Diarrhoea is a disease that is spread from one person to another due to infection from an organism. According to statistics, India falls behind the rest of the world because of the large number of people who do not have access to proper bathrooms which leads to open defecation, a practice common in rural parts of the country. According to the study performed by the Global Enteric Multicenter Study (GEMS), it was found that the most common diarrhoea causing virus is the rotavirus. This virus is mainly spread by the fecal-oral route. This means, that the virus spreads from one person to another when the food or water they consume is contaminated. The government roped in Vidya Balan to campaign against open defecation. 

According to UNICEF-WHO Joint Monitoring Programme Report 2010, nearly 60 percent of India’s 1.1 billion people still practice open defecation and close to 58 percent of all open defecation in the world is in India and the government is likely to spend Rs 150 milion to fight the problem.

While, this particular problem might not be the reason for urban kids suffering from diarrhoea, there a few things that parents should know in order to keep their child safe if he/she suffers from the disease. Apart from the rotavirus, there are a number of other organisms that can cause diarrhoea. Bacteria like Salmonella, Shigella, Campylobacter, and various forms of Escherichia coli , parasites like jade, Cryptosporidium and Entamoeba can be the causative agents in a number of cases. There are other things that could lead to diarrhoea in an infant, for example an allergy to certain foods like milk and soya . A fairly common condition seen is something called ‘toddlers’ diarrhoea’. This is where the child suffers from loose motions because he/she has had too much fluid. It leads to the digestive system getting overwhelmed by the amount of fluids and sugar leading to diarrhoea.  When a child has an infection that leads to diarrhoea, it is called gastroenteritis.

Why should you worry?

Diarrhoea, can be fatal to young children, mainly because they don’t have a well developed immune system to fight the disease, they do not have the skills to tell their caregivers what’s wrong and being very young they tend to get very easily dehydrated which could lead to death.

When should you worry?

In most cases diarrhoea will resolve  with time and home care, but it is essential to be vigilant when it comes to the child becoming dehydrated. The onset of dehydration can be very gradual if the child passes loose stool or urinates fairly infrequently, but if your child need to go to the bathroom very often  and is having watery stools, it is essential that you keep an eye out for signs of dehydration.

Here are a few symptoms of dehydration you should look out for:  

1. The child has dry lips and mouth
2. He/she asks for water frequently and drinks it readily
3. In babies, the top, soft part of the skull (fontanelle) is depressed
4. The child’s hands and feet are cold to touch – this is an indicator of bad circulation and needs immediate medical attention.
5. The eyes of the child are sunken in
6. The skin appears less elastic – a good way to test this is to pinch the skin, on top of the abdomen, and see if it bounced back normally, there is nothing to worry, but If it stays in the raised position it means the child is dehydrated.
7. The child has pale skin – press down with your thumb on the breastbone (bone found between the ribs, at the center of the chest) till the skin becomes white. Now let the skin go and count the amount of time it takes for the colour to return to normal. If it takes longer than 3 seconds, the child requires immediate medical attention.

Steps to avoid further infection

Since the bacteria and viruses that cause diarrhoea is spread very easily, remember to maintain proper hygiene when dealing with a sick child. Teach them to wash their hands well with soap after going to the bathroom, wash your hands well after changing a diaper or cleaning up after your kids. Make sure you wash your hands well before you start cooking to ensure that the bacteria is not passed on.

Vaccines

There is a way to keep your child safe from diarrhoea. Since the Rotavirus is the most rampant causative agent of the disease there are two vaccines that can protect your child. The Rota Teq and Rotarix vaccines are available worldwide and can be administered to children.

Dos and Don’ts:

• If your child suffers from diarrhoea, your number one priority should be to keep their level of their fluids up to ensure that he/she does not get dehydrated.
• Do not discontinue feeding your child milk. Continue to feed your child breast milk (if he/she is still breastfed) or milk as he/she is used to.
• A good way to keep dehydration at bay is to give them ORS (Oral rehydration solution. This mixture is readily available in the market. It contains salt, glucose and electrolytes that help to restore your child’s fluid levels.
• If you do not have access to ORS, you can make the solution at home. Just take one litre of water, add half a teaspoon of salt and 6 teaspoons of sugar to it. Mix well and give this solution to your child as often as possible. 
• Do not try to keep your child hydrated using artificial juices or colas. They contain a lot of sugar which could lead to further dehydration and further irritate the stomach.
• Do not give your child any medications to stop diarrhoea, these medications can be fatal in children.
• Do not start any antibiotics for your child without a doctor’s prescription.

