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Liver diseases silent, don’t ignore symptoms

The Kashmir Monitor




Doctors say, most of the liver diseases are silent and by the time symptoms appear there is already 50% or above damage done to the liver, and cirrhosis (scarring) of the liver set in, especially in viral Hepatitis B and C.

When north Delhi resident Anil Kumar, 45, got high fever in August this year, he thought it was normal flu. He consulted a doctor when the fever didn’t subside even after a couple of days.

“The doctor gave me medicines and my fever came down. A few days later, however, I observed the colour of my urine had turned dark. I consulted my doctor again and he asked me to get a liver function test done,” says Kumar, a civil engineer, who works for a Gurugram-based company.


Kumar was diagnosed with jaundice, and since his liver parameters were unusually off the charts, he was advised admission to a hospital.

“I didn’t have any pain in the abdomen or any other symptoms but since the test readings were alarming I got admitted to a local hospital. The tests confirmed viral Hepatitis E on August 12. By evening of that day I was feeling worse,” he says.

The doctors recommended he be shifted to a bigger hospital after he started losing consciousness the next day.

“I got admitted to BLK Hospital and investigations began and it was diagnosed that I had acute liver failure. Only 50% of my liver was functioning,” he says.

Kumar recovered initially but from August 18, his condition got worse and he was advised liver transplant.

“In just a span of days, my liver was so damaged that I had to undergo a liver transplant. I was shocked. I didn’t know my liver was in such a bad state. I have never had any symptoms,” he says.

Fortunately for Kumar, he received timely treatment and from Monday he will resume work.

“What is important to note in his case is that he didn’t waste time. We mostly get cases too late and that affects the treatment outcome. Time is of essence in such cases,” says Dr Sanjay Singh Negi, director, department of hepato-pancreato-biliary surgery, BLK Hospital.

“It’s usually Hepatitis B and C that’s considered more dangerous but in a small proportion of cases, even A and E can lead to rapid liver damage,” he said.

Doctors say, most of the liver diseases are silent and by the time symptoms appear there is already 50% or above damage done to the liver, and cirrhosis (scarring) of the liver set in, especially in viral Hepatitis B and C.

Liver cirrhosis is one of the major contributors towards developing liver cancer.

“In cirrhotic cases, tumor may develop any time. In fact, in at least 70% of the cases cirrhosis leads to liver cancer, which is one of the fastest growing cancers,” says Dr SK Sarin, director, Institute of Liver and Biliary Sciences.

Vaccination is the key to control infection from spreading. However, there is vaccine to prevent only Hepatitis B.

Keeping in mind the magnitude of the disease, government of India also introduced Hepatitis vaccine in its Universal Immunisation Programme (UIP), to vaccinate newborns and protect them against the deadly disease.

An effective vaccination programme plays an imperative role in preventing HBV infection and is known to decrease the incidence of chronic liver disease and hepatocellular carcinoma (HCC) or liver cancer.

To provide protection to babies, the government is giving three primary doses of the vaccine at 6, 10 and 14 weeks, and to cut mother-to-child transmission, government had introduced the birth dose that is given within 24 hours of birth.

To protect against Hepatitis C, however, there is no vaccine but the infection can be cured with treatment that can last for three to six months. Doctors put a lot of emphasis on screening as timely treatment can prevent the liver from getting damaged beyond repair.

Since faulty lifestyle, which includes lack of exercise, increased intake of junk food and excessive alcohol consumption, is one of the contributing factors for developing Hepatitis, it will benefit to improve one’s lifestyle.

“Faulty lifestyle, primarily excessive alcohol in take, is one of top indications for liver transplant in India. So, people must lead a healthy lifestyle,” says Dr Negi.



This winter control asthma with inhalation therapy

The Kashmir Monitor



Whether youre indoors or outdoors, winter will exacerbate asthma attacks. Winter is the most loved season, but it might be unpleasant for patients with lung diseases. An American Lung Association fact-sheet states that asthma is one of the most common chronic disorders and currently affects about 7.1 million children under 18 years. The World Health Organisation Global Burden of Disease Study estimates that 13.8 million disability-adjusted life years (DALYs) are lost yearly due to asthma, representing 1.8 per cent of the total global disease burden.

For 300 million people around the globe suffering from asthma, the cold winter months often lead to a worsening of their symptoms.

The cold environment it not suitable for asthma patients. Their lungs and airway passages are quite sensitive. To a larger extent, asthma symptoms related to winter can be in controlled and managed by precise treatment and medication. Due to the swelling in the lining of the airways which leads to their narrowing, and the sticky mucus or phlegm build-up that blocks the airways, breathing is difficult and forced for asthmatic patients.


During winter, the cold air causes airways to tighten further, making it even more difficult to breathe.

Many patients and their family members are misinformed about the causes of asthma and the treatment options available. It is a necessity to educate patients and caregivers about the disease and treatment with minimal side-effects of inhaled corticosteroids, i.e. inhalation therapy.

