August 25   2015, Tuesday
eMedinewS
editorial
Kidney stones linked to higher heart risk
Dr KK AggarwalBad news for North Indians who live in a stone belt. Two large prospective cohort studies have shown that women (not men) with a history of kidney stones have a modestly increased risk, ranging between 20% and 50%, of coronary heart disease. Similar increases emerged from separate analyses of fatal and nonfatal heart attacks and revascularization. The findings are reported by Dr Pietro Manuel Ferraro, of Columbus-Gemelli Hospital in Rome, and colleagues online in the Journal of the American Medical Association. The findings suggest that women with a history of nephrolithiasis might warrant more scrutiny for signs of heart blockages.

A previous study has shown that light exercise can lower the risk of kidney stones in women.

Several other studies have identified associations between nephrolithiasis and systemic diseases, including atherosclerosis, hypertension, diabetes, metabolic syndrome and cardiovascular disease.

In the present study, the investigators analyzed data from three large, prospective cohort studies including 45,748 men, ages 40 to 75, and 196,357 women, ages 30 to 55, all without heart blockages at baseline. The studies' data encompassed follow-up of 18 years in women and 24 years in men.
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eMedipics
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Heart Care Foundation of India’s (HCFI) trains over 200 school children on the importance of healthy eating, hygiene and sanitation
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News
Neurology
Psychiatry

A recent study has found links between traumatic brain injury and a history of attention-deficit hyperactivity disorder, thus suggesting that adults with a history of brain injuries may benefit from improved screening for the behavioral disorder. The findings were published in the Journal of Psychiatric Research.

Dermatology
Psychiatry

People with psoriasis are at greater risk of depression, suggested a new study presented at the American Academy of Dermatology's 2015 Summer Annual Meeting.

Pulmonary Medicine
New research published in the journal Chest suggests that the single use of an electronic cigarette approximating the nicotine exposure of one tobacco cigarette reduces the sensitivity of the cough reflex.

Infectious Diseases
No single genetic strain of the widespread Clostridium difficile bacteria appears to be any more harmful than other strains, suggests new research published online in Infection Control & Hospital Epidemiology.

Oncology
Dermatology

While people with more than 50 moles may be at higher risk of developing melanoma, people who have fewer moles may be at greater risk of developing more aggressive melanoma, suggests new research presented at the American Academy of Dermatology's 2015 Summer Academy Meeting.
Cardiology eMedinewS
  • Contrary to previous reports, consuming calcium supplements is not likely to cause heart problems or heart attacks, reported a study published online in the Journal of the American Heart Association.
  • Patients without obstructive coronary artery disease (CAD) are just as at risk of angina as those with obstructive CAD, suggested new research published in the European Heart Journal - Quality of Care and Clinical Outcomes.
Pediatrics eMedinewS
Pediatrics
A new study, published in the journal Environmental Science & Technology, suggests that breastfeeding could expose infants to a number of toxic chemicals. Researchers noted that the longer a baby is breastfed, the greater his exposure to a common class of industrial chemicals called perfluorinated alkylate substances (PFASs).

Pediatrics
Cardiology

Children born with the major congenital heart defect hypoplastic left heart syndrome often must undergo a series of corrective surgeries beginning at birth. A hybrid strategy has been introduced to offset some disadvantages associated with the Norwood surgeries commonly done to correct the defect, suggested a report published in The Journal of Thoracic and Cardiovascular Surgery.
Dr KK Spiritual Blog
The Spiritual Meaning of Lord Shiva

Most of us worship Lord Shiva without understanding the deeper meaning behind him. In Hindu mythology, Shiva is one of the three forms of God (Brahma, Vishnu and Mahesh).

