Vol. VIII Issue V July 2017

LIGNITE LIFE LINE

The NLCIL General Hospital observed World Blood Donor Day on 14.06.2017 on the theme :

‘What can we do?’ Dr P.Ravi, Chief General Superintendent (Medical) of the hospital presided

over the function. On the occasion, the NLCIL-GH doctors gave power-point presentations on

various aspects of Blood Transfusion. Pamphlets carrying messages on the importance of blood

donation for saving precious lives at crucial moments, and on the Do’s and Don’ts for blood

donors were distributed to the patients, their attendants and the general public by the students

of Nursing School. During the event, Central Industrial Security Force personnel, college students

and voluntary blood donors donated blood. Their gesture was widely appreciated.

INSIDE2 6 8

5 74Vitamin D-Sunshine Vitamin

3 Dietary Guidelines for Patients on Dialysis

Nutrition and TB Amoebiasis

Allergic Rhinitis

WHO (World Health Organisation) Day

NLCIL Raising Day at General Hospital

CME ProgrammeCaesarean Section

I N D I A

CREATING WEALTH FOR WELLBEING

Give Blood, Give now and often

NLCIL GH OBSERVES WORLD BLOOD DONOR DAY

Vitamin D-Sunshine Vitamin

Dr Srinivas Suyam Prakash M.D HOD/Pathology

Symptoms of vitamin D deficiency :

Fatigue, general muscle pain and weakness, muscle cramps, joint pain, weight gain, high blood pressure, restless sleep, poor concentration, headache, bladder problems, constipation and diarrhea.

Diseases associated with vitamin D deficiency :

Osteoporosis/osteopenia (bone loss), cancer, heart diseases, high blood pressure, obesity, diabetes, bursitis, gout, infertility, parkinsons disease, depression, chronic fatigue syndrome, chronic pain, peri-odontal disease, psoriasis.

Vitamin D benefits :

Vitamin D is a nutrient for the entire body.

Can reduce the risk of Flu, cancers, chronic muscle ache, cardiovascular diseases, depression, diabetes, auto-immune diseases, can reduce the flare ups in lungs of patients with chronic obstructive lung diseases.

Vitamin D maintains the bone health/bone mass in adequate doses, it prevents fractures. It improves hand grips and reduces falls in the elderly

Vitamin D, the powerful sunshine nutrient for healthy bones and good overall health also helps with some process of the body, including muscle function, respiratory system, cardiovascular function, brain development and the immune system.

Who is at risk of Vitamin D deficiency ?

v People with limited sun exposure – we need 15-30 minutes of sun exposure everyday with 40% of skin exposed.

v Over weight people.

v Pregnant women-those with pregnancy related hypertension.

v Infants – Human breast milk contains low level of vitamin D.

v Dark skinned people – The pigmentation of darker skinned people blocks ultra violet beam.

v Elderly - as you age, your skin loses the ability to generate vitamin D.

Vitamin D Deficiency :

Many times vitamin D deficiency does not present any symptoms. Low levels of vitamin D has been associated with virtually all disease.

Sources of Vitamin D :

Button mushrooms,Vitamin D fortified orange juice and egg yolk are also rich source of Vitamin D.

FOOD SOURCES:

CheeseMargarineButterFortified MilkHealthy CerealsFatty Fish

The body makes Vitamin D when it is exposed to Ultraviolet (UV) rays from the sun.

