One of the commonest reasons why patients come to our general medical clinic is fever.
On questioning, many of them have a high fever for a day or two, that is associated with burning sensation when they pass urine. It is likely that the patient is suffering from an infection in the urine, commonly called UTI, or urinary tract infection.
Given how common this is, we thought we should briefly touch upon what a UTI is, and how it is treated.
What Is A Urine Infection?
A urinary tract infection, also called a urine infection, refers to an infection that has affected the bladder or any other part of the urinary system.
It is commoner in women when compared to men, and is often seen in older individuals.
Before we dive into urine infections and how they are managed, here is a brief look at the urinary tract, or your urinary excretory system.
Our body requires a number of different nutrients to function normally. Vitamin D is one such nutrient that has a variety of different functions in the body. Women (and men) in India are surprisingly low in Vitamin D levels. This can have detrimental effects on the body, and can affect your health in the long term.
Let’s take a brief look at why this vitamin is essential, and how low levels can affect your health.
What Is Vitamin D?
Our body requires vitamins and minerals that ensure normal functioning of all the cells in the body.
Vitamin D is what is called a ‘fat soluble’ vitamin, and forms an essential component of our bones. It plays an important role in the regulation of calcium and phosphate levels in the blood, and these are primary components of bones and teeth.
Once vitamin D is synthesized in the body, it is converting into an active hormone in order to exert its benefits.
What Are The Sources?
Vitamin D is primarily obtained from sunlight. Our skin absorbs the sunlight, and a series of different chemical reactions occur which ultimately results in the production of vitamin D. While a detailed discussion regarding how this occurs is out of the scope of this article, we thought we would include a diagram that illustrates this for those who love science!
There has been a lot of chatter in the last few weeks about the Coronavirus infection pandemic. Hundreds of thousands of people have been affected, and there have been a large number of casualties.
These are no doubt stressful times for all of us.
There have been a plethora of reports about how many people are affected on printed media. There have been even more falsehoods shared about the coronavirus infection on social media.
Many of these talk about the symptoms in short, with only some reports really covering what could happen should you get affected.
Preventive measures are the best way to limit spread and to avoid a pandemic of outstanding proportions. But what you should do to ensure you don’t get this infection is a discussion for another day.
I have a feeling you probably know about it anyway. If you don’t, I have an article for you here.
Today, I will talk about what you can expect should you get affected by the virus.
My information in this article is from reliable sources – Emcrit, New England Journal, etc – that have detailed guidelines on how doctors should manage this condition.
I will try and simplify it to the best of my ability here.
Transmission Of COVID -19
The transmission of the virus appears primarily to be through droplets floating around in the air. These droplets tend to be fairly large and can catapult to around 6 feet from the patient if they cough or sneeze.
The droplets can also be smaller in the form of aerosols (airborne) that float around in the air.
Larger droplets do not penetrate the normal surgical mask. However, to prevent getting affected by aerosols, the N-95 mask is a lot more effective than the surgical mask.
I figure you might be confused about what droplet infection and airborne infections actually are.
This is not a new confusion; it has existed previously as well during the times of Ebola virus and other viral infections.
Let me explain.
Large droplets are generated when a person coughs or sneezes. These large droplets directly land in a person’s eyes, nose or mouth.
So if you in close proximity to someone with COVID-19 infection and they sneeze, large droplets would land on your face and infect you.
Similarly, it is the large droplets that land on surfaces. When you touch these surfaces and then touch your face, nose or mouth, you can introduce these droplets into your system (hence the advice to stop touching your face).
An airborne infection is one where the virus floats around through the air long after the person coughs or sneezes. For example, if a person sneezes and then leaves a room, the virus continues to float around in the air for a while, and does not land on any surfaces.
These viruses can still be inhaled a long time after the person affected has left the vicinity. An example of an airborne illness is tuberculosis.
Currently, it is believed that the Coronavirus COVID-19 primarily spreads through droplet infection. The airborne route is still controversial, but not implausible, as published in an article in the New England Journal Of Medicine (NEJM).
Given the majority of evidence pointing towards droplet infection, the advice for the public is to use normal surgical masks.
However, in hospitals, healthcare professionals are also prone to airborne infections if they are treating COVID-19 patients, and hence they are advised to wear N-95 masks.