Lastly, diarrhoea is a completely avoidable disease. All you need to do is keep a few simple tips in mind.

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Gallbladder is a small, pear-shaped sac on the right side of the abdomen. It is found just beneath the liver. It stores bile (a digestive fluid) made by the liver which helps in fat digestion. Bile is released into the small intestine through two ducts (tubes) – the cystic duct and common bile duct. Gallstones are hard, calcified structures inside the gall bladder formed due to crystallization of bile. They may also form when the gallbladder fails to empty normally.

Cholelithiasis is a term to describe stones in the gallbladder. Gallstones may pass into the cystic duct, common bile duct or pancreatic duct and are called choledocholithiasis. Gallstones in the gallbladder may cause inflammation (acute cholecystitis) causing bile retention. They may also lead to secondary infection by intestinal microorganisms. Gallstones in the biliary tract ducts can cause obstruction leading to life-threatening conditions (ascending cholangitis or pancreatitis) which need immediate medical attention.

Gallstones vary in size from being as small as a grain or as big as a golf ball. There may be a single large stone or many smaller stones. Cholesterol gallstones are the most common type consisting of more than 80% cholesterol by weight. Pigment gallstones are made of bilirubin, a product of red blood cells destruction (haemolysis).

Women and people over age 40 are more prone to develop gallstones. Losing weight quickly may increase the chances of getting gallstones. A lack of melatonin that boosts the conversion of cholesterol to bile has been thought to contribute to gallbladder stones. Other risk factors are bone marrow transplant, pregnancy, cirrhosis of liver, biliary tract infections, diabetes, certain medications and sickle cell anaemia. Prolonged intravenous feedings (receiving nutrition through a vein) may cause gallstones due to disuse of gastrointestinal tract and reduced flow of bile.

Gallstones may be asymptomatic, i.e. a person may not have any symptoms and may be found during a routine examination or medical procedure. Such stones may not require treatment. If a stone is large in size or it blocks either the cystic duct or common bile duct, symptoms may begin to appear.  There may be sharp, cramping pain in the upper right side of abdomen which may spread to the back. There may be fever, nausea, vomiting and jaundice.

Some of the tests that may be used to confirm diagnosis of gallstones are abdominal ultrasound, CT scan, endoscopic retrograde cholangiopancreatography (ERCP), etc. In ERCP, the inside of the stomach and duodenum is seen through an endoscope and radiographic contrast which can be seen on X-rays is injected into the ducts and pancreas. Blood tests may include bilirubin test, liver function tests, test for pancreatic enzymes, etc.

Treatment

Asymptomatic gallstones do not need treatment. In some cases oral medicines (ursodeoxycholic acid) may be given to dissolve cholesterol gallstones. Surgery is indicated if symptoms arise. Less commonly, open cholecystectomy (gallbladder removal) may be done for uncomplicated cases. Laparoscopic cholecystectomy (also known ascholecystectomy) is the most commonly used procedure. After administering general anaesthesia, the gall bladder is removed through several small cuts made in the abdomen. The surgeon inserts a scope with a small light and a video camera (laparoscope) into one incision near the belly button. He will then use a video monitor as a guide, and will insert a surgical instrument into another incision to remove the gall bladder. The surgery lasts for about 2 hours or less. After the gall bladder has been removed, the bile flows directly from the liver into the small intestine through the common bile duct. Smaller cuts allow for a faster recovery and reduced hospitalisation. ERCP with sphincterotomy may be done to relieve obstruction of the bile duct with gallstones. The gallstones are removed by enlarging the opening of the duct with a sphincterotome (electrified wire). Extracorporeal shock wave lithotripsy (ESWL) uses ultrasonic shock waves to break the gallbladder into tiny pieces which later pass safely in the faeces. This treatment is not used very often because of chances of recurrence.

Bile helps digest fats but our body may have no negative consequences without a gallbladder after cholecystectomy. Bile flows straight from the liver to the intestine. Although, very few people develop a condition called postcholecystectomy syndrome which may cause stomach upset, persistent pain in the upper right abdomen and diarrhoea. There may be small changes in fat absorption.

Photo source: www.yalemedicalgroup.org

The liver is a highly under-appreciated organ. In the post, I’ll try and explain what the liver does, the diseases which can affect it and end with tips to maintain it in top shape.

Your liver is a one and a half kg organ that sits behind your right rib cage. If you did not have your liver, you would not be able to process nutrients like carbohydrates, proteins, fats, vitamins and minerals from your food. Your body would not get rid of all the toxins and microbes. Your blood would probably never clot! The liver plays a vital role in maintaining the body’s metabolic balance.

