India, emerging as the global Hepatitis capital of the world

By: Priyanjali Ghose Date: 2011-08-09 Place: Mumbai

What you need to know about the potentially life-threatening liver infection caused by the Hepatitus B virus

A recent finding by doctors from MIOT Hospital in Chennai claims that India is likely to emerge as the global capital of the dreaded Hepatitis B virus, which is responsible for 60 per cent of liver cancer cases.

Ashok Borisa, a Gastrointestinal and Laparoscopic Hepato-Pancreato-Biliary surgeon, Fortis Hospitals says, "The number of HBsAg carriers in India is estimated to be over 40 million or four crores."

Lack of awareness about the virus is a large reason for the spread of the virus, claim doctors. Viral Patrawala, gastroenterologist, Hiranandani Hospital defines Hepatitis B as a serious liver inflammation and infection caused by the hepatitis B virus (HBV).

Five kinds of virus
A, B, C, D and E are the five kinds of Hepatitis. Patrawala broadly classifies A and C to be food and water-borne infections, while B and C are spread through contact with blood or other bodily fluids including saliva, semen and vaginal fluid of an infected person.

Patrawala explains that carrying the virus does not mean that an individual has the disease. He declares that HBV can cause both short-term (acute) disease and long-term (chronic) disease.

"Not everybody develops chronic infection. Only five per cent of those carrying the infection develop the chronic disease," clarifies Patrawala. He adds that being affected by Hepatitis B does not depend on age or gender though children are more prone to develop the chronic disease, as compared to adults.

Consultant gastroenterologist Prassana Shah from Breach Candy says, "Anybody can acquire acute Hepatitis B.
However, in most cases the body produces antibodies and suppresses the virus with regular administration of drug tests. The person is cured mostly in six months," says Shah.

He says that in India, 90 per cent cases show that the infection mostly spreads from mother to foetus and most of them are chronic. Most pregnant women suffering from Hepatitis B are given injections to protect the child from the virus. Also, according to him, blood transfusion, dental treatment and the use of infected needles and razors are other major causes of the spread of Hepatitis B.

Symptoms and cure
Borisa says that the signs of Hepatitis B appear in about three months after being infected. Abdominal and joint pain, dark urine, loss of appetite, nausea and vomiting, weakness and fatigue, and jaundice are some of the symptoms. In case of acute HBV, the doctors may not suggest any treatment and instead work to reduce the symptoms and recommend follow-up blood, liver and viral load tests to make sure the virus has left the body.

However, Borisa informs that those suffering from chronic HBV infection often do not feel any discomfort even after carrying the infection for decades. According to him, 15 to 20 per cent of the patients suffering from chronic Hepatitis B die of liver cancer and cirrhosis, the scarring of liver.

"If you've been diagnosed with chronic hepatitis B infection, your doctor may recommend antiviral medications or getting a liver transplant," says Borisa.

Vaccination, a must?
Experts unanimously agree that vaccination is the best protection against the Hepatitis B virus. Ajay Choksi, gastroenterologist from Nanavati Hospital informs that World Health Organisation has recommended that HBV vaccination should be provided to all adults and infants at the time of birth. "The WHO has made a recommendation, but in India vaccination has not yet been made mandatory in all private and government hospitals. There is no such regulation though most pediatricians normally vaccinate children."

Shah gives the example of Taiwan where Hepatitis B vaccination programme was implemented in 1984. As a result, Taiwan saw a considerable decline of hepatocellular carcinoma or liver cancer in children.

In India each shot, according to Choksi is priced between Rs 50 to 100. Three shots of the vaccine are needed for proper protection. Though there is no age limit, it is advisable to take the HBV vaccine before the age of 40.

Apart from proper vaccination, Borisa advises that maintenance of national registry for Hepatitis, treatment of carriers, educating the common man, availability of treatment for chronic HBV for all classes and proper check on blood blanks be done to curb the spread of the virus.

