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Abdominal Lump

by Pragati Singh
written by Pragati Singh

What exactly is an abdominal lump?

An abdominal lump is a swelling or bulge that appears in any part of the abdomen. It is usually soft, but it can be firm depending on the underlying cause.

A hernia is the most common cause of a lump. An abdominal hernia occurs when the structures of the abdominal cavity push through a weakness in the abdominal wall muscles. Typically, surgery can easily correct this.

In rarer cases, the lump may be an undescended testicle, a harmless hematoma, or a lipoma. In even rarer circumstances, it may be a cancerous tumor.

If you also have a fever, vomiting, or pain around an abdominal lump, you may need emergency care.

Possible causes of an abdominal lump

A hernia causes the majority of lumps in the abdomen. Hernias often appear after you have strained your abdominal muscles by lifting something heavy, coughing for a long period, or being constipated.

There are several types of hernias. Three kinds of hernias can produce a noticeable lump.

Inguinal hernia

An inguinal hernia occurs when there is a weakness in the abdominal wall and a part of the intestine or other soft tissue protrudes through it. You’ll most likely see or feel a lump in your lower abdomen near your groin and feel pain when coughing, bending, or lifting.

In some cases, there are no symptoms until the condition gets worse. A hernia isn’t typically harmful by itself. However, it needs to be repaired surgically because it can cause complications, such as a loss of blood flow to the intestine and/or obstruction of the intestine.

Umbilical hernia

An umbilical hernia is very similar to an inguinal hernia. However, an umbilical hernia occurs around the navel. This type of hernia is most common in babies and often disappears as their abdominal wall heals on its own.

The classic sign of an umbilical hernia in a baby is outward bulging of tissue by the belly button when they cry.

Surgery is required to fix an umbilical hernia if it doesn’t heal on its own by the time a child is four years old. The possible complications are similar to those of an inguinal hernia.

Incisional hernia

An incisional hernia happens when a prior surgical incision that has weakened the abdominal wall, allows intra-abdominal content to push through. It requires corrective surgery to avoid complications.

Less common causes of an abdominal lump

If a hernia isn’t the cause of an abdominal lump, there are several other possibilities.

Hematoma

A hematoma is a collection of blood under the skin that results from broken blood vessels. Hematomas are typically caused by an injury. If a hematoma occurs by your abdomen, a bulge and discolored skin may appear. Hematomas typically resolve without needing treatment.

Lipoma

A lipoma is a lump of fat that collects under the skin. It feels like a semi-firm, rubbery bulge that moves slightly when pushed. Lipomas typically grow very slowly, can occur anywhere on the body, and are almost always benign.

They can be removed surgically, but in most cases, surgery isn’t necessary.

Undescended testicle

During male fetal development, the testicles form in the abdomen and then descend into the scrotum. In some cases, one or both of them may not fully descend. This may cause a small lump near the groin in newborn boys and can be corrected with hormone therapy and/or surgery to bring the testicle into position.

Tumor

Although rare, a benign (noncancerous) or malignant (cancerous) tumor on an organ in the abdomen or in the skin or muscles can cause a noticeable lump. Whether it requires surgery or another type of treatment depends on the type of tumor and its location.

How is it diagnosed?

If you have a hernia, your doctor will likely be able to diagnose it during the physical exam. Your doctor may want you to undergo an imaging study, such as an ultrasound or CT scan of your abdomen. Once your doctor confirms an abdominal hernia is present, you can then discuss arrangements for a surgical correction.

If your doctor doesn’t believe the lump is a hernia, they may require further testing. For a small or asymptomatic hematoma or lipoma, you probably won’t need further tests.

If a tumor is suspected, you may need imaging tests to determine its location and extent. You’ll likely also need a biopsy, which involves tissue removal, to determine if the tumor is benign or malignant.

When to seek medical help

If you feel or see a lump in your abdomen that you can’t identify, make an appointment to see your doctor. If you also have a fever, vomiting, discoloration, or severe pain around the lump, you may need emergency care.

At your doctor’s appointment, you can expect to receive a physical examination of your abdomen. Your doctor may ask you to cough or strain in some way while they’re examining your abdomen.

Other questions they may ask include:

When did you notice the lump?

Has the lump changed in size or location?

What makes it change, if at all?

Do you have any other symptoms?

 

 

 

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UTI: all you need to know

by Pragati Singh
written by Pragati Singh

A urinary tract infection (UTI) affects any component of your urinary system, including the kidneys, ureters, bladder, and urethra. The bladder and urethra are the most often infected parts of the urinary system.

Women are more likely than males to have a urinary tract infection. A bladder infection may be both painful and inconvenient. If a UTI spreads to your kidneys, though, it might have significant implications.

Doctors typically treat urinary tract infections with antibiotics. But you can take steps to reduce your chances of getting a UTI in the first place.

Symptoms

Urinary tract infections don’t always cause signs and symptoms, but when they do they may include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone

UTIs may be overlooked or mistaken for other conditions in older adults.

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Signs and symptoms
Kidneys (acute pyelonephritis)
  • Back pain or side (flank) pain
  • High fever
  • Shaking and chills
  • Nausea
  • Vomiting
Bladder (cystitis)
  • Pelvic pressure
  • Lower abdomen discomfort
  • Frequent, painful urination
  • Blood in urine
Urethra (urethritis)
  • Burning with urination
  • Discharge

When to see a doctor

Contact your doctor if you have signs and symptoms of a UTI.