Vitamin D

2

Recommended Dietary Allowance (RDA) for Vitamin DSet by the Institute of Medicine

Source: IOM (Institute of Medicine)

Infants 0 - 6 months 10 mcg* (400 IU) 10 mcg* (400 IU)

Infants 6 - 12 months 10 mcg* (400 IU) 10 mcg* (400 IU)

Children 1 - 3 years 15 mcg (600 IU) 15 mcg (600 IU)

Children 4 - 8 years 15 mcg (600 IU) 15 mcg (600 IU)

Children 9 - 13 years 15 mcg (600 IU) 15 mcg (600 IU)

Adolescents 14 - 18 years 15 mcg (600 IU) 15 mcg (600 IU)

Adults 19 - 50 years 15 mcg (600 IU) 15 mcg (600 IU)

Adults 51 - 70 years 15 mcg (600 IU) 15 mcg (600 IU)

Adults 71 years and older 20 mcg (800 IU) 20 mcg (800 IU)

Pregnancy all ages - 15 mcg (600 IU)

Breast-feeding all ages - 15 mcg (600 IU)

Femalesmcg/day (IU/day)

Life Stage Age Males

mcg/day (IU/day)

3

Dietary Guidelines for Patients on Dialysis

Dr. C. Dharini Mouli Renal Care Unit

* Potassium Leaching - Effective method to drain potassium from most of the vegetables.

* Rinse the vegetable thoroughly. Peel and soak it in cold water so they won’t darken.

* Slice vegetable ½ inch thick. Rinse in warm water for a few seconds.

* Soak for a minimum of four hours in cold water. Change the water every four hours.

* Cook vegetable with five times the amount of water to the amount of vegetable.

* Drain excess water and cook the vegetable as desired.

As with everything else on dialysis, each individual's diet needs to vary. No single diet chart can cater to all Patients on dialysis. This chart merely serves to present some high level guidelines that can be referred to while planning your meals. Please remember to consult your nephrologist and dietician before finalising your meal plans in accordance to the status of your health and current investigation reports. Please do not treat this chart as your only source of information.

Food Groups Foods Permitted Foods RestrictedModerate Restriction

Wheat, Jowar, Arrow root, Sago, Rice & their products, Oats, Fresh Corn, Semolina, Vermicelli, Rice Flakes, Puffed Rice.

Lentil, Chana Dal, Green Gram Dal, Red Gram Whole, Horse Gram, Peas Dried, Red

Gram Dal (Not exceeding 1 bowl daily)

Skimmed Cows Milk, Curds, Buttermilk, Paneer (Made of Low Fat Milk) - Hung Curd, Soya Curd, Tofu.

Coriander Leaves, Drum Stick Leaves, Ladies Finger, Brinjal, Potato, Bitter Gourd, Cauliflower, Drumstick, Jackfruit tender, Mango Green, Onion stalks, Mushroom.

Fresh green peas

Pulses

Milk &

Milk

Products

Vegetables

Fruits

Non-Veg

Fats & Oil

Sugar &

Sugar

Substitute

Fenugreek Leaves, Lettuce, Beetroot, Onion, Radish, Broad Beans, Cucumber, Knol-Khol, Parwar, Ridge Gourd, Snake Gourd, Tinda, Pumpkin, Tomato, Celery leaves, French Beans, Bottle gourd.

Apple, Guava, Jambu fruit, Orange, Papaya, Pear, Pineapple, Rose Apple.

Honey, Jaggery, Sugar in limited amount as prescribed by the dietician.

Buttermilk, Lassi, Weak Tea, Milk, Lime Water as per the fluid output.

500 ml + Daily Urine output

Salt 2500 mg= ½ tsp. per day

Ragi, Bajra

Amla, Watermelon, Pomegranate, Fresh Figs, Grapes, Strawberry, Blackberry, Blueberry.

Egg white-Chicken (without skin), Fish (grilled/steamed/boiled)

Ghee, White ButterOil in restricted amount. Use Mixture of oils Fish Eater: Sunflower/Safflower Non Veg Eater: Olive + Soya + Groundnut Corn (Throughout the year) Vegetarian : Corn/Rice Bran Oil

Barley, Dried maize & their products, Rice Bran, Quinoa

Cow pea, Moth beans, Green gram Dal

Buffalo’s milk, Khoa, Cheese, Cream & their products, Skimmed Milk Powder.