The Parmatama or spirit or GOD can be equated to a mixture of three forces representing Generator, (Creator or Brahma); Organizer; (Maintainer or Vishnu); Destroyer (Winding up or Mahesh or Shiva).The same three forces are also present inside our body to perform any work, which can be linked to create or generate an idea, maintain or organise the contents of the idea, and then destroy or wind up so that new work can be undertaken through Ganesha – the Lord of new happenings.

For day to day life, one has to understand and implement the principles of Lord Shiva, which can be known by understanding the meaning of Shiva.

Shiva is worshipped in the sitting meditating pose, sitting on a deer’s skin atop the white Himalaya in the background of a blue sky. Shiva is also depicted as smeared with the ash of graveyard, having a snake on neck, Ganga emerging from his matted hairs, three eyes, blue neck, trishul in one hand and damru in his other hand.

All these symbolic representations have a deep spiritual meaning and tell us about Shiva’s principles of success.

Shiva’s third eye means thinking differently or using the eyes of our mind and the soul. The message is, whenever you are in difficulty, use your intelligence and wisdom or think differently for getting different options. The third eye opening also represents the vanishing of ignorance (darkness or pralaya).

Shiva sitting in an open–eye meditating pose indicates that in day–to–day life one should be calm as if you are in the meditation pose. Calmness in day–to–day practice helps in achieving better results. In allopathic language, it is equivalent to mindfulness living.

The snake around the neck represents one’s ego. One should keep the ego out and control it and not let it overpower you. The downward posture of the head of the snake represents that ego should be directed towards the consciousness and not outwards.

The blue neck (Neelkanth) represents that one should neither take the negative emotions out nor suppress them but alter or modify them. The blue color indicates negative thoughts.

The same in the neck indicates that negative slow emotions akin to negative emotions are neither to be drunk nor to be spit out but to be held on to temporarily and with continuous efforts (matted hairs) with cool mind (moon) and with positive thoughts (Ganga) should be directed towards the consciousness keeping the ego directed towards it (sheshnag).

Suppressed anger or any other negative emotions will release chemicals in the body causing acidity, asthma, angina and diarrhea. Expressed anger on the other hand may result in social unhealthiness.

The ash on the skin of the body of Shiva reminds that everything in the universe is perishable and nothing is going to remain with the person. The message is that ‘you have come in this world without anything and will go back without anything, then why worry’.

The Trishul in one hand represents control of three factors i.e. mind, intellect and ego. It also represents controlling your three mental gunas i.e. Sattva, Rajas and Tamas. The damru, the hollow structure, represents taking all your ego and desires out of the body.

The blue sky represents vastness and openness and the White Mountain represents purity and truthfulness.

If one adapts to Shiva’s principles in day–to–day life, one will find no obstacles both in his routine life as well as to one’s spiritual journey.

It is customary to fast on Shivaratri day. The fast does not just indicate not eating on that day, but its deeper meaning signifies fasting of all bad things in life like – "seeing no evil, hearing no evil and speaking no evil". Fasting also indicates controlling the desires for eating foods (like fermented, sweet, sour and salt) and control the negative thoughts both in the mind, deed as well as actions.
Inspirational Story
Don’t Give the Fish, teach them to catch it

Today I visited my bank in order to deposit a cheque for a due payment to a company. The procedure was quite simple but I thought of cross checking it with the teller so as to avoid cheque bouncing back. The teller being a fresh employee (I judged it from the face look and the communication approach) wasn’t sure about it. She called her manager for assistance. The manager, a nice ethical young man, elaborated the details about the form filling which I understood and thanked him for. However I noticed that while the manager was explaining to me, the teller got busy in something else and didn’t pay attention to her manager and neither the manager asked her to listen vigilantly to understand the procedure.

Well, I completed my work in bank and pondered that the manger had taken the corrective methodology instead of preventive methodology. Hence there is a big time chance that the teller would call her manager again in future and every time the manager would have to leave his desk, come to the teller point and explain the same procedure to more customers in future which he could have avoided by teaching the procedure to the ‘right person’, the teller. This extra work would cause disturbance in his routine work and waste his precious time needed to complete jobs which he had been primarily hired for!!!