42 million Indians suffer from Hepatitis B: Study
A recent study by a team of doctors from MIOT Hospital in Chennai conducted a survey which showed that 42 million Indians suffer from chronic Hepatitis B. the virus is also responsible for 60 percent of liver cancer cases in the country, claim the doctors. It was also found that not even one per cent of school children are provided with HBV vaccine though it was developed in 1970. PVA Mohandas, director, MIOT Hospital, reveals that there are 400 million people chronically infected by the HBV and 40 per cent of them are at the risk of suffering from cirrhosis and liver cancer.

Do's and Don'ts for those living with HBV

Dos
> Restrict alcohol intake to a peg twice or thrice a week if you have chronic HBV.
> Practice safe sex. Use condoms each time you have sex. If you are in a monogamous relationship and have had unprotected sex outside your relationship, confide in your partner, as you might be putting them at risk of contracting the virus or an STD (sexually transmitted disease).
> If you are pregnant and carrying the HBV tell the doctor immediately.

Don'ts
> Alcohol, even wine, is an absolute no-no if you have contracted the virus.
> If you are infected with the Hepatitis B virus, don't donate blood or organs.
> Don't share razor blades or toothbrushes. These items may carry traces of infected blood. If you use IV drugs, never share your needles and syringes with anyone.

Myths and truths about Hepatitis B

Myth: Hepatitis B can be transmitted through casual contact such as kissing, handshakes or sharing of food and water.
Truth: The disease can only be contracted on an intimate basis such as sharing bodily fluids through unprotected sex or sexual contact or through blood transfusions with an infected person.

Myth: There is no treatment available for chronic hepatitis B.
Truth: While the disease is not curable, it is manageable. Chronic HBV can be treated with a number of effective medications that can suppress, slow or reverse the liver disease. All chronically infected patients need life-long monitoring.

Myth: Healthy patients with chronic HBV (often called "carriers") do not need regular medical follow-ups.
Truth: Inactive carriers can progress to cirrhosis or liver cancer at any time. Continued screening should take place at regular intervals throughout the patient's lifetime.

Myth: Hepatitis B vaccine prevents liver cancer and enhances healing in infected patients.
Truth: The vaccine prevents infection and thereby cancer. There is no reason to vaccinate a patient who is already infected.

How to end a deadly affair

By: Sheetal Sukhija Date: 2011-08-09 Place: Mumbai

Actor Michael Douglas announced his intention to quit but was caught smoking soon after. Active! gives you tips on how to quit for good

Nicotine addicts mock claims about alternative solutions to help kick the butt as the need to take deep drags often gets to the best of them. So, when throat cancer surviving actor Michael Douglas announced that he would kick the butt, there were skeptics who smirked at the thought. He proved them right, as he was spotted smoking away in style while on a holiday.



The World Lung Foundation revealed a year back that India, apart from China, forms the world's biggest tobacco consumers. Doctors reveal that tobacco is smoked in many forms in the country and statistics prove that 229 million men and 12 million women across the country smoke tobacco and find it hard to kick the habit.

"Nicotine is the most commonly found drug in tobacco. When you smoke, it enters your system and causes physical and psychological dependence. You need to believe that the habit is going to harm you and that is where you start," says Dr Girish Nair, Neurologist at Fortis Hospital, Although doctors have little scientific evidence about hypnosis as a therapy, it has proved helpful. "Hypnosis can be used as a powerful tool to motivate people to quit," explains Dr Nair.

Not addicted, really?
Doctors claim that the habit often sticks for long, if not kicked off early in one's smoking days. "Those who have a craving to smoke even one cigarette a day are addicted in some form. If they stay away from cigarettes for long, they may feel uncomfortable. A common misconception is that cutting down will help people quit. If one needs to quit, they should do just that ” quit completely," says Dr Nair.

Harmful chemicals gain entry
Dr Tejindra Singh, Oncologist, Fortis Hospital, says, "There are around 4,000 chemicals in a cigarette. Around 200 of these chemicals are known to cause cancer. These chemicals change the molecular structure of the DNA and the DNA gets damaged and doesn't repair."

