Hepatitis—B
Tackle the terrorist
Dr Yogesh Chawla
The hepatitis B virus is one of the viruses which predominantly cause liver disease. It infects the liver causing inflammation of the liver, ranging in severity from being asymptomatic to completely resolving and symptomatic with progressive and even fatal illness.

Facial rejuvenation
As we proceed forward in the 21st century, among the many interesting social phenomena to be identified are the ageing of the skin and the attention it is generating. In the last century, life expectancy was approximately 45 to 50 years. Today it has increased to 70 to 75 years. In a highly competitive world, it has become essential to look good.

Stress and depression

VIEW AND REVIEW
Time management
Dr (Brig) M.L. Kataria
Stress is the biggest bugbear of modern life. It not only bites but also licks away our life’s energy. Pitiably, every one is a victim the doctor, the engineer, the executive, the politician, the bureaucrat, the lawyer, the professor, the housewife, the old and the young — even the schoolchild carrying a satchel heavier than his own weight.

AYURVEDA & TOTAL HEALTH
Lavanga’s aroma & power
Dr R. Vatsyayan, Ayurvedacharya
Known as lavanga, devakusuma and shripushpa in Sanskrit and Syzygium aromaticum scientifically, clove is an aromatic spice used in most of the Indian homes. Though a native of South-East Asia, clove is so much embedded in Indian culture that apart from its culinary or medicinal use, it forms an essential part of the ritual offerings made to the gods since time immemorial.

The hepatitis B virus is one of the viruses which predominantly cause liver disease. It infects the liver causing inflammation of the liver, ranging in severity from being asymptomatic to completely resolving and symptomatic with progressive and even fatal illness.

This virus is transmitted largely from the parenteral or inappaent route. The commonest source of the hepatitis B infection is exposure to blood secretions from patients who are already infected with hepatitis B infection.

Although the hepatitis B virus is not highly contagious, its presence in very high amounts in the blood and secretions of infected persons indirectly means that even an isolated single and minute exposure can transmit this infection. The spread of hepatitis B is also facilitated by the fact that many people who are harbouring the hepatitis B virus are asymptomatic and unaware of their infection and thus are a potential source of infectivity.

The commonest source of infection, a few years ago, was blood transfusion (from patients who had not been adequately tested for the presence of hepatitis B infection). But this incidence now, with the proper checking and screening of the hepatitis B virus in the blood banks has come down significantly. The other reasons for the transmission of the infection is the use of unpasteurised plasma products. Needle stick accidents and injections with unsterlised instruments such as in tattooing, acupuncture ear-piercing, dentistry or the shave done by the roadside barbers are among the other causes of acquiring the hepatitis B infection.

The virus could also be transmitted by sexual contact and non-sexual spread by inapparent sources, the vehicle perhaps being blood-tinged salvia or fluid from open skin lesions or scratches. The perinatal spread of hepatitis is another important mode of transmission in our country by which mothers who are having hepatitis B infection transmit it to their children at the time of delivery of 25 to 90 per cent of the situations depending upon the amount of the virus that the mother is harbouring. Urine, stool and drinking unclean water are not important causes of developing the hepatitis B infection.

Once a person develops this infection, symptoms appear in 40 to 140 days. Almost 25 to 50 per cent of these patients develop symptoms of fatigue, loss of appetite and jaundice, which lasts a few days to several months — two to three weeks. This is associated with the weight loss of almost 2 to 10 kgs. In the majority of the patients full recovery takes place. This recovery is heralded by the return of good appetite, improvement in urine colour and decrease in the yellowness of the eyes. About 10 per cent of these patients, who do not recover from jaundice, ultimately develop the chronic disease. Such disease is in the form of chronic hepatitis initially which later progresses to cirrhosis of the liver. It forms the second important cause of liver cirrhosis seen by us at the Institute, the first being alcohol. These patients of cirrhosis of the liver present to us either with blood-vomiting and black stools or generalised swelling all over the body with abdominal distension, irrelevant behaviour and coma. Once a patient develops cirrhosis, a stage when the liver becomes shrunken and fibrosed, he has gone into an irreversible stage and the patient has to be treated of the symptoms as they occur.

This disease is associated with a significant decrease in the lifespan. If a person survives this stage, there is a strong possibility that he would develop liver cancer which, unless detected at an early stage (when it is treatable by surgery or other therapeutic interventions), may prove fatal.

All these procedures are costly and effective but in a very limited subset of patients. Hence, in order to prevent the development of such complications like cirrhosis or liver cancer, the patients should be treated at the stage of chronic hepatitis. B. While those at the acute hepatitis B stage need to be observed carefully, antivirals that are effective in killing the hepatitis B virus should be given in a stage of chronic hepatitis for a period ranging from four months to two years. In the long run it would turn out to be very costly. If a patient presents himself at a stage of cirrhosis, the complications are managed with repeated endoscopies. This turns out to be very costly in the long run. The hepatitis B vaccine is the only vaccine which can prevent this disease. The vaccine should be stored at 4 to 8 degrees. The various hepatitis vaccines are heat-stable. Ideally, hepatitis B vaccination should be advocated for universal immunisation but because of financial constraints it is indicated in high-risk individuals like health-care workers, doctors, patients to be put on dialysis, those who require multiple blood transfusions repeatedly, namely thalasemics, haemophilliacs and those requiring cardiac or other major surgeries.