All Green Leafy Vegetables (can be consumed in restricted amounts only after Leaching*) Carrots, Brussels Sprouts, Colocasia, Tapioca, Lotus Stem, Sword Beans, Sweet Potato, Yam, Jackfruit, Broccoli, Tapioca.

Custard Apple, Banana, Cherries - red, Dates, Sweet Lime, Mango ripe, Musk Melon, Peaches, Chikoo, Walnut, Figs Dried and all other fruits.

Organ meats like Liver, Kidney, Brain, Egg yolk, Shell Fish, Prawns, Lobsters, Ham, Bacon, Sausages, Pork and Beef.

Margarine, Salter Butter, Cheese, All nuts & oilseeds

Sugar Substitute : Aspartame, Sucralose and all others. Jams preserved canned fruit and pulps, chocolates, cakes, pastries, sweets & desserts.

Black salt, Rock salt (Sendhav Namak), Low Sodium Salt. Lo Na Fried foods & Snacks, salty foods, papad, pickles, tinned/preserved foods, bakery items.

Coconut water, Barley Water, Aerated drinks, Soda, Leafy Vegetable - Soup, Strong Coffee, Decaffeinated coffee, Strong Tea, Juice (Fresh and Canned).

Cereals

Salt

Beverages

4

NUTRITIONAL NEEDS OF CHILDREN WITH TB

The rapid growth periods of infancy and childhood can only be

maintained if a child's nutrient intake is optimal.

Insufficient intake → impaired growth → malnutrition.

All children presenting with malnutrition or with failure to gain

adequately in weight must be evaluated for possible TB.

Studies of children presenting with different forms of malnutrition

indicate that TB can be found in 12- 30% of cases.

n In meeting their requirements, it should be born in mind that

chi ldren have l imited

stomach capacity and

appetites and as such

m e e t i n g n u t r i e n t

requirements presents a

difficult challenge.

n It is therefore necessary to

modify and plan the diet

c a r e f u l l y t o e n s u r e

adequate intake of food.

RECOMMENDATIONS

n There is no documented

evidence that any specific

food on its own can alter the course of the disease or can for that

matter be effective in the treatment of malnutrition.

n Pulmonary disease often adversely affects nutritional intake, due

to poor appetites, making patients at risk for malnutrition.

TB and HIV/AIDS patients are encouraged to eat a healthy

varied diet as follows:

1. Six smaller meals per day are indicated instead of three meals.

2. The meals should be appetizing in appearance and taste and

provide enough energy and protein.

3. Commercially available high energy and protein drinks

(balanced in terms of micro and macro-nutrients) may be used

effectively to meet the increased requirements

4. Household ingredients, such as sugar, vegetable oil, peanut

butter, eggs and non-fat dry milk powder can be used in

porridge, soups, gravies, casseroles or milk based drinks to

increase the protein and energy content without adding to the

bulk of the meal.

5. At least 500 - 750 ml of milk or yogurt should be consumed daily

to ensure adequate

intakes of Vitamin D and

Calcium.

6. At least 5-6 portions of fruit

and vegetables should be

eaten per day.

7. Pure fruit juice can be used

to decrease the bulk of the

diet.

8. The best dietary sources of

Vitamin B6 (pyridoxine)

are yeast, wheat germ,

pork, liver, whole grain

c e r e a l s , l e g u m e s ,

potatoes, bananas and oatmeal.

9. Alcohol should be avoided.

10. Adequate fluid intake is important due to increased losses (at

least 10-12 glasses per day).

11. A good multivitamin and mineral supplement, providing

50% - 150% of the recommended daily intake is advisable

12. Safe food handling and personal hygiene is very important.

Nutrition and TB

Dr. S. Aruna Chest Clinic Department

65

Why called so..???

According to legend, Julius caesar was born by this operation and hence the origin of the term caesarean.

Used to be invariably fatal.

Most important modification was the lower segment transverse incision, first done by kehrer and popularized by Munro kerr.

Definition…

Caesarean section is the removal of the fetus, placenta and membranes through an incision in the abdominal wall of an intact uterus.

