Heart Failure: A guideline to optimizing care

Heart failure (HF) is a syndrome resulting from the structural or functional impairment of the ventricular filling or the ejection of blood. Approximately 1% to 2% of adults in developed countries are affected by HF. The risk of HF increases with age, and HF is thought to affect over 10% of adults above 70 years of age. Though common cardiovascular risk factors such as obesity, diabetes, and hyperlipidemia are all prevalent in patients with HF, hypertension is an important cause of HF. Common symptoms of HF include dyspnea, orthopnea, acute pulmonary edema, chest pain, tachycardia, fatigue, weight loss, nausea, and wheezing.

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Lose the Back Pain at Work

In today’s time and age with the wide scale spread of the corporate culture, the majority of the people spend their days working at a desk and in front of a laptop. Despite not having to do anything physical or strenuous that might strain the back directly, this makes people susceptible to back pain irrespective of the age. Long working hours coupled with long commutes only serve to exacerbate the gradual damage that can be caused by having a bad posture.

The ill-effects of sitting with poor posture for a few hours is not immediate, but over time the stress that poor posture places on your spine can lead to anatomical changes in your spine. This, in turn, can provoke back pain through the constriction of your blood vessels and nerves. Back pain due to poor posture is characterised by the following symptoms, firstly, it is worse at certain times of the day. Secondly, it starts in the neck and moves down to the upper and lower back. Thirdly, the pain subsides once you switch positions or stand. And finally, it might coincide with a chair or a new car. However, despite the ill effects of slouching during work or while driving, there are a few remedies to prevent the onset of back pain. These include;

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Obesity Fuels Chronic Kidney Diseases

A health survey conducted by the Dubai Health Authority in collaboration with the Dubai Statistics Centre revealed that 11.9% of people in Dubai suffer from obesity.[i] The growing issue of obesity plays a key role in reducing people’s life expectancy and causes several severe health conditions. Obesity is a combination of factors including high calorie intake, lack of exercise, sedentary lifestyle practices etc. Obesity is now a growing phenomenon across the globe and is one of the key factors responsible for a number of chronic diseases including kidney diseases.

Obesity causes mortality due to diabetes, stroke, conditions of the heart, certain cancers etc. However, a rarely discussed and rather unknown fact is the link between obesity and its consequences on the kidney. Obesity is directly linked to chronic kidney diseases (CKD) and its progression because obesity facilitates diabetes and hypertension which are the two common causes of kidney conditions. Body Mass Index (BMI) is the most used parameter to determine obesity, however, the waist circumference or waist to hip ratio is a better indicator of chronic health conditions. Obesity influences chronic kidney conditions in two ways; an obese individual is at a higher risk of diabetes and high BP which are causative factors of CKD. On the other hand, an obese individual’s kidneys will have to function much harder for the process of filtration in order to meet the demands of a person with higher BMI. An obese individual can also be at the risk of having kidney failure.

Obesity is reported to be one of the leading causes for chronic kidney conditions and end-stage renal disease (ESRD). The end stage of chronic kidney conditions is called ESRD when they kidneys are no longer able to function to its ability on a daily basis.

The most common kidney damaging conditions are;

Polycystic kidneys: is a condition where a person has multiple cysts in the kidneys causing it to enlarge. This condition is generally a birth defect.

Kidney stones: or Nephrolithiasis are hard mineral deposits made of acid salts that form inside the kidney or urinary tract. People who take medicines for gout are at a risk of kidney stones, dehydration is also a cause for the condition.

Proteinuria: a condition developed when there is abnormal protein in the urine. Albumin is a protein found in the human blood because the body needs it to fight infections, build muscle etc. The function of the human kidney is to filter the blood and remove things that aren’t required by the body. There will be an underlying cause for proteinuria which needs evaluation.

Focal segmental glomerulosclerosis: is a condition caused by scarring of the kidney. This condition may be caused due to primary or secondary reasons. The primary reason of scarring being no obvious cause, the secondary reason may be caused by another pre-existing condition, a prescribed drug, obesity or any other underlying condition.