Causes

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.

The most common UTIs occur mainly in women and affect the bladder and urethra.

  • Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.

    Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.

  • Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Risk factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

  • Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
  • Sexual activity. Sexually active women tend to have more UTIs than do women who aren’t sexually active. Having a new sexual partner also increases your risk.
  • Certain types of birth control. Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
  • Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

  • Urinary tract abnormalities. Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
  • Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
  • A suppressed immune system. Diabetes and other diseases that impair the immune system — the body’s defense against germs — can increase the risk of UTIs.
  • Catheter use. People who can’t urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
  • A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

  • Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
  • Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
  • Increased risk in pregnant women of delivering low birth weight or premature infants.
  • Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
  • Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Prevention

You can take these steps to reduce your risk of urinary tract infections:

  • Drink plenty of liquids, especially water. Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
  • Drink cranberry juice. Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
  • Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Empty your bladder soon after intercourse. Also, drink a full glass of water to help flush bacteria.
  • Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
  • Change your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.
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Study examines age-related changes to the small bowel

by Vaishali Sharma
written by Vaishali Sharma

Researchers at Cedars-Sinai have found that aging produces significant changes in the microbiome of the human small intestine distinct from those caused by medications or illness burden. The findings have been published in the journal Cell Reports.

“By teasing out the microbial changes that occur in the small bowel with age, medication use and diseases, we hope to identify unique components of the microbial community to target for therapeutics and interventions that could promote healthy aging,” said Ruchi Mathur, MD, the study’s principal investigator.

Research exploring the gut microbiome, and its impact on health, has relied predominantly on fecal samples, which do not represent the entire gut, according to Mathur. In their study, investigators from Cedars-Sinai’s Medically Associated Science and Technology (MAST) Program analyzed samples from the small intestine-which is over 20 feet in length and has the surface area of a tennis court-for examination of the microbiome and its relationship with aging.

“This study is the first of its kind to examine the microbial composition of the small intestine of subjects 18 years of age to 80. We now know that certain microbial populations are influenced more by medications, while others are more affected by certain diseases. We have identified specific microbes that appear to be only influenced by the chronological age of the person,” said Mathur, an endocrinologist and director of the Diabetes Outpatient Treatment & Education Center.

The 21st century has been referred to as the “era of the gut microbiome” as scientists turn considerable attention to the role trillions of gut bacteria, fungi and viruses may play in human health and disease. The microbiome is the name given to the genes that live in these cells. Studies have suggested that disturbances in the constellations of the microbial universe may lead to critical illnesses, including gastroenterological diseases, diabetes, obesity, and some neurological disorders.

While researchers know that microbial diversity in stool decreases with age, Cedars-Sinai investigators identified bacteria in the small bowel they refer to as “disruptors” that increase and could be troublesome.

“Coliforms are normal residents of the intestine. We found that when these rod-shaped microbes become too abundant in the small bowel-as they do as we get older-they exert a negative influence on the rest of the microbial population. They are like weeds in a garden,” said study co-author Gabriela Leite, PhD.

Investigators also found that as people age, the bacteria in the small intestine change from microbes that prefer oxygen to those that can survive with less oxygen, something they hope to understand as the research continues.

“Our goal is to identify and fingerprint the small intestinal microbial patterns of human health and disease. Given the important role the small bowel plays in absorption of nutrients, changes in the microbiome in this location of the gut may have a greater impact on human health, and warrants further study,” said Mark Pimentel, MD, director of the MAST program and a co-author of the study.

This research is part of Cedars-Sinai’s ongoing REIMAGINE study: Revealing the Entire Intestinal Microbiota and its Associations with the Genetic, Immunologic, and Neuroendocrine Ecosystem.

Source:Cedars-Sinai Medical Center

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Is Your Favorite Spicy Food Causing Stomach Problems?

by Pragati Singh
written by Pragati Singh

Spice can transform an ordinary meal into something far more memorable. However, the signature heat that it produces can have an impact on more than just your taste buds.

Spicy foods were once blamed for causing peptic ulcers, which are sores in the stomach or duodenum (the first part of the small intestine) that cause dull or burning pain. Long-term use of nonsteroidal anti-inflammatory drugs like ibuprofen or aspirin, bacterial infection with Helicobacter pylori (H. pylori), or, in rare cases, tumours are now known to be the root causes of these ulcers.

Similarly, spicy foods do not cause gastroesophageal reflux disease, or GERD, which is a chronic condition in which the contents of the stomach wash back into the oesophagus due to a weak or malfunctioning muscle valve between the two. The stomach acids can then irritate the esophagus and cause heartburn, which feels like a burning sensation in the chest, behind the breastbone, and/or in the throat.

“All foods lead to the reflux of acid,” says Andrew Ippoliti, MD, a gastroenterologist at Keck Medicine of USC and professor of clinical medicine at the Keck School of Medicine of USC.

The stomach secretes acid during meals, and food can buffer the acid while it’s in the stomach. Once the food is digested and empties from the stomach, however, acid secretion continues without any food to neutralize it.

“This is the time when reflux occurs, and regardless of whether you’ve eaten spicy or bland food, the same process takes place.”

The one exception is coffee (both caffeinated and decaffeinated), because it stimulates acid secretion and has no capacity to buffer the acid.

