According to the World Health Organization, “Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.”
WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year. World Hepatitis Day takes place every year on 28th July to bring the world together under a single theme to raise awareness of the global burden of hepatitis especially with more focus on viral hepatitis and to influence real change.
To discuss the same we had a panel of experts: Dr Anil Arora, Head of Gastroenterology Dept, Sir Gangaram Hospital; Dr. Sanjiv Saigal, Principal Director, Liver and Hepatology, from Max Chain of Hospitals; Dr Sudeep Khanna, Senior Consultant, Gastroenterology Dept, Apollo Chain of Hospitals.
Question: Dr. Saigal, why is hepatitis such a crucial problem? According to WHO reports a person dies of Hepatitis dies every 30 second.
Dr. Sanjiv Saigal: Hepatitis is a huge burden in our country as it is worldwide. Hepatitis basically means inflammation of the liver ad the prime reason for this are the hepatitis viruses which are of four types primarily: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D. Hepatitis A & B are self-limiting and spread through blood, water or any fluid. But Hepatitis C & D are huge burden in our country and spread through parental fluid. In India, Hepatitis B has a prevalence of 2-7% and Hepatitis C is 0.5-1.5%. They constitute a huge number if patients in the county and are very important cause of liver related deaths in the country. They also cause liver failure, liver cancer and so on. Thus, it should be our topmost priority to treat and cure this disease.
Question: 40 million people in India are HBV infected and constitute about 11% of the global rate. What would you say Dr. Arora?
Dr. Arora: This topic is very pertinent as Covid will come and go but the illnesses like Hepatitis have not gone ever since. Certain viruses are spread through contaminated water and infected fluid, which are totally preventable. This is a prevalent issue in developing countries like India and South Asian nations whereas it has been totally eradicated in developed countries. Simple provision of safe drinking water and hygiene can prevent Hepatitis A & E. Virus spread through parental route are problematic. Hepatitis B & C are neglected, and like you said there are 40 million carriers of the infection unaware of the fact that they are infected, hence they are not only potentially disease developers but are also becoming a threat for their families. By increasing awareness, we can prevent this.
Question: Dr. Khanna would you agree with Dr. Arora that there is a problem of awareness that needs to be tackled right away?
Dr. Sudeep Khanna: I would like to add something to it, people know that something like this exists but they are not ready to accept it. A recent study conducted on 1 lakh children from India concluded that only 50% of the children were vaccinated against Hepatitis B.
Question: Isn’t it covered under Universal Health Immunization? Then why aren’t people getting vaccinated?
Dr. Sudeep Khanna: For the same reason as why they wouldn’t get anti-covid vaccine. This becomes a problem for us to help people. The vertical and horizontal transmission from mother to baby and during close contact is the most common cause of Hepatitis B. People need to be tested, treated and educated.
Question: Dr. Arora, we rightly spoke about how people are not even ready to accept it. So what can people do to prevent this stigma?
Dr. Anil Arora: A wonder drug called DAA has been discovered which can cure almost any type of Hepatitis C and hence it is as curable as any other disease but Hepatitis B is problematic. They are not aware of the fact that they may be carrying the virus in their blood for ages before they come down with advanced diseases like Cirrhosis and Carcinoma. My advise will be that anybody with a history of liver transplant, blood transmission, surgery, needle prick trauma or even dental manipulation should get a checkup for Hepatitis B. Now coming to vaccination, Hepatitis B vaccines has been available for over three decade at very low rate and very efficient.
Question: There are about 1.1 million who have died due to Hepatitis, and 3 million are still carrying the disease worldwide. How do we really address this in India especially with the urban rural divide?
Dr. Sudeep Khanna: Multimedia and TV are such a big medium and still unused to their full capacity. A lot of people don’t know about Hepatitis C and lack of initiative from the authorities and doctor bodies are causing this. The disease is significantly asymptomatic and by the time they are symptomatic it is too late. So it is all about awareness.
Question: Dr. Arora, what can one do if one is already infected with Hepatitis B? What about cure?
Dr. Anil Arora: There are two aspects of patient suffering from Hepatitis B, unlike other illnesses, if someone gets an infection today, there are 5% chances that as an adult they will carry the virus in the blood for the next 6 months that is called chronic carrier state and may develop the disease later in life. They remain asymptomatic and thus do not bother about it. This is where screening is needed and if a person is accidentally positive for Hepatitis B, he can be treated with antiviral therapy or else he may spread it to his family. In early diagnosis, regular follow up goes a long way in preventing the chronic illness.