As the liver performs a variety of important functions it is extremely vulnerable to a variety of metabolic, toxic, microbial, circulatory and cancerous insults. Awareness of the liver’s functions and what all can cause liver disease can help you take the road to great health.

Let’s start with a few commonly known diseases that can affect the liver:

1. Fatty Liver: This disease was traditionally known to occur in association with excessive alcohol intake but now the non-alcoholic variant is reaching epidemic proportions in the developed countries. Known to occur in association with metabolic syndrome consisting of hypertension, diabetes, obesity and hyperlipidemia this disease occurs because of faulty fat metabolism in the liver. Prevention is the best treatment and if uncontrolled can even end up in liver failure.
2. Viral hepatitis is an infection of the liver that is caused by a group of viruses that have particular affinity for the liver. Out of these, hepatitis A and E are caused by eating food contaminated with the virus. Hepatitis B, C and D are acquired through blood, body fluids and by unprotected sexual contact.
3. Alcoholic hepatitis is inflammation (swelling) of the liver due to ingestion of alcohol.
4. Cirrhosis or scarring of the liver is caused mostly due to alcohol intake, viral infection due to hepatitis B  and C , bile duct disease or iron overload. It is among the top 10 causes of death in the world. The liver ceases to function normally due to irreversible damage. It progresses gradually and can lead to end stage liver disease.
5. Drug induced damage caused due to the various medicines we take and chemicals we are exposed to. As liver is the major detoxifying organ in the body, it is subject to an enormous variety of drugs and chemicals. Always be careful when consuming medicines. Even over the counter medications like paracetamol can cause fulminant liver failure. Never take medications beyond the recommended dosage. It is always better to consult a doctor before taking medications and follow up at the slightest evidence of ill health. Certain herbal medications could also cause damage to the liver and so can medications for tuberculosis.
6. Liver cancer can be caused by many factors including viral infections (hepatitis B and C), chronic alcoholism, certain food contaminants, genetic factors, cirrhosis of the liver.

What are the symptoms of liver disease?

 This depends on the onset and rapidity of progression of liver damage.

In case of acute liver damage (due to drugs, toxins, viral hepatitis A, B or E), there may be fever with yellowish discoloration of sclera (the white of the eye), skin and urine. In most cases this may be self-limiting. In a small percentage, this may progress to fulminant liver failure leading to coma, altered blood clotting, kidney failure, secondary infections and may even require liver transplantation.

In chronic liver damage (due to hepatitis B, C or alcohol), the symptoms would be more gradual in onset:

• Jaundice or yellowish discoloration of skin and the white of the eye.
• Swelling especially in the legs and feet due to low protein levels.
• Enlargement of breasts known as gynecomastia (in a male).
• Reddish spider like discolorations (spider nevi) beneath the skin especially over the chest.
• Accumulation of fluid (ascites) in the abdomen giving it a protruded appearance.
• Problems with clotting of blood
• Vomiting of blood or blood in stools
• Altered senses with change in behavior, confusion, forgetfulness and other symptoms related to the brain also known as hepatic encephalopathy.
• Gradual worsening of kidney function

The above symptoms are not comprehensive and it is best to consult a doctor at the earliest onset of any of the above.

 Tips for a healthy liver:

Diet and Alcohol: A balanced diet with low fat content would be well suited to prevent fatty liver. Alcohol is best avoided.

Exercise: Plays a role in controlling cholesterol and in the metabolism of fat thus indirectly protecting the liver.

Vaccination: Hepatitis B is preventable by vaccination. Three shots of the hepatitis B vaccine taken over three months can provide long term protection against the dreaded disease.

Hygienic food and drinking water: Hepatitis A and E are known to spread via the oral route. Think twice before having road side delicacies! Boil the water that you intend to drink. It is the best way to prevent communicable diseases.

Avoid self-medication: Various drugs can damage the liver if taken indiscriminately

Regular check-ups: Once diagnosed with liver disease, be regular in follow ups with the doctor. Reversible damage can become irreversible if neglected.

 This World Liver day, let’s strive not to abuse our liver, one of the most useful organs that we have. Let’s treat it with the love and respect it deserves. 

This heartwarming story helps create more awareness among people dispelling some of the myths that they usually harbour around the procedure. In this post, we try and help educate about organ donation – how it is done, who can donate, when should it be done, how to pledge your organs etc. While there are two different types – living organ donation and cadaver donations, we are discussing cadaver donations in this post.