Neonates born to hepatitis B - virus-positive mothers should also be vaccinated within a few hours of the delivery so that the transmission to the children is avoided and, finally, the infective general pool of hepatitis B carrier is reduced.

The effect of hepatitis B vaccination has been shown in Taiwan since 1984 when mass immunisation of children with hepatitis B vaccination was undertaken. The prevalence of the hepatitis B infection was reduced from 15 per cent to 1 per cent in children. Thus, there is definitely the need for preventing this disease in our country where almost 2-4% of the population is affected by the hepatitis B virus. (An estimated population of 45 million is feared to have been affected.)

Prof Yogesh Chawla is the Head of the Department of Hepatology at the PGI, Chandigarh.

Facial rejuvenation

As we proceed forward in the 21st century, among the many interesting social phenomena to be identified are the ageing of the skin and the attention it is generating. In the last century, life expectancy was approximately 45 to 50 years. Today it has increased to 70 to 75 years. In a highly competitive world, it has become essential to look good. Science has advanced and it is possible to prevent the major signs of ageing — wrinkles. The last decade has seen significant and exciting new advances in our knowledge of skin-care and hair-care. These have led to important discoveries and formulations in cosmetic products that can make an enormous difference to one’s skin. Wrinkles can be treated.

There are two processes that lead to the skin changes associated with ageing. a) The first is intrinsic chronologic ageing, which is largely genetic. This includes the natural effects of gravity (i.e. skin sag), expression lines (etched over years of use), sleep lines, hormonal changes and genetic programming. (b) The second component of the ageing process is extrinsic ageing. This external injury is from environmental influences such as UV radiation, smoking, wind and chemical exposure. Chronic ultraviolet light exposure is undoubtedly the most significant contribution to extrinsic ageing causing coarseness, fine lines, age spots and patchy darkening.

Various studies from different parts of the world have now shown that 60 to 80% of ageing of the skin is due to the UV rays of the sun. Hence, any skin-care regime must necessarily include use of a sunscreen. This must have a high SPF(sun protection factor) of at least 15 or more. The SPF is a rough indication of the protective ability of the sunscreen.

The sunscreen must have the ability to protect against UVA and UVBrays as well. These rays penetrate deeper and are the major contributory rays which cause ageing of the skin. The UVBrays are the ones to give sunburn and contribute to a lesser extent to ageing of the skin. A commitment to the daily use of sunscreen is the first step in skin rejuvenation. All the anti ageing products which will be discussed, will not work if a sunscreen is not used. It is the most important and, hence, a compulsory part of any anti-ageing regimen. Careful assessment of the patient and the patient’s expectations hold the key to gratifying results for the patient who wants to rejuvenate the skin of the ageing face.

Dr Gurinderjit Singh, is a senior consultant and head of the Department of Dermatovenereology and Hair Transplantation at Mohan Dai Oswal Cancer Treatment and Research Foundation, Ludhiana.

(To be concluded)

*Major depression is the most common psychiatric complaint seen in clinical practice.

*It unarguably affects 6% to 10% of the people, compared to an estimated prevalence of 5.8% for hypertension.

*The data from the National Comorbidity Survey show that the lifetime prevalence of major depression is 17.1%.

These facts are clearly stated in the book titled "Freedom from Stress" written by Dr Rajeev Gupta. Dr Gupta has put his entire energy —and much of his other resources — to the service of the mentally ill. The cheerfully produced volume explains depression and schizophrenia in simple language. His clinical experience has gone into the making of this book in a caring manner. Every parent, college student, teacher, social worker and socio-religious organisation should acquire a copy of the volume and imbibe the information in it, treating it as an unputdownable mental health manual.

— Kamaleshwar Sinha.

VIEW AND REVIEW
Time management
Dr (Brig) M.L. Kataria

Stress is the biggest bugbear of modern life. It not only bites but also licks away our life’s energy. Pitiably, every one is a victim the doctor, the engineer, the executive, the politician, the bureaucrat, the lawyer, the professor, the housewife, the old and the young — even the schoolchild carrying a satchel heavier than his own weight.

Why? We are all fighting against time. There is less time and much more to do. More than the physical aspects, it is the mental flogging and galloping, in essence, the psychological maladjustment in time work equation, which gradually but surely leads to hypertension, coronary artery disease, insomnia, anorexia, the irritable bowel syndrome, inexplicable and intractable headaches, anxiety neurosis, depression and more than half a dozen more frightening syndromes!

And all these for one cause: lack of healthy time management.

