Christian Medical College recognised for COVID care

Today I would like to share the good news that Christian Medical College, Vellore was given three awards in the care of COVID-19.

The first award related to work place for safety.

https://medicaldialogues.in/news/health/hospital-diagnostics/caho-confers-top-awards-to-cmc-vellore-gmc-chennai-columbia-asia-for-workplace-safety-amid-covid-19-69727

The second award was related to excellence in hospital preparedness

“Excellence in Hospital Preparedness for COVID-19”

  • awarded by the Federation of Indian Chambers of Commerce and Industry (FICCI)

The third award was for best charitable hospital

I want to focus on the last award. As a charitable hospital it was a big challenge. Because of COVID 19, other general patients stopped coming as well as the lockdown which prevented the regular flow of patients.

It is within this major challenge, that CMC Vellore was able to continue providing charitable services.

CMC needs the continued support of friends and well wishers to continue its charitable services. Please feel free to share with those who could contribute during this of need in serving the poor in health care.

You can feel free to contact me as well by responding to this blog in the comment section.

Alternately, you can contact me in abel_rajaratnam@hotmail.com

Thank you so much.

Rajaratnam Abel

COVID-19 How to prevent contracting the disease?

One of the purposes of the book on COVID-19 is to prevent the disease. There are two levels at which action needs to be taken to prevent the spread of the disease. The first is at the individual level. It includes the following four tasks.

  1. Stay at home always and as much as possible.
  2. Wear a mask always while going outside and when in contact with others.
  3. Maintain social distance of 1 metre plus mask or >2 M, always while going outside.
  4. Wash your hands with soap and water after coming back home and as often as possible. Alternately sanitisers may be used to keep the hands clean. (Those who have been outside for extended periods of time have a full bath when they return home.)

When is it justified to go out of your home?

In an era where staying at home is the recommended norm, what are the reasonable and justifiable reasons or excuses to go out? The word reasonable is stated differently as what is essential, as people should go out as little as possible and only leave home if they have a reasonable excuse.

Well, here are the valid excuses for going out. Shopping for basic necessities is number one. Any medical need, or providing care for a vulnerable person would be number two. Number three would be travel to or from work, but only when it cannot be done from home. Exercise, either alone, or with members of your household would be the fourth and the last one.

Masks

Provided enough people wear masks when venturing out in public, it could have a dramatic impact on how quickly the spread of COVID-19 is curtailed, particularly if combined with other measures such as social distancing and hand washing.

Tests on homemade masks have shown they can still significantly reduce the spread of other viral infections such as influenza. They can also help to reduce the dispersal of the virus onto nearby surfaces when people cough.

Why is social distancing necessary?

Social distancing is important because coronavirus spreads when an infected person coughs, small droplets which are packed with the virus are dispersed out into the air. No one knows who is infected and might spread the virus. An infected person’s cough or sneeze is likely to disperse a large number of aerosols with the virus.

If you are close to such a person, you are likely to get a heavy dose of virus, which may make it difficult for the body to control through its natural immunity. There are clear indications that this virus is spread through the air and keeping safe distance is one sure manner of preventing the disease.

If a person without wearing a mask comes near you, you take steps to move away from that person. Keeping safe distance always will preventing contacting the virus.

Washing hands with soap and water

Besides airborne transmission of the virus through droplets containing the virus when someone coughs or sneezes, the hands become the next most important means of transmission by the hands coming in contact with the virus that may have settled on the surface of furniture, books or any other substance.

Therefore, cleaning hands often with soap and water helps to clear the virus. Soap is suggested because the virus has a fatty envelope. This gets cleared only with soap and water. While sanitizers are useful and should be used as often as possible, many poor people cannot afford it, so it is not emphasised here.

Government actions

This second action is at the government level either at the national level or even at the state or city level in larger countries. There are three major tasks involved at this level.

  1. Increase rapid testing of the population as much as possible.
  2. Promote, maintain and monitor contact tracing, self-isolation or quarantine as appropriate.
  3. Diagnose early and treat those who are likely to become severely ill. Here’s your link to the book.

http://tiny.cc/scudder

Dr John Scudder: World’s first medical missionary My newest eBook

I am thankful to God for helping me to bring out this newest eBook. It was released on October 1.

