Heart disease is now the leading individual cause of disease burden in India.

• Heart disease now is the leading individual cause of disease the burden in India.
• In 2016, there were an estimated 62.5 million years of life lost prematurely due to Cardiovascular Diseases in India.
• 17.5 million people die each year from Cardiovascular diseases, an estimated 31% of all deaths worldwide (WHO).
• Four out of five Cardiovascular deaths are due to heart attacks and strokes (WHO).

WHAT ARE CARDIOVASCULAR DISEASES?

Cardiovascular diseases (CVDs) are disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other conditions. Individuals at risk of CVD may demonstrate raised blood pressure, glucose, and lipids as well as overweight and obesity. Identifying those at the highest risk of CVDs and ensuring they receive appropriate treatment can prevent premature deaths.

SYMPTOMS

• Chest pain, chest tightness, chest pressure and chest discomfort (angina)
• Shortness of breath
• Pain in the neck, jaw, throat, upper abdomen or back
• Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed

CAUSES

• Unhealthy diet
• Lack of exercise
• Being overweight
• Smoking

TYPES OF HEART DISEASE

The cardiovascular diseases involving the blood vessels (also known as vascular diseases) are:

• Coronary artery disease
• Peripheral arterial disease
• Cerebrovascular disease (includes stroke)
• Congenital heart disease
• Inflammatory heart disease
• Rheumatic heart disease
• Valvular heart disease
• Hypertensive heart disease
• Heart failure

DIAGNOSIS

• Blood Tests
• EKG/ECG (Electrocardiogram)
• Stress Testing
• Echocardiography
• Coronary Angiography and Cardiac Catheterization
• Electron-Beam Computed Tomography or EBCT
• Chest X-Ray
• Cardiac MRI

TREATMENT

Through Medication:                                                                                 

• Statins - For lowering cholesterol 
• Blood thinners (such as warfarin) - For preventing blood clots
• Beta-blockers - For treating heart attack, heart failure, and high blood pressure
• Angiotensin-converting enzyme (ACE) inhibitors - For heart failure and high blood pressure

Through Intervention:                                                                                 

• Angioplasty -A balloon catheter is inserted to widen narrowed blood vessels that might be restricting blood ow to the heart
• Coronary artery bypass surgery - Allows blood ow to reach a blocked part of the heart in people with blocked arteries
• Surgery -To repair or replace faulty heart valves
• Pacemakers or electronic machines -To regulate heartbeat for people with arrhythmia

PREVENTION

• Quit smoking
• Maintain a healthy body weight
• Monitor your blood sugar regularly
• Keep your cholesterol in check
• Maintain the blood pressure below 120/80 mmHg
• Indulge in moderate exercise
• Consume a healthy diet; cut down on salts, added sugar & saturated fats

Get treated at our Cardiac Sciences Department for any heart related diseases.

400 million people live with Hepatitis. 325 million people are living with chronic viral hepatitis B & C infection worldwide.

• 400 million people live with Hepatitis
• 325 million people are living with chronic viral hepatitis B and C infections worldwide
• 6 -10 million people are newly infected annually
• An estimated 95% of people with hepatitis do not know there are infected

WHAT IS HEPATITIS?

It is an inflammation of the liver, characterized by the presence of inflammatory cells in liver tissue mainly caused by viruses; hence it is also known as Viral Hepatitis. Not all Viral Hepatitis cause long term infections but certain types become chronic, lifelong infections and can lead to serious Liver damage, Cirrhosis and even Liver Cancer.

SYMPTOMS

• Fatigue
• Sudden nausea and vomiting
• Abdominal pain or discomfort on the upper right side
• Clay-colored bowel movements
• Intense itching
• Loss of appetite
• Low-grade fever
• Yellowing of the skin and the whites of your eyes (jaundice)
• Dark urine
• Joint pain

CAUSES

Hepatitis infections are most commonly caused by a group of five known viruses designated A-E.

Other possible causes include:

• Excessive consumption of alcohol
• In some cases, immune system identifies the liver as a foreign object and begins to attack and causes inflammation
• Metabolic disorders

TYPES OF HEPATITIS:

There are three major types of Hepatitis. The symptoms seen for the Hepatitis are similar but the treatment options are determined based on the type of the virus and whether it is acute or chronic.