Term not applied to removal of a child from the abdomen after rupture of the uterus with or without protrusion of the whole or part of the child into the peritoneal cavity, nor to an operation for abdominal pregnancy.

Incidence...

It is the most common operation performed worldwide. Ideal caesarean section rate is 10 to 15% (WHO). Increased incidence worldwide during last 25 years.

Why incidence increased…

Increase in Repeat caesarean sections, Identification of risk to mothers or fetuses, Increased diagnosis of Fetal distress, Increase in pregnancies by test tube assisted reproductive technology, increased demand.

Indications…

Divided into.. 1) Maternal indication; 2) Fetal indication; 3) Fetomaternal indications

Maternal Indications…

Medical disorders:- Diabetes mellitus, Hypertension and renal disease, narrowing of main vessels of heart (aorta), viral infections (Herpes) during pregnancy.

Pregnancy disorders:- High blood pressure and fits, abnormal position of placenta in uterus, (Blood gp) Rh type incompatibility.

Past obstetric history:- Previous caesarean section, other surgeries of uterus.

Elderly first pregnancy and previous infertility, Previous repair of genital prolapse, urinary or stress incontinence, Previous difficult vaginal delivery and bad obstetric history.

Labour disorders:- CPD (Baby's head or body too large to fit through mother's pelvis), Fetal malpresentation and malposition, Cord prolapse

Non-progress of labour, Disproportion due to uterine fibroid and impacted ovarian cyst, Failed forceps, Threatened uterine rupture.

Fetal indications: Fetal distress in labour, big baby (maternal diabetes, postmaturity) Multiple pregnancies, triplets and over, Intrauterine growth restriction, Previous unexplained fetal death.

Time of operation:

Elective caesarean section :- When the decision to deliver the baby by caesarean section has been made during the pregnancy before the onset of labour.

Common indications are..CPD, placental insufficiency and bad obstetric history etc.

Emergency caesarean delivery:- When the operation is performed due to unforeseen complication arising either during pregnancy or labour without wasting time following the decision.

Common indications are... prolonged 1st stage of labour, fetal distress, abnormal uterine contractions etc.

Types of operation:

Lower segment CS:- Less muscle and more fibrous tissue in the lower segment which reduces the risk of rupture in subsequent pregnancy.

Classical CS:- Baby is extracted through a vertical incision made in upper segment of uterus.

Rarely performed.

Done only under forced circumstances:-

Carcinoma cervix

Big fibroid in lower segment Constriction ring

Adhesions etc.

Caesarean Section

Dr Anju Singh O&G Department

6

Amoebiasis

Dr.Aswathy Krishna Department of Medicine

Parasitic infection caused by amoeba of the entamoeba group, most

commonly by Entamoeba Histolytica.

Symptoms: Amoebiasis can present with no, mild or severe

symptoms. May include abdominal pain, mild or bloody diarrhoea or

severe inflammation of the intestine with tissue death and

perforation.

Transmission of amoebiasis

n Faecal contamination of drinking water and foods

n Direct contact with dirty hands

n Factors contributing to infection:

n Malnutrition

n Poor sanitary condition

n Alcoholism

n Cortiosteroid therapy

n Immuno deficiency

n Alternation of bacterial flora

n HIV positive patient

Morphology…

A. Trophozoite: Growing or feeding stage of the parasite. Irregular

in shape Actively motile in freshly passed stools

B. Precystic : Trophozoites undergo “Encystment” in intestinal

lumen. Encystment doesn't occur in the tissues nor in faeces outside

the body.

C. Cystic Stage : Infective form of parasite. Mature cyst spherical

and is quadrinucleate.

Amoebiasis classification:

Classified as –Intestinal

- Extraintestinal

A. Intestinal Amoebiasis:

Amoebic dysentry-Afebrile n nontoxic.

Fulminant colitis: Ulceration and tissue death of colon-febrile and

toxic.

