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Good nutrition and regular tests important for women today: Experts

Changing an unhealthy lifestyle and diet, maintaining good hygiene, getting regular check-ups and increasing awareness of the body’s processes are all good ways for women in India to keep a check on their health, suggest top experts.

Shalini Bhardwaj

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Data has shown that only 12% of women in India take decisions regarding their own healthcare. In a country which has a large number of anaemic women, women who die during childbirth and women who fall prey to cervical cancer, how can we ensure better health for half of the population? Experts Dr Ruchi Malhotra, Senior Gynaecologist and IVF Expert at Fertile Solutions IVF Centre, Dr Sheetal Aggarwal, Senior Gynaecologist at Apollo Cradle Royale, Dr Richa Jaiswal, Dietician at AIIMS, and Dr Ekta Bajaj, Senior Gynaecologist at the Ujala Cygnus Hospital, weigh in on important questions about women’s health in an interview with The Sunday Guardian.

Dr Ekta Bajaj

Dr Ruchi Malhotra

Dr Richa Jaiswal

Dr Sheetal Aggarwal

Data has shown that only 12% of women in India take decisions regarding their own healthcare. In a country which has a large number of anaemic women, women who

Q: Why is nutrition so important for women’s health?

Dr Aggarwal: The woman is the backbone of society and if she is weak, society is weak. A woman menstruates every month and loses around 30-40 ml of blood per cycle, so she has to replace that. During the reproductive phase, she gives birth to children, who are just like parasites and draw nutrition from the body, irrespective of whether the mother has adequate iron or calcium reserves. This makes it important for the mother to replace all the nutrition she has lost during this time. Today, women are multitasking. They are going out to work as well as looking after their homes and this drains them physically and mentally. Thus, a woman’s nutrition should be a priority area in a national or a state budget.

Q: What is the reason for an increase in infertility, especially among younger women?

Dr Malhotra: This is a very important question. It is because most women are delaying getting married, as many of us are career-oriented, and age is directly related to fertility. Higher the age, lower the fertility. Lifestyles have also changed as there is too much stress. Having more junk food and alcohol, smoking and a sedentary lifestyle also lower fertility.

Q: Can you name the health tests which are a must for every woman?

Dr Bajaj: These are precautionary times so every healthcare approach should be more prophylactic than treatment. Women should go for proper health check-ups for cervical cancer and screening tests like the Pap smear (now called LBC and HPV test). According to the WHO, every woman should take this HPV test after the age of 24 every five years and the LBC Pap smear every three years. As far as breast cancer is concerned, after the age of 35, mammography is very important. If there is a history of breast cancer in the family, one can even go for it before the age of 35. We see young girls of 25-30 years of age in our OPD with lesions like fibroadenosis and fibroadenoma, for which we suggest an ultrasound or MRI. Routine blood tests to check complete blood count, thyroid function test, lipid profile, LFT and TFT should also be part of a woman’s healthcare, keeping in mind the increasing cases of anaemia in India.

Q: What kind of care is required during puberty?

Dr Aggarwal: Puberty is the time when a female starts menstruating. It is generally an anovulatory cycle, which is the period of the first two or three years when the ovaries are not producing eggs. So, a girl may not first bleed for two or three months and then bleed for one month or so. Concerned mothers often come to us saying, our child has not been having periods for three months or the bleeding is too heavy. This is why we need to counsel the mother and the child; we can’t simply put her on hormones. Secondly, diet is very important as we have to ensure that the girl doesn’t become weak. She has to take an iron-rich diet if she continues to bleed. We may give her some haemostatic agents so that bleeding reduces or stops, but never put her on hormones at such a young age to regularise them. Moreover, such young girls should not be put under any kind of stress.

Q: What are some healthy lifestyle choices that all women must make?