Organs from patients who are brain dead are called cadaver donations. Organs which can be harvested include – heart, eye, liver, lungs, kidneys, etc. Brain death usually occurs six to ten minutes after cardiac arrest and the person can be kept on ventilator support (so all other bodily functions are running) till the organs can be retrieved. Incidentally, brain death is an irreversible end of all brain activity and different from a coma or vegetative state.

Skewed demand and supply

It is estimated that around 200,000 kidneys and 100,000 livers are needed every year in India and only about 2-3% get it. By conservative estimates about 90,000 Indians die in road accidents every year and 40% of those people are left ‘brain dead’. Dr Sunil Shroff of the MOHAN foundation estimates that 50% of all organ donation needs could be met by simply using organs from road accident casualties.

Sadly there’s a distinct lack of awareness about organ donation. Think about it yourself, if your loved one has just passed away how receptive would you be to a procedure like organ donation? The only way to improve this scenario is by educating people about organ donation and putting in place an easymechanism which will allow people to donate their organs upon death.

To donate or not to donate?

Various organisations like MOHAN (Multiple Organ Harvesting Aid Network) and the ZTCC, Mumbai (Zonal Transplant Coordination Centre) are working to increase awareness among the common man. One way to do this is by having driving licenses to double up as donor cards, a practice that’s followed in various Western countries. The Central Government  is currently working on a new draft of the Human Organ Rules 2012 in which the health ministry has suggested that all people applying for driving licenses be asked whether they’re willing to donate their organs upon death or not. This belief is echoed by Dr Ashwin Mallya, a surgeon from Sir Ganga Ram Hospital, New Delhi who feels that since most cadaver donors are deaths from road accidents having their assent on their driving licenses would go a long way in fulfilling organ demands.

Lack of facilities…

Another issue is the lack of facilities; there are only 120 centres all over India which are deemed capable of organ transplant. One way to counter this would be to follow the Maha govt’s recent move to increase organ donation. This move has made it compulsory for all non-transplant hospitals equipped with an ICU and operation theatre’ to retrieve organs for harvesting and made it mandatory for them to officially identify brain dead patients. This would allow hospitals which don’t have organ transplant facilities to at least harvest organs from brain dead patients for use by the facilities which can at least increase the availability of organs.

…and superstitious beliefs

Another major hurdle in India is the superstition attached to death and reincarnation in India. Many people believe in afterlife and feel that organ donation could lead to the body not being ‘whole’. The only way to counter this is to raise the level of awareness about organ donation. It’s important to note that none of the world’s major religions – Judaism, Christianity, Hinduism, Islam – are opposed to organ donation and in fact consider it to be a deeply altruistic gesture.

Two recommendations that have been made include following the Spanish model of recovering all brain dead patients’ organs and the Singaporean model which looks to legalise the sale of organs. However, both initiatives are seen as too radical in India. The latter would in fact bolster the already rampant organ trade feels Dr Mallya. “It would be better to increase media involvement and target youngster, who’d be more receptive to the idea,” he adds.

Where can I donate my organs?

The most common and least hassle-free option is to print a donor card. Many NGOs have the option to simply print an organ donor card in which it’s explicitly written which organs you’d like to donate. At least until driving licenses start doubling up as donor cards this remains the best option to ensure that your organs are donated. Click here to download the MOHAN foundation’s donor card.

It’s very easy to make and takes barely one minute of your time. It’s also important to let your near and dear ones know, that you’re open to organ donation so that they can inform the concerned authorities during the time of a mishap. Pledge your organs today and you can save lives too!

Jai, after skipping lunch to finish his project on time, goes out for dinner with friends. Along with good company, he thoroughly enjoys the rich (spicy and fried) food, a few drinks and after-meal smoke. He goes home and immediately heads for his bed but wakes up 30 minutes later feeling queasy and nauseous with a sour taste in his mouth. He heads to the kitchen, pours himself a glass of water, mixes in a sachet of antacid and gulps down the concoction. Jai’s inconvenient acidity problem is resolved within minutes and he is fast asleep again.

If the above episode was a once-in-a-few-months occurrence there would be little cause for concern. But regular episodes of acidity signal more serious conditions that may impact a person’s quality of life. It is difficult to estimate the prevalence of acidity because of the high usage of over-the counter (OTC) anti-acidity medications.