Question: Dr. Saigal, can a patient of Hepatitis B follow up with their checkup if infected with Covid?
Dr. Sanjiv Saigal: Patients ask that if I am Covid positive then what happens with the other problems of mine and if you look at Hepatitis, the patients are consulting specialist doctors, and hence can manage with a teleconsultation and it is not required to come to the hospital. If there is an emergency, then they should visit the hospital no doubt. If a Hepatitis patient is Covid positive and taking the concerned medications, I would recommend that they don’t stop taking medicines for Hepatitis as this may provide a flare to the disease.
Question: Dr. Khanna, are the patients with Hepatitis at a greater risk if they get Covid? Are they furthermore immunosuppressed like we have seen in Cirrhosis?
Dr. Sudeep Khanna: If one has Cirrhosis, they are not at higher risk of getting infected. If in case the liver function goes down, the risk of Covid complication increases. Similarly, being infected with Hepatitis B or C does not mean that you are at higher risk of getting Covid. There should be no fear of vaccination.
Question: Dr. Arora, what would you say on the point “ No fear of vaccination”?
Dr. Anil Arora: Liver is a vital organ in many functions including metabolism and immunity. Once you have severe Covid, liver gets involved in the immunity in many patients. Patients who have underlying liver disease should be given vaccine on a priority basis. Because liver handles all the drugs given to the covid patient.
Question: In what conditions in Covid patients does it lead to diseases like Cirrhosis other complications?
Dr. Sanjiv Saigal: If you develop Jaundice due to contaminated food or water, it is a small chance that they may develop rapid deterioration and altered sensorium thus may have to be admitted to ICU. If someone has chronic disease like Hepatitis B or C and catch infection like Pneumonia, Covid, etc. then they may develop a liver failure. These are the two situation which may cause rapid deterioration and both the type of patients should be diagnosed early and quick treatment can save these patients.
Question: How can the person know that they are carrying the Hepatitis infection?
Dr. Sudeep Khanna: For most of the patients, the disease is asymptomatic. And hence is it not possible for them to diagnose through symptoms. Tiredness, although is a primary symptom so if you have fatigue throughout the day, you may have Hepatitis. One other way is to know if a family member is diagnosed with Hepatitis, one may be a carrier for the disease. Also, screening the high risk population is a way out.
Question: Dr. Arora, we spoke about who all should get tested, what will be your suggestion to all the policy makers?
Dr. Anil Arora: the only way to pick it up early and diagnose is by testing. So my suggestion is that whenever going for any sort of blood test or screening, get tested for Hepatitis B and C. and executive check up is becoming a routine. It should be mandatory and if an asymptomatic patient is not checked up early, the cost of long-term disease treatment is enormous. While it is very cost effective in early stages.
Question: Dr. Saigal, is there anything that we can do to prevent it other than screening or vaccination?
Dr. Sanjiv Saigal: As we discussed, we have to identify the high risk population. We need to look for any family member with Hepatitis. If you have a liver problem, you should get it checked. Then you need to avoid contaminated food and liquid. Be careful in interpersonal relationships. Dialysis and following all protocols strictly may help diagnose and treat Hepatitis. We should follow universal practice of screening people. Be aware and screen people which may help people to curb the disease.
Question: what do you suggest policy makers, institutions and common people to eliminate the disease?
Dr. Sudeep Khanna: As an individual I can only think of vaccine being made mandatory which is very difficult in the democracy. Other than that nothing is going to help.
Since we all go to annual checkups, our panelists suggest that do get checked up for Hepatitis on a routine basis, avoid contaminated food and get proper vaccination.
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OVERWEIGHT CHILDREN CAN REDUCE CARDIOVASCULAR RISK BY FOLLOWING HEALTHY DIET
Statistically overweight children who follow a healthy eating pattern significantly improve their weight and reduce a variety of cardiovascular disease risks suggests the findings of a Cleveland Clinic-led research team.
The study, which was published in the Journal of Clinical Pediatrics, paired parents and children together throughout the trial. According to the Center for Disease Control and Prevention, obesity now affects 1 in 5 children and adolescents in the United States. Children who are obese are more likely to have high blood pressure and high cholesterol which are risk factors for cardiovascular disease. Adult obesity is associated with an increased risk of several serious health conditions including heart disease, type 2 diabetes, and cancer.