Dr Jaiswal: To summarise, meal timings are very important, as most women are driven by emotions and tend to give more time to family members rather than herself. Women shouldn’t skip meals, especially breakfast. Something ready-to-eat and nutritionally fulfilling should be in their bags so they can eat that anytime. Secondly, fibre is very important. Every age has a different demand and folic acid, iron and calcium are important at different stages. There is also a change in the hormones of a woman every ten years which requires support and a stress-free life. Along with nutrition, physical activities and a holistic approach to health should be taken. A good amount of fluid intake (non-carbonated) and fibre intake should be encouraged. Diet should be wholesome.

Q: Would you add anything about the importance of a healthy diet?

Dr Jaiswal: It is important to start reading about food levels. Food diversity is also very important and in a country like India, where we have very diverse foods available, we should not avoid seasonal foods. Women should embrace practices like ‘poshan ke liye paudhe’ (plants for nutrition) and grow plants for good foods. The importance of nutrition for women must also be inculcated among men in order to bring wider changes in society.

Q: Many women starve themselves to lose weight. How can it be harmful?

Dr Jaiswal: Starvation isn’t absolutely wrong but it should be time-bound and well-monitored, and the expected deficiencies should be taken into consideration. A team should work with a person for binding the time of fasting and what should be eaten after breaking the fast. Weight reduction should not be undertaken through starvation but a holistic approach with complete nutrition. The aim should be to maintain an ideal body weight and also provide basic nutrition according to their particular age group.

Q: How important is hygiene?

Dr Bajaj: Hygiene is very important as women are prone to infections like UTIs and vaginal infections. Hygiene plays a major role, even before any antibiotics do their work. There are campaigns on menstrual hygiene now and people are becoming more aware about it.

Q: Any tips regarding menstrual hygiene?

Dr Malhotra: During menstruation, one should change her pad every 4-6 hours and use clean toilets. Women also need to learn the importance of using sanitary pads rather than other products in the market.

Q: What other health problems need to be discussed more?

Dr Aggarwal: PCOD is a very common problem in which the ovaries ovulate but the eggs are not released into the fallopian tubes, making the ovaries polycystic. Because this is an anovulatory cycle, hormonal imbalance takes place. Hence, the testosterone level rises in the female, leading to hair growth on the upper lip and chin, acne formation and neck pigmentation. Since it is a lifestyle disorder, women also tend to become obese and have irregular cycles. This can also cause infertility and loss of confidence. Earlier, PCOD could be seen in younger age groups, but now I see it in the reproductive age groups too. To prevent it, lifestyle changes need to be made, the woman has to be put on a diet, and if she is obese, she has to lose weight. Even if she loses 10% of it, most problems would be solved. So, the main concerns are having a proper diet, being physically active and proper medication.

Q: Studies indicate that every eight minutes a woman in India dies due to cervical cancer, more than 48% of women are anaemic, only 21.8% mothers get full antenatal care, and more than 1 lakh women die every year due to pregnancy-related problems. What can be done to improve such a scenario?

Dr Bajaj: You have raised three issues: anaemia, cervical cancer and pregnancy-related problems. First of all, anaemia is very common in India because women lose too much blood every month. Iron and calcium supplements are very important to eradicate this, especially during pregnancy and lactation, as blood is comparatively thinner at these times. There is also no proper spacing between births and after one or two years, they are pregnant again, when their body is not prepared, and thus the situation worsens.

For cervical cancer, tests like LBC and HPV are very good as precautionary measures to reduce the number of cases. We cannot reach each and every woman in the country due to India’s high population but we should definitely try. Screening tests should be done too. Most importantly, the cervical cancer vaccine should be used frequently. There are two types of vaccines available and they are expensive—it costs between Rs 2,000 and Rs 3000—and needed in three doses which cannot be affordable for everyone. But the vaccine is very important and effective as it prevents cervical cancer. So, awareness programs for the vaccine must be promoted and this vaccine should be added to the national immunisation programme because the ideal age for this vaccine is 9-13 years. Secondly, screening should be done.

