Tuberculosis is an equalizer. Just like HIV and all the other big scary diseases. During our community medicine classes at Calcutta Medical college, one sir famously said the man driving your AC car is coughing out blood in his handkerchief on the way to your child’s school.

You learn later he has Koch’s disease(Tuberculosis).

What do you do?

So many times in buses trains crowded market place in centrally air-conditioned places you are exposed. You never know. As a doctor, we ask for family history to rule out exposure.

Because Pulmonary Koch’s if sputum positive is highly transmittable. But discrimination will just give the diseases deeper roots.

What should you do?

World TB day is on 24th March.#WorldTBday is a fresh chance of spreading awareness about a treatable disease.his annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB).

The theme of World TB Day 2019 is “It’s TIME” CDC and its partners are working together to eliminate this deadly disease.

What are the common symptoms of TB?

• Fever more than two weeks
• Cough more than two weeks
• Chest pain
• Pain on deep inspiration.
• Blood mixed sputum
• Unexplained sudden weight loss
• Any abnormality in chest Xray

Shocking Tuberculosis stats(Source WHO)

• 1.6 million people die of TB every year.
• 4 out of 10 people are undiagnosed
• It is the top infectious killer disease in the world.
• It kills 4000 people every day worldwide.
• Leading cause of death among HIV infected in the world.
• In India estimated incidence of 28 lakh per year.(Global TB report 2017)
• The incidence of HIV and TB in India 87,000

[bctt tweet=”Any cough more than two weeks with or without producing sputum. Get tested as per WHO guidelines #Healthwealthbridge #EndTB” username=”misra_amrita”]

Chest Xray is not conclusive but additive.

In a country like India, we have all been exposed to the bacteria. The statistics are scary.

Tuberculosis vaccine

BCG at birth protects against miliary Tuberculosis and some protection against meningeal TB.

Transmission of Tuberculosis

Spreads by sneezing, coughing, respiratory droplets. It’s a community disease and needs our support and care.

The Gohn’s foci stay and have a tendency to flare up when your immunity is low, stress and cortisol floods your body.

Lack of awareness is another big problem. Not getting tested in time is scary. Any symptom beyond two weeks needs expert consultation and tests. Tuberculosis can affect any part of your body. Some more dangerous than others.

Tubercular can cause cervical lymphadenitis. It is a type of swellings in the neck not going down with antibiotics and no obvious focus in head neck oral cavity. If not associated with lung infection it may or may not be contagious.

There are excellent drugs to fight TB. You can get them free at Government Hospitals, Medical Colleges, DOTS centers.Drugs can have side effects so get help early.

What makes Tuberculosis worse?

• HIV(Human immunodeficiency virus), coexistent Diabetes and immunity lowering conditions make it a problem.
• Inconsistent medication, not completing treatment makes you at risk and your family too.
• MDR(Multi-drug resistant) TB is a big problem. Incomplete treatment is a  factor behind it,

Prevention against Diabetes mellitus  to prevent  TB bacteria from becoming  super powerful

HIV is another condition which prevents TB destruction. In these cases, the classic Tuberculin test is a false negative.

What should you do if you suspect you have TB?

• Get tested quickly
• Take your medicines
• Take precautions not to spread the disease in case of pulmonary TB. Using face masks protects you from other infections (your immunity is lowered)and also protects your loved ones.
• Your ability to fight the disease may be more than an infant or an elderly person.
• After starting drugs, a repeat test of sputum is done at two months(end of intensive phase) to check status. Sputum positive or negative at this stage will decide the next step. Another sputum test is done at the completion of treatment.

Tuberculosis Test

Microbiological confirmation on sputum: All patients who have presumptive TB and who are capable of producing sputum, should undergo a sputum test for rapid microbiological diagnosis of TB.
Chest X-ray as a screening tool: Where available chest X-ray should be used as a screening tool.
Tuberculin skin test: Used as a complementary test along with history, symptoms, signs and radiology.

Cartridge-Based Nucleic Acid Amplification Test (CB NAAT): The CB NAAT knew as the GeneXpert, is the preferred first diagnostic test in children and people with TB and HIV co-infection.

Serological tests for TB are banned and are not recommended for diagnosing TB.

Diagnosis of pulmonary TBUnder (RNTCP) in India

• Involves collection of at least 2 sputum samples (spot & early morning).
• Followed by sputum smear microscopy (both conventional Ziehl-Neelson staining/fluorescent staining)
• AFB culture
•  Conventional PCR based line probe assay (LPA for Mycobacterium tuberculosis complex)
• Real-time PCR based CB-NAAT.

Tuberculosis Treatment in India RNTCP new guidelines(for Healthcare professionals)(Source)

There are significant changes in the drug regimen in the new guidelines
The principle of treatment shifted towards daily regimen with admin. of daily fixed-dose combination of first-line ATD as per appropriate weight bands

For new TB cases
• Treatment in IP(Intensive phase )will consist of 8 weeks of INH, Rifampicin, Pyrazinamide, and Ethambutol in daily dosages as per four weight bands categories
• There will be no need for an extension of IP
• Only Pyrazinamide will be stopped in CP while the other three drugs will be continued for another 16 weeks as daily dosages.

For previously treated cases
• IP will be of 12 weeks, where injection Streptomycin will be stopped after 8 weeks and the remaining four drugs in daily dosages as per weight band for another 4 weeks
• No need for an extension of IP
• At the start of CP, Pyrazinamide will be stopped while the rest of the drugs will be continued for another 20 weeks as daily dosages.