B. Extraintestinal Amoebiasis:

Hepatic involvement –Liver Abscess.

Pleuropulmonary involvement-lower part of (R)Lung (most

common)

Other organs involved are spleen, kidney, brain

LABORATORY DIAGNOSIS :

1. Trophozoites / cysts can be seen in fresh faeces.

2. Serological tests for Amoebiasis Antibody - present in Ameobic

Liver Abscess.

7

Allergic Rhinitis

Dr.K. Abirami ENT Department

Overview: If you sneeze a lot, if your nose is often running or

stuffy, if your eyes, mouth or skin often feels itchy,

you may have allergic rhinitis.

It develops when the body's immune system

becomes sensitized and over reacts to allergens.

Types:

Seasonal: The symptoms occurs in summer or spring. They are

caused by allergic sensitivity to airborne mold spores

or pollens from grass, trees & weeds.

Perennial: The symptoms are present throughout the year.

They are caused by dust mites, pet hair,

cockroaches or mold.

Symptoms: a. Runny nose

b. Itchy eyes or mouth

c. Sneezing

d. Nasal blockage or congestion

Allergies:

Indoor: Pet hair, dust mites

Outdoor: Pollens from grass, trees, weeds

Irritants: Cigarette, smoke, perfume, diesel exhaust.

I. Management:

1. The first approach should be to avoid the

allergens.

Outdoor

allergens: 1. Stay indoors as much as possible when pollen

counts are at peak (midmorning and evening).

2. Avoid using window fans that can draw pollens into

the house.

3. Wear a filter mask when gardening.

4. Don't hang clothes outdoors as pollen may cling to

towels and sheets.

Indoor

allergens: 1. Keep windows closed, use Air Conditioner (AC) in

the car and at home and keep the AC Unit clean.

2. Reduce dust mite exposure by using “mite-proof”

covers for pillows & beds. Wash the bedding

frequently using hot water.

3. Keep the humidity at home low (dehumidifier).

4. If mold is visible, clean with mild detergent & a

5% bleach solution.

5. Clean floors with damp mop rather than dry

dusting.

Exposure

to pets: 1. Wash hands immediately after petting any

animals.

2. Keep the pet out of the home or at least out of the

bedrooms to limit the exposure.

3. Replace carpeting with tiles.

News Letter of NLC General Hospital(for private circulation only)

Published by NLC India Limited (formerly Neyveli Lignite Corporation Limited), ‘Navratna’ - A Govt. of India Enterprise, Neyveli 607 801, Tamil Nadu. Website : www.nlcindia.com

Every year April 7th is celebrated as WHO (WORLD HEALTH ORGANISATION) DAY. Theme for this year is – “ Mental Depression”.

This was celebrated in our out patient department of General Hospital by posters presentation and patients education on this topic

by OPR Nursing students. The awareness programme benefitted many patients.

WHO (World Health Organisation) Day

CME ProgrammeNLCIL Raising Day at General Hospital

NLCIL Raising Day was celebrated on 20.05.2017 in

our hospital premises. CGS/Medical Dr.P.Ravi hoisted

the NLCIL flag followed by NLCIL theme song and

addressed the gathering of hospital staff. Senior

members of the hospital were honoured.

IMRT/HYPO-FRACTIONATION

IN BREAST CANCER

by: Dr. SUNITHA PRABHAKAR /

MIOT HOSPITAL

on 23.06.2017

COMMON NEUROLOGICAL

PROBLEMS & MANAGEMENT

OF SEIZURES IN CHILDREN

By Dr K Lakshmi Narayanan

(Paediatric Neurologist)

Malar Hospital/

Visiting Conslt. SRMCH

on 28.06.2017

TRUE BEAM ADVANTAGES

IN BREAST

CONSERVATION THERAPY

by: Dr. SOLLIN SELVAN /

MIOT HOSPITAL

on 23.06.2017

LIGNITE LIFE LINE