Regarding pregnancy issues, maternal mortality is very high in spite of all the efforts taken. The main reasons are anaemia and delivery-related complications. In spite of so many hospital services, people still deliver at home, which is really not good and may lead to the death of the mother. So, the government should also promote hospital deliveries.

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REMOTELY SUPERVISED EXERCISE CLASSES ARE BEST OPTION DURING COVID

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The findings of a new study suggest that remotely supervised workout sessions are more effective than face-to-face exercise classes during the COVID-19 pandemic. The findings of the study appeared in the journal ‘Psychiatry Research’. Researchers at the University of Sao Paulo (USP) in Brazil investigated the effects of regular exercise on the physical and mental health of 344 volunteers during the pandemic.

The study compared the effectiveness of three techniques: sessions led in person by a fitness instructor, sessions featuring an online instructor but no supervision, and sessions supervised remotely by an instructor via video call. The two kinds of sessions with professional supervision had the strongest effects on physical and mental health. According to the researchers, this was due to the possibility of increasing the intensity of the exercises over time.

To their surprise, remotely supervised sessions were more effective than face-to-face sessions. Sedentary subjects served as controls. “The findings underscore the benefits of either approach, with the instructor online or physically present, compared with being sedentary. However, the physical and mental benefits have much to do with a secure and progressive increase in the intensity of the exercises, which occurred only when they were supervised by a professional. What’s interesting is that remote supervision by video call was more efficient. The difference was small but statistically significant,” Carla da Silva Batista, last author of the study, told Agencia FAPESP.

Batista is a researcher at the University of Sao Paulo’s School of Physical Education and Sports (EEFE-USP). The study was supported by FAPESP. Volunteers were selected from different age and income groups and came from different parts of Brazil. Some had symptoms of depression. The remotely supervised participants, who worked out using Pilates, Crossfit, yoga, dance and aerobics, exercised more intensely than those who lacked supervision.

“Increasing intensity in supervised online sessions was of paramount importance during the pandemic,” Batista said. “Around half the participants, or 55 per cent, performed high-intensity exercises before the pandemic, but the proportion fell to 30 per cent once lockdown began.” Other research shows intense exercise increases longevity, reduces the risk of developing Parkinson’s disease, and is associated with a reduced risk of 26 types of cancer.

“We don’t know exactly why working out with remote supervision by video call gets better results than when the instructor is physically present,” Batista said. “It’s probably that the participants felt the discomfort of wearing a mask hindered their performance during the pandemic.”

Other reasons could include the possibility that remotely supervised participants were more motivated. “They were doing exercises in safety and at home, but with supervision and without having to wear a mask. They didn’t have to worry about spreading the virus, so the instructor may have felt free to increase the intensity of the exercises safely, without risking injury or discomfort,” Batista said.To evaluate the participants’ physical and mental health, in July-August 2020 the researchers applied validated online questionnaires known as the International Physical Activity Questionnaire – Short Form (IPAQ-SF) and the Montgomery-Asberg Depression Rating Scale – Self-Rated (MADRS-S).

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Chemotherapy can induce mutations that lead to pediatric leukemia relapse

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A new study has found that a group of chemotherapy drugs can result in mutations that may trigger the relapse of blood cancer in children.Chemotherapy has helped make acute lymphoblastic leukemia (ALL) one of the most survivable childhood cancers. Now, researchers working in the US, Germany and China have shown how chemotherapy drugs called thiopurines can lead to mutations that set patients up for relapse. The findings of the study were published in the journal ‘Nature Cancer’.

The research provided the first direct genomic and experimental evidence in pediatric cancer that drug-resistant mutations can be induced by chemotherapy and are not always present at diagnosis. “The findings offer a paradigm shift in understanding how drug resistance develops,” said Jinghui Zhang, PhD, Department of Computational Biology chair at St. Jude Children’s Research Hospital.