This whole situation reminded me of a good quote which says, "Give a man a fish and you feed him for the day; Teach a man how to fish and you feed him for a life time" And this is why I said earlier, that the teller will ask her manager again (asking for the fish) because the manager didn’t teach to ’catch the fish’

So my friend this is where the power of being visionary and proactiveness come into play… that is to see the future now and make the right moves … and this is where Stephen Covey suggests us ‘to begin with the end in mind’
Scientific awareness on personal hygiene and prevention from obesity among school going children, N P Girls Sr. Sec. School, Gol Market-24-8-15
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Make Sure
Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.
Dr Good Dr Bad
Situation: A female with past history of DVT asked for a prescription for oral contraceptives.
Dr Bad: Start OC patch (transdermal).
Dr Good: You cannot be on OCs.
Lesson: The risk of nonfatal VTE for the transdermal contraceptive patch is similar to the risk for oral OCs containing estrogen and progesterone (Contraception. 2006 Mar;73(3):223-8).

(Copyright IJCP)
Wellness Blog
IBD linked to heart disease

Inflammatory bowel disease is associated with increased risks for stroke, myocardial infarction and ischemic heart disease, particularly in women.

A meta–analysis and systematic review published in Clin Gastroenterol Hepatol. 2014 Mar;12(3):382-93.e1 has shown increased odds for cerebrovascular accidents including ischemic and hemorrhagic stroke –– and for ischemic heart disease. These risks are specifically elevated in women versus men, with women having a 28% increased odds of cerebrovascular events and a 26% increased odds of ischemic heart disease, according to Siddharth Singh, MD, of the Mayo Clinic in Rochester, Minn., and colleagues. The authors suggest that these patients should be counseled routinely on aggressive risk factor modification.
eIMA Quiz
Which of the following is not true for malignancy of familial adenomatous polyposis?

a) Adrenals
b) Thyroid
c) Astrocytomas
d) Hepatoblastomas

Yesterday’s Mind Teaser: Which is not true regarding portocaval shunts?

a) Used for intractable ascites
b) It can be made selective by using 8 mm interposition graft
c) It is a partial shunt
d) Distal splenorenal shunt does not involves splenectomy

Answer for Yesterday’s Mind Teaser: c) It is a partial shunt

Answers received from: Dr Avtar Krishan, Raghu Chaks.

Answer for 23rd August Mind Teaser: c) It is associated with APC mutation

Correct Answers received from: Dr K V Sarma, Dr Poonam Chablani, Dr Jainendra Upadhyay.
eMedinewS Humor
Teacher: Billy, stop making ugly faces at other students!

Billy: Why, ma’am!

Teacher: Because when I was a child, my parents told me that if I kept making ugly faces my face would stay that way!

Billy: Well, I can see you didn’t listen then!
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Rabies News (Dr A K Gupta)
Is there carrier state of rabies in dogs?

A carrier state of rabies in dogs/cats has not yet been conclusively proven and established.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF
eIMA News
Low Cost Clinical Fitness Tests
  • 6-minute walk test: If you can't walk six minutes at a comfortable pace, your cardio fitness needs attention: You are in the risk zone if you walk less than 350 yards (for men and women).
    • Normal > 500 m (1700 ft); Risk < 300 m (1020 ft), high risk < 200 m (680 ft)
    • Mean walk distance males 1,188 ft; females 1,089 ft, Symptoms in <25% of pts, (Enright Chest 2003; 123:387-398.)
    • CHF evaluation, 1 year Hospitalization and mortality rates
      • Distance walked: <984 feet (300 meters); HR 40.9%; MR 10.2%
      • Distance walked: <1,227 feet (374 meters): HR 33.6%, MR 7.9%
      • Distance walked: <1,473 feet (449 meters); HR 27.4%, MR 4.2%
      • Distance walked: >1,474 feet (450 meters); HR 19.9%, MR 3.0%