This book describes the life and story of Dr John Scudder who came to India over 200 years ago.

It was his granddaughter Dr Ida Scudder who started the Christian Medical College, Vellore.

It was because of these two individuals that I had the privilege of studying in this institution and then spending 27 years of my life work there.

I am making this eBook available for free download load today and tomorrow. Please feel free to download as well as share with those who might benefit.

http://tiny.cc/scudderi

Besides the above, my two other E-books are also available for free download.

Businessmen for the Poor available today in link below.

The links to the book Businessmen for the Poor are given below.

The e-version is available on the following link.’
Global https://www.amazon.com/dp/B07P7HVQCQ

I am also sharing the link to the eBook on COVID-19

Global https://www.amazon.com/dp/B08FRSNS73

I trust that you will have enjoyable reading.

Rajaratnam Abel




Praise God. I have crossed 75 years

I thank and praise God for giving me 75 years of life. On September 11, I crossed this landmark in my life.

I am thankful for life itself as I passed through some dangerous moments. God was with me at these times.

I am thankful for the blessings He has given me in my life, family and work.

In my retirement years He has given me the wisdom to write from my lifetime experiences.

In the remaining years that has planned for me I want to make sure that I live for His glory.

As a mark of this landmark 75 years, I want to share with you a song that has appealed to me. I trust that you will enjoy it.

The link to the song is given below.

May this song be of meaning to you as it was to me.

May God bless you.

Rajaratnam Abel

How to reduce poverty?

I had written a book earlier and published it as Businessmen for the Poor.

This book describes how we reduced poverty in Vellore District of tamilnadu, India.

It is available for free download in the following links.

The e-version is available on the following link.

Global https://www.amazon.com/dp/B07P7HVQCQ

The eBook in India is available in the following link.

Indian https://www.amazon.in/ebook/dp/B07P7HVQCQ

Please share this link with others.

Rajaratnam Abel

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One month of eBook COVID-19

God gave me the privilege of publishing this eBook on the 25th of August.

I am thankful to those who have downloaded this eBook. As I desired many have downloaded the free book when I made it available.

There have been positive feedback about the book.

I give below the words of Dr. Peter Landless’ (Health Ministries Director, General Conference).

“It was balanced, perspective of the problem. I am deeply impressed by how he tackled the issues with clarity and dignity”. 

I have also made available chapters of the book through my blog and I am happy to know many are viewing the same.

As I am interested in making this book available to as many individuals as possible, I am making this available for free download on the 25th of September (ie tomorrow) to mark the completion of one month.

Those interested in downloading the free book must sign up for an Amazon account with your email id and your new password. Additionally you need to download a free Kindle Reader.

The links to the book are available below.

Global https://www.amazon.com/dp/B08FRSNS73

Indian https://www.amazon.in/dp/B08FRSNS73    

Rajaratnam Abel

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Immunity Boosing Foods and COVID-19

I had promised to share some of the chapters from my book on COVID-19. I am sharing one chapter today.

The links to the eBook COVID-19 are in the following links given below.

Global https://www.amazon.com/dp/B08FRSNS73

Indian https://www.amazon.in/dp/B08FRSNS73    

Since immunity boosting foods has been mentioned so often in connection with COVID-19, I thought it would be useful to bring in a section on this topic. Based on my experience, I thought it would be a simple process of opening up online literature and just copy and paste the relevant information. It wasn’t easy as I imagined.

A cardiologist based from the US has looked at immunity boosting foods in a critical manner. A number of questions that he had raised, forced me to go deeper into this topic. Here are some of his questions.

Can you boost your immune system to fight COVID-19? This is the question on everyone’s mind as we face a worldwide crisis. There are online claims that we can “boost” our immune system with just about everything from Vitamin C or Vitamin D to a number of immunity-boosting foods. But how do we know which of these recommendations, if any, really work? He indicated that the immune system is an intricate and delicate system with many different components. Helping one section might impair another and may not contribute to fighting viruses. How do we know if something that helps with another virus will help with this new corona virus?