Glomerulonephritis: is a condition causing inflammation of the Glomeruli (the kidney cell). This can lead to Hypertension, blood in the urine and proteinuria. In certain cases, this can progress to acute kidney failure.

It is extremely important to keep your kidney healthy for it to function to its full capability. Your blood sugar needs to be in control, failing which will cause diabetes. Keeping your body and mind fit by staying active helps in keeping the body fit and healthy. Water is key to prevent kidney conditions, drinking water flushes out the toxins from the kidneys and reduces the chance of kidney stones. Smoking is a causative factor for a number of health conditions, and it is always best to quit it. Certain over the counter medications may also cause kidney damage. This does not mean that they should not be taken at all, however, a physician must be consulted before self-medication. Routine medical checks are important to screen for chronic kidney conditions and for those who aren’t aware of the health risks they have. An obese individual must be aware of the positive impacts of losing weight which will include prevention and reduction of various chronic health conditions like diabetes, hypertension, heart diseases and kidney conditions.

Every year, March 9th is celebrated as World Kidney Day with the aim of educating people about the importance of kidney health and the diseases associated with the kidney. This year World Kidney Day goes by the theme of ‘kidney disease and obesity’ because obesity is a potential risk factor for kidney diseases which is an unknown fact. Obesity and chronic kidney conditions are both preventable, upon undertaking healthy lifestyle practices. This kidney day lets us all promise ourselves to ensure adopting and advocating healthy lifestyle practices to beat the harmful health consequences of obesity and related kidney diseases.

Dr. John Cherian Varghese

Specialist Nephrologist 

Aster Clinic & Hospital 

Dr. John Cherian

[i] –  http://gulfnews.com/news/uae/health/survey-12-of-dubai-population-is-obese-1.1838295

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Prostate Cancer – Diagnosis & Tests

Prostate cancer is the cancer of the prostate gland, and one of the most common cancers that affects older, adult men. Although this disease has been found in adult men of various ages, the risk of getting it increases considerably once men reach the age of 50. Which is why hospitals and doctors recommend getting checked for the risk of prostate cancer at least once, as early as the age of 40.  The standout feature of prostate cancer is that unlike other forms of cancer, it does not manifest itself in the form of any physical symptoms until it becomes too late. However, the argument for screenings for men is made of the fact that statistics show that those men that get diagnosed with prostate cancer early, have a nearly 90% survival rate. So what exactly do the tests for diagnosing prostate cancer entail?

Prostate cancer screening tests are two distinct types:

  • Digital Rectal Exam (DRE): Is a physical exam where the doctor inserts a gloved, lubricated finger into the patient’s rectum in order to examine the prostate gland. This test is carried out in order to find and identify any abnormalities in the shape, size or texture of the prostate gland.
  • Prostate Specific Antigen (PSA) test: In this test, a blood sample is drawn and analysed for the substance, PSA which is naturally produced in the body by the prostate gland. High levels of PSA in the bloodstream may be an indicator of prostate infection, inflammation, enlargement or cancer.

If the DRE and PSA tests lead to the detection of an abnormality, your doctor might recommend getting an MRI or a biopsy done. Both these additional tests are used to determine whether the initial abnormalities that were discovered are because of cancer or some other prostate disorder such as a prostate infection or prostatitis.

Once the presence of prostate cancer has been determined, it now becomes imperative to go forward and analyse the cancer cells for their degree of aggressiveness and their degree of spread during the time of diagnosis. In order to determine the degree of aggressiveness of the cancer cells, they are sent to be examined by a pathologist. Once examined, the cancer cells are then given a Gleason score. These scores range from 2 to 10 and indicate how likely it is that a tumour will spread. A low Gleason score indicates that the cancer cells are similar to normal prostate cells and are less likely to spread (less aggressive). Conversely, a high Gleason score indicates that the cancer cells are very different from the normal prostate cells and are more likely to spread (more aggressive).