For one year, researchers studied changing cardiovascular disease risk markers associated with three healthy eating patterns in 96 children between the ages of 9 and 18 years old with a body mass index (BMI) greater than 95 percent. BMI is calculated by dividing a person’s weight in kilograms by the square of height in meters, but for children and teens, BMI is age and sex-specific and is often referred to as BMI-for-age.
The three healthy eating patterns studied were the American Heart Association Diet, Mediterranean Diet, and Plant-based diet. All three emphasised whole foods, fruits and vegetables and limited added salt, red meat and processed foods. Parent and child pairs attended weekly educational sessions for four weeks which covered suggested foods to eat and avoid how to read package labels, proper portion sizes and shopping tips.
Fasting blood tests were used to access biomarkers of cardiovascular risk. All three diets were associated with improvements in weight, systolic and diastolic blood pressure, total cholesterol, and low-density lipoprotein.
“This study helps show the importance of starting healthy eating patterns as young as possible. We know that cardiovascular disease begins in childhood, and children’s eating patterns are easier to mold than adolescents and adults,” said lead author Michael Macknin, M.D., Professor Emeritus of Pediatrics of Cleveland Clinic Lerner College of Medicine.
The American Academy of Pediatrics Committee on Nutrition recommends that healthy children age 2 and older follow a diet low in fat (30 percent of calories from fat). These are the same recommendations for healthy adults. In the study, dietary compliance rates averaged 65 percent in week 4 and 55 percent in week 52 suggesting small improvements in diets can still be very beneficial.
“Because the process of heart disease begins in childhood, prevention should begin there as well,” said W.H. Wilson Tang, M.D., study author and research director in the section of heart failure and cardiac transplantation medicine in the Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic.
“A large majority of heart disease is due to modifiable or controllable risk factors, so it’s important for children to understand that they are in large part responsible for their health,” added Tang.
INDIA’S COVID-19 VACCINATION COVERAGE EXCEEDS 81.85 CRORE
With the administration of 96,46,778 vaccine doses in the last 24 hours, India’s Covid-19 vaccination coverage exceeded 81.85 crores (81,85,13,827) as per provisional reports till 7 am on Tuesday, informed the Ministry of Health and Family Welfare.
The ministry said that this has been achieved through 80,35,135 sessions. As per the data, as many as 1,03,69,386 healthcare workers have been inoculated with the first dose of the Covid vaccine while 87,50,107 have been inoculated with both doses. The number of frontline workers vaccinated stands at 1,83,46,016 (first dose) and 1,45,66,593 (two doses).
According to the health ministry, 33,12,97,757 vaccine doses were administered as the first dose and 6,26,66,347 vaccine doses were given as the second dose in the age group 18-44 years.
Also, in the age group of 45-59 years, 15,20,67,152 people have received the first dose and 7,00,70,609 have received the second dose whereas 9,74,87,849 vaccine doses were administered as first dose and 5,28,92,011 vaccine doses given as the second dose to the people over 60 years. Meanwhile, India reported 26,115 new Covid-19 cases in the last 24 hours.
Sustained and collaborative efforts by the Centre and the states, UTs continue the trend of less than 50,000 daily new cases that are being reported for 86 consecutive days now.
“The recovery of 34,469 patients in the last 24 hours has increased the cumulative tally of recovered patients (since the beginning of the pandemic) to 3,27,49,574,” the ministry said.
The active caseload is presently 3,09,575 which constitutes 0.92 percent of the country’s total positive cases while the recovery rate stands at 97.75 percent. The testing capacity across the country continues to be expanded. The last 24 hours saw a total of 14,13,951 tests being conducted. India has so far conducted over 55.50 crores (55,50,35,717) cumulative tests. The weekly positivity rate at 2.08 percent remains less than 3 percent for the last 88 days now. The daily positivity rate was reported to be 1.85 percent. The daily Positivity rate has remained below 3 percent for the last 22 days and below 5 percent for 105 consecutive days now.
‘Robotic lab’ at AIIMS has capacity to conduct 2 lakh tests in a day
Amidst the prevalence of the Covid-19 pandemic, the country’s renowned hospital, All India Institute of Medical Sciences (AIIMS) here has prepared a ‘robotic lab’ that has the capacity to conduct more than two lakh general tests in a single day.
