Tubercolosis

How Do I Know  ??

By

Dr. Madan M Vasandani

I attended a school nurse conference today and what I experienced there today really opened my eyes on how ‘neglect’ is an epidemic of epic proportions. The topic raised in the conference was Management of a Case of Tuberculosis when detected in school.

Dear readers, did you know that Indonesia has the 4^th highest number of cases of Tuberculosis in the world and that 1 in 6 Indonesians have Tuberculosis. This is a concern for me especially as a parent. My mind started wandering during the conference in to the abyss of my sons’ school.

How do I know that my sons’ school is free of Tuberculosis? Do they have a screening test to ensure each and every one in the school compound is free of Tuberculosis? They do not and this has caused me to spiral down to write an email to the school and also to write this blog.

 

What is Tuberculosis?

Tuberculosis is an infection caused by Mycobacterium Tuberculosis. It most often affects the lung causing a condition called Pulmonary Tuberculosis. It can also affect other organs like the Lymph nodes, brain, Gastro Intestinal Tract and even the bones.

How is it transferred?

TB is transferred by droplets. Droplets are only produced by Coughing, sneezing, singing and even talking. The bacteria is not shed in a person’s saliva, hence sharing utensils or food cannot transmit the disease.

What are the symptoms of Tuberculosis?

The most common symptoms of TB are: 

• Cough lasting more than 2 – 3 weeks
• Weight loss
• Decreased Appetite
• Night sweats

Infected people may not feel ill or show any symptoms if their immune system can keep the bacterial under control. About 1/3^rdof the people of Indonesia are infected without showing any symptoms. When someone’s immune system is weakened, the chances of being sick are greater.

Can TB be cured?

TB can be cured with medication ….. but untreated it can kill. Treatment usually takes 6 months and costs as little Rp 1,000,000 in Jakarta.

So what’s the big idea?

Well, as the conference was attended by school nurses, I would like to ask any head of school, principal, teacher or school owners – Do you have an effective program to ensure your staff, teachers, drivers and even students do not have Tuberculosis? If the answer is NO, which I am sure most of you will answer then it is time to throw the ‘neglect’ in the trash bin and get on with a program. This will not only help us doctors to eradicate TB, it will also boost up the pedigree of your school. As parents we would like our kids to be safe and healthy in school. Kids spend long hours in schools and it is the responsibility of schools to ensure they are safe and free of preventable diseases.

As my eyes were opened, I hope it has the same effect on you.

~If you are a parent, question the school.

~If you work in a school question the management.

~If you own a school or part of management,it is time to implement this program. 

Health is a social word; hence, it requires the involvement of the society to keep each and every one healthy. Health doesn’t just fall to your lap like manna from the sky, you have to attain it.

Be active and fight for a school free of Tuberculosis.

Vitamin D

"Vitamin D"

Question: Should I start Vitamin D supplements?

Dr.Madan: Before answering this question let me first tell you a bit about Vitamin D

What you should know about Vitamin D?

It is a fat soluble vitamin that exists in various forms. The animal form is Vitamin D3 and the plant form is Vitamin D2. They are not biologically active; they must be modified in the body to have any effect. The active form is a hormone known as 1, 25 di-hydroxyvitamin D3 or Calcitriol.

How is Vitamin D produced in our body?

 

Vitamin D is not a true vitamin. Believe it or not the basic component of Vitamin D in our body is Cholesterol. Cholesterol is converted to 7 – Dehydrocholesterol. With the help of Ultra Violet – B (UVB) from sun rays 7 - Dehydrocholesterol is converted to Cholecalciferol and this is further modified in the liver and kidney to become the active hormone – 1, 25 di-hydroxyvitamin D3.

Fact Number 1

Think you are soaking up Vitamin D through office/car windows? Wrong. Glass blocks virtually all UVB, preventing vitamin D from being made

Fact Number 2

Applying sunscreen with an SPF of 15 will decrease the amount of vitamin D made in the body by about 99%.

Sources of Vitamin D

What is the optimal level of Vitamin D in the blood and how much vitamin D do I need?

The most advantageous serum concentration of 25(OH)D seem to begin at 75 nmol/L, with optimal levels being between 90 and 100 nm/L. An intake of greater than or equal to about 1000 IU may be needed for most of the population.

So, why is Vitamin D so important?

Nearly every tissue and cell in our body has Vitamin D receptor. Without enough activated Vitamin D in the body, dietary calcium CANNOT be absorbed. Calcium is essential for signaling between brain cells, development of bone, and tooth formation. Studies also reveal that low Vitamin D levels in the body are associated with:

• Increase loss of muscle strength and mass as we age
• Increase risk of cancers 
• LOWER LEVELS OF IMMUNITY – Maybe this is the reason for the recurrent cold and cough 
• Higher blood pressure 
• The development of neurological disorder 
• The development of diabetes

Did you know?

    Spending 20 minutes outside in the summer sun produces 100 times more vitamin D than you need. And once serum levels reach 150 nmol/L, any excess is inactivated.Thanks to Mother Nature Soo, in summary, following is what you need to do:  

1. Wake up 30 minutes earlier and bake yourself in the sun for at least 20 minutes. 
2. If you feel you have Vitamin D, deficiency get a 1, 25 di-hyrdoxy Vitamin D blood test. 
3. If you cannot bake yourself in the sun, ensure you get a good Vitamin D supplement. 

Hope this article is beneficial. Make sure your Vitamin D levels are adequate.