Chronic liver diseases are common worldwide, especially in developing countries. The rapid spread of Covid-19 leads to the infection of many patients with underlying chronic liver diseases. To discuss the same, we spoke to Dr Shiv Kumar Sarin, Director of Institute of Liver and Biliary Sciences (ILBS); Dr Anil Arora, Chairman, Institute Of Liver Gastroenterology & Pancreatic Biliary Sciences Sir Ganga Ram Hospital, and Dr Kaushal Madaan, principal director and head of Hepatology from Max chain of hospitals.
Q. What would be your advice regarding checkups to people with liver diseases and fear contracting Covid-19?
Dr Sarin: If somebody has cirrhosis, alcohol liver injury or cancer, they all require treatment and monitoring. So don’t put it away. Treatment for all liver diseases must be given and should not be delayed. Treatment is essential whether you opt for teleconsultation or go to the hospital. What you can do at home is to continue your diet and the prescription that the doctor has given.
Q. What would be your stand on alternative medication for liver diseases?
Dr Arora: Liver is an organ that does not require any servicing and maintenance till you intentionally or accidentally try to injure it. You don’t need any medication. You don’t need a specific diet. You don’t need any type of maintenance but do everything to prevent the damage.
Two major reasons why the liver gets damaged are if you are having too many of the calories in the diet, so initially, it gets deposited in the peripheral tissue that is subcutaneous tissue, and once those stores get exhausted, it tends to get into the vital organs. The liver is a central organ for the metabolism, production and synthesis of various proteins, and the integrated metabolism of fat, carbohydrates as well as proteins. It also is known to produce a number of coagulation and anticoagulation factors.
There have been guidelines from CDC, from our own ICMR and the Government of India and AIIMS, that stress on minimum medication. Even allopathic medicines are needed in minimum doses for a minimum duration of time. They will do more harm than good. Especially all chemicals, all ingestions, all food has to be metabolised through the liver. So anything and everything that you are taking for any purpose you have to take under the guidance of a registered medical practitioner, take it for a minimum period of time, at a minimum dose, for a minimum duration. Never self-medicate yourself.
Q. There were reports that drugs like azithromycin and remdesivir could affect the liver but they were widely prescribed by physicians. What would you say to liver patients?
Dr Sarin: Remdesivir cannot be given to patients with liver disease. Secondly, it is not proven beneficial. So I would be very hesitant to give. Azithromycin can also give liver injury. In fact, there is no reason to give these drugs if the patient has pre-existing liver diseases. Some Lancet papers stated that Covid-19 was more serious in those patients who had a BMI of about 25. In India, nearly 30%, one in three people, have a high BMI, they all have fatty liver. So, the disease is more common, more susceptible, injury is more progressive, and liver injury enzymes being abnormal or very high. Also, some people were mixing alcohol with Covid-19 pills as people were staying home and they were drinking.
Q. What would you say to those who have liver diseases, perhaps got Covid-19, have recovered and are craving alcohol?
Dr Arora: Drinking as a habit, when it is harmful for you, it is not recommended. If you look at our baseline population, which has non-alcoholic fatty liver disease coupled with so many metabolic abnormalities like diabetes, hypertension, these are all the risk factors that will aggravate the injury related to alcohol. Once in a while, socialising is understandable, but the problem is that alcohol is an addictive agent. If you look at the data from the US, the maximum number of cases that are being reported after cure from hepatitis is related to alcohol.
This is absolutely preventable. Not only on its own it causes problems, but in patients with underlying fatty liver or those with hepatitis B or C, this alcohol is an added synergistic effect to cause further liver damage. So, unless you are sure that there is nothing wrong, you should avoid alcohol.
Q. Does Covid affect more severely to liver cirrhosis and liver transplant patients?
Dr Madaan: There is ample data to suggest that patients who have the fatty liver disease will have a severe lung disease when they get Covid-19. They have very poor outcomes and more of them end up in the ICU. Patients, who are just at the stage of waiting for a transplant, are the ones with advanced liver diseases. So, if they get Covid-19, they are at high risk of dying. If they have a new liver, they already are immunosuppressed. Some schools of thought say that since they are already immunosuppressed, they’re not able to mount an immunoinflammatory response to Covid-19 so they may have mild disease. But this is a controversial issue.