• Hepatitis A (HAV) - is caused by the Hepatitis A virus and is one of the major causes of food-related infections and illnesses. It appears as an acute infection and doesn't cause chronic liver diseases. Vaccination is available and usually resolved within 2 months of infection.
• Hepatitis B (HBV) - is a chronic Liver inflammation caused by the Hepatitis B virus. It is potentially life-threatening infection leading to severe Liver conditions like Cirrhosis and Liver cancer. Vaccination is available for Hepatitis B.
• Hepatitis C (HCV) - is a long term infection caused by the Hepatitis C virus. People become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. There is no vaccination available for Hepatitis C.

Other Less common types of Hepatitis are:

• Hepatitis D - is caused by the Hepatitis D virus and occurs when a person is infected with Hepatitis B.
• Hepatitis E - is self-limiting liver inflammation caused by the Hepatitis E virus and usually associated with water contamination.
• Autoimmune Hepatitis - is a chronic, autoimmune disease of the Liver that occurs when the body's immune system attacks Liver cells causing the liver to be inflamed. Treatment of Autoimmune Hepatitis involves the prescription of immunosuppressive glucocorticoids.

DIAGNOSIS:

Common tests that help diagnose Hepatitis are:

• Liver function tests (AST and ALT elevated out of proportion to alkaline phosphatase, usually with hyperbilirubinemia)
• Viral serologic testing
• PT/INR measurement
• Ultrasound
• Liver biopsy

TREATMENT
Treatment for Hepatitis is determined based on the type and stage of the viral infection:

• Interferon injections – Most common treatment to manage and slow diseases progression
• Anti-viral Drugs – Early treatment can stop the chronic infection and prevent Liver Cirrhosis
• Liver transplant – If the liver is severely damaged, a liver transplant may be an option

COMPLICATIONS OF HEPATITIS

Hepatitis can progress to further complicated diseases. Some of the most common complications of Chronic Hepatitis are:

• Fibrosis
• Cirrhosis
• Liver cancer
• Liver failure

PREVENTION

Viral Hepatitis can be prevented through hygienic lifestyle and other precautionary measures like:

• Getting Vaccinated
• Safe Blood transfusion
• Safe Injection
• Don't share or re-use sharp objects or syringes

Liver transplantation is a life-saving surgical procedure performed to replace a diseased or failing liver with a healthy one from a donor. This complex procedure offers hope to individuals with end-stage liver disease, liver cancer, or acute liver failure, providing them with a chance at renewed health and longevity. In this comprehensive guide, we'll explore everything you need to know about liver transplantation, from the indications and evaluation process to the surgical procedure and post-transplant care. 

Dr Suresh Raghavaiah, HOD & Sr Consultant - HPB & GI Surgery, & Multi-organ (Liver, Pancreas, Small Intestine) Transplant Surgery, emphasizes the transformative impact of liver transplantation, stating, "Liver transplantation offers a second chance at life for individuals battling end-stage liver disease. It not only saves lives but restores hope and vitality to patients and their families."

Understanding Liver Transplantation:

Liver transplantation is typically recommended for individuals with advanced liver disease that cannot be effectively managed with medical therapy or other interventions. Common indications for liver transplantation include cirrhosis, chronic hepatitis, alcoholic liver disease, autoimmune liver disease, primary biliary cholangitis, and liver cancer (hepatocellular carcinoma). Additionally, acute liver failure resulting from viral hepatitis, drug toxicity, or other causes may also necessitate urgent transplantation.

