Know the Hepatitis Virus to Stay Safe – World Hepatitis Day

Viral hepatitis is inflammation of the liver caused by a virus. There are five different hepatitis viruses, hepatitis A, B, C, D, and E. On this World Hepatitis Day, the theme for this year’s global campaign is ELIMINATION. In regards, with the campaign we asked our doctor a few questions and below are the replies:-

 

1) Have you received any patients suffering from Hepatitis during 2015 and 2016?

I have had a few cases of acute viral hepatitis in 2015-6. I cannot give exact data. I have seen 3 to 4 cases of chronic hepatitis C and treated one of them. I have also encountered a couple of cases of chronic hepatitis B and one of them is under investigations for possible antiviral therapy.

 

2) What is Hepatitis and how does one get affected?

Hepatitis is a term used to denote “inflammation” of the liver. Many agents- infectious as well as chemical- could potentially cause hepatitis. However, commonly when we talk about hepatitis, we generally intend to indicate infection by certain viruses that have a special affinity for the liver. These agents could be hepatitis A, B, C, D, or E viruses.

At this stage, it is important to get familiar with two main presentation of hepatitis- acute vs. chronic. While acute hepatitis is a short-term illness that comes with easily noticeable symptoms, chronic hepatitis does not produce dramatic symptoms, to begin with, but could last for years or even indefinitely if not treated. We label any hepatitis that lasts more than 6 months as being chronic in nature.

The A and E viruses are mostly transmitted through food or water or close personal contact. They could easily be transmitted by food handlers as well. These viruses generally cause acute hepatitis only and do not lead to long-term illness.

The B and C viruses are transmitted through contact with contaminated blood or bodily secretions. They could also be passed on from mother to child. While B virus could cause both acute as well as chronic hepatitis, the C-virus by and large causes chronic hepatitis only.

 

3) How can one prevent being affected by Hepatitis?

To prevent infection with hepatitis A and E, simple measures like maintaining hygiene at a personal and public level is extremely important. In fact, governmental effort in improving public hygiene like provision of clean drinking water has gone a long way in decreasing the incidence of infection with these viruses.

At a personal level, good hand washing before and after meals and avoiding eating at unclean eateries is important. Food handlers, especially in public arena must be properly trained. There is a vaccine available for prevention of hepatitis A, but so far no effective vaccine for clinical use is available for preventing hepatitis E.

Certain populations are at increased risk; for example, elderly people living in old age homes, mentally challenged patients who are unable to maintain personal hygiene by themselves, prisoners etc. Such potential patients should be considered for vaccination for hepatitis A. Infection with blood borne viruses like HBV and HCV can be prevented by following scrupulous blood banking practices. These are already in place internationally and modern blood-banking methods ensure that transmission of these viruses as a result of blood transfusion is now a rarity. It is advisable to be careful whenever there is potential for contact with blood or bodily secretions of another individual. Never share razors or injection needles. Always insist on disposable and sterilized equipment for tattoos, body piercing etc. Safe sexual practices need to be emphasized as well.

Since these viruses are transmitted through blood, there is a potential for transmission of infection from mother to baby. Mothers at risk need to be screened before childbirth and proper measures need to be taken at the time of delivery to minimize the risk of perinatal infection to the infant.

There is an effective vaccine available for hepatitis B but not against C. Hepatitis B vaccine is now offered as part of the standard immunization program for all infants in a large number of countries, and this has helped in decreasing the incidence of HBV infection significantly.

Finally, it is important for healthcare providers to observe standard safe practices when dealing with patients, blood samples, and secretions. This will help the health workers as well as their patients. All healthcare providers should ensure that they are vaccinated against hepatitis B and that they have protective antibody titers in the blood.

 

4) What are its symptoms?

Acute viral hepatitis generally presents with a low-grade fever and some discomfort in the upper abdomen. There is also some nausea/vomiting and distaste for food. A few days later jaundice appears and this takes several weeks to subside. Most acute hepatitis recovers spontaneously without permanent damage to the liver.

Rarely it is very severe and can cause danger to the patient’s life. Chronic hepatitis, unfortunately, cannot be identified with typical symptoms and that’s why it may not be diagnosed for several years in some cases. Most chronic hepatitis, particularly hepatitis C, would probably be associated with unexplained fatigue. When the liver damage becomes extensive then various symptoms of liver failure start appearing and this normally indicates a very late stage in the timeline of the illness.

 

5) What are the damage control measures to follow when found affected by Hepatitis?

