International Week For Breast Feeding

courtsey image WBW

Breast feeding

The world breast feeding week (WBW) was in the first week of august.

Yes my blog did not commemorate the event, simply because I realize that ground reality varies.

Most women today are aware of the need to nurse their child. But challenges are many. The woman could be working in the formal, or non-formal or home setting but she should be empowered to claim her and her baby’s right to be breast fed.

In 1993 WBW had a campaign on Mother-Friendly workplace initiative.  There has been viable improvement achieved over the past 22 yrs. There are laws in place and there are women who are not satisfied with the law. There are also women who abuse the law.

The 1990 Innocenti Declaration recognized that breast feeding provides ideal nutrition for the infants and contributes to their health, growth and development. There is much that remains to be done despite 25yrs of hard work and the progress achieved.

image courtesy WBW

What WABA called for this year was

• Organized global action to support such that they combine breast feeding and work is it in the formal sector or non-formal sector at home.
• Maternity protection laws along the ILO Maternity protection convention.
• Inclusion of breastfeeding target indicators in the sustainable development goals.

What I would like to share is what some women did achieve and this is what was shared on the platform of SHEROES.IN, when women came up with their job challenges.

Let me start with Dr.Lathika (name changed to maintain her privacy) she was heading the department of Periodontology  and was a nursing mother, first week after she returned to work post partum she would drive home nurse the kid and return. After which she just shifted the crib to her cabin. The child would there and she would excuse herself when she had to nurse him. When a staff nurse was in the similar situation she suggested that the nurse use either uses the nurses room, she then ensured that there was a duty staff room, like the students lounge where duty doctors could relax and many of the lady staff started leaving their kids in that room along with the baby sitter.

Mrs.Shashi Deshpande (name changed to ensure her privacy) taught in an engineering college. Post maternity leave, she would express milk into a feeding bottle and refrigerate it, and her mother would feed the child while she was away. Of course when she was at home she nursed the child herself.

Image courtesy internet

But the most interesting share came from the CEO of facebook, when she had to travel  leaving a month old child was definitely  not done, definitely for two months period. Colleagues suggested using fed-ex to transport expressed milk, various other suggestion each seemed more unviable than the other. She then came up with the simplest solution. She requested for a place within her workspace where she could leave the child with a sitter and take a break to feed. To her surprise the other person on her team was a single father with three months old kid, things worked fine.

At the end the end of the day generations of women have coped with work and nursing. We just need to tap that memory and rewrite it in contemporary context.

“Breastfeeding does not have to be hard. Breastfeeding is natural. With rare exceptions, it becomes hard only because of all the interference caused by the medicalization of birth and unsupportive culture. Animal’s breastfeed instinctively with no need for supplementation, classes, or support. We as humans also have these instincts. We have become so disconnected. Breastfeeding my children has been one of my greatest joys in life, and I am filled with sorrow when I imagine how many mothers and infants haven’t been able to experience this because of misinformation.”
― Adrienne Carmack, Reclaiming My Birth Rights

Hepatitis awarenes

 

World Hepatitis day July 28^th.

Hepatitis is the inflammation of the liver. The condition is self-limiting but sometimes process to scarring called cirrhosis of the liver.  It can also progress to liver cancer.

The most common cause of hepatitis in the world is virus. Through infection, toxicities like alcohol, drugs and some autoimmune diseases can also cause this condition.

Hepatitis could be type A,B, C,D and E. These 5 types are of greatest concern, because they are potential epidemic.

Hepatitis A and E are typically caused by ingestion of contaminated food or water, while B, C and D usually occur as a result of parental contact with infected body fluids. This could happen due to contaminated medical equipments, mother to child at birth, sexual contact or contaminated equipment.

Symptoms of acute infection occurs as jaundice (yellowing of skin and eyes), dark urine, extreme fatigue nausea, vomiting and abdominal pain.

Different hepatitis identified by A, B, C, and E. All these cause liver disease, though vary in important ways.

Hepatitis A Virus (HAV) is present in the faeces of an infected person. This gets transmitted through contaminated water or food. It can spread through certain sexual practises too. If the infection is mild the person recovers and acquires immunity to the strain. It can be severe and life threatening though. The outbreak of this strain is seen in places where sanitation is poor.—vaccines are available for this.

Hepatitis B Virus (HBV) is transmitted through exposure to infected blood, semen and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV- contaminated blood and blood products or medical procedural equipment. Health care workers are also at the risk of HBV.

Hepatitis C Virus (HCV) is mostly transmitted through exposure of infected blood. This is transmitted through blood, body fluids, and contaminated medical equipments. Sexual transmission is also possible but it’s less common. There is vaccine for HCV.

Hepatitis D Virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.