To understand immunity boosting foods, I have classified them into four broad categories. The first category is vitamins and minerals given as supplements or through foods rich in these. The second category is the regular fruits and vegetables used in day to day cooking and diet, considered to have immune promoting properties. I am handling both the first and second categories together, relating the immunity boosting foods with the foods that are rich in these vitamins and minerals.

The third category is the variety of condiments and spices used, and claimed to have immunity boosting properties. Finally, in the fourth category are traditional herbs and other substances considered to be immunity boosting.  While the first category is the most scientifically studied, there is not enough scientific studies to conclude on the immunity boosting properties of the other three categories.

Vitamins, Minerals and Supplements

Taking vitamins, minerals, or other supplements could help protect from COVID-19. Here’s what we do know about certain supplements that reportedly have immune-boosting properties. Consuming foods rich in these would also be helpful.

Vitamin C has been used to help prevent the common cold. It may improve the function of certain white blood cells that fight infection. Vitamin C is known to strengthen the body’s T cells and phagocytes, which are the two main components of the immune system. There’s no harm in taking up to 2,000 mg per day (the upper limit set by the National Academy of Medicine).

Taking a Vitamin D supplement seemed to have a mild protective effect against respiratory tract infections in most people, especially those who were very deficient in Vitamin D. It is probably wise to take a Vitamin D supplement, especially if there is increased risk for COVID-19. Additionally, try to get some sunlight for about fifteen minutes daily if possible.

Vitamin E the next is a great source of strength to fight infections. Nuts such as almonds and walnuts as well as certain seeds like sunflower seeds, flax seeds, pumpkin seeds and melon seeds are excellent sources of protein and vitamin E with anti-inflammatory properties. Vitamin A, B6, C, D and E can help increase the strength of the immune system. Vitamin C is the biggest booster of all.

Zinc is a mineral involved in the white blood cell response to infection. It has been identified that supplementing with zinc reduced the duration of the common cold. It is not sure whether it can have a similar effect on COVID-19. Taking supplementary zinc (< 40 mg) may be a good strategy for older people and others at increased risk. Selenium is another important trace mineral that is useful for increasing immunity. This naturally leads me to the second group.

Fruits and vegetables

Citrus fruits are an excellent source of vitamin C, a nutrient that strengthens the immune system. Some of the popular citrus fruits are: orange, lemon, lime, grapefruit or pomelo, sweet lime or mosambi (citrus limetta), mandarin, tangerine, galgal (citron) or naarthenkai in Tamil. Other fruits include mangoes, strawberries, blue berries and apples.

Broccoli is packed with vitamins A, C and E. Tomatoes have valuable nutrients. Vegetables such as the red or the green bell peppers contain large amounts of vitamin C. Bell peppers are also a great source of beta carotene. Gooseberry or amla is considered another good immunity boosting food. Cashews, pumpkin seeds, chickpeas contribute to providing zinc. Consuming a wide variety of seasonal vegetables would contribute to boosting immunity.

Leafy vegetables such as spinach or palak or pasalai (Tamil), and kale or parattai keerai (Tamil) are a great source of daily vitamin intake. Spinach is rich in high amounts of carotenoids, vitamin C, vitamin K, folic acid, iron, and calcium. Kale is rich in Vitamin A, Vitamin K, Vitamin C, Vitamin B6, Manganese, Calcium, Copper, Potassium, Magnesium, vitamin B1, B2, B3, iron and phosphorus. 

Condiments and spices

Turmeric a spice commonly used in Indian and Asian cuisine belongs to the third category. It contains a bright-yellow compound known as curcumin, which emerging research suggests might enhance immune function, although not sure that it helps fight viral infections.

Garlic, another popular and widely used pungent herb with a characteristic aroma, is widely believed to have antibacterial and antiviral effects, including helping to fight the common cold. In one study, people who took a garlic supplement had fewer colds and recovered more quickly from colds than people who didn’t take garlic.

Ginger is another common food stuff used that is believed to have immunity building properties. Many test-tube and animal studies suggest that ginger can enhance immune response. Specific compounds in ginger, such as gingerols, shaogals and zingerone, have been found to inhibit viral replication and prevent viruses from entering host cells.

