Overview

This is a disease that is transmitted from mosquitoes to humans and affects many people in the world. Found in densely populated countries and continents, like Africa, Asia and the tropics of the Americas, this has severe symptoms. This viral disease is caused by the Chikungunya virus of the Togaviridae. First identified in the United Republic of Tanzania in 1952 and subsequently in other countries like Africa and Asia. Since 2004 the outbreak of CHIKV virus has become more widespread and caused partly due to the viral adaptations allowing the virus to be spread more easily by Aedes albopictus mosquitoes. The transmission has been noted to persist in countries where there is a large population, but interestingly, the transmission has been interrupted on islands where a high proportion of the population is infected and then immune.

Symptoms

The onset of the disease is usually in 4-8 days and after a bite of an infected mosquitoes, it is characterized by an abrupt onset of fever and then joint pain. This joint pain is severed and lasts for a few days but may prolong for months maybe even years. Other signs are joint swelling, muscle pains, headache, nausea, fatigue and rash. These symptoms also overlap with those of dengue and Zika virus and can be misdiagnosed. Most people fully recover from the infection and experience only mild and sometimes the infection even goes unrecognized. However, there have been cases of eye, heart, and neurological complications. The elderly and newborns are more susceptible to the infection and if they have any underlying conditions then they are likely to become severely ill increasing the risk of death.

Diagnosis and treatment

The diagnosis and treatment of the virus may be done by blood sampling and other tests like reverse transcriptase–polymerase chain reaction (RT–PCR). Other tests detect the activity of the antibodies. These can be detected in the first week after illness onset and can be detected for about 2 months. Many clinical measures can be taken to address fever and joint pain. But there is no specific anti-viral drug treatment for the virus.

Preventing Chikungunya

As this disease is caused by the bite of a mosquito, you must reduce the opportunities to let the mosquito breed. Mosquitoes bite during the day and night, and for people who live in risk areas like southeast Asia, Africa and tropical regions of America, many outbreaks happen each year. The best way to prevent it is to protect yourself from the mosquito's bite. You also must get vaccinated before travelling to any of these regions. Use insect repellent, and wear long-sleeved shirts and pants. You can also treat your clothes and gear with permethrin. As we all know, they tend to breed in humid places and places where they have access to water, so try to close the rooms that are air-conditioned with screens and windows. Use nets and mosquito repellents if you are sleeping outside. There are many different types of mosquito repellents like paper, liquid etc, and they are quite effective. If your job needs, you to be stationary for long hours or frequently go outside you must take the necessary precautions.

The recent launch of the indigenous Td vaccine in India by Union Health Minister JP Nadda will boost immunity and reduce the risk of tetanus and diphtheria in children and adults, said health experts.

Union Health Minister JP Nadda formally launched the indigenously manufactured Td vaccine in Himachal Pradesh last week.

With the launch, the Tetanus Toxoid (TT) vaccine has been replaced with the Tetanus and adult diphtheria (Td) vaccine in India’s immunization program for all age groups, including pregnant women.

The move comes amid increasing numbers of cases of diphtheria amongst older age groups. Tetanus and diphtheria can lead to hospitalizations or even cause death. The Td vaccine will help to decrease diphtheria outbreaks.

“In keeping with global practice, India has shifted from TT, which covers for tetanus, to Td, which covers for both tetanus and diphtheria. This vaccine is indigenously manufactured and is expected to significantly reduce the risk of both these diseases in older children as well as adults,” Dr. Rajeev Jayadevan, Ex-President of IMA Cochin and Convener of the Research Cell, Kerala, told HealthandMe.

What Is The Td Vaccine?

The Td vaccine, indigenously manufactured at the Central Research Institute (CRI), Kasauli in Himachal Pradesh, is a combination of tetanus and diphtheria with a lower concentration of diphtheria antigen (d), and is recommended for older children and adults.

The use of Td, instead of TT, is recommended during pregnancy to protect against maternal and neonatal tetanus and diphtheria during prenatal care.

Vaccination during pregnancy also serves to boost immunity and increase the duration of protection in pregnant women who have not received the full set of recommended booster doses.

The Td is a safe vaccine, and 133 countries are currently using it.

The Health Ministry, in a statement, said that the Central Research Institute will supply 55 lakh doses to the UIP by April 2026, with production expected to scale up progressively in subsequent years to further strengthen the Universal Immunization Program in India.