Hepatitis e virus (HEV) is transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized an important cause of disease developed countries. Safe and effective vaccines to prevent HEV infection have been developed though not widely available.

Hepatitis awareness–Hepatitis C

World Hepatitis awareness Hepatitis C

July 28^th is the world Hepatitis awareness day.

The Hepatitis C virus causes both acute and chronic infection.

Acute is something that is happens quickly, it is usually asymptomatic and rarely life-threatening. About 15-45% of the infected people spontaneous heal within 6 months and do not require treatment. The other 55-85%  go into the chronic stage. Of whom 15-30% could develop into cirrhosis of the liver in 20 yrs.

Geographically hepatitis C is found world wide. Though central and east Asia and northern Africa are most affected. The epidemic  could be concentrated in high risk populations like people use infected needles, or could be general. There are multiple strains of HCV virus and their distribution.

Transmission  is blood borne. And common pathways are

• Use of infected needles.
• Use of contaminated medical equipment without adequate sterilization.
• Transmission of contaminated blood.
• Transmission through body fluids and from mother to her fetus these are however rare.

Hepatitis however does not spread through breast milk, food, water or casual contact like hugging or kissing or share food with an infected person.

Symptoms  show after a period of 2 weeks or 6 months of incubation. About 80% of the people do not exhibit any symptoms. Those do exhibit acute symptoms may show fever, fatigue, decreased appetite  nausea, vomiting, abdominal pain, dark urine, grey-colored faeces, joint pain and jaundice.(jaundice is the yellowing of skin and whites of the eyes.)

Screening and diagnosis of the early stage is rare, as it is asymptomatic.  Many a times it remains undiagnosed until serious liver damage has developed.

The diagnosis of HCV is in 2 steps.

• Screening for anti HCV antibodies with a serological test – this identifies people who have been infected with virus.
• If the serological test is positive, a nucleic aci test for HCV-RNA  is needed to confirm  chronic strong immune response without the need for treatment. Although no longer infected they will still test positive for anti-HCV  infection  because 15-45% of the people infected with HCV spontaneously clear the infection.

Once the person is diagnosed of harboring hepatitis C the liver is damaged is assessed for fibrosis and cirrhosis. This can be done by non-invasive test. The treatment plan and disease management is decided after identifying the strain. There are 6 strains of HCV.

Getting tested:

Early diagnosis can prevent further destruction  from the disease and transmission of the virus. high risk population could periodically be screened for the infection. And high risk include

• People who inject drugs.
• Recipients of blood products from probable unsafe source.
• People undergo going invasive health care procedures in healthcare facilities with inadequate infection control practices.
• People who sexual partners of HCV infected people.
• People using intranasal drugs.
• People who have had tattoos or piercing.

Hepatitis C does not always require treatment as the immune system in most people can clear the infection. When necessary the goal of the treatment is to cure. The cure rate dependents on factors like the strain of virus and treatment given. The appropriate approach of treatment is decided after carefully  screening the patient.  The current standard treatment is an antiviral therapy which is a combination f interferon and ribavirin.  This combination is effective against all the strains.  Unfortunately this is poorly tolerated by in some patients and is not widely available globally either. this makes management of the treatment a little complex, many patients do not finish their treatment.

Scientific advances have lead to the development of new antiviral drugs for hepatitis C which is much more effective, safer and better tolerated than existing therapies. These therapies are known as oral directly acting antiviral agents. Therapies simplify hepatitis C by significantly decreasing monitoring requirements and by increasing cure rates.  Though the production cost of DAA is low, the intial price set by the pharmaceutical companies are high and access to these drugs could be difficult even in high income countries.

WHO is launching new guidelines for screening care and treatment of persons with hepatitis C in April 2014.  These are the first guidelines dealing with hepatitis C treatment produced by WHO and complement the existing guidance on prevention of transmission of blood borne diseases in including HCV.

These guidelines are intended for the policy makers, government officials and others working in low-and middle income countries who are developing programs for the screening, care and treatment of persons with HCV infections. These guidelines will help expand of  treatment services to patients with HCV infections as they provide key recommendations in these areas and discuss considerations for implementations.

Prevention of HCV is on three planes, primary, secondary and tertiary. There are no vaccines for HCV so primary prevention of infection depends on  reduction of the risk of exposure to the virus, in healthcare settings, and high risk populations,  here are some examples of the primary prevention interventions recommended by WHO

• Hand hygiene—including surgical hand preparation, hand washing and use of gloves.
• Safe handling and disposal of sharps and waste.
• Safe cleaning of equipment
• Testing of donated blood
• Improved access to safe blood.
• Training of health personnel.