“The results also suggest possible treatment strategies for ALL patients who relapse, including screening to identify those who should avoid additional thiopurine treatment,” added Zhang. Zhang is co-corresponding author of the study with Bin-Bing Zhou, Ph.D., of Shanghai Children’s Medical Center; and Renate Kirschner-Schwabe, M.D., of Charite-Universitaetsmedizin Berlin.

THE ROOTS OF RELAPSE

While 94 per cent of St. Jude patients with ALL become five-year survivors, relapse remains the leading cause of death worldwide for children and adolescents with ALL. This study involved ALL samples collected from relapsed pediatric ALL patients in the US, China and Germany. Researchers analysed more than 1,000 samples collected from the patients at different times in treatment, including samples from 181 patients collected at diagnosis, remission and relapse.Co-first author Samuel Brady, PhD, of St. Jude Computational Biology, identified a mutational signature that helped decipher the process. Mutational signatures reflect the history of genetic changes in cells.

Brady and his colleagues linked increased thiopurine-induced mutations to genes such as MSH2 that become mutated in leukemia. The mutations inactivated a DNA repair process called mismatch repair and rendered ALL resistant to thiopurines. The combination fueled a 10-fold increase in ALL mutations, including an alteration in the tumour suppressor gene TP53. The mutation, TP53 R248Q, promoted resistance to multiple chemotherapy drugs, including vincristine, daunorubicin and cytarabine.

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STUDY SUGGESTS EXCESS COFFEE CONSUMPTION COULD INCREASE RISK OF DEMENTIA

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It’s a favourite first-order for the day, but while a quick coffee may perk us up, new research from University of South Australia showed that too much could be dragging us down, especially when it comes to brain health.In the largest study of its kind, researchers have found that high coffee consumption is associated with smaller total brain volumes and an increased risk of dementia. The findings were published in the journal ‘Nutritional Neuroscience’.

Conducted at UniSA’s Australian Centre for Precision Health at SAHMRI and a team of researchers, the study assessed the effects of coffee on the brain among 17,702 UK Biobank participants, finding that those who drank more than six cups of coffee a day had a 53 per cent increased risk of dementia. Lead researcher and UniSA PhD candidate, Kitty Pham, said the research delivers important insights for public health. “Coffee is among the most popular drinks in the world. Yet with global consumption being more than nine billion kilograms a year, it’s critical that we understand any potential health implications,” Pham said.

“This is the most extensive investigation into the connections between coffee, brain volume measurements, the risks of dementia, and the risks of stroke – it’s also the largest study to consider volumetric brain imaging data and a wide range of confounding factors,” Pham added.

“Accounting for all possible permutations, we consistently found that higher coffee consumption was significantly associated with reduced brain volume – essentially, drinking more than six cups of coffee a day may be putting you at risk of brain diseases such as dementia and stroke,” Pham further said.Dementia is a degenerative brain condition that affects memory, thinking, behaviour and the ability to perform everyday tasks. About 50 million people are diagnosed with the syndrome worldwide. In Australia, dementia is the second leading cause of death, with an estimated 250 people diagnosed each day.

Stroke is a condition where the blood supply to the brain is disrupted, resulting in oxygen starvation, brain damage and loss of function. Globally, one in four adults over the age of 25 will have a stroke in their lifetime. Data suggests that 13.7 million people will have a stroke this year with 5.5 million dying as a result.Senior investigator and Director of UniSA’s Australian Centre for Precision Health, Professor Elina Hypponen, said while the news may be a bitter brew for coffee lovers, it’s all about finding a balance between what you drink and what’s good for your health.

“This research provides vital insights about heavy coffee consumption and brain health, but as with many things in life, moderation is the key,” Professor Hypponen said. “Together with other genetic evidence and a randomised controlled trial, these data strongly suggest that high coffee consumption can adversely affect brain health. While the exact mechanisms are not known, one simple thing we can do is to keep hydrated and remember to drink a bit of water alongside that cup of coffee,” Professor Hypponen added.