Traditional herbs and other food stuffs

It is the fourth category that is apparently not well studied scientifically. However anecdotal experiences and some of the studies carried out point to their usefulness in boosting immunity. I have listed two scientific studies from this category in the bibliography section to add weight to their possible role in increasing immunity.

The first one is drum stick leaves. Moringa have seven times more vitamin C than oranges and fifteen times more potassium than bananas.  It is also packed with antioxidants, substances that can protect cells from damage and may boost your immune system. They can be consumed as a leafy vegetable, or boiled and juice extracted, or shade dried and powdered and then consumed as a powder or extracted as juice. Personally, I have witnessed HIV/AIDS patients using this as an immunity boosting food, just before the arrival of Anti-Retroviral Treatment for the disease. Their CD4 count as a marker of immunity remained high.

Based on the above, I can add other similar herbal products. First is aloe vera. The next is Rosella, used as a juice extract.  Black pepper is known for its potent antioxidant and anti-inflammatory properties through its active compound, piperine. Star anise, black cumin (jeera), tulsi leaves or royal basil are used in traditional home remedies. Fenugreek seeds are packed with antiviral properties and have the ability to kill viruses that cause sniffles and sore throats. Onion is a rich source of organo sulfur compounds like quercetin and allicin which are associated with inhibition of viral infection.

Egg yolks and mushrooms are a good source of Vitamin D with eggs additionally having selenium. Milk contains nutrients like probiotics, vitamin D and immunoglobulins that boost the immune system and in turn reduce the risk of allergies. Honey, especially ‘Manuka’ honey, has strong antiviral properties against the varicella-zoster virus, the respiratory syncytial virus, and also has anti-influenza activity. It is also known to soothe a sore throat, suppress cough and can boost the cold-fighting action of black peppercorn. While I do not know the basis, drinking hot water is supposed to improve immunity.

Personal experience

I just want to add a few from my experience. My mother always gave me a special blend of hot drink prepared with dried ginger and coriander seeds, whenever I had cough. It was effective.

Earlier, my grandmother used to make a preparation using ginger fresh or dried, long pepper or tippili (Tamil language), betel leaves and the bark of neem tree. I have forgotten the other ingredients that went into it. It was not the tastiest concoction. We grandchildren, just closed our eyes and gulped it in one go once a month. Today, I presume that the action of these is by boosting the immunity. I can tell of other herbal practices to overcome childhood constipation or even abdominal colic among children. I would however, like to present my own experience with a chronic cough.

In my sixty fifth year, while visiting the US, suddenly I had a bout of cough. I knew it was not infection. There was a tendency to blame the allergens of the season. I put up with it for the two months that I was there, without visiting a doctor. When I returned to India, I still had the cough. I went to my physician. Walking along with me he could hear a loud wheeze. Without even putting a stethoscope on my chest, he said that I had asthma. I knew it was not asthma.

Later, I visited one of my relatives who was being trained in herbal medicines. We had just arrived that morning in their home and as we sat down for breakfast, I started coughing. He told me he had the correct medicine for my cough.

Immediately after breakfast, he took out a bottle of a dark greenish powder, took one spoonful mixed with honey and then asked me take it. He told me to take it three times a day for three days. By the time we left the next evening, I had taken it for two days and I began to feel better. Actually, I had to take to take it for about a week and the cough vanished and I had no indication of asthma at all.

He called this ‘five medicines,’ the literal translation of the Tamil name ‘anjumarunthu.’ They are dried ginger, black pepper, long pepper or tippili, akkara, and chitharathai all locally available herbal medical substances. He gave me the proportions to be used for preparing them and I always had them locally prepared and in my fridge.

Research on immunity boosting foods

Having said that there are not enough studies to either prove or disprove the effectiveness of these substances in boosting the immunity levels, I would like to take it to the next level. This is an excellent area for research by some of the younger professionals. If teams consisting of pharmacologists, virologists, physicians of different specialties and some from Siddha or Ayurvedha come together and carry out research on the immunity boosting potential of these foods, it would be a great contribution to the future of medicine.

 Just to take the first step, I have listed some of the indicators that could be measured to test the effectiveness of these foods. Probably the two that stand out are levels of infection-fighting proteins (immunoglobulin) in the blood and measure the levels of blood cells and immune system cells. May be other indicators could be added by experts in this area as they start working together.