        Source: Bittner. JAMA 1993;270:1702-1707

        6 Minutes Walk Distance 87-419 m = 5.1 METS = 61.9 % risk of death/MI/CHF

        6 Minutes Walk Distance 420-480 m = 7.1 METS = 43.2 % risk of death/MI/CHF

        6 Minutes Walk Distance 481-543 m = 8.6 METS = 30.2 % risk of death/MI/CHF

        6 Minutes Walk Distance 544-837 m = 10.6 METS = 21.6 % risk of death/MI/CHF

        People who can walk 500 m in 6 minutes can safely do Amarnath Ki Yatra.
  • 30-second chair-stand: Gauges lower body strength needed for tasks like climbing stairs, getting up from chair or out of a car etc., by the number of sits to full stands that can be done without using the arms.

    Number of full stands that can be completed in 30 seconds with arms folded across chest.

    Risk zone: Less than 8 unassisted stands (for men and women)
  • The back-scratch test: Done to assess upper body (shoulder) flexibility, which is important in tasks such as combing one’s hair, putting on overhead garments and reaching for a seat belt; evaluates how close the hands can be brought together behind the back; indicates shoulder flexibility.

    With one hand reaching over the shoulder and one up the middle of the back, the number of inches (cm) between extended middle fingers (+ or -) is measured. Men: Minus (-) 4 inches or more; women: Minus (-) 2 inches or more
  • 8-Foot Up-and-Go Purpose: To assess agility/dynamic balance, which is important in tasks that require quick maneuvering, such as getting off a bus in time or getting up to attend to something in the kitchen, to go to the bathroom or to answer the phone.

    Number of seconds required to get up from a seated position, walk 8 feet (2.44 m), turn, and return to seated position.

    Risk zone More than 9 seconds
  • The standard required for driving is the ability to read a car number plate at 20 m.
  • Two-minute step-up task: Number of full steps completed in 2 minutes, raising each knee to a point midway between the patella (kneecap) and iliac crest (top hip bone).

    Score is number of times the right knee reaches the required height.

    Risk zone: Less than 65 steps for men and women (alternative to 6-minute walk test)
  • 30-second arm curl: To assess upper body strength, needed for performing household and other activities involving lifting and carrying things such as groceries, suitcases and grandchildren. Number of bicep curls that can be completed in 30 seconds holding a hand weight of 5 lbs (2.27 kg) for women; 8 lbs (3.63 kg) for men.

    Risk zone: Less than 11 curls using correct form for men and women
  • Get Up and Go Test. In this brief and practical test, the older patient is asked to rise from a chair, walk 10 feet, turn around, walk back, and then sit down in the chair. The test is timed and usually takes 15 seconds.
  • The whisper test is used as a brief screening tool to determine whether there is a difference in hearing in each ear and whether referral for formal audiologic examination is necessary. In this test, one ear is occluded and the older patient is asked to repeat the words or numbers whispered softly by the clinician standing one to two feet away, usually to the back of the patient. The whispered words or numbers used for the test should be those with equally accented syllables, such as baseball or twenty-two.
  • Pentagon test: In this portion of the MMSE, the clinician draws two intersecting pentagon or hexagon figures, each side about one inch, and then asks the older patient to copy the figures exactly. The test is scored as a "pass" if all the sides and angles of the figures are preserved and if the sides intersect. Any tremor or rotation of the figures is ignored
  • Grip test: Measuring grip strength with a dynamometer can be useful for older drivers who have had a stroke. The general rule is that 35 pounds of strength in the dominant hand is necessary for safe driving.
  • Functional reach test: It is another test for balance and fall risk that is easily administered in the primary care office. A yardstick is mounted to the wall. The patient stands close to the wall with feet flat on the floor and raises one arm parallel to the yardstick, with the arm at 90 degrees of shoulder flexion, the elbow extended, and the hand fisted. The patient is asked to keep the fist in line with the yardstick and lean forward as far as possible, without taking a step or falling forward. As the patient leans forward, the fist moves along the yardstick. If the starting and ending point of the fist is less than six inches, the patient is at a high risk of falling within the next 6 months.
  • Chair Sit-and-Reach: To assess lower body flexibility, which is important for good posture, for normal gait patterns and for various mobility tasks, such as getting in and out of a bathtub or car. From a sitting position at front of chair, with leg extended and hands reaching toward toes, the number of inches (cm) (+ or -) between extended fingers and tip of toe. Risk zone Men: Minus (-) 4 inches or more Women: Minus (-) 2 inches or more
Platelet deficiency does not kill dengue patients
Ankur Tewari, TNN | Aug 23, 2015: Ahmedabad