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A NEW STUDY FINDS COVID-19 PATIENTS WITH MALNUTRITION AT HIGHER RISK OF DEATH

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According to a new study, adults and children with COVID-19 who have a history of malnutrition may have an increased likelihood of death and the need for mechanical ventilation. The findings of the study appeared in the journal ‘Scientific Reports’. Malnutrition hampers the proper functioning of the immune system and is known to increase the risk of severe infections for other viruses, but the potential long-term effects of malnutrition on COVID-19 outcomes are less clear.

Louis Ehwerhemuepha and colleagues investigated associations between malnutrition diagnoses and subsequent COVID-19 severity, using medical records for 8,604 children and 94,495 adults (older than 18 years) who were hospitalised with COVID-19 in the United States between March and June 2020.Patients with a diagnosis of malnutrition between 2015 and 2019 were compared to patients without.

Of 520 (6 per cent) children with severe COVID-19, 39 (7.5 per cent) had a previous diagnosis of malnutrition, compared to 125 (1.5 per cent) of 7,959 (98.45 per cent) children with mild COVID-19. Of 11,423 (11 per cent) adults with severe COVID-19, 453 (4 per cent) had a previous diagnosis of malnutrition, compared to 1,557 (1.8 per cent) of 81,515 (98.13 per cent) adults with mild COVID-19.Children older than five and adults aged 18 to 78 years with previous diagnoses of malnutrition were found to have higher odds of severe COVID-19 than those with no history of malnutrition in the same age groups.

Children younger than five and adults aged 79 or above were found to have higher odds of severe COVID-19 if they were not malnourished compared to those of the same age who were malnourished. In children, this may be due to having less medical data for those under five, according to the authors. The risk of severe COVID-19 in adults with and without malnutrition continued to rise with age above 79 years.

The authors suggest that public health interventions for those at the highest risk of malnutrition may help mitigate the higher likelihood of severe COVID-19 in this group.

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HOW TO DEAL WITH ‘LONG COVID’ IN KIDS

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Coronavirus has left a scar on our minds, and its impact is not only felt by adults but kids as well. The concept of ‘long COVID’ is not well defined yet, but there are several research papers that highlight the long-term effects of COVID on various age groups. Children who have battled COVID are coming back to hospitals with post-COVID symptoms like persistent headaches, fatigue, abdominal pain, gastric issues, heart palpitations, difficulty to sleep, muscle pain, loss of smell, and Tachycardia (increased heart rate). This symptom typically manifests after 2-4 weeks of the initial infection and may last for weeks to months. 

RISK FACTORS FOR KIDS: Adolescents and teenagers may be prone to witness long COVID symptoms. Moreover, children with higher BMI or obesity are at higher risk of experiencing long COVID.  Initially, we were under the impression that long COVID can occur in kids having acute infections. However, that has changed over time, and we see a lot of children with asymptomatic and mild infection also experiencing long COVID. Having said that it is important to note that kids experiencing such symptoms should be properly screened by medical experts as many of these could be a result of mental health issues induced by the lockdown and pandemic. 

 There are studies that indicate that isolation and lockdown have resulted in mental health issues among kids, further resulting in headaches, fatigue, anger, misbehaviour, and similar issues. Parents and doctors need to ensure proper diagnosis of these health ailments. 

MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C) A CAUSE OF MANY SUCH LONG COVID ISSUES IN KIDS: MIS-C in children is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. We know that many children with MIS-C had the COVID virus or had been around someone with COVID19. When a child’s immune system reacts extensively to fight the virus in such cases, the immune system adopts in abnormal ways to fight the disease and that’s when organs start to get inflamed causing MIS-C. MIS-C can be serious, even deadly, but most children diagnosed with this condition have gotten better with medical care. 