On the other hand, intolerances or sensitivities to certain foods, including spicy foods, may be behind irritable bowel syndrome (IBS), a gastrointestinal condition that comes with symptoms like abdominal pain, diarrhea, constipation or bloating. One study found that people who consumed certain spices more than 10 times a week — chili pepper, curry, ginger, cinnamon and turmeric — were more likely to have IBS than people who never consumed them. If spicy foods trigger IBS symptoms for you, your doctor will probably suggest you take them off your menu.

Less conclusive at the moment is whether spicy food increases the risk for cancer. A recent meta-analysis looked at almost 40 studies and found that eating large amounts of spicy food was associated with an increased risk for gastric cancer. But more research needs to be conducted before there’s conclusive evidence that spicy food is a definitive risk factor for gastric cancer.

When it comes to spicy food and gastrointestinal issues like heartburn, bloating and diarrhea, however, the bottom line is this: “There’s no need to avoid spicy foods unless they regularly lead to symptoms.

 

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Liver transplant beneficiaries at no increased risk of mortality of covid without comorbidity: study

by Pragati Singh
written by Pragati Singh

A Covid 19 study of adult patients who have undergone Max Healthcare liver transplantation suggests that non-complicated liver transplants with no comorbidity have no elevated coronaviral mortality rate.

The study looked at 2182 people who had undergone liver transplantation at Max Hospital, Saket from 2006. Of these 88 people reported to have got Covid and 81 were included in the study. The average age of patients in the study was 51.3 years.

Among the 81 patients, 35 or 43.2 per cent of the patients had one or more comorbidities. Among the 81, 14 died of Covid-19. Of those who died, three or 6.5 per cent did not have any comorbidities.

Among the patients 22 (27.1 per cent) had diabetes mellitus (DM) as the most common comorbidity while hypertension was present in 3.7 per cent, and 7.4 per cent had DM2 with hypertension. Four of them had chronic kidney disease (CKD) along with DM2, of which one had stage 2 CKD and the other three patients had stage 3 CKD.

In the studied group, 59 (72.8 per cent) were on two immunosuppressants – calcineurin inhibitors (CNIs) and mycophenolate mofetil. 10 (12 per cent) were receiving three immunosuppressive drugs—CNIs, mycophenolate mofetil and prednisolone. 11 (13.5 per cent) were taking single immunosuppressive medication (tacrolimus) only. One patient was on steroids with tacrolimus and everolimus due to a recent rejection episode.

“In our study, all patients who died except one had received a liver transplant more than a year ago. After one year of transplantation, the dosage of immunosuppressive medication is usually significantly reduced and therefore the cytokine storm may not be ameliorated. In our study population, Covid-related mortality was 17.3 per cent which is comparable to the 18.2 per cent mortality seen in older patients with comorbidities. Our study suggests that uncomplicated liver transplant recipients who get infected with coronavirus do not necessarily have higher mortality as compared to similar non transplanted populations. However, more studies are needed with a larger patient population and matched control groups to reach a firm conclusion,” said Dr Subhash Gupta, chairman of the Centre for Liver & Biliary Sciences, at the hospital.

 

 

 

 

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Gut bacteria influence brain development

by Vaishali Sharma
written by Vaishali Sharma

Complex interplay: the gut-immune-brain axis

The early development of the gut, the brain and the immune system are closely interrelated. Researchers refer to this as the gut-immune-brain axis. Bacteria in the gut cooperate with the immune system, which in turn monitors gut microbes and develops appropriate responses to them. In addition, the gut is in contact with the brain via the vagus nerve as well as via the immune system. “We investigated the role this axis plays in the brain development of extreme preterm infants,” says the first author of the study, David Seki. “The microorganisms of the gut microbiome — which is a vital collection of hundreds of species of bacteria, fungi, viruses and other microbes — are in equilibrium in healthy people. However, especially in premature babies, whose immune system and microbiome have not been able to develop fully, shifts are quite likely to occur. These shifts may result in negative effects on the brain,” explains the microbiologist and immunologist.

Patterns in the microbiome provide clues to brain damage

“In fact, we have been able to identify certain patterns in the microbiome and immune response that are clearly linked to the progression and severity of brain injury,” adds David Berry, microbiologist and head of the research group at the Centre for Microbiology and Environmental Systems Science (CMESS) at the University of Vienna as well as Operational Director of the Joint Microbiome Facility of the Medical University of Vienna and University of Vienna. “Crucially, such patterns often show up prior to changes in the brain. This suggests a critical time window during which brain damage of extremely premature infants may be prevented from worsening or even avoided.”

Comprehensive study of the development of extremely premature infants

Starting points for the development of appropriate therapies are provided by the biomarkers that the interdisciplinary team was able to identify. “Our data show that excessive growth of the bacterium Klebsiella and the associated elevated ??-T-cell levels can apparently exacerbate brain damage,” explains Lukas Wisgrill, Neonatologist from the Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics at the Department of Pediatric and Adolescent Medicine at the Medical University of Vienna. “We were able to track down these patterns because, for a very specific group of newborns, for the first time we explored in detail how the gut microbiome, the immune system and the brain develop and how they interact in this process,” he adds. The study monitored a total of 60 premature infants, born before 28 weeks gestation and weighing less than 1 kilogram, for several weeks or even months. Using state-of-the-art methods — the team examined the microbiome using 16S rRNA gene sequencing, among other methods — the researchers analysed blood and stool samples, brain wave recordings (e.g. aEEG) and MRI images of the infants’ brains.