 Multiple terms are used interchangeably to describe varying, but related, digestion or gastrointestinal (GI) conditions: acidity, heartburn, indigestion, hyperacidity, dyspepsia, acid reflux, peptic ulcer, and gastro-esophageal reflux disease (GERD). The table below illustrates how these conditions are related:

The term acidity or hyperacidity in particular refers to a condition in which the stomach’s glands overproduce gastric acid – the major component being hydrochloric acid – which is necessary for normal food digestion. This overproduction of acid may occur as a consequence of stress, diet (especially spicy and non-vegetarian food), lifestyle (smoking, alcohol), peptic ulcers, GERD, stomach tumors or medications (in particular, non-steroidal anti-inflammatory drugs, NSAIDs).

The symptoms of acidity – after a meal – include restlessness, nausea, belching, sour taste, stiff stomach, indigestion and constipation.

 Normally, the stomach and duodenum are protected from the corrosive effects of the gastric acid by natural bicarbonate and prostaglandins secreted in the mucous lining – these neutralize the acid and dilate blood vessels for regular blood flow respectively. The breakdown in these defensive mechanisms leads to damaged stomach lining which causes bleeding and ulcers.

 Often a patient presenting with acidity symptoms is treated with acid-neutralizing or acid-controlling medications. If the symptoms do not improve after 4 weeks, then several clinical tests may be performed for a more detailed diagnosis. Some of the tests include upper gastrointestinal endoscopy to identify ulcers or barium meal test for Zollinger-Ellison Syndrome or ulcer biopsy to detect tumors.

 Regardless of the diagnosis, treatment includes changes in diet (avoid acidic foods including spicy and salty foods), lifestyle (no smoking and alcohol) and stress-reduction. Antacids are the first-line of defence and offer immediate symptom relief by neutralising excess acid. Antacids contain either magnesium or calcium or aluminium containing compounds. Histamine blocking agents (H2 receptor blockers) such as cimetidine, ranitidine, famotidine or nizatidine or proton pump inhibitors such as omeprazole and lansoprazole reduce the production of acid by the stomach. Rarely, surgery (vagotomy) is used to reduce the acid secretion.

 Antacids and other medications are a quick fix for acidity but are not meant for long-term use. There are multiple home or non-medication remedies for reducing or inhibiting acidity. Some of the more well-known ones are:

• eat banana, watermelon, cucumber, yogurt, jaggery
• add ginger to all food items
• drink water, coconut-water, lemon juice, amla-juice, milk
• consume last meal a few hours before sleeping
• have small, regular meals
• chew tulsi leaves, cloves, saunf (aniseed) or chewing gum
• avoid pickles, spicy chutneys, vinegar
• reduce aerated (soft) drinks, smoking, alcohol

A common home-made antacid remedy is to consume a half glass of water with ½ teaspoon of baking soda. There are also acidity-free or treat-acidity recipes that can be adopted in regular cooking e.g. cucumber plus curd rice.

Acidity prevention actions include limited intake of alcohol, spicy plus non-vegetarian food and medications e.g. NSAIDs, steroids. Also stress reducing and management approaches help in decreasing the occurrence of acidity.

Read more about acidity prevention and treatment:

• Acidity recipes
• Ayurveda Treatment for Acidity
• Antacids
• Antacids Not Meant to Be Used As Long-term Treatment

Key facts

• Every year there are 20 million hepatitis E infections, over three million acute cases of hepatitis E, and 70 000 hepatitis E-related deaths.
• Hepatitis E is usually self-limiting but may develop into fulminant hepatitis (acute liver failure).
• The hepatitis E virus is transmitted via the faecal-oral route, principally via contaminated water.
• Hepatitis E is found worldwide, but the prevalence is highest in East and South Asia.
• China has produced and licensed the first vaccine to prevent hepatitis E virus infection, although it is not yet available globally.

Hepatitis E is a liver disease caused by the hepatitis E virus: a non-enveloped, positive-sense, single-stranded RNA virus.

The hepatitis E virus is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4–6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death.

Globally, there are approximately 20 million incident hepatitis E infections every year.

Geographical distribution

Hepatitis E is found worldwide and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community level outbreaks while genotype 3 is usually seen in the developed countries and does not cause outbreaks. Globally, 70 000 deaths and 3.4 million cases of acute hepatitis E are attributable to infection with hepatitis E virus genotypes 1 and 2.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. Over 60% of all hepatitis E infections and 65% of all hepatitis E deaths occur in East and South Asia, where seroprevalence rates of 25% are common in some age groups. In Egypt, half the population aged above five years is serologically positive for the hepatitis E virus.

Transmission

The hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Other transmission routes have been identified, which include:

• foodborne transmission from ingestion of products derived from infected animals;
• zoonotic transmission from animals to humans;
• transfusion of infected blood products;
• vertical transmission from a pregnant woman to her fetus.