Secondary and tertiary prevention for infected with the HCV WHO recommends-

• Education and counselling on options for care and treatment.
• Immunization with the hepatitis A and B vaccines to prevent co-infection from hepatitis viruses to protect their liver.
• Early and appropriate medical management and administration of antiviral therapy if appropriate.
• Regular monitoring for early diagnosis of chronic liver disease.

WHO is working in the following areas to prevent and control viral hepatitis.

• Raising awareness, promoting partnerships and mobilizing resources.
• Formulating evidence based policy and data for action.
• Prevention of transmission
• Executing ,screening, care and treatment.

Hepatitis C is a liver disease caused by hepatitis C virus it can be both acute and chronic, and can last from a few weeks to a serious lifelong disease. It is blood borne. Significant number of those who suffer from chronic infection  develop liver cirrhosis or cancer. About 350,000-500,000 people die each from HCV.  This is curable 50-90%

though diagnosis and accessibility to the treatment is low. The success rate is  5o0-90% though research is on for vaccine against HCV.

Insulin Inhalation.

The inhalation of insulin into the lungs offers a new method of insulin treatment delivery for people with diabetes. The same features that make the lung so well suited for gas exchange also make it an ideal organ for absorption of small molecules into the bloodstream. The pulmonary alveolar surface area of the lung is 130 m2, the size of a tennis court, and the pulmonary capillary surface area is nearly as large at 115 m2. With each breath, air flows into nearly 300 million alveoli. Moreover, the alveolar lining cell is just 1 to 2 mcm from the pulmonary capillary lumen, a distance that favors rapid uptake into the bloodstream. Absorption of a molecule across the alveolar-capillary interface is inversely related to its molecular mass. Small peptides, such as insulin (approximately 6000 Daltons) are readily absorbed across the very thin, vesiculated, permeable membrane. Molecules that make it to the alveolar level have longer residence time there, because mucociliary mechanisms at this level are minimal. There are several factors affecting lower respiratory deposition of an aerosol or dry powder formulation. One of these is particle size. Particles greater than 5 mcm in diameter impact and are deposited in the pharynx and large airways. Particles 1 to 3 mcm generally reach the lower airways and alveoli. Particle velocity also affects deposition. Flow rates > 35 L/min or < 10 L/min will favor upper airway impaction, while flow rates of 15 to 25 L/min are ideal for lower airway deposition. Even under the best of circumstances, however, only the minority of an aerosol or dry powder usually makes it deep into the lungs Inhaled Human Insulin There are several forms of inhaled insulin, either approved or in development. The only inhaled insulin that is approved is Exubera® (insulin human [rDNA origin]) Inhalation Powder. Other forms in development include AERx (NovoNordisk), AIR (Lilly), Spiro (Dura), Technosphere Insulin (MannKind), and Aerodose (Aerogen). Some are not powder but aerosol. Their excipients and medication delivery systems also differ. Exubera is a dry powder insulin contained in small blisters of 1 mg and 3 mg potency. After the blister is inserted into the base of the inhaler, a vacuum is established by cocking the lever at the base, allowing aerosolization of the powder. The aerosolized particles are then inhaled.[21] Each actuation of the Exubera inhaler produces 200 mL of a homogeneous powder. This powder contains human (rDNA origin) insulin, and the excipients sodium citrate, glycine, sodium hydroxide (to maintain pH), and mannitol. None of these are known to be immunogenic. Mannitol has been clinically used as an agent in bronchoprovocation testing, but its concentration in Exubera is lower than the lowest dose used in such testing. There are several forms of inhaled insulin, either approved or in development. The only inhaled insulin that is approved is Exubera® (insulin human [rDNA origin]) Inhalation Powder. Other forms in development include AERx (NovoNordisk), AIR (Lilly), Spiro (Dura), Technosphere Insulin (MannKind), and Aerodose (Aerogen). Some are not powder but aerosol. Their excipients and medication delivery systems also differ. There are several forms of inhaled insulin, either approved or in development. The only inhaled insulin that is approved is Exubera® (insulin human [rDNA origin]) Inhalation Powder. Other forms in development include AERx (NovoNordisk), AIR (Lilly), Spiro (Dura), Technosphere Insulin (MannKind), and Aerodose (Aerogen). Some are not powder but aerosol. Their excipients and medication delivery systems also differ. Exubera is a dry powder insulin contained in small blisters of 1 mg and 3 mg potency. After the blister is inserted into the base of the inhaler, a vacuum is established by cocking the lever at the base, allowing aerosolization of the powder. The aerosolized particles are then inhaled.[21] Each actuation of the Exubera inhaler produces 200 mL of a homogeneous powder. This powder contains human (rDNA origin) insulin, and the excipients sodium citrate, glycine, sodium hydroxide (to maintain pH), and mannitol. None of these are known to be immunogenic. Mannitol has been clinically used as an agent in bronchoprovocation testing, but its concentration in Exubera is lower than the lowest dose used in such testing. The dose of Exubera that reaches the alveolar level is the “fine particle dose,” which consists of particles 3.3 mcm in diameter or smaller. The “fill mass” is the amount of insulin plus excipient in the individual insulin blister. In the case of a 1-mg Exubera blister, there is 0.7 mg of excipient and 1 mg of insulin; on actuation of the inhaler, 0.53 mg of insulin is emitted, of which 0.4 mg is less than 3.3 mcm in diameter. Thus, of the 1-mg insulin in the blister, 0.4 mg or 40% is deposited at the alveolar level. A 3-mg Exubera blister creates a 1.0 mg fine particle dose; hence, 33% is deposited in the alveoli. This explains why 3 1-mg blisters deliver more insulin (1.2 mg) than 1 3-mg blister, which delivers only 1 mg to the alveoli.