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of cancer. If your doctor suspects your cancer may have spread beyond your prostate, imaging tests such as bone scan, CT scan, MRI, and PET scan might be recommended. Once the testing phase is complete, and the diagnosis and level of aggressiveness of cancer have been determined, the doctor then assigns cancer a stage. The stage at which cancer has reached is the most important factor in determining treatment options. The stages of prostate cancer are:

  • Stage 1 – This stage signifies very early cancer that’s confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren’t considered aggressive.
  • Stage 2 – Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
  • Stage 3 – Cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  • Stage 4 – Cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.

Knowing the type and stage of cancer helps the doctor decide what treatment option would be best suited for a particular situation.

Dr.Rahul Bhatt 

Specialist Urologist 

Aster Clinic, Bur Dubai (AJMC) 

Dr.-Rahul-Bhatt

 

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GERD (Gastroesophageal Reflux disease)

Gastroesophageal reflux is essentially the reflux or regurgitation of stomach contents back into the food pipe or esophagus. This is a normal process that occurs in otherwise healthy children, and adults. Most episodes are brief without causing any symptoms or problems. However, in some people, acid reflux can injure the esophagus and result in symptoms such as heartburn, vomiting, or pain when swallowing. This condition is called gastro esophageal reflux disease (GERD).
GERD occurs when the lower esophageal sphincter (LES) becomes weak or relaxes when it shouldn’t, thereby causing the stomach contents to rise up in the esophagus. Increased pressure on the abdomen due to excessive weight, obesity, pregnancy, and certain medicines such as those for asthma, calcium channel blockers, painkillers, sedatives, antidepressants and smoking, all contribute to the eventual weakening of the lower esophageal sphincter
The most common symptoms of GERD include heart burn, the regurgitation of food, chest fullness/ pain, feelings of excessive salivation and so on. Some patients also experience feelings of nausea, pain or the feeling of constantly having a lump in their throat, bad breath and the wearing down of their teeth. These symptoms are further exacerbated at night while lying down flat to sleep.
GERD can affect people of all ages, from infants to older adults. People with asthma are at a higher risk of developing GERD as asthma flare ups cause the stomach contents to flow back, or reflux into the esophagus. Conversely, acid reflux can make asthma symptoms worse by irritating the airways and the lungs. If one has both GERD and asthma, managing the GERD may help control the asthma symptoms.
Investigations may be necessary in some cases and may include Endoscopy (inserting a tube through the mouth to examine the inside of the esophagus), an X-ray of the upper digestive system, an ambulatory acid pH test (which monitors the amount of acid in the esophagus), and an esophageal impedance test (which measures the movement of the substances in the esophagus). If you have accompanying symptoms like persistent vomiting, loss of appetite, weight loss, difficulty in swallowing or vomiting blood etc. it is advisable to immediately see a doctor and get their advice.
Treatment for GERD starts with changes in lifestyle measures such as waiting for at least two hours after food before lying down, raising the head of the bed, avoiding tobacco, losing weight if overweight, decreasing alcohol intake, avoiding heavy meals, and decreasing caffeine intake.

However, the first step for treating GERD is to begin making the necessary dietary changes to help reduce the severity of your symptoms and give your body time to heal. It is important to consider which foods cause heartburn and discomfort and which foods don’t cause any painful symptoms at all. Few foods which are best avoided when on a GERD diet are spicy foods, trans fat and high-fat foods, very hot foods and liquid, mint and chocolate, alcohol and other foods which could be triggering an individual’s GERD. It should also be noted that each individual’s case is different and not everyone reacts the same way to particular foods. One needs to take the time to find out what ‘triggers’ theirs symptoms and make their own ‘safe to eat’ and ‘foods to avoid’ lists. It may take a little while before you fully understand your body’s reactions, but the most effective way to manage the condition is to “listen” to your body and work with it to devise a plan that will help in your specific situation. If these symptoms interfere with your daily life it is time to see your physician. Medications like proton pump inhibitors or histamine blockers may be necessary. Although sometimes in severe and intolerant cases, surgery may also be recommended.

Dr. Vijay Anand. V

Specialist Gastroentrologist

Aster Clinic, Al Qusais

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