Although humans are considered the natural host for the hepatitis E virus, antibodies to the hepatitis E virus or closely related viruses have been detected in primates and several other animal species.

Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. The ingestion of raw or uncooked shellfish has also been identified as the source of sporadic cases in endemic areas.

The risk factors for hepatitis E are related to poor sanitation in large areas of the world and shedding of the hepatitis E virus in faeces.

Symptoms

The incubation period following exposure to the hepatitis E virus ranges from three to eight weeks, with a mean of 40 days. The period of communicability is unknown.

The hepatitis E virus causes acute sporadic and epidemic viral hepatitis. Symptomatic infection is most common in young adults aged 15–40 years. Although infection is frequent in children, the disease is mostly asymptomatic or causes a very mild illness without jaundice (anicteric) that goes undiagnosed.

Typical signs and symptoms of hepatitis include:

• jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools);
• anorexia (loss of appetite);
• an enlarged, tender liver (hepatomegaly);
• abdominal pain and tenderness;
• nausea and vomiting;
• fever.

These symptoms are largely indistinguishable from those experienced during any acute phase of hepatic illness and typically last for one to two weeks.

In rare cases, acute hepatitis E can result in fulminant hepatitis (acute liver failure) and death. Overall population mortality rates from hepatitis E range from 0.5% to 4.0%. Fulminant hepatitis occurs more frequently during pregnancy. Pregnant women are at greater risk of obstetrical complications and mortality from hepatitis E, which can induce a mortality rate of 20% among pregnant women in their third trimester.

Cases of chronic hepatitis E infection have been reported in immunosuppressed people. Reactivation of hepatitis E infection has also been reported in immunocompromised people.

Diagnosis

Cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis. Diagnosis of hepatitis E infection is therefore usually based on the detection of specific antibodies to the virus in the blood.

Two additional diagnostic tests require specialized laboratory facilities and are used only in research studies. These are:

• reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis E virus RNA;
• immune electron microscopy to detect the hepatitis E virus.

Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded.

Treatment

There is no available treatment capable of altering the course of acute hepatitis. Prevention is the most effective approach against the disease.

As hepatitis E is usually self-limiting, hospitalization is generally not required. However, hospitalization is required for people with fulminant hepatitis and should also be considered for infected pregnant women.

Prevention

The risk of infection and transmission can be reduced by:

• maintaining quality standards for public water supplies ;
• establishing proper disposal systems to eliminate sanitary waste.

On an individual level, infection risk can be reduced by:

• maintaining hygienic practices such as hand washing with safe water, particularly before handling food;
• avoiding drinking water and/or ice of unknown purity;
• avoiding eating uncooked shellfish, and uncooked fruits or vegetables that are not peeled or that are prepared by people living in or travelling in highly endemic countries.

In 2011, the first vaccine to prevent hepatitis E infection was registered in China. Although it is not available globally, it could potentially become available in a number of other countries.

Guidelines for epidemic measures

In epidemics, WHO recommends:

• determining the mode of transmission;
• identifying the population specifically exposed to increased risk of infection;
• eliminating a common source of infection;
• improving sanitary and hygienic practices to eliminate faecal contamination of food and water.

WHO response

WHO is working in the following areas to prevent and control viral hepatitis:

• raising awareness, promoting partnerships and mobilizing resources;
• evidence-based policy and data for action;
• prevention of transmission; and
• screening, care and treatment.

Source: WHO

WHO has identified four key actions countries can take to prevent viral hepatitis B and C among people who inject drugs. Of the estimated 16 million people who inject drugs worldwide, it is estimated that 10 million are infected with hepatitis C. An additional 1.2 million are infected with hepatitis B.

Risk from shared syringes and needles

Many drug users are unable to obtain sterile syringes: in some countries it is illegal to distribute or possess syringes for non-medical purposes. The risk of contracting hepatitis and HIV infection occurs when people share syringes and needles. Used injection equipment retains traces of blood. If that blood contains HIV, hepatitis or another type of virus, the next person using the syringe could be infected.

Reducing the risk of HIV and hepatitis infections

A number of countries have established programmes to reduce HIV infections among people who inject drugs.

“Most of the interventions that prevent HIV transmission between people who inject drugs are virtually the same as those for preventing viral hepatitis B and C,” says Dr Gottfried Hirnschall, Director of the WHO Department for HIV/AIDS. “So it makes sense to reduce the risk of both infections by linking viral hepatitis prevention with HIV prevention, care and treatment.”