[21] Most of the insulin that reaches the distal lung is absorbed. There is no evidence of insulin accumulation in the alveoli. The insulin that is not absorbed undergoes metabolic degradation or slow mucociliary clearance Smoking. Insulin absorption studies have looked at the maximum concentration of serum insulin after a dose of insulin (Cmax) as well as the area under the serum insulin vs. time curve (AUC) following that dose. Such studies have shown that active smoking increases absorption of inhaled insulin 2- to 5-fold. The mechanism by which smoking affects inhaled insulin absorption is still unknown. The absorption of subcutaneous insulin is not affected by smoking.[22] Cessation of smoking is accompanied by a reduction in absorption of inhaled insulin toward normal in as little as days. After a week of abstinence from smoking, inhaled insulin absorption decreases toward normal by as much as 50%. Resumption of smoking for just 3 days increases absorption of the peptide toward levels seen during chronic smoking.[22] Because of the wide variations in absorption of inhaled insulin observed with smoking, cigarette smoking within the past 6 months has been a contraindication to inhaled insulin use in Phase 2 and 3 studies, and remains a contraindication to use of inhaled insulin.[21] Passive smoking has been examined experimentally, in a study in which subjects were exposed to smoke in a smoking chamber for 2 hours at concentrations mimicking those found in a smoky bar. Contrary to active smoking, passive smoking appears to decrease inhaled insulin absorption by as much as 20% to 30%.[23] It is not clear how long this effect lasts after subjects are removed from the smoky environment. It is likewise unclear why passive smoking and active smoking have opposite effects on the absorption of inhaled insulin. Asthma, Chronic Obstructive Pulmonary Disease, and Their Treatment. Studies have shown that insulin absorption, as measured by area under the curve (AUC) and maximum concentration (Cmax), is 20% to 50% lower in mild to moderate asthmatics than in normals.[23] In contradistinction to asthmatics, a small cohort of patients with chronic bronchitis and emphysema having a predicted baseline forced expiratory volume in 1 second (FEV1) of 35% to 40% were tested and found to have rates of absorption for inhaled insulin that were 2-fold higher than those of subjects without chronic obstructive pulmonary disease (COPD).[23] Although both asthma and COPD are characterized by small airway inflammation, it is not known why inhaled insulin absorption is affected in opposite ways by these disorders. In patients with mild (FEV180% or more) or moderate (FEV180% or less) asthma, the administration of albuterol 30 minutes before taking inhaled insulin resulted in a 25% to 50% increase in systemic insulin absorption compared with administration of inhaled insulin alone. (Data on file) Inhaled fluticasone appears to have no effect on inhaled insulin absorption, but other medications used for asthma and COPD have not been systematically This slide summarizes how respiratory factors affect inhaled insulin absorption. Other Factors Affecting Absorption. In clinical studies of Exubera, episodes of viral upper respiratory infection, laryngitis, and acute bronchitis had no discernible effect in either direction on inhaled insulin absorption. There were not enough cases of pneumonia in phase 2/3 studies to be able to comment on the effects of a more severe infection on inhaled Respiratory Tract Effects of Inhaled Insulin Symptoms, Adverse Events. Respiratory safety of inhaled insulin has been a concern for several reasons: 1. It is a novel drug substance with novel excipients that is being inhaled. 2. Its administration is chronic. 3. Insulin is a polypeptide with potential for immune response in the lung. 4. Insulin has growth-promoting properties. Consequently, respiratory side effects have been looked at closely in phase 2/3 studies. In some studies, cough has been reported in 22% to 30% of patients with diabetes on Exubera compared with 4% to 10% of patients with diabetes on comparator treatment. (Data on file) The cough tended to occur within seconds to minutes after Exubera inhalation, and was generally rated as mild. The cough was rarely productive and rarely occurred at night. Cough prevalence was greatest in the first month of use, then decreased by 20% to 40% over the next 3 months, and remained constant thereafter. In clinical studies, only 1.2% of patients discontinued Exubera because of cough. Patients who cough while on Exubera do not, on average, have any change in pulmonary function tests (PFTs) that distinguishes them from those who do not cough. Finally, such patients destined to cough cannot be reliably determined beforehand—they have the same mean pretreatment FEV1 as those patients who do not cough. Shown here are respiratory adverse events reported in >1% of patients receiving inhaled insulin or a comparator drug (oral medications or subcutaneous insulin) in phase 2/3 studies.[21] Dyspnea has been reported by 4% of patients on Exubera and by 1% to 3% of patients on comparator agents. Nearly all cases were reported as mild or moderate; discontinuation of Exubera due to dyspnea was uncommon (0.4%). In clinical studies, patients with dyspnea were more likely to have a reduction in their pulmonary function, whether they were treated with Exubera or a comparator drug. Additionally, on occasion, the cause of dyspnea was another disease process, unrelated to either the Exubera or the comparator treatment. Chest pain has been reported in 4.7% of patients on Exubera and in 3.2% of patients treated with subcutaneous insulin or oral antidiabetes medications. Of these patients, 90% rated the pain as mild or moderate. There were no differences in the incidence of angina (1%) and myocardial infarction (1%) between those patients treated with Exubera versus other agents. Other symptoms reported more often in Exubera-treated patients than in comparator-treated patients include: 1. Increased sputum in 3% to 4% (vs. 1% of comparator patients) 2. Epistaxis in 1.2% (vs. 0.4-0.8%) 3. Voice alteration in 1.3% of patients with type 2 diabetes (vs. 0-0.3%) 4. Dry mouth in 2.4% (vs. 0.8%)[21] Effects on Pulmonary Function. More than 43,000 PFTs have been performed in over 4600 adult subjects taking inhaled insulin. Spirometry, with measurement of FEV1 and forced vital capacity (FVC), has been used to look for the effects of inhaled insulin on airflow and airway function. Lung volumes, and especially carbon monoxide diffusing capacity of the lung (DLCO), have been used to look for any effect of inhaled insulin on pulmonary