He adds, "Nicotine and other chemicals are carried through the blood to the heart, brain liver and spleen. They affect the hormonal system, a person's metabolism and eventually damage the brain."

Therapy to the rescue
Doctors suggest that the best way to get de-addicted is to use alternate ways to satisfy the nicotine need for a smoker. "There is a psychological preparation called Buspirone that helps people overcome the craving for nicotine. The non-pharmacological methods consist of therapy and counselling that help you quit. Apart from that, a person could start with nicotine sprays, gums and patches," concludes Dr Nair.

Yes you can quit smoking, says Obama
Being the man in power, who presently seems to be tensed because of the US downgrade, it sure seems like a time when Barack Obama would want to pop one of those sticks to do away with the world's tensions.

However, Obama, who set an example for many in various walks of life, has finally managed to quit the habit.

Having picked up the habit early in life, Obama stuck to it for a long time and would smoke at least eight cigarettes a day. He had earlier said that his wife was the motivation behind him kicking the evil habit and had promised her to quit when he embarked on his campaign to become president. However, it was only a few months back that the man in power eventually gave up the stick, for a peaceful healthier life -- as nicotine gums came to his rescue.

PARATHRYOID HORMONES

ICMR to study if probiotics can replace antibiotics

Shalini, Nikita Mishra, CNN-IBN

New Delhi: The Indian Council of Medical Research is now taking up a large scale research to study if probiotics can be an used as an alternative medicine for women and children's health. The Rs 20.6 million industry in India, has been quite a rage since probiotic products hit store shelves five years ago.

One can pick from curd (already a natural probiotic product), tofu, milk, even get their ice-cream fermented with millions of good bacteria.

Starting from August 15, the ICMR is going to study 400 strains of probiotics as possible alternatives to antibiotics in severe viral infections, infectious diarrhea, reducing pre-term birth and even to prevent transmitting the HiV virus through breast milk.

Mumbai Fortis Hospital Nutritionist Purva Duggal said, "The mechanism by which it actually facilitates or promotes health is by something known as competitive elimination where actually the probiotics, once ingested, compete for nutrient and space in our body thereby, they stop the growth of unwanted bacteria and once ingested, they will result in production of lactic acid which actually helps in eliminating the growth of the harmful bacteria."

Probiotic products can ease indigestion and acidity. In fact a study at Ohio University this year found a particular strain of probiotics, was nearly as good as antibiotics in treating diarrhea in children. But products need constant refrigeration - which was not mentioned on product labels, until the ICMR recently released guidelines.

Stress, alcohol, caffeine and medications are all killers when it comes to one's body's natural good bacteria. Probiotics can boost one's immunity, but till now, they are no substitutes of regular medications. Also, some people tend to have an intolerance towards probiotics, so one should always check with their doctors as to what suits them

Nothing to kid about

Having kidney stones is not a light matter and it is perhaps one of the most unfortunate and uncomfortable conditions. Dev Goswami tells you all that you need to know about them…

Suffering from kidney stones is a very strange experience. On one hand you experience constant bouts of extreme pain, yet most of your daily functions won’t be disturbed as they often are with other medical conditions. You will not have to apply for leave at work nor will you have a plethora of visitors coming in to check up on your condition. But, at the same time, suffering from kidney stones can be a serious situation. If left untreated it can lead to a range of other health conditions such as kidney damage, urinary tract blockage, urinary tract infection and urinary fistula.

Symptoms
The symptoms faced on contracting a kidney stone depend on the size of the stone and to what extent it can irritate the body. Extreme pain in the back or the side region that does not subside is the first major sign that you may be suffering from kidney stones. Dr. Ramesh Mahajan, an urologist at Fortis Hospital says, “Apart from the pain, other symptoms include blood in the urine, nausea and vomiting.” Also, since the body readies itself to fight with the condition, it may result in inflammation setting in, resulting in fever which sometimes maybe accompanied by chills.