Many pharmaceutical organisations are running campaigns to bust myths around inhalation therapy. Often, the word steroids evokes apprehensions in the minds of patients causing them to shy away from inhalers. The steroid is produced by the human body naturally to deal with inflammation and it is also safe for children and pregnant women. The inhalation therapy consists of an inhaler pump to send the corticosteroids into airway passages.

According to a research article published in Respiratory Medicine journal, the correlation between inhalation therapy for asthma and clinical efficacy is positive, with improved symptom-control and lung-function shown in most studies of adults, adolescents and children.

In the inhalation therapy, the inflammation of the airway requires a very small quantity of corticosteroids — around 25 to 100 micrograms — but when it is consumed through the oral/intestinal route the amount administered is very large — about 10,000 micrograms, since only a fraction of the drug reaches the lungs. This means that every time an asthma patient pops a pill or a tablet, he/she is actually taking almost 200 times the amount of medication required, leading to ill-effects on health.

Inhalation therapy directly gives body only that amount of steroid needed to control the symptoms. Against this, oral medication first gets dissolved in the blood and then reaches various organs, including the lungs.

Thus, inhalation therapy is a simple and easy solution for asthma patients to enjoy their winter to the fullest.

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Some nose, throat bacteria less likely to develop into flu: Study

The Kashmir Monitor



US researchers have identified a cluster of nose and throat bacteria that made their hosts less likely to get flu.

The researchers from the University of Michigan (UM) looked at samples of nose and throat bacteria and used DNA sequencing to identify which bacteria were present.

Analysing the bacterial composition across all samples, they found five clusters.After taking into account other known factors that could affect an individual’s
susceptibility to influenza, such as age, exposure to tobacco, crowded household and flu vaccination, the researchers then looked to see if individuals with a given cluster were less likely to get influenza.


“We looked at who had which cluster and whether it makes a difference on whether they got influenza, and it does,” said lead author Betsy Foxman, Professor at UM. “That’s the exciting thing about it. It tells us if you have this bacterial community, you have lower risk for getting the flu. That’s big news because it really hasn’t been shown before.”

However, the findings published in PLOS ONE journal also bring new questions.”Is it really possible to push someone’s microbiome in a way that would make a difference? Is it possible that we could tell people – ‘Here’s your microbiome pill?'” Foxman said, adding that “It’s a very long road and we’re at the beginning.”

Researchers hope that similar studies can be done in a different population and possibly follow them longer for secondary bacterial infections.”We know we are always going to need new antibiotics but this way we could hold on to them longer and, presumably, if we could intervene in this way there would be fewer side effects,” Foxman said.

For the study, the team enrolled 717 participants from 144 households. Household members of individuals with confirmed influenza were recruited for the study and followed for 13 days or until they developed influenza, whichever came first. They included only the 537 individuals who tested negative for influenza at the beginning of the study.

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Taking artificial sweeteners as a sugar substitute? Study says it may not be effective

The Kashmir Monitor



While some people who are trying to avoid sugar are increasingly opting for artificial sugar, a recent study has revealed that taking artificial sugar may not be a good idea after all.”Growing concerns about health and quality of life have encouraged people to adapt healthy lifestyles and avoid the consumption of food rich in sugars, salt, or fat to prevent obesity and other non-communicable diseases. With increased consumer interest in reducing energy intake, food products containing non-sugar sweeteners (NSSs) rather than simple sugars (monosaccharides and disaccharides) have become increasingly popular”, the study stated.

But replacing sugar with artificial sweeteners used in Diet Coke and other soft drinks has no effect on weight loss and their long-term health effects are still poorly understood, the review said. The study titled ‘Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies’ was led by the University of Freiburg and published in the BMJ.

It also highlighted the absence of research on the long-term health effects of sweeteners when taken over years or decades. In this comprehensive systematic review, a broad range of health outcomes was investigated to determine a possible association with non-sugar sweetener used by a generally healthy population.


“The studies were set up to look at different types of sweeteners, measuring weight, blood sugar (glycaemic) control, oral health, cancer, cardiovascular disease, kidney disease, mood and behaviour in consumers. For most of them, there was no statistical difference in weight loss or health benefits of adults and children using higher doses of sweeteners rather than small amounts or none”, a report in The Guardian stated.

This comprehensive systematic review covers a broad range of benefits and harms of NSSs in a generally healthy population of adults and children, following rigorous systematic review methods. “Overall, we included 56 studies of adults and children, which assessed the associations and effects of NSSs on different health outcomes.

For most outcomes, there seemed to be no statistically or a clinically relevant difference between NSS intake versus no intake, or between different doses of NSSs. No evidence was seen for health benefits from NSSs and potential harms could not be excluded. The certainty of the included evidence ranged from very low to moderate, and our confidence in the reported effect estimates is accordingly limited”, the study stated.

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January 2019
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