Management of extra-pulmonary TB (new guidelines)
The CP in both new and previously treated cases may be extended 3–6 months in certain TB such as CNS, skeletal, disseminated TB. This will be based on the clinical decision of the treating physician’s. Extension beyond 3 months will only be on the recommendation of experts of the concerned field.

Listen to the newest episode of my podcast, Healthwealthbridge by Dr.Amrita: Tuberculosis: What you must know to stay safe #WorldTBday

Conclusion

Be aware. Get tested. Get treated on time. It is very important to complete treatment otherwise you have a real risk of suffering a relapse. Multidrug-resistant TB needs awareness. Tuberculosis is curable. It’s time to end the stigma.#Endtb

Watch @misra_amrita‘s broadcast: #WorldTuberculosisDay:Tuberculosis Awareness Dr.Amrita Basu (Misra) was live https://t.co/m64pP5VubM

— DrAmrita Basu Misra (@misra_amrita) March 24, 2019

Disclaimer: I am a qualified medical practitioner sharing healthcare information. But all healthcare information is rapidly evolving and updates if delayed, this website or the author is in no way responsible. Kindly take all healthcare decision after consulting your own doctor.

References:

Central Tuberculosis Division Government of India

CDC 

Research gate data

What are kidney stones or nephrolithiasis?

Mineral salt deposits forming hard stone like substances inside your kidney

The wastes in your blood are removed by kidneys. When water is not enough these wastes can weigh down the scanty fluid. Deposits stick to the kidney structures build over time and form stones. There are different kind of kidney stones.T hey are calcium stones, uric acid stones, struvite and cystine stones

Contents

Who has higher risk of kidney stones?

Symptoms of Kidney Disease

When should you  visit a doctor urgently

How to prevent kidney stones?

Where will you find a specialist?

Treatment of Kidney stone

Kidney stones may be an incidental finding on routine abdominal ultrasonography. Symptoms occur when the stone passes through the different part of your urinary tract. This causes the pain to shift and is spasmodic.

The stones are painful when passed through the ureter. Prevention is a very important part of public health awareness. Imaging is often needed for diagnosis. Initial stages of medical management are possible. Delays with experimental therapy make the situation complicated.
No time to read?Listen to the highlights

Consultation with a Nephrologist or a urologist is needed Specialized hospitals with good post op care facility is a must for surgery.

Who has a higher risk of kidney stones? (Source)

• Men are more likely than women.
• You don’t drink enough water
• You have diabetes, hypertension
• Repeated urinary tract infection
• Congenital or other kidney diseases
• You previously had kidney stones
• Obesity
• History of gastric bypass surgery
• Certain medicines

Symptoms of Kidney Disease

• Severe spasmodic pain mainly the side and back. The location is below your ribs
• The Pain can spread to lower part of the abdomen and groin
• Pain is spasmodic
• Pain during passing urine
• Reddish  or brownish staining of  urine
• Cloudy  appearance of urine
• Bad smell from urine
• Increased frequency of urination. A small amount of urine being passed but the urge is there
• Fever and chills
• Nausea and vomiting

When should you  visit a doctor urgently

• Severe spasmodic pain with nausea and vomiting
• Fever with chills
• Blood in urine
• Pain not relieved by oral medicines

How to prevent kidney stones? (Source)

• Drink enough water. Not just tea, coffee, cold drink. If you have a chronic kidney disease your fluid intake will need to be monitored too.
• Ask your Doctor for diet recommendations, after you know what kind of stone you have.
• Check the heavy metal content of the water you drink and cook with.
• A balanced diet is important. A diet with very high protein intake can make stones likely. Fad diets will make you more susceptible.
• Prevention and good control of Diabetes and hypertension are important. Metabolic syndrome puts you at risk of kidney diseases.

Where will you find a specialist?

Most Government Medical Colleges have experienced qualified specialist to help you with your diagnosis and treatment. Many high-end private hospitals with multi-specialty expertise will have a specialist to help you.

Treatment of Kidney stone

This depends on the size of the stone and symptoms. Several investigations are needed before surgery and lifestyle changes must be understood. Anyone with kidney stones suffers from the risk of repeated stone formation if not taking care. Medicines work in many cases, but surgery may be needed depending on size, location of stone and complications.

Important things you must know (Source)

[bctt tweet=”30 to 50 out of 100 people with a kidney stone are at risk of having another within five years.” username=”misra_amrita”]

80% of all kidney stones are made of calcium Uric acid stones are about  5 to 10 %. Decreasing dietary calcium is bad for health. But you can decrease oxalates in your diet and prevent the calcium oxalate stones. Foods containing a high amount of oxalate are rhubarb, parsley, walnuts, spinach, and chocolate. Calcium supplements need to be taken after doctor’s consultation.

It’s important to know what kind of stone you have, to make dietary changes accordingly. It’s not the same for everyone.

Avoid soft drinks. They can form hard kidney stones.

Low sodium diet is recommended.

Animal protein intake should be properly regulated in those with a high risk of kidney stone formation.

Conclusion

• Prevention is golden.
• Having good personal hygiene and prevention of urinary tract infection is important.
• Lifestyle diseases must be avoided at all costs.
• Drink enough water
• Avoid crash diets and experimental drugs

Get help from a specialist on time

Disclaimer: This is information for awareness. As healthcare information is constantly updated, the blog post is not meant to be a replacement for a doctor consultation, nor is it a medical recommendation or treatments. Any reader of this blog, with problems, should specifically consult his/her doctor for medical conditions and follow the suggested course of treatment’.