With dengue sting getting sharper, Indian Medical Association secretary general Dr K K Aggarwal has said the primary cause of deaths is capillary leakage not platelet deficiency.

Capillary leakage causes blood deficiency in the intravascular compartment, leading to multi-organ failure. At the first instance of plasma leakage from the intravascular compartment to the extravascular compartment, fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the difference between the upper and lower blood pressure is over 40 mmHg, or the patient passes adequate urine. This is all that is required to treat the patient. Giving unnecessary platelet transfusion can make the patient more unwell.

Dr Aggarwal said, "While treating dengue patients, physicians should remember the 'Formula of 20', that is rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high-risk situation and the person needs immediate medical attention."

It is caused by any one of four types of dengue virus, which is transmitted by the bite of an infected female Aedes aegypti mosquito. Common symptoms of dengue include high fever, runny nose, a mild skin rash, cough, and pain behind the eyes and in the joints. However, some people may develop a red and white patchy skin rash followed by loss of appetite, nausea and vomiting.

Patients suffering from dengue should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.
Unnecessary platelet transfusion causes more harm than good
Ankur Tewari, TNN | Aug 23, 2015, 04.46 PM IST

Ahmedabad: Unless a patient's platelet count is below 10,000 and there is spontaneous, active bleeding, no platelet transfusion is required in dengue patients as it might cause serious complications like sepsis and transfusion-related acute lung injury.

"It is a myth that all dengue patients require platelet transfusion. In fact, unnecessary transfusion causes more harm and puts the patient at risk of complications such as sepsis, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), allo-immunization and allergic and anaphylactic transfusion reactions," Dr K K Aggarwal, secretary general, Indian Medical Association.

Other risks of platelet transfusion include febrile non-hemolytic transfusion reactions (FNHTR), transfusion-associated graft-versus-host disease (ta-GVHD), and post-transfusion purpura (PTP). The primary cause of death in patients suffering from dengue is capillary leakage, which causes blood deficiency in intravascular compartment and leads to multi-organ failure. At the first instance of plasma leakage from the intravascular compartment to the extravascular compartment, fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the difference between the upper and lower blood pressure is over 40 mmHg, or the patient passes adequate urine. This is all that is required to treat the patient. Giving unnecessary platelet transfusion can make the patient more unwell.

Dr Aggarwal added, "While treating dengue patients, physicians should remember the 'Formula of 20', that is rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high-risk situation and the person needs immediate medical attention".

Why platelet transfusion is risky

Donor screening does not eliminate the risk of bacterial and other bloodborne infections

Platelets are stored at room temperature, where bacteria can proliferate rapidly

The incidence of bacterial contamination is higher for platelets than for red blood cells (RBC) (1 in 2000 for platelets versus 1 in 30,000 for RBC)

Transfusion of any blood product, including platelets, can lead to transfusion-related acute lung injury Transfusion of any blood product may be associated with circulatory overload. Platelet transfusion introduces approximately 200 mL of intravascular volume per transfusion. The incidence of TACO is in the range of one to three per 100,000 transfusions and is higher in patients predisposed to volume overload (eg, with co-morbidities such as congestive heart failure, renal failure, respiratory failure, and positive fluid balance).