Hepatitis is an inflammation of the liver. Together, hepatitis B and C are the most common cause of cirrhosis and cancer of the liver. Viral hepatitis progresses faster among people living with HIV because their immune systems are weaker, and causes more severe liver-related health problems than it does among people without HIV infection.

WHO recommendations

WHO recommends:

• Implementing and scaling up HIV prevention programmes such as clean needle and syringe programmes and opioid substitution therapy (treatment of opioid dependence with methadone or buprenophine).
• Offering people who inject drugs the rapid hepatitis B vaccination regimen (completed in 3 weeks instead of 6 months), along with incentives to increase uptake and completion of the vaccine schedule. More than 175 countries now include a cheap, safe and effective vaccine against hepatitis B in their national infant immunization schedules. WHO has already recommended countries provide catch-up vaccination for people at increased risk of hepatitis infection, including injection drug users, but this does still not occur systematically at present. There is no vaccine against hepatitis C.
• Using “low dead space” syringes that retain less blood after use reduces the survival of HIV and hepatitis C in the blood that remains in the syringe. This potentially reduces the risk of transmission if injecting equipment is shared.
• Involving drug users in hepatitis prevention programmes to maximize their impact.

Public health approach

“Countries that have adopted a public health approach to injecting drug use and HIV have been the most successful in turning round their HIV epidemics. We need to do the same for hepatitis,” says Dr Ying-Ru Lo of the HIV Department at WHO.

The new evidence-based guidelines are designed for use by national public health officials, managers of HIV, drug dependence and harm reduction programmes, civil society and health workers in low- and middle-income countries. They are intended to be tailored and implemented according to local situations and needs.

Rajesh Khanna, India’s first superstar passed away recently. A close friend of his said that he died of liver infection. Kaka’s battle with alcohol is well documented. Though no one wants to say it out loud, it was his drinking habit that probably hastened his early demise. So why is alcohol dangerous to the liver? For that we need to understand how important an organ the liver is – click here to read more about the importance of the liver. 

What does the liver do?

The liver serves so many different functions that till now no single artificial organ or device that can perform all its functions. The liver processes nutrients from your food, gets rid of toxins and even helps your blood clot. The liver is also responsible for providing glucose so that all your bodily functions can take place properly.

What happens when you drink alcohol?

When you drink booze, the liver works overtime to convert ethanol into acetic acid which is then converted into a less toxic form like acetate which we eventually release as urine. However, this means that the liver is diverted from its primary functions like providing glucose. The effects of hangovers like nausea, vomiting, headaches and fatigue is due to this – the lack of glucose or hypoglycaemia. Glucose is also very important for our brain functions and this explains why we are lethargic and have slower cognitive function during hangovers. And these are only the short term effects.

Long term effects of alcohol consumption on liver

The long term effects are far worse. It takes a toll on all liver functions. Along with fatty foods excessive alcohol consumption is one of the primary causes of all liver diseases. The fat deposited due to absorption of alcohol leads to fatty liver disease. It also causes inflammation of the liver which leads to alcoholic hepatitis. Hepatitis is inflammation of the liver and alcoholic hepatitis is one of the first stages of alcohol liver disease and may progress to fibrosis (thickening of connecting tissues) or cirrhosis (a chronic liver disease marked by cell degeneration, inflammation and advanced fibrosis). Though the liver is a remarkably resilient organ (it can function normally even after losing 70% of its mass), cirrhosis of liver leads to its complete shutdown. It prevents the free flow of blood leading to accumulation of waste and toxins in the body. The symptoms of cirrhosis (jaundice, fluid build-up, itching, nosebleeds, red spots, lowered immunity) may occur either simultaneously or gradually. The symptoms of liver cirrhosis are only visible when it has progressed to an advanced stage. By that time very little can be done for the patient.

So think what the alcohol is going to do to your body before you have your next drink. 

In one of the widest single-centre studies conducted by the All India Institute of Medical Sciences (AIIMS) here, it was found that water-borne Hepatitis E was the basic cause of acute liver failure in nearly 60 percent of pregnant women. Hepatitis E, a preventable disease, is transmitted mainly through contaminated drinking water and can lead to death by triggering acute liver failure. Post failure, the liver is not able to remove toxic substances in the blood. The two-decade study closely examined over 1,000 consecutive patients admitted at AIIMS from Jan 1986 to Dec 2006. It compared the progression of Hepatitis E in pregnant women, non-pregnant women and men in the age group 15-45 years.