WHO fact sheet on Blood donations

Blood Donation 10 facts

This is a share from WHO

1. Blood donation saves lives and improves health. Voluntary blood donation ensures screening of the donor. So patients requiring transfusion receive safe blood and blood products in time.
2. Blood transfusions are used to support various treatments. In low-income countries the blood transfusions majorly done for pregnancy related complications, severe anaemia and trauma injuries. In high income countries about 76% of all transfusions are for people over 65yrs and for supportive care, like cardiovascular surgery.
3. Since blood is an immediate urgent need, its availability is very important. Adequate reliable supply of safe blood can only be assured through voluntary donors.
4. In 60 countries 100% of the blood donations are from voluntary unpaid donors. But 72 countries still report that 50% of their donors are voluntary unpaid but much of their blood supply is still dependent on family/replacement and paid donors.
5. 108 million blood donations are collected globally every year. The average blood donation rate is more than 9 times higher in high income countries.
6. The collection at blood centres vary with the income group. 10,000 blood centres in 168 countries collect blood donation.
7. The median blood donation rate in high income countries is 36.8 donations per 1000 people. While it is 11.7 in middle-income countries and 3.9 in low-income countries.
8. Donated blood should always be screened to avoid transfusion transmitted infections like HIV, Hepatitis B and C or syphilis. 25 countries are unable to do due to irregular supply of test kits, short of staff  or basic lab facilities.
9. A single unit of blood can benefit several patients when the components are separated and delivered on need base.
10. Unnecessary transfusions increase the risk of the patients to transfusion  transmitted infection and other transfusion reactions.

 

 

About Blood Donation

Facts:

In 2004 50% of the blood donations collected globally came from high income countries.

65% of the blood transfusions are given to children younger than 5yrs in low-income countries while in high income countries 76% of the transfusions are to people over the age of 65yrs.

In high income countries transfusion are more common for supportive care in cardiovascular surgery, transplant surgery, trauma, and therapy for solid and haematological malignancies. While in low-income countries it is often used to manage pregnancy related complications and severe childhood anaemia.

The per 1000 population of blood donations is 36.8 in high income, 11.7 in middle-income and 3.9 in low-income countries.