Time has been tackled variously from time immemorial. Ancient Indian scriptures narrate it as Bhrama’s four yugas — Sattayuga, Treta, Dvapar and Kaliyuga each with its own inevitable criteria, within which man must learn to live and unwillingly surrender for peace. Scientific fiction by HGWells "Time Machine", gives an interesting account of time. Einstein imparted a new dimension to time in his theory of relativity to explain God’s law of expression of His universe wherein man is just a bubble. Kahlil Gibran philosophically conceives life’s timelessness, calling yesterday as today’s memory and tomorrow as today’s dream.

However in the yuga in which we live, time is "the most precious commodity" according to Nobel laureate Amartya Sen. Peter Drucker, the modern time management philosopher, calls time "the most scarce resource".

In this era of science and technology, we live in a global village where every one has to work, work and work to overtake the other. There is so much work and little time. Therefore, for healthy time management, to maintain inner tranquillity, we must learn to do stresslessly more in scarcely lesser time. This has been wonderfully explained by Col. D.S. Cheema, a philosopher, an engineer and a management guru par excellence, in his book, rightly titled "How to Get More Done in Less Time".

Formerly a specialist at prestigious defence training institutes, and a visiting professor to various universities and institutes of management, in his prophetic elucidation, he reveals a novel approach to time management:"Manage yourself with respect to time, since you have no control over time". To achieve this, he gives a strategy for self-development and balance in life-style.

Some of his aphorisms aptly sound like universally applicable laws of self and time management: "Set goals everyday. Allocate your time. Judge your time-effectiveness. Make a record of what you do. Summarise every week or two. Evaluate your performance and many more in every chapter make the book an invaluable guide and companion for professional in every field and for every man and woman in every walk of life.

Col D.S. Cheema can be contacted on the phone number 570529.

Dr (Brig) M.L.Kataria and his team are managing 16 healthcare centres, in tune with time, following Colonel Cheema’s laws in "How to Get More Done in Less Time".

AYURVEDA & TOTAL HEALTH

Lavanga’s aroma & power
Dr R. Vatsyayan, Ayurvedacharya

Known as lavanga, devakusuma and shripushpa in Sanskrit and Syzygium aromaticum scientifically, clove is an aromatic spice used in most of the Indian homes. Though a native of South-East Asia, clove is so much embedded in Indian culture that apart from its culinary or medicinal use, it forms an essential part of the ritual offerings made to the gods since time immemorial.

Ancient ayurvedic texts describe the dried flower buds of the clove tree, which are its usable part, as bitter and pungent in taste and light, sharp and unctuous in action. Clove alleviates kapha and pitta and, contrary to the general belief, Ayurveda considers it to be cold in effect. An analysis of clove shows it to contain protein, fat, carbohydrates and minerals. The clove buds, on steam distillation, yield a volatile oil.

Charaka has described clove as agnimandya-nashak (remover of anorexia). Other scholars have explained it as aromatic, stomachic, antiflatulent and antispasmodic. It stimulates various body organs like the salivary glands, the skin, the liver, the heart and the kidneys and also acts as a deodorant, expectorant, antipyretic and bitter tonic. Clove oil contains ingredients that help stabilise blood circulation and regulate body temperature.

Clove is a widely used drug in Ayurveda. It cures indigestion, loss of appetite, excessive thirst and vomiting. It checks tooth decay and counters halitosis (bad breath). It is also prescribed in hyperacidity and gastritis.

Clove is used in chronic cough, bronchitis and hiccup. In China and Persia, it is considered to be an aphrodisiac.

Clove forms an essential part of the household kit to treat many ailments. Here are a few tips:

Taking half a gram of the powder of fried cloves in a teaspoonful of honey promotes enzymatic flow and boosts the digestive function. The decoction of clove is also a good digestive cordial and is given to persons after the ritual fasting. In cough associated with bronchitis, clove works as a mucolytic agent if its powder is taken in honey with a little powder of mulethi. The famous Lavangadi Vati is an effective medicine to allay bouts of dry or wet cough of any etiology. The use of clove in toothache is a common practice. In tooth decay or cavity, the application of clove oil not only relieves the pain. Due to its mild antibacterial properties it also fights infection. It is a commonly used ingredient of mouth freshners.

Clove oil, though a skin irritant, is used in many linaments and oils which are applied to relieve joint pains, sprains and other soft tissue and bone injuries. In the market, cloves from which the oil has already been extracted, are also sold. Having poor curative value, these are light-weight and small in size. They exude less aroma than normal and have a wrinkled appearance.

Many classic ayurvedic medicines such as Avipattikar Churna and Lavangadi Churna contain cloves as an important ingredient. The average daily dose of the clove powder is 1 gm whereas of its oil it is one to three drops. Prolonged use may cause inflammation and ulceration of the tongue and the mucous membrane of the mouth cavity. (Next week - Bhilawa (marking nut).

Dr R. Vatsyayan is an ayurvedic consultant based at the Sanjivani Ayurvedic Centre, near Rose Garden Main Gate, Ludhiana. (Phones - 423500, 431500; E- mail-sanjivni@satyam.net.in)