“We found that Hepatitis E was the causative agent of acute liver failure in among 60 percent of pregnant women and girls. However, the virus caused acute liver failure in only 30 percent non-pregnant females,” S.K. Acharya, head of department of a gastroenterology at AIIMS, told IANS. ”Among men, only 23 percent were affected by liver failure caused by Hepatitis E,” said Acharya, who is also the co-author of the study. Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. In the study, 249 pregnant women were compared with 341 non-pregnant females and 425 males.

“Pregnant women may be more vulnerable to infection by Hepatitis E virus. The mortality rate among hepatic pregnant women was found to be over 50 percent,” the study noted. The study puts pregnant women at an increased vulnerability to Hepatitis E, leaving them with more cautions to follow on hygiene, safe drinking water and sanitation.

“There is a general liver insufficiency or weakness during pregnancy. So, Hepatitis E virus has a higher attack rate and progression in pregnant women,” Acharya explained. There are five main Hepatitis viruses – types A, B, C, D and E. Other than viral infection, Hepatitis is also caused by alcohol, drugs, chemicals, fatty liver and autoimmune disease.

According to World Health Organisation (WHO) estimates, nearly 5 million people will loose life due to viral Hepatitis over the next decade in southeast Asia. The UN health agency says that Indian subcontinent, China and other countries in southeast Asia bear the highest burden of acute liver failure. The study bears out the WHO statistics, adding: “Although pregnancy does not grant increased susceptibility to Hepatitis A, B, and C viruses. Pregnant women may be more vulnerable to infection by Hepatitis E virus.”

However, rather than waiting for a vaccine, experts say the preventive measures come handy and help in preventing the disease to a great extent. ”The vaccine for Hepatitis E is still in the pipeline, but the issue is that all causes of Hepatitis E are very much preventable,” said A.S. Puri, professor with department of gastroenterology at G.B. Pant hospital. ”The virus is transmitted through faecal-oral route, contaminated drinking water which all reflect poor sanitation,” Puri told IANS. According to WHO, China has produced and licensed the first vaccine to prevent Hepatitis E. The vaccine is yet to be available globally.

Source: IANS

Under the World Hepatitis Day theme “It’s closer than you think”, WHO is urging governments to strengthen efforts to fight viral hepatitis, an inflammation of the liver that kills about one million people every year. In addition, an estimated 500 million people experience chronic illness from their infection with hepatitis; it is a major cause of liver cancer and liver cirrhosis.

“The vast majority of people infected with hepatitis are unaware, undiagnosed and untreated,” says Dr Sylvie Briand of WHO’s Pandemic and Epidemic Disease Department. “Only by increasing awareness of the different forms of hepatitis, and how they can be prevented and treated, can we take the first step towards full control of the disease and save thousands of lives.”

Types of hepatitis

There are five hepatitis viruses defined by types – type A, B, C, D and E. Types B and C are of significant concern since a high proportion of people infected with these viruses may not experience symptoms at the early stage of the disease, and only become aware of their infection when they are chronically ill. This can sometimes be decades after infection. In addition, these two viruses are the leading cause of liver cirrhosis and cancer,accounting for almost 80% of all liver cancer cases.

People can get hepatitis from either infected bodily fluids or contaminated food and water depending on the type of hepatitis.

• Types B, C and D are contracted through the blood of an infected person (e.g. through unsafe injections or unscreened blood transfusions) and in the case of hepatitis B and C, also through unprotected sex.
• Type D only infects persons who are already infected with type B.
• Types A and E are typically transmitted via contaminated water or food and closely associated with poor sanitation and poor personal hygiene (e.g. unwashed hands).

Effective vaccines are available for all the virus types, except C.

Given the scale of the epidemic – with 1 in 12 people infected – and recent advances in prevention and treatment, the World Health Assembly in 2010 designated 28 July as World Hepatitis Day. The Day serves to promote greater understanding of hepatitis as a global public health problem and to stimulate the strengthening of preventive and control measures against infection in countries throughout the world.

New framework

In preparation for this year’s World Hepatitis Day, WHO is launching a new global framework to tackle the disease. The Prevention and control of viral hepatitis infection: Framework for global action describes four areas of work to prevent and treat hepatitis infection.

Raising awareness, together with promoting partnerships and mobilizing resources constitute the first of the four priorities in WHO’s new framework. The others are: transforming scientific evidence into policy and action; preventing transmission; and screening, care and treatment.

WHO will work with its Member States and partners on all four priority areas of the framework to help expand access to prevention, care and treatment programmes to people who need it. The framework will guide the development of regional and country-specific strategies to combat hepatitis.

Source: WHO