“India’s indigenous Td vaccine rollout marks a significant milestone in strengthening the nation’s immunization program by enhancing self-reliance, affordability, and supply stability,” Dr. Neha Rastogi, Senior Consultant - Infectious Diseases, Fortis Gurugram, told HealthandMe.

“Locally produced vaccines reduce dependency on imports, ensuring uninterrupted protection for adolescents and adults against tetanus and diphtheria. This initiative supports wider coverage, faster distribution to remote regions, and improved public health preparedness,” she added.

Tetanus And Diphtheria: Disease burden In India

As per the National Health Profile 2022, India has reported 1,586 cases and 22 deaths due to diphtheria in 2020, and 3,677 cases and 47 deaths in 2021.

Around 10 Indian states report the majority (84 per cent) of the cases.

As of 21 June 2024, Orissa has also reported six deaths and 21 suspected diphtheria cases. There has been more than 90 percent coverage of diphtheria vaccination in birth cohorts since 2014, but gaps in booster dose coverage are widely prevalent.

Plugging of gaps in the routine immunization, coupled with inclusion of booster doses in the national data on diphtheria vaccination, is the need of the hour.

“Diphtheria is one of the most dangerous infectious diseases known to man; it spreads easily through the respiratory route. It can cause death due to the bacterial toxin affecting the heart (Myocarditis). It is vaccine-preventable, but the immunity fades over time,” Dr. Jayadevan said.

Therefore, the Td booster shots at ages 10 and 16 are essential to maintain protection. Similarly, pregnant women should receive two doses to protect both mother and child.

Given the recent outbreaks of diphtheria in India and elsewhere, this transition is a public health priority, the expert said.

Cardiovascular emergencies remain among the most time-critical and life-threatening events in modern medicine. From sudden cardiac arrest to acute coronary syndromes and hypertensive crises, these conditions demand not only clinical excellence but also seamless systems of care. In an era where cardiovascular disease continues to dominate global mortality charts, preparedness is imperative.

Understanding Cardiovascular Emergencies

Cardiovascular emergencies encompass a spectrum of acute conditions that compromise cardiac output, coronary perfusion, or vascular integrity. These include myocardial infarction, cardiac arrhythmias, acute heart failure, aortic dissection, pulmonary embolism and cardiogenic shock. What unites them is speed: the window between reversible injury and irreversible damage is often measured in minutes.

Timely recognition of symptoms like chest pain, breathlessness, syncope, palpitations or sudden neurological deficits can dramatically alter outcomes. Delays, even minor ones, translate into myocardial loss, cerebral injury or death.

Acute Coronary Syndromes

Acute coronary syndromes (ACS) remain the cornerstone of cardiovascular emergencies. Plaque rupture and thrombosis can abruptly occlude coronary arteries, leading to unstable angina or myocardial infarction. Early electrocardiographic evaluation and cardiac biomarker guide diagnosis, but decisive action is paramount.

Rapid reperfusion, whether via thrombolysis or primary percutaneous coronary intervention, restores blood flow and salvages myocardium. Modern emergency cardiac care prioritises well-rehearsed protocols, ensuring that “door-to-balloon” times are aggressively minimised. In cardiovascular emergencies, hesitation is the enemy of survival.

When the Heart Loses Its Rhythm: Arrhythmias and Cardiac Arrest

Sudden cardiac arrest, often precipitated by malignant arrhythmias such as ventricular fibrillation or ventricular tachycardia, is the most dramatic cardiovascular emergency. Survival hinges on immediate cardiopulmonary resuscitation (CPR) and early defibrillation.

Equally dangerous are unstable bradyarrhythmias and supraventricular tachycardias, which can compromise haemodynamics within moments. Advanced cardiac life support protocols, continuous monitoring, and access to defibrillation and pacing are non-negotiable components of any emergency-ready healthcare facility.

Hypertensive and Aortic Emergencies

Hypertensive emergencies occur when severely elevated blood pressure causes acute target-organ damage, affecting the brain, heart, kidneys, or eyes. Stroke, acute left ventricular failure, and myocardial ischaemia are common and devastating consequences.

Aortic dissection, though less common, is among the deadliest cardiovascular catastrophes. Sudden tearing chest or back pain, pulse deficits, and blood pressure differentials demand immediate imaging and surgical consultation. Here, precision in diagnosis and blood pressure control can mean the difference between life and sudden death.