SYMPTOMS OF MIS-C: Signs and symptoms of MIS-C in children include: 

• High-grade fever that lasts 24 hours or longer 

• Vomiting 

• Diarrhoea 

• Pain in the stomach 

• Skin rash 

• Feeling unusually tired 

• Fast heartbeat 

• Rapid breathing 

• Red eyes 

• Redness or swelling of the lips and tongue 

• Redness or swelling of the hands or feet 

• Headache, dizziness, or light-headedness 

DIAGNOSIS AND TREATMENT OF MIS-C: If MIS-C is suspected, a diagnostic or antibody test for COVID19 can help confirm current or past infection with the virus, which aids in diagnosis and treatment. 

TESTS YOUR DOCTOR MAY PRESCRIBE, TO LOOK FOR INFLAMMATION OR OTHER SIGNS OF THE DISEASE, INCLUDE: 

• CBC Blood tests 

• C-reactive protein test 

• Chest X-ray 

• Heart ultrasound (echocardiogram) 

• Abdominal ultrasound 

Usually, supportive care for symptoms i.e., medicine and/or fluids are given to make your child feel better, coupled with various medicines to treat inflammation. Most children who become ill with MIS-C will need to be treated in the hospital. To treat this condition normally, Intravenous Immunoglobulin (IVIG) to improve antibody content or steroids in appropriate dosages is given. All these medications are given, and the children are kept under observation. Some children may need to be treated in the Paediatric Intensive Care Unit (ICU) if they are severely ill. 

Above all, prevention is always better than cure. Vaccinate your kids with the flu vaccine to reduce the impact of any viral infection. More so, follow COVID-appropriate norms at home and outside. Ensure that your kids stay hygienic and maintain COVID19 norms. 

The Author is Consultant Paediatrics & Neonatology, Fortis Hiranandani Hospital Vashi & Dr Asmita Mahajan, Consultant Neonatology & Paediatrics, SL Raheja Hospital, Mahim. 

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Benefits and afflictions of using Giloy

Meenakshi Upreti

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A year and a half have passed since the Covid-19 pandemic swept across the globe. While there seemed no possible cure for the disease and researchers intensified their search for effective treatment and vaccine, many clinical trials were happening around the world and herbs emerged as a possible alternative treatment. Two of them include Giloy and Ashwagandha.

Giloy is a popular ayurvedic remedy for a number of health conditions including fever, infections and diabetes. However, there have been numerous debates about its benefits. While Ayurvedic doctors have claimed that the herb is not harmful, there have also been some reports claiming that giloy can lead to liver damage. A study published in the Journal of Clinical and Experimental Hepatology claimed the herb is harmful to the liver. On the other hand, the Ministry of AYUSH argued that giloy had been scientifically proven to be an effective remedy for multiple disorders.

To comprehend the facts related to the medicinal herb, we interviewed some eminent personalities from the field of gastroenterology and hepatology. An expert from the field of liver and gastroenterology suggested that alternative medications like giloy can cause some serious liver injuries. Dr Kaushal Madaan, Head of Hepatology, Max chain of hospitals, said: “When this pandemic came, we realised that there were many patients who came to us with unexplained liver failure and liver injury and some of them had even died. Only after a few months, we realised that they were taking a concoction and the most common ingredient of that concoction in these particular patients was giloy.” He pointed out that people were consuming kadhas or concoctions, twice or thrice a day, for a year, which could have caused serious liver damage.

“Even before the pandemic started, we had been advising our patients, whether or not they have underlying liver disease, to avoid taking herbal medicines of whose ingredients we are not sure about,” Dr Kaushal added, in the context of herbal and alternative medicines.

Alluding to the fact that all medicines — allopathic, homoeopathic or ayurvedic — have their pros and cons, Dr Sarin, Director, ILBS, said, “I can certainly say that there are certain herbs that can be harmful. There are certain preparation; unless they have published data, or they have data that they are only beneficial, just don’t take them if they have no scientific evidence.”

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