Furthermore, healthcare workers are involved in ventilating patients, placing oxygen masks on patients with low oxygen levels, performing cardio-pulmonary resuscitation and conducting life-saving procedures, all of which generate airborne particles.
They are directly in the line of fire.
The CDC have currently stated that in the absence of N-95 masks, regular surgical masks could be used for now.
Okay, so what about direct contact?
There are so many messages about the virus lasting on surfaces for a few hours to days. Some even go on to day that they last for a shorter duration on metal surfaces, longer on cardboard surfaces etc.
But what is the truth really?
When a person coughs or sneezes, the droplets fly out of the respiratory tract, landing on surfaces within 6 feet or so. The virus persists as ‘fomites’ in the environment.
In the NEJM paper I mentioned earlier, the research group found the virus was more stable and lived longer on plastic and stainless steel (up to 72 hours), and for a shorter duration on copper (4 hours) and cardboard surfaces (24 hours).
So if you touch these surfaces within this time frame and then touch your face, you could catch the infection.
When Do People Transmit The Infection?
You will already know that the first transmission occurred from animal to human in the Huanan Seafood And Live Animal Market in Wuhan, China. Since that index case, transmission has been between humans.
The problem lies in the fact that some people with the virus do not have symptoms. These are ‘asymptomatic’ patients, and can transmit the virus to other unsuspecting folk.
However, from the available data, it appears transmission occurs over 8 days after the illness begins and symptoms develop.
This number comes from virus culture tests, which are usually negative after 8 days of the illness in affected patients.
This information still remains vague. Some study groups have found that the virus might be transmitted over a longer duration.
Just so you also know that the basic reproduction number, or R0 (pronounced R-naught) is 2.2. This means that one person can transmit the infection to 2.2 people. The SARS virus transmitted it to 3 people.
Watch this space for more information.
So You Catch The Infection – Now What?
Once the virus enters your system, it will multiply over a period of around 4 days (may take up to 14 days), after which the symptoms begin. This period is called the incubation period.
Symptoms begin after this. There is no particular order of appearance of symptoms.
Fever is the primary symptom, accompanied by cough and breathing difficulty. Fever is seen in around 50% of cases, and the absence of fever does not rule out COVID-19 infection.
As the disease evolves (and if it becomes severe), patients may develop breathing difficulty around 6 days after exposure. They end up getting admitted around 8 days after exposure, and on a ventilator around 10 days after exposure.
In essence, severe cases will be on a ventilator within 48 hours of admission to hospital.
Bear in mind that nearly 80% of patients have mild disease. Of the remaining 20%, only around 2 to 5% will end up with severe disease (these numbers might change in the near future).
Besides the above symptoms, around 10% of patients may develop gastrointestinal symptoms. Diarrhoea and vomiting are a part of this, and can occasionally precede the fever and breathing difficulty.
Runny nose is a rare feature, though it has been seen a few cases.
One problem with the COVID-19 patients is that some of them have what is called ‘silent hypoxemia’.
Hypoxemia refers to low blood oxygen levels. Normally, if we have low oxygen levels, we would breath at a faster rate in an attempt to inhale more oxygen.
A proportion of COVID-19 patients would have low oxygen levels, but would not be breathing at a fast rate.
In severe disease, a large part of the lungs will get filled with infection, leading to a ‘ground-glass’ appearance on a chest x-ray or CT scan. As the virus is filling up the lungs, there is insufficient space for oxygen to enter. This is why patients with lung involvement need oxygen treatment.
CT scans are better at picking up COVID-19 lung infections compared to chest x-rays.
There have been reports of patients with COVID-19 infection suffering from heart attacks. The ECG changes are similar to those with a heart attack, but angiograms just show mild disease.
This is likely due to the virus attacking the heart muscle, leading to a condition called myocarditis. A troponin test will confirm whether there has been heart damage or not.
I have been talking to doctor friends of mine abroad, who are at the frontline managing COVID-19 cases actively.
Currently, when screening patients entering hospital, everyone’s temperature is checked, travel history is ascertained and oxygen levels are checked. Those with a fever and cough and low oxygen levels (below 94% – normal is 96-99%) are considered high risk and will likely be admitted.