Research continues with two studies

The study, which is an inter-university clusterproject under the joint leadership by Angelika Berger (Medical University of Vienna) and David Berry (University of Vienna), is the starting point for a research project that will investigate the microbiome and its significance for the neurological development of prematurely born children even more thoroughly. In addition, the researchers will continue to follow the children of the initial study. “How the children’s motoric and cognitive skills develop only becomes apparent over several years,” explains Angelika Berger. “We aim to understand how this very early development of the gut-immune-brain axis plays out in the long term. ” The most important cooperation partners for the project are already on board: “The children’s parents have supported us in the study with great interest and openness,” says David Seki. “Ultimately, this is the only reason we were able to gain these important insights. We are very grateful for that.”

Source: University of Vienna

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Naturopathic Tips to Address Fatty Liver Disease

by Dr. Shanmugam
written by Dr. Shanmugam

By Shanmugam Asst CMO, Jindal Naturecure Institute

The liver is the largest organ inside the body that helps digestion of food, energy storage, and removal of toxic substances. Fatty liver disease happens to be a condition where excess fat deposits inside the liver. The fatty deposits interfere with the liver’s normal functioning and slow down the process of bile and insulin production necessary for various body functions. Excess amounts of fat in the liver can be worrisome, which can lead to permanent scarring and ultimately leading to liver failure.

Types of Fatty Liver Disease

There are two types of fatty liver disease – Non-Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Fatty Liver Disease. Non-alcoholic fatty liver disease is further categorised into 2 types – Simple Fatty Liver and Non-Alcoholic Steatohepatitis (NASH). In the case of NASH, the inflammation of the liver can lead to cancer or cirrhosis. On the other hand, Alcoholic Steatohepatitis is a condition that results from excessive consumption of alcohol. The liver releases toxic substances while breaking down alcohol which damages the organ’s cells and causes inflammation. Though globally, 25% of the adult population is affected by NAFLD, the prevalence rate is 9% to 32% in India.

Symptoms of Non-Alcoholic Fatty Liver Disease

Individuals of all age groups can be affected by non-alcoholic fatty liver disease. But, it is commonly observed in people within the age group of 40-50 who have certain pre-existing conditions like obesity, type 2 diabetes, high cholesterol, PCOS, sleep apnea, and metabolic syndrome. Usually, NAFLD doesn’t cause any symptoms; however, those with any of the above condition/s can experience enlarged spleen, abdominal swelling, enlarged blood vessels, yellowing of the skin and eyes, and red palms.

Naturopathic Treatment for Fatty Liver Disease

Naturopathic treatment encourages NASH patients to manage their comorbidities through various lifestyle changes, diet and supplements. Naturopathy recognises that every individual is different and requires a different treatment option. Here we look at some of the staples in a naturopathic treatment plan to deal with fatty liver disease.

Diet

Those with fatty liver disease must include plenty of organic fruits and green leafy vegetables in the diet. Proper nutrition can increase antioxidants and lessen the oxidative stress in the body leading to better health. If possible, it is always a good idea to opt for GMO-free (genetically modified organisms free) and organic products. If there is insulin resistance, one should also stay away from sugars.

Exercise

A study published in the ‘Alimentary Pharmacology and Therapeutics’ journal stated that daily exercise effectively reverses NAFLD. One can opt for exercise like yoga, running, cycling, swimming, etc., to maintain a healthy weight and stay fit. Regular exercise reduces fatty acid synthesis, increases fatty acid oxidation and prevents hepatocellular and mitochondrial damage.

Avoid Salted and Fried Foods

High in calories and fats, fried foods can make it a tough job for the liver to deal with them. With increased calorie intake, the chances of putting on weight also increases. Obese people are more at risk of developing fatty liver disease. The Journal of Agriculture and Food Chemistry has published a study stating that too much sodium harms the liver. Excess of sodium in the diet can lower cell division and increase cell deaths in the liver, which can cause liver fibrosis.

Natural Remedies

There are plenty of simple ingredients in everyday use that can bring positive outcomes and enhance the healing process of damaged liver.

  • Turmeric

Curcumin present in turmeric helps protect the liver cells from non-alcoholic fatty liver disease (NAFLD) when appropriately administered.

  • Cinnamon

Cinnamon has strong anti-inflammatory properties that are effective in bringing down the inflammation in the liver.

  • Indian Gooseberry

Amla or Indian Gooseberry is stuffed with antioxidants and Vitamin C that protects the liver from damage and cleans the toxins.

  • Apple Cider Vinegar

When it comes to home remedies, apple cider vinegar is a preferred choice since it has amazing detoxification properties. Apple Cider Vinegar works by helping the liver flush out the toxins that can interfere with the body’s normal functioning.

Stay Hydrated

When the body is well-hydrated, the toxins are easily removed from the body and blood flow is also improved. Daily 10-12 glasses of water are necessary to keep the body adequately hydrated.