I am a firm believer in herbal medicines and practice them regularly. In our home we take moringa juice once or twice each week. I frequently consume one fresh tender betel leaf from a plant that grows in our home garden. I take a herbal candy for my cough. I wish someone would come forward and carry out the research that is needed and prove one way or the other the effectiveness of these herbal medicines in increasing the immunity for treating or controlling the commonly prevalent diseases as well as COVID-19.

The links to the eBook COVID-19 are in the following links given below.

Global https://www.amazon.com/dp/B08FRSNS73

Indian https://www.amazon.in/dp/B08FRSNS73    

Rajaratnam Abel

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Free COVID-19 e book on September 11

It is my pleasure to share with you my eBook COVID-19 once again for a free download on the 11th of September 20202.

I am thankful to the many who downloaded it last time when it was released in August.

I would like to see as many as possible benefit from this book especially during this time of the pandemic.

With no drug and vaccine available, the responsibility for protecting ourselves rests on each one of us.

The links to the eBook are in the following links given below.

Global https://www.amazon.com/dp/B08FRSNS73

Indian https://www.amazon.in/dp/B08FRSNS73    

Please share freely with your friends and relatives and anyone else who might benefit.

Rajaratnam Abel

Sharing from COVID-19 e-book

I was happy to see a number downloading the free ebook on COVID-19. I had stated it is my intention to share this with as many as possible.

While the free e-book will be available from time to time, I want to share some of the chapters from the book so that even those who do not download the book, may find this useful.

In this post I want to share about the pathophysiology of the disease. From the time the book was written new information could have emerged which readers can share as feedback.

The Pathophysiology

In this chapter, I would like to describe in a simple manner the pathological changes that are produced inside the lungs once the virus gets inside a human and multiplies. Very little was known from the initial autopsies conducted in China. Later pathologists in Italy carried out a larger number of autopsies and newer knowledge became available. Over time even newer knowledge is likely to occur. I am sharing what is currently known.

When an infected person expels virus-laden aerosol droplets and someone else inhales the SARS-CoV-2, it enters the nose and throat especially the epithelial lining of the nose. The cells there are rich in a cell-surface receptor called angiotensin-converting enzyme 2 (ACE2). These help in producing angiotensin which normally helps regulate blood pressure.

When the virus encounters an epithelial cell in the nose, the spike proteins on its surface stick to the ACE2 receptors of the host epithelial cells, which allows the virus to gain access and replicate. These virus act in a highly selective manner, and that it is dependent on certain specific human cells in order to spread and replicate,”

Once inside, the virus hijacks the cell’s machinery, and starts making numerous copies of itself and also starts invading new cells. As the virus multiplies, an infected person may shed copious amounts of it, especially during the first week or so. Symptoms may be absent at this point or the patient may develop a fever, dry cough, sore throat, loss of smell and taste, or head and body aches. The natural immunity of the individual in most individuals would overcome the virus and the individual may pass off as an asymptomatic or subclinical individual. This is the mildest and may be considered as the initial or phase 1 of this disease.

If the immune system doesn’t beat back SARS-CoV-2 during this initial phase, the virus then marches down the trachea and bronchi. This is considered the second phase or the second window of opportunity to ‘kill’ the virus. The mechanism is similar to that in the nose with the virus sticking the ACE2 receptor cells. The symptoms of cough and fever may be more than in the first phase. Many individuals with COVID-19 without any risk factors would be able to come out safely even in phase two with the help of natural immunity.

If it passes beyond this level to attack the lungs, it can then turn deadly. The thinner, distant branches of the lung’s respiratory tree end in tiny air sacs called alveoli, each lined by a single layer of cells that are also rich in ACE2 receptors. In between this layer of cells are tiny capillaries, which are tiny blood vessels. Carbon dioxide in the blood is exchanged for the oxygen in the alveoli. The oxygen is then carried to the rest of the body.

But as the immune system wars with the invader, the battle itself disrupts this healthy oxygen transfer. Front-line white blood cells of the immune system, release inflammatory protein molecules called chemokines or cytokines, which in turn summon more immune cells that target and kill both the virus, which is the normal function. and also, virus-infected cells (abnormal function in COVID-19).