As mentioned earlier, acute hepatitis rarely poses a threat to the life of the patient and generally recovers spontaneously. It is, however, important to trace close contacts of patients who could be at risk of contracting the same illness. This will depend on what kind of hepatitis the patient is diagnosed with. Patients should always consult their physicians for guidance.

If chronic hepatitis is diagnosed, then depending on the type of infection and its stage, treatment options are available. Patients should contact their physicians at soonest. It is not advisable to ignore the issue even if there are no symptoms because damage to the liver might continue/persist even when the patient feels no symptoms at all.

 

Dr. Amal P Upadhyay, 

Consultant Gastroenterology,

Aster Hospital, Mankhool

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beat the summer heat

Beat the heat – Summer Health Tips

Some great tips for staying healthy during the summer season are :-

  • Make Friends With H2O  – Drink plenty of water and fluids! Higher temperatures and more time outdoors lead to internal dehydration, which can result in headaches and dizzy spells.
  • Screen The Sun – It’s not enough to just apply sunscreen: you must apply enough, and apply frequently. Most people do not apply for enough daylight protection.
  • Keep up the exercise regime – Before you hide those running shoes in the wardrobe, remember summer exercise doesn’t have to stop because of the rising temperatures. Instead of working out outside, change your exercise plan and take it indoors. Join a gym, take up a step class, or get a group of friends around for an afternoon of exercise DVDs.
  • Take A Cold Shower – A cool shower after excess sweating helps keep the skin unoccluded, decreasing acne breakouts.
  • Load Up On – Melon Watermelons are rich in antioxidants and delivers a unique hydration to the skin, resulting in a radiant complexion.
  • Remember Hair Care – The beating sun will hit your hair hard, but there are a number of sprays containing SPF that you can put on after you wash your hair. This is a must if your tresses have been chemically treated.Another tip: Don’t overwash your hair as this can remove the oils that naturally protect it.
  • Eat Your SPF – Oral intake of vitamins C and E together can limit the potential for sunburn. A salad with vitamin C rich citrus, berries, tomato, and vitamin E rich nuts is an ideal SPF meal
  • Simplify your makeup routine – Stick to the basics: mascara, lip gloss, concealer and switch to a bronzing blush to show off your natural beauty this summer.
  • Have lots of summer fun, but don’t skimp on sleep – Lack of sleep can lead to increased levels of stress hormones, which may slow the production of collagen in the skin. When our skin stops producing collagen, it begins to lose elasticity and starts looking tired and worn.
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FAQ’s on Infertility

Statistics show that one in five couples in the UAE face fertility issues, a figure that is higher than in other parts of the world.  As per the Dubai Health Authority’s (DHA) latest findings, around 50 per cent of women in the UAE face issues pertaining to infertility.  This is in large part caused by a shifting demographic trend coupled with late marriages, and consequently, late attempts to start a family.

At the recent inauguration of the Aster IVF & Women Clinic, it was observed that fertility treatments in the UAE need to become easily accessible and affordable to tackle the growing infertility numbers among couples.

Dr. Gautam Allahabadia, Medical Director of Aster IVF and Women Clinic delves into the various aspects of infertility in the UAE.

Is infertility still a subject that women shy away from or is there a growing awareness about the treatments available to resolve this?
Today women recognise infertility as a medical issue and are much more open to consulting Infertility Specialists. Infertility is defined as the inability to conceive or carry a pregnancy to term after 12 months of trying to conceive.  If you are over the age of 35, the time of trying to conceive is reduced to 6 months.  It is important to see a Fertility specialist, or a Reproductive Endocrinologist, or in some cases your Obstetrician and Gynaecologist or Urologist for a complete fertility check-up and diagnosis.

What are the common causes for infertility?
Painful or irregular periods, unable to pinpoint ovulation days, partner having a history of sexually transmitted disease for which he has undergone treatment, unhealthy BMI, more than one miscarriage are some of the common causes. Other reasons are Endometriosis, a disorder of the female reproductive system in which the endometrial tissue (the normal lining of the uterus) is found outside the uterine cavity. Luteal Phase Defect (LPD) when the endometrium is inadequately prepared, either because the secretion of progesterone by the ovary is below normal or because the endometrium isn’t responding to the normal stimulation by progesterone. Polycystic Ovary Syndrome is a very common hormone disorder in women, a leading cause of infertility, and one of the most under diagnosed diseases in the UAE. Infertility of about 30 per cent is also due to a male problem such as structural abnormalities, sperm production disorders, ejaculatory disturbances and immunologic disorders.