 

 

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Patients with Hepatitis should be vaccinated for Covid on Priority basis, experts suggest

by Vaishali Sharma
written by Vaishali Sharma

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. Sanjeev Sehgal, Principal Director, Liver and Hepatology, from Max Chain of Hospitals; Dr Sudeep Khanna, Senior Consultant, Gastroenterology Dept, Apollo Chain of Hospitals.

Dr. Sehgal, why is hepatitis such a crucial problem? According to WHO reports a person dies of Hepatitis dies every 30 second.

Dr. Sanjeev Sehgal: 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 and E are self-limiting and spread through feco-oral route by contaminated food and water. Hepatitis B and C are huge burden in our country and spread through parenteral route, that is by blood and body fluids. 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.

40 million people in India are HBV infected and constitute about 11% of the global rate. What would you say Dr. Arora?

Dr. Anil 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.

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.

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.

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.

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.

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.

Dr. Sehgal, can a patient of Hepatitis B follow up with their checkup if infected with Covid?

Dr. Sanjeev Sehgal: 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.

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.

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.

In what conditions in Covid patients does it lead to diseases like Cirrhosis other complications?

Dr. Sanjeev Sehgal: 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.

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.

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.

Dr. Sehgal, is there anything that we can do to prevent it other than screening or vaccination?

Dr. Sanjeev Sehgal: 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.

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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Gastroenterology NewsNational & International News

World Hepatitis Day: Hepatitis Can’t Wait

by Vaishali Sharma
written by Vaishali Sharma

Dr Naveen Polavarapu

Sr Consultant Gastroenterologist and Transplant Hepatologist, Apollo Hospitals, Jubilee Hills.

Dr K.S. Soma Sekhar Rao.

Consultant Gastroenterologist and Hepatologist, Apollo Hospitals, Jubilee Hills.

Dr D K Raghu,

Consultant Gastroenterologist and Hepatologist, Apollo Hospitals, Jubilee Hills.

Dr Sarathchandra G

Consultant Gastroenterologist and Hepatologist, Apollo Hospitals, Jubilee Hills.

On world hepatitis day today, here are some facts about liver, causes of hepatitis, symptoms, diagnosis and prevention of the disease complications.

 

According to WHO, Liver cancer is the fastest growing cancer in the World currently and a person is dying every 30seconds from hepatitis related illness even in the current COVID-19 crisis. 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.

 

What is Liver and what does it do?

Liver is the largest organ in the human body which performs more than 500 vital functions. All the food that we eat including carbohydrates, fats, minerals gets metabolised in the Liver after getting absorbed from the intestines. It produces important proteins which help in clotting of the blood. Liver along with kidneys work like a filter removing all the toxins and acids from the body. It also plays a crucial role in maintaining adequate sugar levels in the body and also acts like a storage organ.

 

What is hepatitis?

Hepatitis means inflammation of the liver which if unchecked will lead to significant permanent damage to the Liver and life risk. The most common causes of Liver damage are Viral Hepatitis (mainly B,C), fatty Liver and alcohol. Along with these there are more than 100 different causes of Liver damage which will lead to Cirrhosis (end stage Liver disease).

 

Why is it important to know about Viral Hepatitis?

Hepatitis B directly has been causing 10 lakh deaths every year for the last few decades. It is estimated that around 200 crores population is currently or previously infected with Hepatitis B and around 35 crore population is currently infected and carrying this Hepatitis B virus. Around 75% of these infected people are in Asia and Africa. People with Hepatitis B have 100 times more risk of developing Liver cancer compared to people who do not have Hepatitis.

 

Similarly Hepatitis C is estimated to be present in 18 crore populations worldwide and most often cause long-term significant damage to the Liver leading to irreversible cirrhosis and Liver cancer. In fact 2 out of 3 Liver cancer deaths are related to Viral Hepatitis.

What are the symptoms and signs of hepatitis?

Liver is such a brilliant organ that it copes until it is at least more than 80% damaged and by the time symptoms appear it is often too late, hence Liver is like a silent killer.

 

9 out of 10 people don’t even know that they have the virus and often it gets picked up whilst doing routine testing for other reasons.

 

Common symptoms they present with are Jaundice, tummy swelling, leg swelling, blood vomiting or black stools, confusion and drowsiness. These symptoms appear only when the Liver is significantly damaged.

 

How can I get checked if I have the virus?

Detection of these viruses is with a simple blood test, which is widely available. Once these viruses are detected then the Liver specialist will evaluate the stage of the virus and also the amount of the damage that has happened to the Liver. Based on these we can offer further treatment.

 

Are there any treatments available?

If recognised early, Hepatitis is treatable and sometimes curable too. We can arrest the progression to cirrhosis by early recognition of these viruses and early commencement of the medications.

 

There are excellent medications available now to completely cure the Hepatitis C. You just need to take one tablet a day for generally 3 months with almost 99% chance of completely curing the virus therefore eradicating the risk of future Cirrhosis and Liver cancer.

 

For Hepatitis B also there are excellent medications to control the virus. Of course there are excellent vaccinations available for Hepatitis B and A.

 

We at Apollo Hospitals have been running dedicated Liver clinics specifically designed to treat and cure these deadly viruses. We have the state of the art equipment and expertise to identify and treat these viruses with excellent cure rates. In patients who have developed advanced Liver disease, we have been treating them with excellent outcomes and in patients who need Liver transplant as the only mode of survival, we have been doing them at our centre successfully for nearly 10 years.

