|
|
|
|
| HEALTH & FITNESS |
|
|
|
July
28 is World Hepatitis Day Poor sleep
‘accelerates skin ageing’
|
|
July 28 is World Hepatitis
Day Hepatitis is a serious condition, which may lead to liver cirrhosis, liver failure and liver cancer Dr Arvind Sahni
Viral
hepatitis puts a tremendous burden on society. Chronic viral hepatitis, which can cause liver cirrhosis and /or liver cancer, is fatal. Apart from the medical consequences, this also puts a huge economic burden by repeated hospitalisations and costly medical treatment. Acute viral hepatitis, apart from causing sporadic cases of jaundice, can cause epidemics affecting thousands of people. Rarely, a patient of acute viral hepatitis may die of liver failure. Types of virus There are various types of viruses that cause hepatitis — Virus A, B, C, D & E. These viruses cause “inflammation of the liver”, medically called viral hepatitis. The symptoms can include — loss of appetite, vomiting, fever, jaundice, joint and muscle pain and weight loss. All these viruses can cause acute viral hepatitis. If the liver inflammation persists beyond six months, it is labelled as chronic hepatitis. Maximum mortality is caused by chronic hepatitis, which is a serious condition and which, over the decades, may lead to liver cirrhosis, liver failure and liver cancer, thereby causing death. Disease burden According to WHO, globally every third person has evidence of viral hepatitis. Over 500 million people are living with chronic hepatitis B and C, out of which India has 33 million chronic hepatitis B cases and 13 million chronic hepatitis C patients. The Asia-Pacific region carries an estimated 75 per cent of total global burden of chronic hepatitis B. Annually 1.4 million deaths occur globally. India is a hyper-endemic region both for hepatitis A and E. Around 20 million cases happen annually around the world of hepatitis E, out of which 2 million occur in India. Global mortality of hepatitis E is over 300,000 annually. Globally, there are estimated 1.5 million hepatitis A infection cases annually. Water-borne and blood-borne viruses Hepatitis A and E are water borne, and are frequently seen in poor sanitary conditions. These are spread mostly by drinking faecal-contaminated water and/ or food. These are the most common causes of acute viral hepatitis in the Asia-Pacific region and may also cause epidemics when thousands of people are affected by outbreak of jaundice. These do not cause chronic hepatitis. Most of the mortality caused by hepatitis A is due to the rare event of acute liver failure, which may be seen in one in 1,000 children, and up to two per 100 adults. Both these viruses have a devastating effect if a person has pre-existing liver disease, a condition called acute-on-chronic liver failure (ACLF), which has a high morbidity and mortality. Hepatitis B, C and D are blood borne and are spread by transfusion of infected blood, infected needles and /or syringes, infected haemodialysis equipment, sharing of infected needle and/ or syringe among intra-venous drug users (IVDU), occupational hazards by needle-prick injury, promiscuous sexual behaviour etc. These modes of transmission are called horizontal transmission. Particularly in hepatitis B infection, mother passes on the infection to the new-born. This is called vertical transmission and a common mode of infection in Asian countries. Delta virus is a defective virus, which can only infect people who are already infected with hepatitis B. Diagnosis Clinically all these viruses cause hepatitis and cannot be distinguished only by symptoms but by simple blood tests. Most of these lab tests are ELISA based. Chronic viral hepatitis may present differently depending on, whether liver cirrhosis and/or liver cancer is existing. Important manifestations are fatigue, weight loss, jaundice, swelling of legs and abdomen, anorexia, fever, arthritis, coma and gastro-intestinal bleeding. These patients, in addition, may present with symptoms related to kidney, joints or skin. Chronic viral hepatitis B and C are among the most common cause of liver cirrhosis and liver cancer (HCC), globally. Hepatitis B alone causes over 50 per cent of all liver cancers and 33 per cent of all liver cirrhosis, globally. Liver cancer (HCC) is highly malignant tumour with average survival of 3-6 months. However, if diagnosed early by imaging modalities and blood tests, patients may be cured by liver surgery which includes liver transplantation. This facility is available across many hospitals in India. Prevention Water-borne hepatitis Simple measures like proper chlorination of water, boiling of water, replacing damaged or leaking sewerage pipes, ensuring safe and hygienic drinking water supply at all times can prevent infection. The hepatitis A infection can also be prevented by hepatitis A vaccine. The first dose is followed by a second dose after six to 12 months. This is a safe vaccine and is highly effective, with protective antibodies being formed in over 95 per cent of vaccinated people. Combination of hepatitis A ansd B vaccine is also commercially available. Besides children, it is also recommended for: Hepatitis E vaccine was launched in China last year. Three doses — at day 0, one month and six months — are given intramuscularly, in the arm. Hepatitis E vaccine is safe in pregnancy. Its efficacy in preventing hepatitis E infection for the last three years has already been shown. This vaccine will especially be useful for patients with a pre-existing liver disease like cirrhosis, in which hepatitis E can cause aACLF. Hepatitis E vaccine is still not available in India and most of the world. Blood-borne hepatitis Blood-borne hepatitis can be prevented by safe medical and surgical practices, by screening all blood