Once admitted, tests will be conducted to confirm the viral infection.
Confirmation of the presence of the coronavirus infection is through an oral and nasal swab test. Orals swabs are taken before nasal swabs.
Blood tests will show a normal white blood cell count, though a specific subset of cells called lymphocytes will be low in number in up to 80% of patients.
It is rare for platelet counts to drop (seen in conditions like dengue fever), but those with a platelet count below 1 lakh carry a poorer outcome (normal platelet count is between 1.5 to 4 lakhs).
In practice, when we admit patients in hospital with suspected infections of any sort, we conduct a blood test called serum procalcitonin levels. These are generally elevated in infections.
However, in COVID-19 infections, it appears the procalcitonin levels are normal. If elevated, an alternative diagnosis may be considered.
Another blood test called C-Reactive Protein, or CRP, will be elevated. The higher it is, the poorer the outcome. A normal CRP should prompt searching for a different diagnosis.
I have already mentioned chest x-ray and CT scans as tests to determine how badly the lungs have been affected.
A small proportion of people who undergo a swab test may turn out to be negative in the early stages despite them being infected. Studies have found that up to 23% of them become positive shortly after.
This could mean that sequential testing may be needed if the clinical suspicion is high.
Treatment Options For COVID-19 – What’s Available?
There is active research ongoing with scholars and scientists testing out different tablets.
Drugs that were used to treat HIV infections are under scrutiny to evaluate their effects. Vaccines production is underway, and human trials have started. However, an effective vaccine is still months away.
Just recently, hydroxychloroquine (HCQS), a close cousin of the anti-malaria drug chloroquine, has been shown to be effective in lowering overall viral load.
Regime of administration varies, with some suggesting a loading dose of 400 mg twice daily for the first day, followed by 200 mg twice daily for 5 to 10 days, while others suggest 200 mg twice daily for 10 days.
However, do note that while the benefits have been demonstrated, they have been on a small patient group and not on a large scale.
And of course, always talk to your doctor about the real benefit versus the risks of taking the medicine. For example, if you have had certain forms of cardiac disease in the past, you may not be suitable for HCQS.
Anti-HIV drugs and other antivirals are being evaluated, and none of them are effective as of yet.
Some groups advocate adding Azithromycin, an antibiotic, to the HCQS regime. This has some effect on the COVID-19 virus, but has the added advantage of treating any super-added bacterial infections that may occur as well.
Vitamin C has gained some media attention and ‘WhatsApp forward status’ as being effective in battling the Coronavirus. But the evidence is limited.
Tablets and vaccines that were effective against H1N1 swine flu virus are not effective against COVID-19. So don’t rush to get the flu vaccine – it’s not going to protect you.
Steroids do not seem to help in early coronavirus infection, and may in fact be harmful. But in more advanced disease where the lungs are affected, they may have a limited role.
Patients who are admitted to ICU will be put on high flow oxygen delivered directly into their nostrils through a nasal cannula. This appears, so far, to be the most effective way of helping the body get enough oxygen.
More advanced therapies such as non-invasive ventilation (BiPAP) is believed to be useless.But one modality called Continuous Positive Airway Pressure, or CPAP, may have benefits, especially if delivered through a hooded device.
If these measures fail, then a tube will be inserted into the wind-pipe to ventilate the patient. Doing this can release a large number of viruses into the air, and can affect healthcare personnel greatly.
I will not go into any more detail about these ventilator modalities as it is fairly technical and out of the scope of this article.
Who Gets Better?
Around 80% of patients affected with a coronavirus infection do not need to be hospitalised and can be managed at home.
Of the hospitalised patients, up to 20% require ICU admission. Of this, around 2 to 5% die.
If you have suffered from a COVID-19 infection, then you will develop antibodies in your blood that will confirm your immunity.
It is easy to get it arranged at home, as it is a simple blood test.
Dr Vivek Baliga is a consultant physician and cardiologist with a special interest in the management of diabetes and heart disease. He is the director of Baliga Diagnostics Pvt Ltd and proprietor of HeartSense.
He has a specialist interest in echocardiography and heart failure management, and currently serves as the treasurer of the Indian Academy of Echocardiography for Karnataka. His experience encompasses a wide variety of medical conditions.