 

The theme of World Hepatitis Day 2021 is “Hepatitis can’t wait” to raise the awareness among masses. It is strongly recommended that all of us get checked for these deadly silent killing viruses and if negative then let us get vaccinated.

 

In fact WHO goal is to make the HEPATITIS FREE WORLD BY 2030 and it is achievable by all of us doing our part in coming forward, getting checked and treated if positive or vaccinated if negative. And we all know that prevention is better than cure.

 

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chronic liver diseases
Gastroenterology News

How does underlying Cirrhosis influence Covid-19?

by Vaishali Sharma
written by Vaishali Sharma

Chronic liver diseases are common worldwide, especially in developing countries. The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/(COVID-19) leads to the infection of many patients with underlying chronic liver diseases. To discuss about the same, we interviewed Dr. Shiv Kumar Sarin, Director of Institute of Liver and Biliary Sciences (ILBS); Dr. Anil Arora, Chairman, Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences Sir Ganga Ram Hospital and Dr. Kaushal Madaan, principal director and head of Hepatology from Max chain of hospitals.

Question: Since there is a lot fear among people as far as Covid is concerned, how should a liver patient, someone who perhaps has fatty liver, liver cirrhosis, how should they go about their regular checkups? Should they visit hospitals? Should they consult you all over? What are they supposed to do?

Dr. Sarin: First of all we should know that liver is located on the right side of the body and weighs a kilogram and a half. It is one of the largest organs in the human body. If you put a lot of stuff on the liver, then it is not a healthy liver. If there is extra fat for too long, the liver will shrink and it may become fibrous, discard and late stages of cirrhosis.

Question: Those who already perhaps have these diseases, they also have a lot of apprehensions as far as their regular checkups are concerned, because that’s also extremely important for them. Should they skip it as of now, should they visit hospitals, or should they stick to video consultation? What would be your advice to those who already have liver diseases, but perhaps don’t have Covid, have an anxiety or fear of Covid in the back of their mind.

Dr. Sarin: Those who have fatty liver certainly are not having the disease. Fatty liver itself is just extra fat. But if somebody has cirrhosis and he knows somebody who has got alcohol liver injury or has cancer, they all require treatment and monitoring. So don’t put it away. Treatment for all liver diseases must be given and should not be delayed. Treatment is essential whether you use a teleconsult or go to the hospital. What you can do at home is, of course, continue your own diet and the prescription that the doctor has given.

Question: We all know that because of the fear of Covid, there is a lot of concoction of medicines which many of us are consuming already. There are alternate medications that many people are taking. There were reports that Giloy could cause some liver damage, then later there were reports no it doesn’t do that.

What would be your stand on this alternative medication when it comes to avoiding Coronavirus or just taking these medications as a precaution?

Dr. Arora: Liver is an organ that does not require any servicing, does not require any maintenance till you intentionally or accidentally try to injure it. You do not need any medication. You do not need a specific diet. You do not need any type of maintenance, but do everything to prevent the damage.

Two major reasons why the liver gets damaged is, if you are having too much of the calories in the diet, so initially it gets deposited in the peripheral tissue that is subcutaneous tissue, and once those stores get exhausted, it tends to get into the vital organs. The liver is a central organ for the metabolism, production and synthesis of various proteins, and integrated metabolism of fat, carbohydrates as well as proteins. It also is known to produce a number of coagulation and anticoagulation factors.

In fact, there have been excellent guidelines from CDC, from our own ICMR and the Government of India and AIIMS, which tell us that we need minimum medication. Even allopathic medicines are needed in minimum doses for a minimum duration of time. They will do more harm than good. Especially all chemicals, all ingestions, all food has to be metabolized through the liver. So anything and everything that you are taking for any purpose you have to take under the guidance of a registered medical practitioner, take it for a minimum period of time, at a minimum dose, for a minimum duration. Never self-medicate yourself.

Question: But I specifically mentioned giloy because there is a lot of debate around it. And also it’s not just giloy, but a lot of as I said ayurvedic, alternative medication which people are taking. Dr. Kaushal, would you also perhaps tell your patients to stay off this concoction of alternative medicine, medicine that claim to be herbal and perhaps give you better immunity against Coronavirus?

Dr. Kaushal: These herbal and alternative medicines, even before this pandemic of Covid started, we have been advising our patients, whether or not they have underlying liver disease, to avoid taking herbal medicines of whose ingredients we are not sure of. When this pandemic came, we realised that there were many patients who were coming into us with unexplained liver failure and liver injury and some of them had even died. Only after a few months, we realised that they were taking a concoction and the most common ingredient of that concoction in these particular patients was Giloy. In fact, you would have recently seen a publication published in an indexed journal that presented about five or six cases similar to what I have been talking about and I think all of us would have seen such cases. See, how we make a diagnosis is by the exclusion of all other possibilities. We could not find any cause and only this thing stood apart, as patients were using kadhas… I don’t know what kind of mixtures they were having, what kind of concoctions… Two times a day, three times a day, for almost a year they were having it and they landed up with liver injuries. So I definitely think that these are the culprits in such cases.

Question: Could it also affect a healthy patient, someone who has a healthy liver and they start to take alternate medication? What would be your advice to them?

Dr. Sarin: Any medicine whether allopathic, homoeopathic or ayurvedic or preparation can be harmful or beneficial. I do not know much about the homeopathic or allopathic medicines. I can certainly say that there are certain herbs that can be harmful. No medicine should be consumed without a scientifically proven safety.

Secondly, a healthy liver is a necessity for better immunity. As far as covid is concerned, the infection initially transits to the lungs and then to the liver where it finally settles. This is called bystander hepatitis. Bystander implies that whatever Corona does, harm to the liver is possible.  has severe Covid, he will have something like 70% of them will have liver enzymes being normal. In mild Covid, 10-20% will be having liver enzymes normal. Food can injure the liver, drugs which are taken, preparations that are taken, all can cause injury to the liver.

Question: Talking of drugs, there were reports that azithromycin, remdesivir, those drugs could also affect the liver, but they were widely prescribed by physicians. What would you say to liver patients? Should they stay off these drugs? And those who get serious, perhaps their families are told to administer remdesivir. What are they supposed to do then?

Dr. Sarin: So, remdesiver cannot be given to patients with liver disease. Secondly, it is not proven beneficial. So I would be very hesitant to give. Azithromycin can also give liver injury. In fact, there is no reason to give these drugs if the patient has pre-existing liver diseases. If you have read some very interesting Lancet papers, Corona was more serious in those patients who had a BMI of about 25. In India, nearly 30%, one in three people have a high BMI, they all have fatty liver. So, the disease is more common, more susceptible, injury is more progressive and liver injury enzymes being abnormal or very high. Secondly, if somebody is also mixing alcohol with Corona pills and ppl were staying home, they were drinking.

Question: Dr. Arora, I know a lot of patients, not liver patients but younger ones who are comorbid, have diabetes etc. The day they recovered, the first question they have in mind is that can I have a drink now? What would you say to those who have liver diseases, perhaps got Corona, have recovered and are craving a drink?


Dr. Arora: See drinking as a habit, when it is harmful for you, it is not recommended. If you look at our baseline population, which has non-alcoholic fatty liver disease coupled with so many metabolic abnormalities like diabetes, hypertension, these are all the risk factors that will aggravate the injury related to alcohol. Once in a while, socializing is understandable, but the problem is that alcohol is an addictive agent. If you look at the data from the US, the maximum number of cases that are being reported after cure from hepatitis is related to alcohol.

This is something that is absolutely preventable. Not only on its own it causes problems, but in patients with underlying fatty liver or those with hepatitis B or C, this alcohol is an added synergistic effect to cause further liver damage. So, unless you are sure that there is nothing wrong, you should avoid alcohol.

Question: Does Covid affect them more severely if they have liver cirrhosis? And what about those who have had a liver transplant?

Dr. Kaushal: There is ample data to suggest that patients who have fatty liver disease have a very severe lung disease when they acquire Covid. They have very poor outcomes and more of them end up in the ICU, end up with ventilatory support. Patients who are just at the stage of waiting for a transplant, are the ones who have advanced liver diseases. So, obviously, if they acquire Covid-19, they are at high risk of dying. If they have a new liver, they already are immunosuppressed. Some schools of thought say that since they are already immunossuppressed, they’re not able to mount an immunoinflammatory response to Covid so they may have mild disease. But this is a controversial issue and more and more data is coming in.

Question: Is the severity or risk of Covid a lot more once they catch it? Secondly, is the treatment for them different? Is it special treatment or they take the same medication as the general population who catches the virus? And if someone has liver disease, generally when people catch Covid, they go to general physicians. Should they also consult their liver doctor in the loop about the medications they are taking?

Dr, Sarin: If the transplant was done within the last three months, corona can be very severe, and you should act quickly. People who are on heavy immunosuppressants have rejections even after a year, and if they get a corona infection, there is a problem again. Corona does not make people worse, but they are already predisposed to other illnesses.

Liver is the root cause of diabetes and blood pressure and high triglycerides. If you have fatty liver or is obese, diabetic, is comorbid, he must look at the liver enzymes. Covid gives you all a chance to lose weight. Become healthy, lean and thin, so that unfortunately, if the third wave comes, you are strong, your liver is strong and your body is strong.

Question: What about liver patients? Once they recover, what is the post-Covid care that they need? What are the tests which are required and why would you say they shouldn’t throw caution to the wind? Perhaps why would you say that those who have liver diseases have recovered from Covid should still be cautious and should still measure their parameters? 

Dr. Arora: All those who suffer from Covid are likely to come down with something called ‘Long Covid’ There is a multitude of reasons for that. You may have a bit of virus or the immune process which may still be simmering around the body. Or you may have an immune complex disease that may be present or activation of the immune system. Now coming back to the liver, in patients with liver disease, if you have a concomitant Covid, you may have multiple reasons why the liver can get affected. It may occur because of the hyperinflammatory syndrome which comes out from the lungs and gets disseminated in the body, of which the liver gets the major share of the blood.

A number of drugs that are given to treat Covid have indirect toxicity on the liver. If you have had a recent infection, you are likely to come down with more complications. You have to regularly follow up with a liver specialist if you have underlying liver disease.

Question: what would you tell all your patients, should they go, and get vaccinated at the earliest? Perhaps it is these patients who already are susceptible, who already have compromised immunity, who need to get vaccinated at the earliest.