What are the other known types of infertility?
There is a condition called Secondary Infertility which is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. Unexplained Infertility is experienced by one in five couples despite completing a full infertility work-up. The emotional response to hearing, “there is no apparent reason for your infertility” can be frustrating. Fortunately, there are many options available for the couple diagnosed with unexplained infertility. Besides, abnormalities of the uterus can have a significant impact on the ability of a woman to conceive and to carry a pregnancy successfully. Some women have an abnormally developed uterus from birth (congenital) while others may develop a uterine problem due to infection or surgery (acquired).

What are the unhealthy lifestyle choices leading to infertility?
There is an increasing body of evidence that lifestyle factors can impact reproductive performance. For example, studies have demonstrated that smoking in women significantly decreases the chance of conception. In males, smoking negatively affects sperm production, motility and morphology and is associated with an increased risk of DNA damage. In the female, the constituents of cigarette smoke may affect the follicular microenvironment and alter hormone levels in the luteal phase. Obesity and low body weight can impact reproductive function by causing hormone imbalances and ovulatory dysfunction. Alcohol is a known teratogen and its consumption has been reported to decrease fertility.

Fertility treatments as a broad rule are considered expensive…
This is because the equipment, fertility injections and consumables that go into making babies in the laboratory are very expensive with a short expiry. At Aster IVF, we have introduced treatments like IVF Lite which decrease the total amount of fertility injections and hormones that go into a patient with lesser harmful effects and better pregnancy rates in most groups of patients. With decreasing costs and increasing patient compliance, treatments such as IVF Lite are the future of Assisted Conception.

How important is counselling and explaining the various options that are available to a patient, as a good starting point before a treatment is suggested?
A person suffering from infertility will face complex issues, which span biological, psychological, social and ethical domains. Discussion of these issues in a counselling context is often beneficial for patients. The aim of counselling is to explore, understand and resolve issues arising from infertility and infertility treatment and to clarify ways of dealing with the problem more effectively.

 

Reference :- http://bit.ly/29SUNbj

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Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is one of the most common female endocrine disorders and is now recognized to be a  Metabolic Syndrome. The World Health Organization estimates that it affects 116 million women worldwide as of 2010 (3.4% of the population).

 

Polycystic Ovary Syndrome (PCOS)

 

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a common  disorder, affecting 5-10% of women of reproductive age. Women with PCOS have a number of conditions that may include irregular menstrual cycles, an increase in facial and body hair, increased weight, hyperinsulinemia and infertility. Diagnosis is made on the basis of a combination of clinical, laboratory and ultrasound findings.

 

How is PCOS diagnosed?

PCOS is diagnosed based on the inability to release an egg from the ovaries on a regular (monthly) basis, increased male hormone levels and/or an increase in hair in the midline of the body (hyperandrogenism), and polycystic-appearing ovaries on ultrasound.  Because of the variable nature of PCOS, its diagnosis is based upon the combination of clinical, ultrasound and laboratory features.

 

What risks do women with PCOS have?

Lack of ovulation in women with PCOS results in continuous exposure of their uterine lining (endometrium) to estrogen. This may cause excessive thickening of the uterine lining and abnormal bleeding. The bombardment of estrogen without ovulation may lead to eventual uterine cancer or pre-cancer. Metabolic syndrome along with hyperinsulinemia is more common in obese women with PCOS. This condition is characterized by abdominal Obesity, Cholesterol abnormalities, Hypertension and Insulin Resistance/ Diabetes Mellitus. Each of these increases the risk of Heart Disease. Obesity is noted in over 70% of women with PCOS. Diet and exercise that result in weight loss improve the frequency of ovulation, enhance the ability to get pregnant, lower the risk of Diabetes and lower androgen levels in many women with PCOS. All hyperinsulinemic PCOS patients need long-term Metformin therapy for the above-mentioned beneficial effects.

 

What is the link between PCOS and Insulin/ Glucose Abnormalities?

A majority of women with PCOS have decreased sensitivity to Insulin due to increased weight. Higher levels of Insulin are needed to keep sugar levels under control in overweight PCOS patients. The resulting high levels of Insulin may contribute to excessive production of male hormones (such as Testosterone) and can lead to problems with Ovulation (timely release of an egg).

 

Can Metformin be taken by Hyperinsulinemic teenage PCOS girls? How long can uninterrupted Metformin be taken?