At this stage, the patient begins to find it difficult to breathe. With supportive measures by providing oxygen supply through masks, many who reach this phase three, are able to overcome the disease and get well. Right from the time a patient is admitted, the lung function of oxygenation is measured by special tests. Oxygen saturation is measured by pulse oximeter with a sensor attached to a finger. Normal pulse oximeter readings usually range from 95 to 100 per cent. Values under 90 per cent are considered low. Additionally, the oxygen concentration is measured from arterial blood. Normal arterial oxygen concentration is approximately 75 to 100 millimetres of mercury (mm Hg). Values under 60 mm Hg usually indicate the need for supplemental oxygen.

For some unknown reason, the normal cytokine reaction gets into overdrive or hyper-reactive, resulting in what is called a cytokine storm. During a cytokine storm, the cells of the immune system attack and kill the virus as well as the normal alveolar cells of the lung. This leads to an accumulation of fluid and dead cells in the air sacs of the alveoli in place of air. This makes the patient struggling to breathe.

Some COVID-19 patients recover, sometimes with no more support than oxygen breathed in through nasal prongs or masks initially and then under pressure. But others deteriorate, often quite suddenly, developing a condition called acute respiratory distress syndrome (ARDS). Oxygen levels in their blood plummet and they struggle even harder to breathe. The patient has now reached what I would call the critical phase four.

By the time a patient reaches a stage of breathing difficulty, you can understand the changes that have taken place inside that person’s lungs. The patient is now put on a ventilator. There is very little functioning lung at the alveolar level. Even the oxygen pumped in by the ventilator is not adequately transferred at the alveolar level, because of the damage done by the cytokine storm. Oxygen does not reach in adequate concentration to different organs, resulting in failure of multiple organs, starting with the kidneys, the heart, brain, liver etc. resulting in death.

Italian pathologists who carried out a large number of autopsies of patients who died of COVID-19 observed that the cytokine storm created endothelial vascular thrombosis. The lung is the most affected because it is the most inflamed, but there is also a heart attack, stroke and many other thromboembolic diseases. Taking a viewpoint different from the earlier diagnosis, they conclude that it is not pneumonia but pulmonary thrombosis, that results from the cytokine storm. It was a major diagnostic error. This finding has an echo in the treatment which we shall soon see.

Another study in the US found that inflammation and systemic changes, due to the infection, are influencing how platelets function, leading them to aggregate faster, which could explain why the is increased numbers of blood clots in COVID-19 patients. It was discovered that the virus causes genetic changes in the platelets that also alter their interaction with the immune system and maybe the reason COVID-19 patients often suffer from severe lung damage.

Another, related change at this stage needs to be highlighted. Earlier, mention was made of ACE2 cells. These viruses, destroy these cells which help in producing angiotensin, a substance used for regulating blood pressure. With decreased angiotensin, blood pressure starts going upwards, which has to be managed along with oxygen for difficult breathing.

We have talked about breathing difficulty in COVID-19 individuals caused by four changes in the lungs. 1. This is caused by the swelling of the respiratory tract, which narrows the lumen of the wind pipe. 2. The infection fills the empty air sacs with fluid, preventing exchange of oxygen and carbon dioxide. 3. Thrombosis of the capillaries of the alveoli result in oxygen being not taken to different parts of the body. 4. Scarring of lung tissue takes place, which results in poor functioning of the lungs. All these result in difficulty in breathing.

As I mentioned all along, our knowledge around this disease is continuously changing. It cannot be said that we have reached an endpoint in our knowledge of this disease. However, this limited description of the pathology may help you understand what the research world is trying out with medicines that could at least restrict deaths first and then have medicines that could kill or control the viruses itself. If you have a relative who is admitted for care for COVID-19, you can understand what is happening to them when they indicate the various parameters of oxygen and blood pressure.  

I will make the book available for free download again next week. Once I confirm the dates I’ll let you know. In the meantime here’s the link to the book.

Global https://www.amazon.com/dp/B08FRSNS73

Indian https://www.amazon.in/dp/B08FRSNS73     

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