Dr. Kaushal: I totally agree. I feel that there is a lot of vaccine hesitancy, especially in patients who have comorbidities. Since they have an underlying disease, they have anxiety that whether the vaccine will suit them or not or whether it is going to cause harm to them. So we keep getting phone calls and patients want to ask one thing that should we get vaccinated? So answer for all of that is whether they have early liver disease or advanced liver disease, they are best in a vaccinated state. So they should all get vaccinated, whichever stage of liver they are in. Because if they don’t take and if they have advanced liver disease and if they catch the infection then definitely the outcomes are going to be worse. So one-line answer is that any patient who has any kind of liver disease must take a vaccine.

Question:  What is the post-Covid care? I would like to ask you also this question because a lot of people seem to be ignoring that.

Dr. Sarin: First, patients with liver disease have weak muscles. We call it sarcopenia. Even if they are obese, they have very limited muscle power. If your liver is weak, your muscles are also weak and after Covid there is extreme fatigue, loss of appetite. You have to work extra, be more careful about this, and get your antibodies done if you need them.

The second important thing for a patient with cirrhosis after Covid is gone is to remember that the liver can digest more fats than it can digest pure carbohydrates. So just avoid carbs. Your main diet should remain protein-based, good whey protein or something and then next, the energy source can be fat. But yes exercises are very essential. It’s very difficult for patients who have got cirrhosis and Covid.

Question: A question that comes to the mind of liver patients is that they already have compromised immunity, they may not have enough antibodies. So, is the vaccine even good enough for me? What if I don’t end up making antibodies?

Dr. Arora: If you look at the various registration trial which was conducted in both US and UK, the initial registration trial excluded patients who had chronic liver diseases or those with an immunocompromised state. In fact, there is data published on Pfizer’s registration trial which has shown that in patients who have advanced liver disease and those who had undergone liver transplantation, the chance of development of antibodies is only 20%. So not all those with the immunocompromised state will develop antibodies. All patients who have an immunocompromised state will not produce antibodies. But in case you have developed antibodies and you can be more confident that you won’t have the viral infection, do not be under the wrong impression that you have been protected. If you do not have antibodies even after vaccination, you have to be extra careful. You have to use double the precaution which a normal person uses. You just cannot move out to public places. You must be extra cautious.

Question: As we conclude what will be your one message to all the liver patients, all those who are suffering from liver diseases, one as far as prevention is concerned and two, in case they get Covid?

Dr. Kaushal: So I think in terms of prevention, I think everyone knows in the last one and a half years what they have to do in order to prevent getting Covid, that is masking, social distancing and washing hands. So that is one message which is true even for patients who have underlying liver disease. Second, they should not fear. Patients who have the early liver disease may not fear. They will have outcomes that are similar to the normal population. Only, those patients who have advanced liver disease, advanced fatty liver, obese, diabetic and post-transplant patients are the ones who need to fear and therefore need to take more precautions and they should get vaccinated as early as possible. And they should avoid like we said the herbal and these kinds of concoctions which contain unscientific mixtures of medicines that might harm the liver. So these are my messages.

Question: What would you say to assuage the fear of perhaps those who already have liver diseases and generally have a fear of Covid? We were speaking earlier of transplant as well, should perhaps people keep such procedures at bay or go ahead with them?

Dr. Sarin: Well the first message for those who do not have liver diseases is to reboot yourself. Lose weight, be careful. Only a healthy body will sustain the onslaught of any Covid infection. So be ready and be healthy. For those who have liver disease, be extra cautious. Transplants are going on and in fact, nearly a hundred have been done during the Covid era at ILBS and I’m sure at many many other centres. So please if you need a transplant, you should go, get yourself transplanted. But yes those who are not… one in a hundred gets a transplant, all other patients, 99 out 100 please be careful. Be in touch with your doctors and specialists. Do not miss your drugs and get your regular screening done. Must get vaccinated for Covid and do not let your guards down. Have Covid appropriate behaviour. You will live normally and you will pass through this Covid. Don’t be worried. But be careful, don’t make a mistake. 

Question: as far as Covid is concerned, we were speaking of course in extensive detail about managing your liver diseases, preventing Covid. Final question for those who have liver diseases, should they continue the medication which they were taking earlier or should they halt at a time when they have Covid and perhaps are taking Covid medication coz there is a lot of confusion amongst the laymen on the same?

Dr. Arora: Ya. I think almost all medication that is necessary for the management of liver diseases can be continued under the supervision of a trained doctor. That goes without saying. We have very few active Covid cases now and I am sure that doctors are good enough to know what sort of combination is safe for them. Coming on to the message that I have to give. Starting with what Dr. Sarin said about the liver on the right side, I think you should always listen to your heart. The heart is always on the left side but it is always right. So if you have learnt any lesson during this devilish perfidious second wave which has killed millions of people. If you have learnt something then have some civility, behave properly, get vaccinated and do not just move out of the house. You should remember till everybody is safe, you cannot be safe. The whole world has to get vaccinated before you can lower your guard. So listen to your heart if you have understood something from this devilish virus.

One clear message coming from all the doctors collectively here is that prevention is better than cure. Stay home. It gains all the more significance considering we have those viral pictures of people holidaying in Manali. Don’t do that. We have these doctors who are working a lot for us. Let’s keep ourselves safe.

Watch the latest episode on Medically Speaking: https://youtu.be/abqn-aV6H6c

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