Dr Sarin: If the transplant was done within the last three months, Covid-19 can be very severe, and you should act quickly. People who are on heavy immunosuppressants have rejections even after a year, and if they get a Covid infection, there is a problem again. Covid-19 does not make people’s health condition worse but they are already predisposed to other illnesses.
The liver is the root cause of diabetes and blood pressure and high triglycerides. If you have fatty liver or are obese, diabetic, comorbid, then you must look at the liver enzymes. Covid-19 gives you all a chance to lose weight. Become healthy, lean, and thin, so that unfortunately, if the third wave comes, you are strong, your liver is strong, and your body is strong.
Q. Tell us about the post-Covid care for liver patients?
Dr Sarin: Patients with liver disease have weak muscles. We call it sarcopenia. Even if they are obese, they have limited muscle power. If your liver is weak, your muscles are also weak and after Covid-19, there is extreme fatigue and loss of appetite. You have to be more careful about this and get your antibodies done if you need them. For a patient with cirrhosis after recovering from Covid-19, he needs to remember that the liver can digest more fats than pure carbohydrates. So avoid carbs. Your main diet should be protein-based and the energy source can be fat. Exercises are essential.
Dr Arora: All those who suffer from Covid-19 are likely to come down with ‘Long Covid’. There are many reasons for that. You may have a bit of virus or the immune process which may still be simmering around the body or an immune complex disease that may be present or activation of the immune system. Coming back to the liver patients, if you have a concomitant Covid, you may have multiple reasons why the liver can get affected. It may occur due to the hyperinflammatory syndrome which comes out from the lungs and gets disseminated in the body, of which the liver gets the major share of the blood. Several drugs that are given to treat Covid-19 have indirect toxicity on the liver. If you have had a recent infection, you are likely to come down with more complications. Regularly follow up with a liver specialist if you have underlying liver disease.
Q. Liver patients have compromised immunity, they may not have enough antibodies. So, is the vaccine good for them?
Dr Arora: In the initial registration trials that were conducted in the US and UK, they excluded patients who had chronic liver diseases or those with an immunocompromised state. There is data published on Pfizer’s registration trial that has shown that the chance of development of antibodies is only 20% in patients with advanced liver disease or liver transplantation. Not all those with the immunocompromised state will develop antibodies. All patients who have an immunocompromised state will not produce antibodies. But in case you have developed antibodies and can be more confident that you won’t have the viral infection, don’t be under the wrong impression that you have been protected. If you don’t have antibodies even after vaccination, you have to be extra careful. You must be extra cautious.
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The Power of Seva
If I were to ask you as to what differentiates the human species from other species, your response would probably be that humans are bipedal, have the power of language, are self-aware, can think, but what really differentiates us is our capacity to do “seva”, our ability to help others. Only the human species has this capacity for helping all life forms, which we call altruism, prosocial and philanthropic behaviour. But the essence is captured in the word ‘seva.’
Seva is a Sanskrit word meaning selfless service and is perhaps considered the most important part of our existence. It asks us to serve others with no expectation of outcome. A parallel western concept is volunteerism/help/service/community/social service, philanthropy, and the more contemporary and chic Corporate Social Responsibility and Institutional Social Responsibility.
Seva is a motivational state that a person possesses with the goal of increasing the welfare of another living being. While Seva, on the surface, seems to benefit others, it is actually the individuals engaged in Seva who also benefit. Seva is positively correlated with happiness, health, and well-being. People who did Seva showed greater satisfaction in life and exhibited reduced rates of depression and anxiety. So when you feel depressed, lonely, or anxious, go out and do seva. It could be working with animals, humans, the environment, etc. It is therapeutic and all-consuming and leaves no room for negativity.
While many of us feel drawn to helping others, our ego tends to drop in and voice our own thoughts. We use it to promote ourselves, our brands, and flaunt our service, which makes it counterproductive. Ego can also judge how we serve others. It may tell us that some types of service are more noble than others. “Oh, you help your neighbour once a week with her groceries? Well, I run events that serve 500 people.” “Oh, you help animals. Why don’t you help old people or children? “ This is not seva but the ego at work, because the aim of seva is to silence the ego, dissolve the ego, as all mental diseases emanate from the ego and its fears.
