the body against infections, cancers, and other life-threatening complications. (WHO(World Health Organization), June 2022).
PREVENTION AND TREATMENT MEASURES
HIV disease can be managed by preventive measures and, of course, treatment medications. Having clean, safe household conditions, a nutrient-rich diet, safe s*x, avoiding used needles and syringes, and getting tested for the presence of viruses plus s*xually transmitted diseases could save lives. Apart from preventive measures, the treatment regimens composed of
⦁ Antiretroviral therapy (ART) suppresses viral load clouding the immune system. This therapy has been recommended by WHO since 2016, that all people living with HIV be provided with lifelong ART, regardless of clinical status or CD4 cell count.
⦁ Another medication that can stop infection is non-other than post-exposure prophylaxis (PEP). It is taken after advice from a healthcare practitioner after 72 hours of disease from a virus.
⦁ Community-based Rehabilitation or CBR programs are another effective modes of HIV protection. It can help people :
⦁ With disabilities
⦁ With low socioeconomic conditions to avail the precautionary programs
Responses to human immunodeficiency virus or AIDS are often targeted at key populations, areas, gender or age. Yet preventive measures from infected hosts can help beat the virus from spreading the cause.