Director, Baliga Diagnostics
Visiting Consultant in Internal Medicine – Fortis Hospital, Bannerghatta Road
Visiting Consultant in Internal Medicine – Aster RV Hospital
Visiting Consultant in Internal Medicine – Neighbourhood Hospital
Former visiting consultant – Garden City Hospital
Former visiting consultant – Ashwini Nursing Home
Dr Vivek Baliga studied in the prestigious Manipal Academy of Higher Education where he completed his MBBS.
Following a brief stint of working in Bangalore, he moved to the UK where he worked his medical rotation and post graduate training in various parts of England. He secured his MRCP (Membership of The Royal College Of Physicians) and while training as a specialist registrar went on to complete his doctorate. He is certified proficient in echocardiography by the British Society of Echocardiography.
During his time there, he contributed to and authored numerous medical publications that you can find on Google Scholar by clicking here. Given his interest in lipid management, he pursued a Post Graduate Diploma in Lipid Management from the University of Middlesex, United Kingdom.
Besides this, Dr Vivek has also completed a certification program from the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR).
Dr Vivek has also completed the post graduate program in Cardiology from Johns Hopkins University with distinction. He has attended the Advanced certificate course in the management of Diabetes held by the Cleveland Clinic.
He is an International Associate Member of the American College of Cardiology.
Given his enthusiasm in business, Dr Vivek Baliga continued his education by pursuing an Masters in Business Administration from University of Phoenix, USA. He has trained in digital marketing including website designing and WordPress and is responsible for the development of not just this website but also his own website and blog HeartSense. Over the years, he has designed websites for friends and colleagues, including paid clients across the world.
HeartSense is an information portal offering free health related information to patients on health and heart disease. Dr Vivek Baliga is the author of almost all the articles on that site. Attached to the website is a shop that sells quality health care products. He runs the shop along with his wife who is a partner in HeartSense.
In 2017, Dr Vivek Baliga won an online echocardiography competition held by 123sonography.com. As his prize, he was enrolled on their Echocardiography Masterclass course. Having completed that and passing the test, was awarded a Diploma Certificate in Echocardiography by the University of Vienna.
In addition to this, Dr Vivek Baliga is responsible for the publication of Sowkhya Magazine, of which he is the author. The magazine has been received well by readers and is currently in its 6th successful year. It boasts readership not only in India but also in the USA, Singapore, and other parts of the world.
As a part of his venture to educate the public, Dr BV Baliga also publishes videos on YouTube that remain quite popular with his patient. You can visit his YouTube Channel here.
Dr Vivek Baliga also writes academic articles, not just for his professional career, but also as a ghost author on Fiverr.com, a popular microbusiness site. He is also a writer for Medlife, India’s largest medicine delivery portal.
He is now an invited author on myteacher.in, an information portal for teachers all over India. He authors health articles on this website every month.
Dr Vivek Baliga on LinkedIn
As an active member of LinkedIn, Dr Vivek participates in numerous discussions that take place in the academic and business world.
Time and again, he posts updates from this blog and also pens his thoughts on various conditions that would help the remainder of the professional world.
The recent coronavirus COVID-19 outbreak has created a great deal of panic. Dr Baliga’s article on the virus was taken up by a Kannada newspaper and published in print and online.
Dr Vivek has been a part of medical studies, and recently was the chief supervisor for the state of Karnataka of a clinical study on hypertension conducted across India. The article was published in numerous papers.
The human body has never ceased to amaze me. It is not just bones, muscles and vital tissues – it is a complex physiological system that consists of thousands if not millions of concurrently running processes that keep every cell in the body functioning normally.
Now that’s just amazing.
Every organ has a function. Every cell has a purpose. Different parts of our brain control different parts of our body.
I thought I would highlight some of the most remarkable aspects of the human body that I know will just baffle you.
Our body has a core temperature (temperature deep inside our body) of 98.6 degrees Fahrenheit (37 degrees Celsius).
Ever wonder how it is maintained at that level though?
We are exposed to extremes of temperature every day, and the body has to be able to keep our temperature at this value to allow our vital organs and tissues to function normally.
This ‘thermoregulation’ is essential for life. If the balance is tipped, we will not survive as our organs will all fail, and fast.