Metformin is safe to use in teenage girls who have PCOS and Hyperinsulinemia.  Long-term Metformin therapy can be started when PCOS is first diagnosed, with the goal of lowering the risks of Diabetes, Infertility and Heart Disease after the age of 40 years. There is no particular time limit for the use of Metformin. For patients on long term Metformin, Serum Insulin levels and Liver Function Tests should be done on a yearly basis.

If no beneficial effect is seen even after 6 months of Metformin, there is no point in continuing it.

 

How is Insulin Resistance diagnosed?

A 12-hour fasting Serum Insulin of more than 10 mIU/mL diagnoses Hyperinsulinemia and Insulin Resistance.

 

What are the options to treat Insulin Resistance?

Regular exercise, weight loss and improved nutrition are very important. Behavioral change should be the first line of therapy for an overweight woman with PCOS. Oral Insulin Sensitizing Agents like Metformin are used in conjunction with other sensitizers like Chromium Picolinate.

 

How is infertility in women with PCOS treated?

Ovulation may often be induced with Clomiphene Citrate (CC), an orally administered fertility medication. In hyperinsulinemic PCOS women, a 1-3 month pre-treatment with Metformin helps in the ovulation induction process. Gonadotropins (injectable fertility medications) may be used to induce ovulation if CC does not result in ovulation or pregnancy. However, gonadotropins are associated with a higher risk of Multiple Pregnancy and/or overstimulation of the ovaries (Ovarian Hyperstimulation Syndrome). Therefore, PCOS patients must be monitored very carefully when gonadotropins are utilized.

 

Should all PCOS patients be started on Metformin?

No. Metformin should  be given only if associated Hyperinsulinemia is diagnosed.

 

Should Metformin continue during fertility treatment & pregnancy?

For hyperinsulinemic PCOS patients, the continuation of Metformin during fertility treatment improves pregnancy rates.

While safety during pregnancy has not yet been established, patients who inadvertently continued Metformin during their entire pregnancy delivered normal babies.Continued use during pregnancy has been shown to reduce the risk of miscarriage and of developing Diabetes during pregnancy.

 

Are women with PCOS at a greater risk of complications during pregnancy?

Women with PCOS are at a greater risk of complications during pregnancy, including Miscarriage, Diabetes (Gestational Diabetes), Preterm Birth, and increased Fetal and Neonatal Death.

 

 

– Dr. Gautam Allahbadia

Medical Director & Consultant IVF,
Aster IVF & Women Clinic

 

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Case representation of Fibroids

A 42 years old unmarried female had presented with complaints of feeling extremely cold and weak along with shortness of breat upon exertion. The patient also had a history of palpitations for a week. She provided

She provided history of a lump in her lower abdomen which had increased in size over a month. She had regular menstrual cycles of 28 days with heavy flow, passing clots with flooding of blood on days 2 and 3. This had been experienced by her for the past 7 years and she had never underwent any treatment for the heavy cycles. She had continuous bleeding for one month and reported to Dr. Sejal Devendra Surti – Specialist in Obstetrics and Gynecology

Upon examination, an extremely distended abdomen was observed with a mass which could be felt up to the epigastrium that extended to the lumbar region; the mass was non-tender and made it impossible to palpate beneath it. The woman’s Haemoglobin levels were down to 5.3gm/d1. An MRI Pelvis was suggested which showed a grossly enlarged uterus measuring 26x24x14cm with multiple fibroids.

Diagnosis: Large fibroid causing menorrhagia and microcytic anaemia.

Treatment: The anaemia was treated by transfusing 3 units of blood before surgery in addition to iron infusions.

A midline incision on the abdomen showed a big mass extending from the diaphragm to the pelvic floor. After assessment, extension of incision delivery of mass was conducted. Multiple fibroids were seen occupying the entire uterus with very big tortuous blood vessels between them. Total hysterectomy with bilateral

Multiple fibroids were seen occupying the entire uterus with very big tortuous blood vessels between them. Total hysterectomy with bilateral salpingo-oophorectomy was performed as discussed with the patient beforehand. While operating, extreme care was taken to avoid injury to a lot of pelvic structures like intestines, bladder, and ureters due to the altered anatomy owing to the effect of the giant fibroids.

The specimen weighed a massive 6.5kg and has been sent for histopathology evaluation.

 

 
Sejal - OBSGYN-min

Dr. Sejal Devendra Surti

MBBS, MD

Specialist in Obstetrics and Gynecology

Aster Hospital, Mankhool

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