The System Behind The Save: Integrated Emergency Cardiac Care

Effective management of cardiovascular emergencies extends beyond individual expertise. It relies on an integrated ecosystem, trained emergency teams, rapid diagnostics, catheterisation laboratories, cardiac intensive care units, and post-event rehabilitation.

Hospitals that invest in protocol-driven care pathways, continuous staff training, and advanced cardiac technology consistently achieve superior outcomes. Equally vital is public awareness: early symptom recognition and prompt presentation to medical facilities significantly reduce mortality.

Preparedness Is The New Prevention

While prevention remains the long-term strategy against cardiovascular disease, preparedness defines survival during emergencies. From ambulance services equipped with defibrillators to hospitals offering round-the-clock cardiac intervention, readiness saves lives.

Cardiovascular emergencies do not announce themselves politely. They arrive uninvited, escalate rapidly, and punish complacency. In these moments, excellence is measured not in intent but in response.

Kidney disease rarely announces itself loudly. Many people discover it only after significant damage has already occurred. According to Dr Mitesh Makwana, Consultant Nephrology at Manipal Hospital, who wrote in The Week one often overlooked factor is gender. Biology, hormones, social behavior and access to healthcare all influence how kidney disease develops, progresses and is treated.

Globally, research published in The Lancet and the International Society of Nephrology estimates that chronic kidney disease affects roughly 1 in 10 adults. Yet the pattern is not the same in men and women.

Biology And Hormones Shape Risk Differently

Although kidneys perform identical functions in both sexes, the way they age and respond to stress differs.

Dr Makwana explains that estrogen in women appears to protect kidney filtration units by reducing inflammation and scarring. Testosterone, on the other hand, increases activity of the renin angiotensin aldosterone system, which raises blood pressure inside the kidney and increases protein leakage in urine.

This partly explains a common observation in nephrology clinics. Women develop chronic kidney disease more frequently, but men tend to reach kidney failure faster.

A large European CKD registry analysis has shown that men progress to end stage kidney disease nearly 1.5 times faster than women once damage begins.

Certain conditions are also gender linked:

Women: lupus nephritis, recurrent urinary infections, pregnancy related kidney injury

Men: IgA nephropathy, polycystic kidney disease, hypertension related kidney damage

Pregnancy adds another unique risk. Preeclampsia, gestational diabetes and severe hypertension can permanently damage kidneys. Women who already have protein in urine face higher chances of fetal growth restriction and pregnancy complications.

Infections And Anatomy Matter

Women experience urinary tract infections far more frequently because the urethra is shorter and closer to the anal canal. Repeated infections can gradually scar the kidneys.

However, when infections occur in men, they are often detected late and tend to be more severe. Clinically, men with untreated infections are more likely to present with advanced kidney damage.

Lifestyle Differences Affect Diagnosis Timing

Lifestyle habits significantly influence outcomes.

Dr Makwana notes that men commonly delay health checkups, smoke more and consume higher amounts of alcohol. This increases risk factors like high blood pressure and diabetes, the two leading causes of kidney failure worldwide.

Women face a different challenge. Many prioritize family health over their own and ignore fatigue or swelling until daily functioning is affected. Studies from rural India have also shown that anaemia and malnutrition during pregnancy increase the risk of acute kidney injury in women.

Despite different behaviors, both groups often reach hospitals late, missing the window for early treatment.

Chronic Diseases Behave Differently In Men And Women

Diabetes and hypertension account for nearly 70 per cent of kidney failure cases globally, according to the Global Burden of Disease study. But progression varies.

Women often show mild or borderline abnormalities in early tests, delaying diagnosis. Men experience faster decline once disease begins, making early monitoring critical.

This is why nephrologists stress gender sensitive screening rather than a one size fits all approach.

Treatment Gap And Transplant Imbalance

Gender differences continue even after diagnosis.

Across many countries, women donate kidneys more often but receive fewer transplants. Social factors, economic dependency and delayed referrals contribute to this imbalance.

Women are also less likely to start dialysis early and more prone to complications such as low blood pressure during sessions due to vascular access challenges.

Why Early Screening Matters

Kidney disease is preventable or controllable when detected early. Screening becomes especially important for:

• diabetics
• hypertensive patients
• pregnant women with high blood pressure
• people with family history of kidney disease

Simple urine and blood tests can prevent dialysis or transplant in many cases.