Platelets express Class I human leukocyte antigen (HLA) antigens, which can be recognized by the recipient's immune system as foreign. Production of anti-HLA antibodies can adversely affect the response to future platelet transfusions.

Allergic reactions to platelet transfusion are relatively common. They are usually due to IgE directed against proteins in the donor plasma. Common symptoms include urticaria and pruritus in mild cases, and wheezing, shortness of breath and hypotension in more severe cases.

Anaphylactic reactions (severe allergic reactions) are a very rare complication of platelet transfusion. These are associated with rapid onset of shock, angioedema, and respiratory distress. Many cases occur due to the production of anti-IgA antibodies in recipients who are IgA deficient.

Febrile non-hemolytic transfusion reactions are mediated by various inflammatory mediators and leukocytes and may manifest as fevers, chills, and rigors.

Transfusion-associated graft-versus-host disease (ta-GVHD) can occur with any transfusion that contains lymphocytes, given the correct immunologic setting.

The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. The onus of prevention lies in the hands of each person. We must not let mosquitos breed around our houses, wear full sleeve clothes while going out and use mosquito repellent in the monsoon season.
eBOOKs
Kindly sign this petition: For allowing parliament to function
Link: https://www.change.org/p/members-of-parliament-political-parties-parliament-to-function-urge-all-political-parties-to-have-a-collaborative-and-consultative-process-in-the-parliament

Tiny url to pass on to other members: http://tinyurl.com/qff68sf

To sign, we can login through Facebook or email account on the right hand side.

Dr Marthanda Pillai,                        Dr KK Aggarwal
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Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
ICON 2015
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Reader Response
Dear Sir, Very informatory news. Regards: Dr Kanan
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Press Release
Stop mosquito breeding – prevent dengue

Dengue cases are on the rise, and it is important that each one of us works towards preventing the onset on the disease. However, to do so, we must know all about the disease carrying vector and the disease itself.

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. The symptoms include severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion, and rashes. Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgias lasts about one to two weeks.

Speaking about this, Padma Shri Awardee Dr. KK Aggarwal, President HCFI & Honorary Secretary General IMA said, “What most people do not realize is that the dengue mosquito breeds in fresh clean water as opposed to dirty drains. Thus, people living in clean urban surroundings are more at risk of acquiring the disease. People must ensure that they do not let water accumulate in their houses, wear full-sleeve clothing and use mosquito repellents during the monsoon season when the incidence of the disease is the highest. Prevention is always better than cure. In case of being diagnosed with dengue, people must not panic, consume ample amounts of fluids since the dangers of dengue lie in dehydration and must only get a platelet transfusion if their platelet counts are below 10,000 or there is active bleeding. Unnecessary transfusion can cause more harm than good."

The dengue mosquito lays its eggs on the walls of water-filled containers in the house and patio. The eggs hatch when submerged in water and they can survive for months. Female mosquitoes lay dozens of eggs up to 5 times during their lifetime. The life cycle of the mosquito from egg to larvae, pupae, and to an adult mosquito, is about eight days and occurs in water. Adult mosquitoes live for about one month and rest indoors in dark areas (closets, under beds, behind curtains). It is only the female mosquitoes, which bite humans.

The dengue mosquito can fly several hundred yards looking for water-filled containers to lay their eggs. A few mosquitoes per household can produce large dengue outbreaks. The dengue mosquito does not lay eggs in ditches, drainages, canals, wetlands, rivers or lakes; pouring chlorine into these habitats is useless. Chlorine is harmful to aquatic life.

The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided. The onus of prevention lies in the hands of each person. We must not let mosquitos breed around our houses, wear full sleeve clothes while going out and use mosquito repellent in the monsoon season.