73 countries collect 90% of their blood supply from voluntary unpaid donors while 72 countries collect more than 50% from paid or family replacement sources. The over donation from voluntary unpaid donors has increased of 8.6 million from 2004 to 2012

Of the 156 countries reporting blood donations, only 43 produce plasma derived medicinal products through fractionation of plasma collected in the countries while the others import PDMP from abroad.

About Blood Donors:

Gender profiling of blood donors shows30% of the donors are women. While 20 of the reporting countries show less than 10% donations from women.

Age profiling shows more young people donate blood in low and middle-income groups when compared to high income countries.

Donors could be either, voluntary i.e. unpaid, paid or family replacement.

Voluntary donors are the safest group of donors as the prevalence of blood borne disease is the lowest in this group. These groups can assure a stable base of regular safe supply of blood. World Health Assembly promotes the development of this blood system, so that self-sufficiency can be achieved in low and middle-income countries. 60 countries report 100% of their blood supply from voluntary unpaid blood donors, while 25 countries still report collecting paid donations.8 are high income countries, 48-middle income and 16 low-income countries.

Of the 72 countries whose 50% of the blood supply is still dependent of family replacement

Blood Supply

About 108 million blood donations are collected worldwide, of which more than half come from high income countries. There 168 countries reporting, and about 10,000 blood centres, the collection varies according to income group.

Screening of the Blood

The prevalence of transfusion-transmissible infections through blood donation is considerably lower in income countries as compared to middle and low-income one It is a recommendation from WHO that all blood donations should be screened for infections before use. Particularly screening for HIV, Hepatitis B and C, and syphilis.

About 25 countries are not able to screen for either one or more of these infections, the major barrier being non-availability of test kits.

In the high income countries 97% of these screening laboratories are monitored through external quality assessment compared to 33% of middle-income countries and 16% of low-income countries.

Processing Blood

Whole blood transfusion is blood collected in an anticoagulant and is stored in an unmodified state.

When processed into components like red cell concentrates, platelet concentrates, plasma and cryoprecipitate, it can meet the needs of more than one patient.

45% of the blood collected in low income countries is separated into components while 80% separation occurs in middle-income and 95% in high income.

Plasma Derived Medicinal Products: (PDMP)

World health assembly resolution, urges the member states to establish, implement and support a sustainable blood and plasma program nationally that would make them self-sufficient. The individual governments are responsible for ensuring the availability of immunoglobins and coagulation factors which help to prevent and treat various serious conditions worldwide.

43 countries of the reporting 156 countries are self-sufficient when it comes to PDMP through fractionation. Of which 35 countries carry out fractionation within the country, while 8 countries outsource it.

Clinical Use Of Blood:

Patients are exposed to the risk of transfusion transmitted infection due to the practise of unnecessary and unsafe transfusion.

WHO recommends haemovigilance a system developed to monitor and improve safe transmission in hospitals.

111 countries have national guidelines for appropriate clinical use of blood. About 70% of the hospitals performing transfusions in high income countries have this in place the same goes for 50% of middle and low income countries.

WHO Input:

WHO aims to make blood transfusion available and safe. It recommends the following integrated strategy to ensure both availability and safety—

1. Establishment of a national blood system with well-organized and coordinated blood transfusion services, effective evidence-based and ethical national blood policies with the goal of achieving self-sufficiency, and legislation and regulation, that can provide sufficient and timely supplies of safe blood and blood products to meet the transfusion needs of all patients.
2. Collection of blood, plasma and other blood components from low-risk, regular, voluntary unpaid donors through the strengthening of donation systems, the phasing out of family/replacement donation, the elimination of paid donation, and effective donor management, including care and counselling.
3. Quality-assured screening of all donated blood for transfusion-transmissible infections (TTI), including HIV, hepatitis B, hepatitis C and syphilis, confirmatory testing of the results of all donors screen-reactive for infection markers, blood grouping and compatibility testing, and systems for processing blood into blood products (blood components for transfusion and plasma derived-medicinal products), as appropriate, to meet health care needs.
4. Rational use of blood and blood products to reduce unnecessary transfusions and minimize the risks associated with transfusion, the use of alternatives to transfusion, where possible, and safe and good clinical transfusion practices, including patient blood management.
5. Step-wise implementation of effective quality systems, including quality management, standards, good manufacturing practices, documentation, training of all staff and quality assessment.

Through its Blood and Transfusion Safety programme, WHO supports countries in developing national blood systems to ensure timely access to safe and sufficient supplies of blood and blood products and good transfusion practices to meet the patients’ needs. The programme provides policy guidance and technical assistance to countries for ensuring universal access to safe blood and blood products and work towards self-sufficiency in safe blood and blood products based on voluntary unpaid blood donation to achieve universal health coverage.

 

Reference WHO fact sheets.

.

History about blood donations.