AIIMS “robotic smart lab” has the capacity to conduct two lakhs tests in a single day. This hi-tech lab was started last year in July and inaugurated by Former Union Health Minister Dr Harsh Vardhan. Union Health Minister Mansukh Mandaviya on Monday also visited this lab and spent more than 20 minutes to see the working of this robotic lab which is fully IT and digitally enabled. Currently, this lab is conducting 3,000-4,000 tests per day but it has a capacity to conduct 8,000 tests per hour and two lakh tests in a single day.
“As of now, we are conducting 3,000-4,000 sample testings in a single day via this lab. The capacity is almost 8,000 tests per hour and 2 lakh tests in a day,” said Dr Tushar Sehgal, Assistant professor, Department of Medicine at AIIMS, Delhi.
This AIIMS smart lab is providing high-quality diagnostics and reduced time in producing lab reports here. The lab is doing more than 70- 270 advanced tests and some of them are free of cost for the patients, the official said.
Elaborating further, Dr Sehgal told ANI, “The testing involves a few stages. It primarily involves three main stages i.e. pre-analytical, analytical and post-analytical stage.” “We have three different types of sample testing methods as well. Haematology, Coagulation, Chemistry are the methods,” he added. AIIMS Hi-tech robotic lab is also providing some free-of-cost tests like the D-Dimer test that costs around Rs 1,000 in private labs. “There are some tests which we do free of cost. Our vision is to provide most of the tests free of cost like LFT, CBC, D-Dimer test etc.”
VARIOUS INFECTIONS SURGE AMONG CHILDREN AS POST-COVID SYMPTOMS
Respiratory syncytial virus (RSV) is emerging as the latest post-Covid symptom among infants and young children, said a paediatric expert on Tuesday.
According to Dr Dhiren Gupta, a senior paediatric pulmonologist at Sir Ganga Ram Hospital, the early phase of RSV infection in babies and young children is often mild, like a cold. However, in children younger than age three, the illness may move into the lungs and cause coughing and wheezing. In some children, the infection can also turn into severe respiratory disease. Dr Gupta told ANI, “Among 100 cases of post-covid complications, 80 percent patients are suffering from RSV, whereas among RSV cases 80 percent patients are infants.”
The expert also added that if a patient had prolonged fever as a post-Covid symptom, then about 1 percent to 20 percent chances are patient is suffering from Tuberculosis.
“Unfortunately there is no specific treatment for RSV infection and normally takes between seven and 10 days to settle,” said Dr Gupta. The doctor said though the Covid-19 infections have not increased in number, the severity of Covid infection was a little bit more than generally found.
“Also, children who were completely fit and healthy before Covid are suffering from tuberculosis and liver abscess along with RSV and they were not given immunosuppressant such as steroids,” he added.
A pyogenic liver abscess is the development of a pus-filled pocket of fluid within the liver. Pyogenic means producing pus. A liver abscess can develop from several different sources including a blood infection, an abdominal infection or an abdominal injury that was infected.
Completing recommended sleeping hours could lead to smarter snacking choices, says a new study
The findings of a new study suggest that people who miss the recommended seven or more hours of sleep per night might make poorer snacking choices than those who adhere to shut-eye guidelines.
The study abstract has been published in the Journal of the Academy of Nutrition and Dietetics and the research will be presented in a poster session on 18 October at the 2021 Food and Nutrition Conference and Expo. The analysis of data on almost 20,000 American adults showed a link between not meeting sleep recommendations and eating more snack-related carbohydrates, added sugar, fats and caffeine.
It turns out that the favoured non-meal food categories—salty snacks and sweets and non-alcoholic drinks—are the same among adults regardless of sleep habits, but those getting less sleep tend to eat more snack calories in a day overall.
The research also revealed what appears to be a popular American habit not influenced by how much we sleep: snacking at night. “At night, we’re drinking our calories and eating a lot of convenience foods,” said Christopher Taylor, professor of medical dietetics in the School of Health and Rehabilitation Sciences at The Ohio State University and senior author of the study.
“Not only are we not sleeping when we stay up late, but we’re doing all these obesity-related behaviours: lack of physical activity, increased screen time, food choices that we’re consuming as snacks and not as meals. So it creates this bigger impact of meeting or not meeting sleep recommendations,” added Taylor.
The American Academy of Sleep Medicine and Sleep Research Society recommends that adults should sleep seven hours or longer per night on a regular basis to promote optimal health. Getting less sleep than recommended is associated with a higher risk for a number of health problems, including weight gain, and obesity, diabetes, high blood pressure and heart disease.
“We know lack of sleep is linked to obesity from a broader scale, but it’s all these little behaviours that are anchored around how that happens,” said Taylor.