donors for HBV, HCV and HIV, refusing blood donation from commercial/ professional donors, using disposable and sterilised needles and syringes, avoiding recycling of needles, syringes and other medical equipment, avoiding sharing of needles/ syringes among IVDU, taking proper precautions during haemodialysis, and vaccinating all pregnant women. In fact, WHO recommends universal hepatitis B vaccination for everybody. If a family member tests positive for hepatitis B or C infection, following precautions should be observed: Hepatitis B vaccine was launched in 1982 and worldwide 1 billion doses have been used. Three doses are given intramuscular in the arm at day 0, one month and six months. It is important, not to forget the third dose at six months, which gives protective immunity for over two decades. Hepatitis vaccine coverage in India is under 50 per cent as compared to international coverage of over 75 per cent. The hepatitis B vaccine can truly be called a cancer-preventive vaccine, because it protects against hepatitis B, which causes liver cancer. This vaccine also protects against Delta virus infection. Hepatitis vaccine is especially recommended for the following: Hepatitis B vaccination Post Exposure
prophylaxis For hepatitis B infection- immunoglobulin (HBIG) is very costly, but has a special role in occupational accidental needle exposure from hepatitis B infected patient. HBIG is used in new-born to prevent vertical transmission (mother to baby) in hepatitis B positive mothers. In both above-mentioned indications, HBIG is combined with three doses of hepatitis B vaccine. HBIG is used in post-liver transplant recipient to prevent hepatitis B virus reactivation, in patients who have been transplanted for hepatitis B related chronic liver disease. — The writer is Director Gastroenterology, Fortis Hospital, Mohali |
|
Poor sleep ‘accelerates skin ageing’
A
new
study has found that sleep quality impacts skin function and ageing. The recently completed study by physician-scientists at University Hospitals (UH) Case Medical Center, demonstrated that poor sleepers had increased signs of skin ageing and slower recovery from a variety of environmental stressors, such as disruption of the skin barrier or ultraviolet (UV) radiation. Poor sleepers also had worse assessment of their own skin and facial appearance. “Our study is the first to conclusively demonstrate that inadequate sleep is correlated with reduced skin health and accelerates skin ageing. Sleep deprived women show signs of premature skin ageing and a decrease in their skin’s ability to recover after sun exposure,” Primary Investigator Elma Baron, MD, Director of the Skin Study Center at UH Case Medical Center and Associate Professor of Dermatology at Case Western Reserve University School of Medicine, said. “Insufficient sleep has become a worldwide epidemic. While chronic sleep deprivation has been linked to medical problems such as obesity, diabetes, cancer and immune deficiency, its effects on skin function have previously been unknown,” she said. Skin functions as an important barrier from external stressors such as environmental toxins and sun-induced DNA damage. The research team set out to determine if skin function and appearance is also impacted by sleep quality, which is vital to the growth and renewal of the body’s immune and physiological systems. The researchers found that good quality sleepers recovered more efficiently from stressors to the skin. Recovery from sunburn was more sluggish in poor quality sleepers, with erythema (redness) remaining higher over 72 hours, indicating that inflammation is less efficiently resolved. A Transepidermal Water Loss (TEWL) test was used at various time points to determine the ability of the skin to serve as an effective barrier against moisture loss. In measurements 72 hours after a skin barrier stressor (tape-stripping), the recovery of good quality sleepers was 30 percent higher than poor quality sleepers (14 percent vs. -6 percent) demonstrating that they repair the damage more quickly. Additionally, poor quality sleepers were significantly more likely to have a higher Body Mass Index (BMI). For example, 23 per cent of good quality sleepers were obese compared to 44 per cent of poor quality sleepers. Not surprisingly, self perception of attractiveness was significantly better in good quality sleepers (mean score of 21 on self evaluation) vs. poor quality sleepers (mean score of 18). — ANI |
|
Have breakfast; reduce risk of heart attack
Washington: Skipping breakfast could make you vulnerable to heart attack, warn US researchers. Older men who missed breakfast are a quarter more likely to have a cardiac arrest or die from coronary disease than those who do, Daily Mail reported. Missing a morning meal or eating very late at night may trigger changes in the metabolism that leads to coronary heart disease. It may also affect blood sugar and hormone levels that make heart disease more likely. For their study spanning 16 years, the researchers tracked the health of 26,902 male health professionals aged 45-82. Men who skipped breakfast were found to have a 27 percent higher risk of heart attack or death from coronary heart disease than breakfast eaters. Men who ate after going to bed had a 55 per cent higher coronary heart disease risk than those who did not. — Agencies |
Patients with pre-existing liver disease like cirrhosis.
For hepatitis A infection, hepatitis A vaccine or hepatitis A immunoglobulin is effective, if given within two weeks of exposure. However, hepatitis A vaccine is recommended over hepatitis A immunoglobulin, as it gives greater long-term immunity. It is safer and does not have any side effects. However, for hepatitis E immunoglobulin is not effective.