When we serve with the essence of seva in mind, we begin to see the myriad ways the ego, the source of all our troubles, is standing in front of the heart. When we transition from the head to the heart, then Seva becomes a practice of purification, a spiritual act. It is also in listening to the heart that we begin to understand that our innermost nature is a giving one. While the ego mind may tell us we need to focus on ourselves and even when we serve, it is when we shift into the spirit of seva that we realise we are naturally kind. In other words, we are naturally moved to serve others. It is when we do seva that we realise that all life is connected and working for others is the only path to mental fitness, wellness, and wellbeing and the royal road to spiritual growth.
The question you need to ask yourself for your happiness is, “Did you do Seva today?”
Dr Chavi Sharma Bhargava is the founder and CEO of Indic Center for Psychological Wellness and Holistic Health and Conversationists-Talking Cures.
Dr. Vishali Gupta becomes the first Indian in Asia to become President of the global Uveitis body
In a rare feat, an ophthalmologist from India, the First in Asia outside US and Europe, has become President of the International Uveitis Society Group and has been able to mark PGIMER at the global level. Uveitis is a field of medical science in which rare specialists are found and trained. The Daily Guardian had a one-on-one conversation with Dr. Vishali Gupta on this and talked about her responsibilities as president of this prestigious society.
What is this society all about? What is Uveitis?
The International Uveitis Study Group was formed in 1978 by a small number of clinicians who shared a common interest in Uveitis. Over the next almost 40 years, the group has increased in size to over 180 Uveitis specialists from all over the world.
What is uveitis?
Uveitis is the name given to inflammation inside the eye that, in some patients, can lead to blindness. It can affect one or both eyes, and the inflammation involves the uveal tract (iris, ciliary body, and choroid), although inflammation of adjacent tissues, such as vitreous humour, retina, and optic nerve also occurs. It could be due to autoimmune disease and seeing no age.
How long has the PGIMER been treating Uveitis, and how many experts does the department have?
PGIMER, under the stewardship of Dr. Amod Gupta, has been working in the field of Uveitis since the 1990s. Then a team of five experts inducted Tuberculosis in Uveitis for the first time in the world. PGIMER has a special clinic for Uveitis patients, and these patients’ treatments are long, sometimes lifelong. Since PGIMER has Rheumatology, Microbiology, Research Scientists, and Pediatricians all under one roof, it is easy for the patients to get the best treatment. In the other sectors, it is not that easy.
Foods that can help you REDUCE headaches, migraine
Following a healthy diet can increase longevity, protect against disease, and improve your overall quality of life. Several nutrients in food promote health and protect your body from disease. The “Food as Medicine” concept generally refers to managing food and diet in an individual’s routine, with the aim of preventing, reducing symptoms of, or reversing a disease process. Research has shown that dietary habits can influence risk factors for disease. While certain foods can trigger and aggravate health conditions, others may offer significant medicinal and therapeutic advantages.
Headaches are a common occurrence that is encountered routinely by individuals. A study conducted by Biman K Ray in 2017 revealed that the one-year prevalence of migraine in an Indian population was found to be 14.12%. Headaches can be triggered by several small incidents that might not be considered significant. Sleepless nights, skipping breakfast, work pressure or stress, and excessive blue-screen exposure are all examples of irregular routines that can cause headaches. Migraine is a disabling primary headache disorder experienced predominantly by women and triggered by hormonal, emotional, physical, dietary, environmental, and medicinal factors.
In individuals, migraine triggers can include specific foods or types of foods. Eating a healthy diet can help prevent migraines and headaches. Alternatively, certain foods can decrease the frequency of migraine headaches or lessen the intensity of their symptoms. Though no definitive ‘migraine diet’ has been described,’ individuals may be able to reduce their migraines by monitoring the food that they eat.
Foods to avoid
Nuts and certain seeds: Tyramine, present in nuts and certain seeds, can induce headaches and migraines.
