Dr. Ankit Kumar Katiyar

Mechanical ventilation is the artificial method of assisting a person to breathe with the help of a device called ventilator. It is employed when a person’s spontaneous breathing who has been affected and cannot breathe on his/her own.

When is Mechanical Ventilation indicated?

Several injuries or other medical conditions could call for assisted breathing-

• Apnea (inhalation muscles become non-functional) that leads to intoxication and respiratory arrest
• Lung injury or trauma that leads to an inadequate exchange of gases between the lungs
• Acute asthma that requires intubation
• Chronic obstructive pulmonary disease
• Obesity hypoventilation syndrome
• Respiratory acidosis (excessive carbon dioxide in the blood)
• Respiratory distress like tachypnea that leads to rapid breathing
• Hypoxemia (too little oxygen in the blood)
• Muscular dystrophy (weakening of skeletal muscles)
• Amyotrophic lateral sclerosis (neurons controlling the voluntary muscles die)

Duration of artificial respiration

1. It is used for the entire duration of a surgery.
2. Long-term ventilation is necessary for people suffering from chronic illnesses who have been hospitalized. In such cases, special measures are taken to stabilize the trachea.
3. It can be used by ailing persons at home as well.

How is mechanical ventilation performed?

1. A tube is inserted into the trachea. This process is called intubation. The tube goes in through the mouth or nose (endotracheal tube). The tube is kept in place with a metal strap that goes around the head. The other end of the tube is attached to the ventilator. The ventilator pumps oxygen and other gases into the lungs. It can be a painful process, and before surgeries, it is performed under anaesthesia.

2. The tube can be inserted through a surgical hole in the throat. This process is called tracheotomy.

When the ventilator applies pressure to blow air into the lungs, it is called positive pressure. the exhalation can be done by the person himself/herself or if spontaneous respiration is compromised, the ventilator will help pump out the carbon dioxide.

Both types of tubes affect a person’s ability to speak because they pass through the vocal chords. Tracheotomy is performed on people who will require ventilation for long stretches of time because endotracheal tubes are uncomfortable and sometimes painful.

Risks associated with artificial ventilation:

1. The gravest risk is that of pneumonia. A person who is undergoing ventilation is already physically weak. And that makes the person susceptible to a wide range of diseases. The tube that is inserted into the trachea allows the entry of different types of bacteria. The result is Ventilation Associated Pneumonia (VAP). Because the tube is always present in the trachea, a person cannot cough. Coughing flushes out many bacteria. VAP is curable with antibiotics.

2. Endotracheal tubes may also lead to a sinus infection

3. Pneumothorax is yet another risk linked with artificial ventilation. Air leaks from the lungs and this causes pain and in extreme cases may even lead to the collapse of the lungs.

4. Because air is pushed into the lungs with pressure, it might cause lung damage.

5. Too much oxygen is also harmful to the lungs.

Taking a person off ventilation

This process is called weaning. The ventilator is turned off but still attached to the person. The person is allowed to breathe on his/her own. If there are difficulties, the ventilator is turned back on. It is like a trial run. Gradually the individual develops the ability to breathe on his/her own.

Mechanical ventilation is a painful and often risky method. But when a person is unable to breathe, it is the only way to save his/her life.

Food adulterants are basically addition small quantity of non-nutritious substances of or removal of vital substance to improve the appearance, texture or storage properties of the food.
Traditionally, food is used to cook at home with healthy ingredients and knew what went into the meal but now days with rising incomes, more and more people are moving away to readymade fast foods and eating regularly at restaurants. The food in many of these outlets is cooked with poor quality ingredients to attract and satisfy the palate rather than provide a wholesome nutritional meal. Adulterated food is impure, unsafe and not wholesome. Food can be adulterated intentionally and accidentally. 
The most common form of intentional adulteration is color adulteration. Some examples of intentional adulteration are addition of water to liquid milk, extraneous matter to ground spices, or the removal or substitution of milk solids from the natural product.
Adulteration affects health:

• Mineral oil may be added to edible oil and fats and can cause cancers
• Lead chromate added to turmeric powder and spices can cause anemia, paralysis, brain damage and abortions. 
• Lead added to water, natural and processed food can lead to lead poisoning causes foot drop, insomnia, constipation, anemia, and mental retardation.
• Cobalt added to water and liquors and can cause cardiac damage. 
• Copper, tin and zinc can cause colic, vomiting and diarrhea. 
• Mercury in mercury fungicide treated grains or mercury contaminated fish can cause brain damage, paralysis and death. 
• Non-permitted color or permitted food color like metanil yellow, beyond the safe limit in coloured food can cause allergies, hyperactivity, liver damage, infertility, anemia, cancer and birth defect.

Mitigation measures for addressing food adulteration:

Buy our food ingredients from reputed shop or retailer with who keep their premises clean with no infestations.

Use homemade food and beverage

Check the packaging is intact, as also the expiry date and the source of the product. 

It is also necessary to talk regularly to the local community to check if people are falling sick after eating in a particular restaurant 

We should also create awareness in the local community on the ill effects of food adulteration

We need to remember that contamination could happen in very small amounts over a period of time.

Dam, Dama & Diwali

Asthma and Chronic obstructive pulmonary disease (COPD) are most common morbidity and mortality causing respiratory airway disease. Patient of these disease present with shortness of breath, chest tightness, cough and wheeze etc first time or rise in intensity and frequency of these symptoms.

Diwali is festival of sweets, lights, candles and fire-crackles. The festival Diwali brings happiness, but also brings suffering for respiratory patients. Spike in respiratory problems happens during Diwali in our country due to several factors like changing weather pattern, an increase in allergens, smog combined with air pollution and unhealthy food.

The number of patients suffering from asthma and other respiratory disorders shows a sharp rising trend during Diwali. Smoke from colourful crackers increased symptoms of these during Diwali.

The rise of bronchial asthma and the role of pollution in respiratory disease need Awareness against exacerbation factor

It was observed that bursting crackers aggravates the condition among people with asthma. Most asthma patients continue to suffer from severe exacerbations despite being on their regular medication. The effective alternatives, such as inhalation therapy, are being employed as the mainstay of asthma treatment during exacerbation.

It may be noted that days before Diwali, the Supreme Court has banned the sale of firecrackers in Delhi-NCR and fixed the hour of cracker as a measure to control pollution levels. It should be followed in all over country to reduce suffering for respiratory patient.

What action should be taken to avoid exacerbation attacks?

1. Stay away from smoke: The best way to keep the celebration fun and safe is to avoid fire-crackers and smoke.
2. Exercise: Avoid outdoor exercise in early morning. Instead, exercise indoors.
3. Stay indoors, keep windows and doors closed - this is even more important for pregnant women, newborns, kids, and the elderly, and those with chronic conditions, such as asthma, COPD, heart disease, etc.
4. Face masks: While stepping out of home prefer N95 face masks or handkerchief, wear protective eye gear to prevent entry of particles into the eye and irritation by fumes and should avoid prolonged or heavy exertion.
5.  Inhalers: patient should take their medicines & inhaler regularly during this period to keep their symptoms under control as well as prevent severe attacks.
6. Diet: Eat healthy, balanced diet consisting of fresh fruits and vegetables and Drink plenty of water to keep your body hydrated.
7. Every patient should have their asthma action plan.
8. Seek medical help in case of any sign of increased breathlessness.

On the festival of Diwali, we wish you all a very safe, healthy and prosperous Diwali

When it comes to COPD or Chronic Obstructive Pulmonary Disease, not many people are aware of this condition. COPD is a chronic medical condition characterized by the inflammation of lungs. The inflammation interferes with the functioning of the lungs resulting in breathing problems. An early diagnosis and timely medication can improve the condition to a great extent. However, lack of proper knowledge and myths surrounding COPD often make the situation worse. In this article, we will discuss some myths and facts related to COPD to help people understand the condition better.

Myth: COPD is an incurable chronic lung disease mainly affecting the aged people (above 60 years).
Fact: There is no denying the fact that COPD is indeed a chronic disorder that severely affects the lungs and its functioning. However, with timely diagnosis and treatment, the condition and the deleterious consequences can be managed and controlled significantly. Since COPD triggers breathing problems (the airflow from the lungs gets obstructed), the use of bronchodilators, oxygen therapy or corticosteroids can be highly beneficial. Though COPD is rare among young adults, the condition can affect people in their late 30's or early 40's as well.

Myth: COPD only affects people who smoke.
Fact: Smoking is one of the triggers for COPD, but the condition can also affect people who have never smoked in their lifetime. Factors such as neonatal chronic lung disease or prolonged exposure to substances that cause lung irritation and damage (toxic industrial fumes and chemicals) can play a pivotal role in triggering COPD. COPD can also be a genetic predisposition.

Myth: People with COPD should avoid exercise and physical activities.

Fact: Mild to moderate exercise (especially breathing exercise) are indeed helpful and go a long way in the effective management of COPD. Exercising regularly (for 20-30 minutes or as the doctor recommended) help to lower the blood pressure and improve the circulation that provides fruitful results for people with breathing problems. However, doctors do advise people with shortness of breath to avoid strenuous exercise.

Myth: COPD only affects the lungs.
Fact: With time and left unmanaged and untreated, COPD acts as a catalyst making a person more susceptible to heart ailments. In some cases, the condition can also trigger depression and anxiety.

Myth: In the case of COPD, giving up on smoking will not produce any positive results.
Fact: Giving up on smoking may not help to reverse the damage that has already been caused by COPD. However, quitting smoking along with proper medications and lifestyle changes does help to control the condition better. In some instances, there were also significant improvements in the associated symptoms (such as shortness of breath, fatigue, wheezing, a chronic cough).

Myth: COPD is another name for Asthma.
Fact: Many people confuse COPD with Asthma. Though some symptoms may appear identical (such as wheezing, shortness of breath), the conditions are different and so are their treatments. In case you have a concern or query you can always consult an expert & get answers to your questions!

Diabetes is one of the most common problems that are caused by obesity, unhealthy and inactive lifestyle. It is a metabolic disorder in which the body is unable to store and use energy from food. Being physically inactive and eating unhealthy food are primary causes of diabetes. It is a long term condition, which causes high or unstable blood sugar levels in the body.

When a patient suffers from low blood sugar it is called Hypoglycemia and if the blood sugar levels are too high, it is called Hyperglycemia. Both are extremely harmful for a patient.

Type 1 and Type 2 and Gestational Diabetes:

Type 1

In Type 1 diabetes, the body does not produce insulin. The condition has no known cure and is usually hereditary in nature. Approximately 10% of those suffering from diabetes have Type 1 diabetes. Patients with Type 1 diabetes have to take regular medication, including insulin injections as well as take care of their diet.

Type 2

Type 2 diabetes happens when the body does not produce enough insulin for its proper functioning. 90% of all diabetic people suffer from Type 2 diabetes. It is usually caused by poor lifestyle choices, like physical inactivity and unhealthy food habits. The disease lasts a lifetime and is usually progressive in nature, but can be managed by taking regular medication, choosing an active lifestyle and maintaining proper body weight.

Gestational Diabetes

Diabetes during pregnancy is known as gestational diabetes. This has to be managed by taking medication or in extreme cases insulin shots. If undetected or untreated, gestational diabetes increases complications during childbirth, and causes unusual weight gain in the baby. However, gestational diabetes usually ends after the baby is born and women can go back to their normal lifestyle and eating habits post delivery.

Symptoms of Diabetes

1. Frequent urination
2. Extreme hunger or thirst
3. Weight loss
4. Problems with vision
5. Tingling or numbness of the extremities.
6. Unexplained fatigue
7. Dry skin
8. Cuts or sores that heal slowly
9. High number of infections

Who is at greatest risk for developing diabetes?

People who:

1. are 45 or over
2. are overweight
3. are habitually physically inactive
4. have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
5. have a family history of diabetes
6. are members of certain ethnic groups (including Asian American, African American, Hispanic American, and Native American)
7. have had gestational diabetes or have given birth to a child weighing more than 9 pounds
8. have elevated blood pressure
9. have an HDL cholesterol level (the good cholesterol) below 35 mg/dl and/or a triglyceride level above 250 mg/dl
10. have polycystic ovary syndrome
11. have a history of vascular disease

What is pre-diabetes?

Pre-diabetes is a condition of elevated blood glucose level that has not yet reached a diabetic level. Along with insulin resistance, pre-diabetes causes no symptoms. An individual may be pre-diabetic for years without knowing it. Pre-diabetes increases your risk of developing Type 2 diabetes and heart disease. Weight loss and exercise may halt the onset of diabetes from pre-diabetes by returning blood glucose levels to a normal range.

Every copd, asthma and patient with age more than 65 year should vaccinated with influenza vaccine every year and pneumoccocal vaccination every 5th year.