Inside the brain is a structure called the ‘hypothalamus’. It is the temperature regulation center of the brain. When the surrounding temperature changes, the hypothalamus sends signals to blood vessels, skin, muscles and glands to change their function and keep the temperature normal.
For example, in extreme heat, the hypothalamus signals the skin to regulate temperature by sweating. The hair on the skin stick to the surface. The muscles relax. The heat from the body is disseminated through vaporization, radiation, conduction, and convection (remember your physics??).
The exact opposite happens in cold weather, where the muscles begin to contract fast (shivering), the hair follicles stand erect and we get goosebumps due to this.
When we are ill, thermoregulation is what helps get rid of the virus or bacterial infection.
Our nails are protein tissues at the tips of our fingers and toes. They don’t really serve much of a purpose, except to relieve us when we have an itch.
Nail growth has been studied extensively, with each finger demonstrating different growth rates. You might be interested in hearing that the nail growth of the middle finger of the right hand is a lot faster than that of the little finger of the left hand.
The growth rate of the nails of the toes is slower than the fingers. Toes average a rate of 0.43 mm in 10 days, while fingers can average between 0.74 – 0.94 mm in 10 days.
Those who bite their nails seem to have more rapid growth of their nails. If you lose a fingernail, it can take nearly a year to grow back. Toenails can take around 1.5 years to grow back! Fingernails grow faster during the day and in the summer months.
Did you know that for sperms to be active and to aid reproduction, the temperature at which they are stored must be less than the rest of the body? Ever wondered why the testicles are outside the body, and not on the inside?
The male scrotum, which harbours the two testicles, has a temperature that is 2 to 3 degrees centigrade lower than the rest of the body. This is ideal for the sperms to flourish, and the ideal temperature for this to happen is 34 degrees C.
Those who place laptops over their lap and work for long hours can, over a period, affect the quantity and quality of sperm produced, making it difficult to father children. This is because the heat from the laptop affects the scrotal temperature.
So why is 90% of the world’s population right handed? Studies have found that it might be because the part of the brain that controls the speech is located on the left half of the brain. Cross wiring means the left brain controls the right half.
But then, those who are left-handed can also have their speech center on the left side of their brain.
I hope this article piqued your interest! For more of my reviews, visit our blog.
Giving patients the right information is extremely important. Dr Vivek Baliga B, Consultant Internal Medicine and Cardiology at Baliga Diagnostics, believes that it is essential to spend time with patients and give them all the information that they deserve about their medical condition.
However, time constraints make it very hard to achieve that. At the most, doctors only spend a few minutes with their patients.
This is mostly because they are busy and find it difficult to answer questions.
Dr Vivek Baliga B came up with a solution to help patients who feel they do not get enough time with their patients. He started a podcast.
Podcasts are audio interviews or discussions on different topics.
In these podcasts, Dr Vivek Baliga B reviews (along with Dr BG Baliga), common conditions that patients encounter and how simple conditions can be managed at home.
They are easy to understand, and are helpful to many. He has had some great feedback so far!
If you are looking to keep your eyes healthy, then there are certain things that you need to do to ensure that. Here are a few ways you can do so.
Eat healthy foods, especially ones that are colored orange. They are rich in vitamin A that is essential for good eyesight.
Stop staring at the computer for too long
Give your eyes some rest
There are many more ways that you can keep your eyes healthy. Rather than go into the specifics, I would like to draw your attention to an article Dr Vivek Baliga published on how to keep your eyes healthy.
As is very evident from the presentation, bone thickness can be affected due to a number of reasons. Dr Vivek Baliga clearly explains what can be done to keep the bones healthy. In addition to this, he also talks about how a bone mineral density test is done and how useful it is in determining whether the bones are of normal thickness or whether they are thin and weak.
Bone fractures can be very painful, and Dr Vivek clearly describes how the BMD test can help detect bone thinning early. This will help you start treatment sooner rather than later.
Home monitoring is essential for clinical conditions such as diabetes of hypertension. Purchase medical and health related equipment for home monitoring in our online store powered by Flipkart. Click here
Baliga Diagnostics Pvt Ltd
712, 38th Cross, 16th A Main, Jayanagar 4th T Block
Bangalore – 560041
Tel (080) 26646793, (080) 22443330, (080) 22454632