When do you require Liver Transplantation: 

• Liver transplantation is indicated when the liver reaches a point of irreversible damage or dysfunction, compromising its ability to perform essential functions.
• End-stage liver disease, characterized by extensive scarring and impaired liver function, is a primary indication for transplantation.
• Liver cancer, particularly hepatocellular carcinoma, may require transplantation when conventional treatments such as chemotherapy or surgery are not viable options.
• Acute liver failure, resulting from viral hepatitis, drug toxicity, or other causes, may necessitate urgent transplantation to prevent life-threatening complications.
• Certain metabolic disorders, such as Wilson's disease, hemochromatosis, and alpha-1 antitrypsin deficiency, may progress to a stage where liver transplantation is the only treatment option to prevent organ failure and associated complications.
• In some cases, liver transplantation may be considered for autoimmune liver diseases, primary biliary cholangitis, primary sclerosing cholangitis, and other chronic liver conditions that do not respond to medical therapy or other interventions.

Indications for Liver Transplant: 

The indications for liver transplantation vary depending on the underlying liver disease or condition. Common indications include cirrhosis, chronic hepatitis, alcoholic liver disease, autoimmune liver disease, primary biliary cholangitis, and hepatocellular carcinoma (liver cancer). Acute liver failure resulting from viral hepatitis, drug toxicity, or other causes may also necessitate urgent transplantation.

Types of Liver Transplant: 

Liver transplantation involves two primary types, each with its own unique process and considerations:

Deceased Donor Liver Transplantation:

• In this type of transplantation, the liver is obtained from a deceased donor who has previously consented to organ donation.
• The donor liver is carefully procured and matched with a suitable recipient based on factors such as blood type, body size, and medical urgency.
• Deceased donor liver transplantation offers the advantage of utilizing a whole liver, which can be particularly beneficial for recipients with extensive liver disease.

Living Donor Liver Transplantation:

• Living donor liver transplantation involves the surgical removal of a segment of the liver from a healthy living donor.
•  The donor liver segment is then transplanted into the recipient, where it gradually regenerates and assumes full functionality.
•   Living donor liver transplantation offers the advantage of reducing wait times for transplantation and may be particularly beneficial for recipients with urgent medical needs or incompatible blood types with deceased donors.

Eligibility and Evaluation:

Before undergoing liver transplantation, candidates undergo a comprehensive evaluation to assess their overall health and suitability for the procedure. This evaluation includes medical history assessment, physical examination, laboratory tests, imaging studies (such as ultrasound, CT scan, or MRI), and specialized liver function tests. Additionally, candidates undergo psychosocial assessments to ensure adequate support and compliance with post-transplant care requirements.

Transplant Procedure: 

During the liver transplantation surgery, the diseased liver (recipient liver) is surgically removed, and the healthy donor liver is implanted in its place. The transplant team meticulously connects the donor liver to the recipient's blood vessels and bile ducts, ensuring proper blood flow and bile drainage. The surgical procedure may take several hours to complete, depending on the complexity of the case.

Surgical Procedure:

Liver transplantation involves the surgical removal of the diseased liver (recipient liver) and its replacement with a healthy liver from a deceased or living donor. The procedure may be performed using either a whole liver from a deceased donor or a segment of the liver from a living donor (living donor liver transplantation). During the surgery, the donor liver is meticulously connected to the recipient's blood vessels and bile ducts, ensuring proper blood flow and bile drainage.

Post-Transplant Care: 

Following liver transplantation, recipients require lifelong medical supervision and adherence to a comprehensive care plan. This includes immunosuppressive medications to prevent rejection of the transplanted liver, regular monitoring of liver function and drug levels, vaccination against infections, and lifestyle modifications to promote overall health and well-being. Recipients also undergo regular follow-up appointments with their transplant team to monitor graft function, manage complications, and address any concerns.

Outcomes and Prognosis: 

Liver transplantation offers excellent long-term survival and quality of life for eligible candidates, with the majority of recipients experiencing significant improvement in symptoms and overall health. However, the success of liver transplantation depends on various factors, including the underlying liver disease, the presence of comorbidities, surgical technique, post-transplant care, and adherence to medical therapy. With advancements in surgical techniques, immunosuppressive medications, and transplant protocols, the outcomes of liver transplantation continue to improve, offering hope to countless individuals worldwide.