Researchers analysed data from 19,650 US adults between the ages of 20 and 60 who had participated from 2007 to 2018 in the National Health and Nutrition Examination Survey. The survey collected 24-hour dietary recalls from each participan—detailing not just what, but when, all food was consumed—and questions people about their average amount of nightly sleep during the workweek. The Ohio State team divided participants into those who either did or didn’t meet sleep recommendations based on whether they reported sleeping seven or more hours or fewer than seven hours each night. Using US Department of Agriculture databases, the researchers estimated participants’ snack-related nutrient intake and categorized all snacks into food groups. Three snacking time frames were established for the analysis: 2:00-11:59 a.m. for the morning, 12:00-5:59 p.m. for the afternoon, and 6 p.m.-1:59 a.m. for the evening.
Statistical analysis showed that almost everyone—95.5 percent—ate at least one snack a day, and over 50 percent of snacking calories among all participants came from two broad categories that included soda and energy drinks and chips, pretzels, cookies and pastries.
Compared to participants who slept seven or more hours a night, those who did not meet sleep recommendations were more likely to eat a morning snack and less likely to eat an afternoon snack and ate higher quantities of snacks with more calories and less nutritional value.
Though there are lots of physiological factors at play in sleep’s relationship to health, Taylor said changing behaviour by avoiding the nightly nosh, in particular, could help adults not only meet the sleep guidelines but also improve their diet.
“Meeting sleep recommendations helps us meet that specific need for sleep-related to our health, but is also tied to not doing the things that can harm health,” said Taylor, a registered dietitian.
“The longer we’re awake, the more opportunities we have to eat. And at night, those calories are coming from snacks and sweets. Every time we make those decisions, we’re introducing calories and items related to increased risk for chronic disease, and we’re not getting whole grains, fruits and vegetables,” added Taylor.
“Even if you’re in bed and trying to fall asleep, at least you’re not in the kitchen eating – so if you can get yourself to bed, that’s a starting point,” noted Taylor.
INFANTS EXPOSED TO DOMESTIC VIOLENCE HAVE POOR COGNITIVE DEVELOPMENT: STUDY
A new study has revealed that infants coming from homes with domestic violence often go on to have poor academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating, and sleeping, as well as stress and illness.
The findings of the study were published in the ‘Maternal and Child Health Journal’. While assessing a pregnant woman with premature labour in 1983, Linda Bullock noticed bruises on the woman. When she asked what happened, the woman told Bullock a refrigerator had fallen on her while cleaning the kitchen.
“Something didn’t seem right, but I didn’t know what to say at the time. I just went on to the next question of the assessment,” said Bullock, now a professor emerita at the University of Missouri Sinclair School of Nursing.
“We stopped her labour and sent her home, but I will bet my last dollar I sent her back to an abusive relationship, and it sparked my interest in helping other nurses assist battered women. What we didn’t know at the time was the impact violence had on the baby,” Bullock added.
Bullock helped implement the Domestic Violence Enhanced Perinatal Home Visits (DOVE) program in rural Missouri, which empowered safety planning and reduced domestic violence for hundreds of abused pregnant women.
After learning from home health visits that many of the abused women had up to nine different romantic partners during and following pregnancy, Bullock conducted a study to examine the impact of multiple father figures on the cognitive development of newborn infants.
After administering neurodevelopmental tests during home visits three, six and 12 months after birth, she was surprised to find the infants of women who had only one male partner who abused them had worse cognitive outcomes compared to infants of women with multiple male partners, only some of whom were abusive.
“The findings highlight the variety of ways the multiple father figures may have been helping the mom support her baby, whether it was providing food, housing, childcare or financial benefits,” Bullock said.
“For the women with only one partner who abused them, the infant’s father, the father may not have provided any physical or financial support or played an active role in the child’s life. It can be difficult for busy, single moms struggling to make ends meet to provide the toys and stimulation their infants need to reach crucial developmental milestones,” Bullock added.
Bullock added that infants coming from homes with domestic violence often go on to have worse academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating and sleeping, as well as stress and illness.
“When nurses are visiting homes to check in on pregnant women and their developing babies, we want them to be trained in recognising the warning signs of potential intimate partner violence,” Bullock said.
“I still think back to 1983 when I sent that lady back home into a terrible situation, and I am passionate about making sure I can help nurses today not make the same mistake I made,” Bullock continued.
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