WHO conducts awareness campaigns, each year focusing on an issue. Here we are looking at the World Blood Donor Day Campaign and focus this year is to ensure safe bold for saving mothers. The pregnancy and childbirth related complications are high and India ranks highest in neonatal and maternal deaths. One major cause of being severe bleeding after childbirth. The WHO campaign this year focuses on timely access to safe blood and blood products is essential for all countries ad a part of comprehensive approach to prevent maternal deaths. History about blood donations.  The first successful blood transfusion was accomplished in 1818 but as the knowledge and research was insufficient there were failures. It was only 80 yrs later that the variation in RBC was discovered. With this discovery came the procedure of matching blood before donating it. the blood groups are A, B, AB and O then came the discovery of the Rh or the rhesus factor, which came up with +Rh or –Rh grouping. During the World War I the issue was preserving and transporting blood, for the soldiers, the process of effectively preserving, transporting and transfusion blood was achieved only during the 2^nd world war. Major cities of United States saw blood banks in 1947 and blood donation was campaigned as a civic responsibility. Centrifuging and freezing of the blood now allows us to use each element to treat different disease. With all this advancement we have new regulations governing the donations and transfusion of blood as it has been identified as the pathway of transfer of Hepatitis C, HIV and other diseases. Human blood is precious and cannot be manufactured outside the human body. Millions of times each year, human blood is required to save the lives of people who suffer from disease or who are victims of accidents. WHO commemorates June 14^th as world blood donation awareness day.

The Sanskaar

I have been attending a workshop by Ustaad Bah’uddin Dagar, where Ustaad, made an observation about sanskaar. When we say sanskaar we tend to think of values or upbringing with an underlying infliction of conservative outlook. But sanskaar, is more than that, it something that gives an individual his outlook to himself, world and his relation to the world, this includes the physiologic, and psychological aspects. The sanskaar start from before birth, according to ayurveda one needs to take care before pregnancy that is basically talking about planning a baby that would involve create the mother, and the environment in which the child is to be nurtured. Then there are sanskaar during pregnancy. This is something I will vouch for with my personal experience. The emotion, the thought the sadhana that the mother imbibes during pregnancy is definitely the child’s legacy. Abhimanyu is not a figment of Vyasa’s imagination but a physio-psychological fact. Have you seen a dancer depicting a baby the first thing they show is a baby being carried, then placed in a cradle the more innovative one’s will show you a baby massage. This is a practise done away in many houses, but believe me it is necessary. Why is a massage necessary?

1. It helps to prevent dryness and easy transition of skin texture from the womb to the external environment.
2. Gives suppleness to the skin.
3. The muscles are toned
4. Bone is strengthened,
5. Touch creates a sense of security in a child.

In children over 3mnts, the massage helps to release trapped gas and even constipation. What is the massage done with, in the coast of course coconut oil; the best oil to use is the oil that is locally produced and used is everyday cooking. The most important aspect of the massage is the bath should be only after about 45mnts of the massage. This allows the oil to be absorbed by the skin, if the child is left uncovered in an area mildly exposed to sun; it activates the natural production of vitamin D3. Traditionally massages need to carry on everyday at least until the age of 5. And at regular intervals after that. Remember the Sunday tail-abhyanjana before we became, civilized global citizens and Sunday came to mean sleeping late, and bingeing on food? Coming to the oil used, in the west coast traditionally coconut oil is used. This is fortified with Shah Jeera and turmeric. Actual massage techniques – in the next blog. http://www.dabur.com/Products-Consumer%20Health%20%28OTC%29-Dabur%20Lal%20Tail

 

Mama No Soak

 

No more soaking,

The image this conjures?  A woman with a toddler and a bucket of dirty diapers, a toddler in a puddle,

But believe me we have only changed one soak to the other, when I see the fall out of diapers and sanitary towels, I feel like shouting no more soaking pad, and diapers, use cloth,  give it a hot water treatment after wards.

When we say diapers,

The crappy advts. That come with

• “kid sleeps through the night so he grows.”
• Wet diapers lead to serious chest infections.
• Wet cotton diapers lead to rashes.

The great brand of diapers come and the child is free of “unhygienic factors ” so the child is closer to achieving super person status.!!!

Well young parents, before you buy that huggies, biggies and poko-pads, just look around we are second only to china when it comes to population, so obviously we are not hitting the mortality scale.

Some unpleasant truth is

• Diapers are made of sodium polyacrylate –SAP–a chemical so that it absorbs up 100 times its weight in water,
  •  this can stick to the children’s genitals and cause allergic reactions.
  • SAP  was proved to be responsible for Toxic Shock Syndrome
  • The skin irritation caused by SAP lead Staphylococcus infection.
  • In 1985 tests on rats showed hemorrhaging, cardiovascular failure and ultimately death.
  • Many diapers use VOC – volatile organic compounds like ethylbenzene, toluene and xylene. According to the EPA some VOC’s carcinogenic, some cause neurological problems, eye irritation and decreased immunity.
  • Dioxin is a by product of paper bleaching used in disposable diapers and training pants, in the laboratory animals, this showed to be the most toxic, and causing liver disease.
  • 8 billion disposable diapers end in Landfills, in the US alone, this adds the human waste to the landfill.
  • Of course in India we have not yet come up with law against human fecal matter in the household garbage.
  • It takes 500 yrs for these diapers to decompose in a landfill. The non biodegradable products like absorbent vinyl layers, Velcro, absorbent gelling material and plastic packing which makes up 30% of each diaper does not ever breakdown!!
  • About 100 viruses can survive in disposable diaper, or training pant for months. This includes polio virus, hepatitis specially if the child is just vaccinated. It is a biohazard.
  • Dioxins are also persistent environmental pollutants.

I know parents who want to ensure their good sleep, reduction in laundry cycle use absorbent disposable diapers at night. Ladies and gentleman, your child maybe will have to pay a heavy price for your comfortable sleep.

By the way bed wetting is not some life endangering problem most kids outgrow it. The emotional contribution is not yet known but logically nocturnal urination is normal in all young creatures.

If you have a girl child from diaper to sanitary towels her risk persists.

For Dioxin is a great component of the sanitary pad.  So is Asbestos. The Asbestos guys get away as it is not”ingested.”

Dioxin is also linked to immune and reproductive disorders and endometriosis.

Before you feel very smug about the  NO MORE SOAKING just take a check if you are willing to pay the price.

 

Soda Pop

Should soda be banned in all schools?

Lets reframe the question, “should we ban fountain machines dispensing destruction?”

Jarod Kintz $3.33 asks a question for your life “if there was a fountain machine that dispensed destruction instead of soda, would you grab an extra-large cup?” interesting.

Yet that is precisely what soda is all about. Look at this guy who feels his body needs a boost, he reaches into his pocket, finds a dollar slides into the machine and a con rolls out, he opens the can and guzzles. He feels his energy return he has had his fix for the rest of the morning. The child is only 12yr. Old and his drug is a soft drink, that he has bought from vending machine in his school, never mind the special classes sponsored by his school to warn him about drugs, tobacco and alcohol.

The soda consumption has tripled for the boys and doubled for the girls and accounts for the 10% of the caloric intake. This is not a random occurring coco-cola has a target of 25% annually and the target group kids are the target group as adult market is saturated. Schools have deals with soft drink companies.

AMA has issued warnings on the danger of soft drink consumptions as early as 1942. It was 1998 the first public outcry came about.

Lets look at the ingredients in a soft drink.

• high fructose corn syrup animals exhibit poor development  collagen during growth period. There was also a context to copper deficiency. Animals also exhibited liver problems similar to alcoholics.
• Aspartame used in diet sodas, is a potent neurotoxins and endocrine disruptor. Caffine stimulates the adrenal glands with nourishment causing adrenal exhaustion particularly in children.
• Phosphoric acid that gives the soft drink that bite causes calcium loss.
• Citric acid contains traces of MSG a neurotoxin.
• Water could contain high amounts of fluoride and other contaminants.

Gastro intestinal distress is another is another soda induced problem. This occurs because there is increased acid level in the stomach  the result could be erosion of the stomach lining. Another problem with soda’s they act like dehydrating diuretics like tea, coffee and alcohol inhibiting proper digestive.

Bone fractures and osteoporosis has been linked to soft drink consumption in a study in 1994 in the Journal of adolescent health. This could be that increased consumption of soda has resulted in decreased consumption of milk.

Tooth rot or loss of enamel resulting in yellow teeth is a dental condition which we saw only in elderly patients until the increase in soft drinks. If the bone has to loose calcium, enamel loss has to occur before that. This is because the slightly alkaline nature of the salivary pH is lowered by the acid in the soda.

In india in the yer 2003 a non-profit organization called centre for science and environment, found pesticide levels in coke and Pepsi 30 times more that what is considered safe by the European Economic commission. This report lead to banning of the sale of soft drinks at schools in many states since august  2006 this was unfortunately struck down at the courts.

To quote Chris Rock, “actually ,i think all addictions start with the soda. Every junkie did soda first. But no one counts that. Maybe they should. The soda connection is clear. Why sin’t a presidential commission looking into this? Or at least some guys from National carbonation council.”

The soda industry has fought back saying that there is a positive relation ship between soft drink consumption and exercises, this only means that children participating in sports drank more sodas.