Conclusion: 

Liver transplantation represents a remarkable achievement in modern medicine, providing a lifeline to individuals with end-stage liver disease and liver failure. By understanding the indications, evaluation process, surgical procedure, and post-transplant care involved in liver transplantation, patients, caregivers, and healthcare providers can navigate this complex journey with knowledge and confidence. Through ongoing research, innovation, and collaboration, the field of liver transplantation continues to evolve, offering hope and renewed vitality to those in need of a secon

There are nearly 180 million children and more than 600 million adults with BMI exceeding 30.

• There are nearly 108 million children and more than600 million adults with BMI exceeding 30
• China had 15.3 million children with obesity and India 14.4 million
• Among adults, the U.S. topped the list with 79.4million people with obesity and China came second with 57.3 million people

WHAT IS OBESITY?

Obesity is a complex disease involving an excessive amount of body fat which isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure, and certain cancers. There are many reasons why some people have difficulty avoiding obesity. Usually, obesity results from a combination of inherited factors, combined with the environment and personal diet and exercise choices. The good news is that even modest weight loss can improve or prevent health problems associated with obesity.

SIGNS

• Breathlessness
• Increased sweating
• Snoring
• Feeling very tired every day
• Back and joint pains
• Inability to cope with sudden physical activity

CAUSES

• Calories
• Poor diet
• Lack of physical activity
• Medical reasons
• Genetics

PREVENTION

Obesity is associated with a long list of chronic health conditions, many of which become more difficult to treat over time. It can be prevented by:

• Exercising regularly
• Monitoring your weight regularly
• Following a healthy-eating plan
• Being consistent

DIAGNOSIS

• Taking your health history
• A general physical exam
• Calculating your BMI
• Measuring your waist circumference
• Checking for other health problems
• Blood tests

TREATMENT

Obesity can happen for a number of reasons, including diet, a sedentary lifestyle, genetic factors, a health condition, or the use of certain medications. A number of treatment options can help people achieve and maintain a suitable weight.

NON-SURGICAL

You may require treatment by a physician if your own efforts to lose weight have failed and/or if co-existing medical conditions make it crucial for you to lose weight. That treatment may include:

• Behavioral changes to improve dietary habits and increase activity levels
• Therapy or treatment for any dietary disorders
• Medication to treat obesity-related health problems, such as fatty liver, high blood pressure, etc.

SURGICAL

Weight-loss surgery (bariatric surgery) is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise and medication have failed.

BARIATRIC SURGERY - INDICATIONS FOR BARIATRIC SURGERY
It is important to note that weight is only one of the several criteria when considering bariatric surgery. Candidates may include those who:

• Those who are morbidly obese which means a BMI of > 40, or
• Those with a BMI between 35 & 40, but with co-existing medical conditions

COMMON WEIGHT-LOSS SURGERIES/PROCEDURES INCLUDE:

GASTRIC BYPASS SURGERY- The procedure enables food to bypass parts of the digestive system, specifically the first part of the mid-section of the small intestine. It may also reduce the size of the stomach.

ADJUSTABLE GASTRIC BANDING- In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently.

BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH- A biliopancreatic diversion with duodenal switch (BPD/DS) is a less-common weight-loss procedure that entails two major steps. The first step is sleeve gastrectomy in which about 80 percent of the stomach is removed, leaving a smaller tube-shaped stomach. The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach.

GASTRIC SLEEVE- In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It's a less complicated surgery than gastric bypass or biliopancreatic diversion with duodenal switch.

ENDOSCOPIC PROCEDURES FOR WEIGHT LOSS- These types of procedures don't require any incisions in your skin. After you receive anesthesia,flexible tubes and tools are inserted through your mouth and down your throat into your stomach.

*Reference - Mayo Clinic, World Health Organisation

Find out more about our Bariatric & Weightloss Surgery Department here

In the face of a worldwide crisis, the government bodies and the healthcare sector are working day and night to fight the pandemic. They have given precautionary measures that must be practiced to avoid the risks of being infected, which are essential. These include frequently washing the hands, covering the mouth while sneezing and coughing, and avoiding touching the face.

Besides these, you can do something too. You need to boost your immunity to fight COVID-19. Studies so far say that people with compromised immunity are more susceptible to the Coronavirus. If you have a strong immune system, your survival rate to the virus is high.