Cheese: Aged cheese consists of high levels of tyramine, which aggravates migraines and headaches.
Caffeine: According to clinical studies, drinking more than one to two cups of coffee per day can cause migraines in 14% of patients.
Chocolate: Chocolate is the most common migraine food trigger, and it has been epidemiologically linked to migraine attacks, so doctors typically advise migraine patients to avoid it.
Tomato-based products: They contain a high amount of histamine or tyramine that can aggravate migraines.
Avoid processed (packaged) foods: Nitrates and nitrites present in processed foods cause swelling of the blood vessels and can trigger migraines.
Foods to consume
Dark green leafy vegetables: Study published in BMJ Case report revealed that inclusion of leafy vegetables in meals can play pivotal role in relieving migraine or chronic headache .
Turmeric: Curcumin present in turmeric helps in relieving migraine frequency and duration.
Coriander: Consumption of coriander leads to a greater reduction in the duration, severity, and frequency of migraines.
Citron: It has reported several benefits in clinical trials however it also helps in reducing migraine intensity and duration.
Clinical trials of several herbal medicines indicate that various foods, through their multifactorial physiological influences, present potential options to improve migraine treatment.
The author is MD, Clinical Pharmacologist and Nutraceutical Physician, Founder and CEO IntelliMed Healthcare Suctions.
Active Covid cases have decreased, with 3,947 cases reported in the last 24 hours
According to Union Health Ministry data updated on Friday, India’s COVID-19 case tally increased by 3,947 in a day to 4,45,87,307, while active cases decreased to 39,583.
The death toll has risen to 5,28,629, with 18 more deaths, including nine fatalities reconciled by Kerala, according to data updated at 8 a.m.
According to the health ministry, active cases account for 0.09 per cent of total infections, while the national COVID-19 recovery rate has increased to 98.73 per cent.
The daily positivity rate was 1.23 per cent, with a weekly positivity rate of 1.44 per cent.
The number of active Covid cases fell by 1,167 in a single day, while the number of people who recovered from the disease rose to 4,40,19,095. The case fatality rate was calculated to be 1.19 per cent.
According to the ministry, the Nationwide Vaccination Drive has resulted in the administration of 218.52 crore total vaccine doses (94.84 crores second dose and 21.19 crore precaution dose).
Two deaths were reported in Maharashtra and West Bengal, and one each in Uttar Pradesh, Punjab, Karnataka, Haryana, and Chhattisgarh. Kerala has made amends for nine deaths.
On August 7, 2020, India’s COVID-19 case tally surpassed 20 lakh, followed by 30 lakh on August 23, 40 lakh on September 5, and 50 lakh on September 16. It surpassed 60 lakh on September 28, 70 lakh on October 11, 80 lakh on October 29, 90 lakh on November 20, and one crore on December 19.
Last year, the country passed the two crore mark on May 4 and the three crore mark on June 23. On January 25, this year, it surpassed the four-crore mark.
PREVENTION: HOW TO KEEP YOUR HEART HEALTHY AT AGE 40
An individual becomes more concerned about their health as they reach a certain age. As the most vital organ of the body, the heart requires extreme care as its chances of developing cardiac diseases increase with age.
Among older people, heart disease is the leading cause of morbidity. To reduce the risk of CVD in middle age, it is recommended to maintain or increase physical activity. Dr AnbuPandian, Medical Advisor, Agatsa, shared some tips to keep the heart healthy at 40 with us.
The most effective way to prevent heart disease at 40 is to adopt a healthy lifestyle. If you work nine hours in an office job, take short breaks every two hours. Taking the stairs instead of the lift, walking short distances instead of using a vehicle or public transportation. Exercise, meditate, swim, play basketball, dance, and do yoga—whatever you love.
Physical exercise has been shown to have a positive effect on heart health in comparison to sedentary lifestyles in various studies. A great quality of life is dependent on a healthy heart. Maintaining a regular exercise routine will keep the heart healthy for years to come.
Regular Heart Health Check-ups
A heart health check-up is essential at every stage of life, but becomes especially crucial after age 40. There are several factors that determine how often a person should get a check-up, including smoking, alcohol consumption, heart disease in the family, being overweight, and diabetes. Blood sugar and cholesterol levels should also be monitored closely. Heart diseases can be better treated if they are detected early. Once a person crosses the age of 40, a yearly checkup is mandatory. The physician may recommend more frequent check-ups if heart disease is detected.
As age increases, metabolism tends to decrease by 5 % every decade after 40. Hormonal imbalance and bone density are two other significant changes that the body registers while getting old. Increase the intake of fruits rich in Vitamin C. All citrus fruits, for that matter, have a bonus heart-healthy benefit. The best diet for preventing cardiac disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils. Individuals who follow their dietary pattern have a 31% lower risk of heart disease than those who consume junk food.
Remote Monitoring Machines
Remote monitoring machines have been around for years but have gained significant prominence recently, thus resulting in high demand. Such devices are used on a daily basis to monitor diseases such as heart attacks, hypertension, and diabetes. These devices are very portable, user-friendly and capture patients’ health parameters via cables and sensors. These devices are cost-effective for patients because they reduce medical care costs and provide more timely intervention for chronic conditions. No one can slow down the ageing process. However, with proper care, one can be more fit, look younger, and lead a more energetic and active life. Life doesn’t end, but begins afresh again at 40!
The author is a Medical Advisor at Agatsa.
Why heart attacks are on the rise among women
Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Heart diseases are no longer a “men’s problem” and women too are equally prone to them. According to a recent report published by the National Family Health Survey, it was found that the overall prevalence of undiagnosed hypertension in women of the age group 15–49 years is 18.69% in India, which busts the myths that heat conditions are most prevalent among men.
Several other international studies have also indicated that heart ailments are now a leading cause of death among women, resulting in ten times more fatalities than breast cancer. Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Why are heart diseases going undetected in women? While ensuring the well-being of their loved ones, women in India tend to ignore their own needs and often neglect their health. For instance, if a woman has mild chest pain, she would rather ignore the symptoms and focus on managing the work/household chores rather than visiting a doctor. The patriarchal setup of our society also expects women to keep the well-being of others at the forefront rather than taking care of themselves, which results in late diagnosis and is one of the primary causes of increasing heart ailments among women in the country.
As the symptoms of a heart attack are different in both men and women, many women often don’t know if they have already suffered one or two heart attacks in the past until eventually, they visit a doctor. While in men, a heart attack usually results in extreme and sudden chest pain and breaking out in cold sweats, whereas in women, the symptoms are usually mild and heart attacks can be frequent and smaller. The symptoms in women can range from jaw pain to fatigue to pain in the neck and back to sweating or just heartburn, indicating the need for them to undergo regular health check-ups and take proactive measures to ensure overall well-being.
Which age group is most susceptible to heart attacks and what are the major concerns?
Women of the age group 45–55 years are at a high risk of experiencing a heart attack due to low levels of estrogen post menopause, work and family-related stress, loneliness, and lack of physical activity. More women in this age group may go undiagnosed and have atypical symptoms compared to men.
The second most affected age group is 60 years of age, where the biological deterioration makes both men and women more susceptible to heart attacks. High cholesterol, blood pressure, obesity, smoking, sedentary lifestyle, and diabetes are also some of the main concerns that make women more prone to cardiovascular diseases.
How can women take care of themselves and keep heart attacks at bay?
There are several steps that women can take to prevent heart ailments, such as:
- Educate yourself and increase awareness about the risk factors that can lead to blockages.
- Avoid smoking or the use of tobacco.
- Engage in physical activities like yoga, dancing, running, and walking for 30–45 minutes every day to maintain heart health and overcome obesity.
- Avoid junk food, aerated drinks and adopt a balanced diet. Healthy heart diets that include complex carbohydrates, legumes, fruits, vegetables, and less sugar, salt, and fat can have a positive impact on heart health.
Lastly, it is important to note that gender has nothing to do with heart attacks, and the condition affects both men and women equally. However, adopting a healthy lifestyle and undergoing regular health checkups can help you get the gift of good health.
The author is a Senior Consultant at Interventional
Cardiology, Aster CMI
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