Causes
Unlike most other conditions, suffering from kidney stones can be a result of factors which are not entirely in your hands. These causes include having a hereditary condition, having diabetes and diseases of the urinary tract. However, those which depend on you are habits such as not drinking enough water, excessive intake of carbonated drinks, eating too much of junk food and a poor lifestyle quality in general. The unfortunate nature of this condition becomes clear when we hear what Dr. Ramesh has to say, “A person who is pre-disposed to form kidney stones will always remain so for the rest of his life and there is nothing that can be done about that.”

Precautions
While you may not be able to completely prevent the condition from happening, you can take precautions that can decrease the risk considerably. Drinking adequate water should be first on the list of precautions.
Dr. Ramesh says, “No matter what the climate, you should drink enough water to produce about 2 to 2 ½ litre of urine everyday. Also, take care to eat a balanced diet which does not include excessive intake of junk food and carbonated drinks.” Those who are pre-disposed to the condition should especially take these precautions and also make sure that they undergo periodical tests. Keep in mind that in the early stages, when the stone is quite small in size, it will be easier to naturally flush it out of the system if you take proper care. If not diagnosed early enough, the stone may get bigger and you will have to opt for surgical treatments to remove it.

Recurrence
A person who has suffered from kidney stones is at a high risk of contracting them again if proper care and precautions are not followed. Dr. Ramesh says, “Once a patient gets kidney stones, there is a 25-30% increased chance of stones forming again.”
To ensure that this does not happen, it is essential to take the precautions mentioned above. Also, Dr. Ramesh advices that you should undergo sonography and urine tests once a year for at least 3 years after you have been cured of them.
One last thing you need to keep in mind is that this is a condition where you need proper advice and guidance from the first stage itself. So, make sure that you undergo proper tests and visit a doctor to stop it from turning into a major health problem for you.

Expert Speak
“When it comes to kidney stones, diet does not play that big a factor. If you are either pre-disposed to stone formation or your lifestyle is unhealthy, food will not help you to either prevent it or completely cure it. However, a balanced diet when combined with a healthy lifestyle will definitely help you reduce the risk of you suffering from kidney stones.”
— Dr. Ramesh Mahajan, Urologist, Fortis Hospital

Critical cases reach hospital late due to bad roads: docs

Critical cases reach hospital late due to bad roads: docs

HT Correspondent, Hindustan Times
Mumbai, July 30, 2011
Problems caused due to potholes – which have become a recurring feature in the monsoon – are not just limited to traffic congestion and bumpy rides for commuters. Pothole-filled roads in the city and the resulting traffic jams are endangering the lives of emergency and trauma patients,
who need to reach the hospital in the golden hour – the first 60 minutes following a serious injury.

“Precious time is lost because of delay in reaching the hospital, owing to the traffic snarls caused by potholes and waterlogging. Many emergency patients don’t reach hospital on time,” said Dr Khusrav Bajan, head of emergency at Hinduja Hospital.

The golden hour is the most critical period – a matter of life and death for the victim. This is particularly important for those who have suffered a heart attack, a brain stroke, or been seriously injured in an accident.

“In the event of a heart attack, if the patient does not receive the essential life-saving treatment in the first 90 minutes, irreversible damage can be caused,” said Dr Rajiv Karnik, interventional cardiologist, Fortis Hospital.

In fact, Dr Bajan said, doctors now follow the platinum half-hour rule, as even 60 minutes could be a little too long.

Nearly 50-60% of the emergency patients reach hospitals late in the monsoon. “The gap between an emergency call and the arrival of the patient in the hospital is significantly more presumably due to bad road conditions and traffic jams,” said Dr Karnik.

Not just the travel time, the commute also makes things doubly dangerous for patients. “Patients have to endure jerks. This is a major concern when we are handling cardiac and fracture cases,” said Sweta Mangal, chief executive officer, Ziqitza Health Care Ltd. which operates 35 ambulances as part of the Dial 1298 for Ambulance service in the city.

Ambulance providers also find it difficult to maintain the monitoring equipment. “In cardiac cases we have to continuously monitor the patient’s pulse. Some times the medical equipment get switched off due to the jerks and need to be restarted, which takes a few minutes,” said Mangal.

DNA