To have a healthy and perfectly functioning immune system, every individual must have an adequate and balanced diet. Here are some tips on how to eat healthily.

Eat More Green Leafy Vegetables

Include green leafy vegetables in your diet. Increase the intake of spinach as it is packed with antioxidants and beta carotene, which helps the immune system to fight against the infections. Try and cook it with required water as little as possible preferably closed cooking, so that it retains its nutrients.

Include Vitamin E

Eat food that is a rich source of vitamin E like almonds, hazelnuts, avocado, and broccoli as vitamin E is a powerful antioxidant source, and is crucial for maintaining a healthy immune system, especially in the elder people.

Have Seafood

Seafoods like oysters contain a rich amount of zinc, which helps the immune system in fighting the virus. That is probably because of zinc that helps in the creation and activation of white blood cells which are involved in the immune responses.

Include Poultry Items

I know that people have stopped consuming meat and poultry in order to protect themselves from being infected, but there is no evidence or study that shows any specific connection as to how the coronavirus can spread through or by consuming meat, seafood or any poultry items. If you cook the meat thoroughly (for minimum 30 mins) it is safe to consume. They are a very good source of protein, which is important for your growth, and also have a significant amount of zinc that helps your immune system.

In times like these, you really need to take care of your health. Eat healthily, exercise daily, have a good amount of sleep and drink a lot of water. Take care of yourself and the people around you. Cooperate with the authorities, and we’ll be out of this very soon.

For more information on Healthcare services, visit our website BGS Gleneagles Hospitals.

Ms Karthigaiselvi

Chief Dietitian, BGS Gleneagles Hospital

Disclaimer: The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization

Globally, it is estimated roughly one billion people suffer from anxiety and a third of these will also suffer depression. The World Economic Forum in 2019 predicted by 2030 the global primary cause of ill health will be depression.

While these figures are staggering, it is not only the mental health problems which need to be addressed, it is also the physical health of people with mental illness. People with severe mental disorders have, on average, a life expectancy of 10-25 years less than the general population. A majority of mortalities are connected to chronic conditions such as respiratory and infectious diseases, heart diseases, diabetes and more. People with severe mental illness tend to smoke more, have less physical exercise, poor diet, impacted on by side effects of medication. Additionally, living with a chronic condition like diabetes, endometriosis, respiratory or neurological conditions can also increase your risk of depression and anxiety.

Sadly, many countries including India, do not have the right care and support for it. As nurses we have a role and responsibility to break down these barriers and support the advancement of mental health care to all people.

Contribution of Nurses for Mental Care

As nurses, we work across all clinical and service care settings, with people from all cultural backgrounds, across the entire life span, and addressing the spectrum of healthcare needs. Nurses account for nearly 50% of the health workforce, with over 20 million nurses globally, a powerful force for change. The number of mental health/psychiatric nurses vastly outweighs that of psychiatrists. It seems abundantly clear that the way to address the mental health needs of our Gleneagles communities is through nursing.

Mental Health Nurses in India

In India, while there is awareness around mental health the stigma is also equally present. In such cases, we need our nurses to be more aware and capable to address the mental health needs of the people. This is even more so, in cases of patients who suffer from chronic diseases. For instance, when you walk into a hospital, you are likely to see a reproductive nurse for PCOS and an orthopedic nurse for aches and pains. Hence, these nurses need to be able to explain the connection between mental health problems and chronic illnesses.

At the same time, it is critical we continue to build and support the mental health/psychiatric nursing workforce who have the skills, knowledge and experience required to be a part of the solution of the growing mental health needs of people. We need to have a higher number of mental health/psychiatric nurses in India, who can support other healthcare staff to help them and the patients recognize problems, and provide general support and care.

Our country also needs more educational programmes for these workers. It will ensure that the nursing workforce is skilled and confident to recognize minor mental health problems and know when to refer to a doctor.

To drive change, we need to address the mental health needs not just in urban India but also in smaller cities and towns with access to medical care.

Ms Joice Inbarani,

Chief Nursing Officer, BGS Gleneagles Hospital, Kengeri, Bengaluru

Disclaimer: : The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization.