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What is swine flu?
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Influenza, commonly known as the “flu”, is an acute infection of the respiratory tract caused by influenza viruses. There are three types of seasonal influenza viruses – A, B and C. Influenza A viruses are further categorized into subtypes. Seasonal influenza epidemics can be caused by new virus strains that are antigenically distinct from previously circulating virus strains to which a population has immunity; this is known as antigenic drift.

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How it transmit?
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Influenza viruses are spread from person-to-person. They can be transmitted by exposure to infectious droplets expelled by coughing or sneezing that are then inhaled, or can contaminate hands or other surfaces. Most persons ill with influenza shed virus (i.e. may be infectious) from a few days before symptoms begin through 5-7 days after illness onset.

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Clinical features
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Infection with influenza viruses can give rise to a wide range of clinical presentations, ranging from asymptomatic infection to severe illness and death depending on the characteristics of both the virus and the infected person. In the majority of people, influenza is an uncomplicated illness which is characterised by sudden onset of constitutional and respiratory symptoms such as fever, myalgia, cough, sore throat, rhinitis and headache. Uncomplicated influenza illness resolves after 3-7 days although cough and malaise can persist for >2 weeks.

• Uncomplicated influenza: ILI (Influenza-like illness) may present with fever, cough, sore throat, coryza, headache, malaise, myalgia, arthralgia and sometimes gastrointestinal symptoms, but without any features of complicated influenza.
  
• Complicated/severe influenza: Influenza requiring hospital admission and/or with symptoms and signs of lower respiratory tract infection (hypoxaemia, dyspnoea, tacchypnoea, lower chest wall indrawing and inability to feed), central nervous system involvement and/or a significant exacerbation of an underlying medical condition. 
  

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Risk factors for complicated/severe influenza:
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• Pregnant women (including the post-partum period)
  
• HIV–infected individuals
  
• Individuals with tuberculosis
  
• Persons of any age with chronic disease, including:
  
• Pulmonary diseases (e.g. asthma, COPD)
  
• Immunosuppression (e.g. persons on immunosuppressive medication, malignancy)
  
• Cardiac diseases (e.g. congestive cardiac failure)
  
• Metabolic disorders (e.g. diabetes)
  
• Renal disease
  
• Hepatic disease
  
• Certain neurologic and neurodevelopmental conditions, including: disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy; epilepsy (seizure disorders); stroke; mental retardation; moderate to severe developmental delay; muscular dystrophy; or spinal cord injury.
• Haemoglobinopathies (e.g. sickle cell disease)
  
• Persons aged ≥65 years
  
• Persons ≤18 years receiving chronic aspirin therapy
  
• Persons who are morbidly obese (i.e. BMI ≥40)[23]
  
• Young children (particularly <2 years of age)

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Prevention of influenza 
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Influenza vaccination is the most effective method for prevention and control of influenza infection available currently. In general, influenza vaccines are most effective among children ≥ 2 years and healthy adults.

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Influenza vaccination 
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Because of the changing nature of influenza viruses, WHO monitors the epidemiology of influenza viruses throughout the world. Each year recommendations about strains to be included in the vaccine for the following influenza season are made. Separate recommendations are made for the Southern and Northern Hemisphere vaccines each year.

Consult for medical advise. Book an appointment with 

Dr Sudhaker Barla
Consultant Physician, Diabetologist and Intensivist

Thrombosis is a serious condition that occurs when a blood clot forms in a vein. Other names for this condition include thromboembolism, post-thrombotic syndrome, and post-phlebitic syndrome.
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Risk factors for thrombosis?
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Certain conditions that alter how your blood moves through your veins can raise your risk of developing clots. These include:

• having an injury that damages your veins
  
• being overweight, which puts more pressure on the veins in your legs and pelvis
  
• having a family history of thrombosis
  
• having a catheter placed in a vein
  
• taking birth control pills or undergoing hormone therapy
  
• smoking (especially heavy)
  
• staying seated for a long time while you’re in a car or on a plane, especially if you already have at least one other risk factor
  

Some diseases and disorders can increase your risk of having blood clots. These include hereditary blood clotting disorders, especially when you have at least one other risk factor. Cancer and inflammatory bowel disease can also increase the risk of developing a blood clot. Heart failure, a condition that makes it more difficult for your heart to pump blood, also occurs with an increased risk of clots.

Surgery:  Thrombosis is a major risk associated with surgery. This is especially true if you’re having a surgery in the lower extremities, such as joint replacement surgery. Your doctor will discuss the risk of Thrombosis if you need joint replacement surgery.

Pregnancy:  Being pregnant increases your risk of Thrombosis. Increased hormone levels, and a slower blood flow as your uterus expands and restricts blood flowing back from your lower extremities, contribute to this risk. This elevated risk continues until about six weeks after giving birth. Being on bed rest or having a C-section also increases your risk of having Thrombosis.

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Symptoms of thrombosis?
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Common symptoms include:

• swelling in your foot, ankle, or leg, usually on one side
  
• cramping pain in your affected leg that usually begins in your calf
  
• severe, unexplained pain in your foot and ankle
  
• an area of skin that feels warmer than the skin on the surrounding areas
  
• skin over the affected area turning pale or a reddish or bluish color
  

People may not find out that they have thrombosis until they’ve gone through emergency treatment for a pulmonary embolism. A pulmonary embolism is a life-threatening complication ofthrombosisin which an artery in the lung becomes blocked.

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Treatment options for thrombosis?
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Treatment will attempt to prevent a pulmonary embolism and lower your risk of having more clots.

• Medication: doctor might prescribe medications that thin your blood
  
• Compression stockings: Wearing compression stockings can prevent swelling and lower your chance of developing clots. They reach just below your knee or right above it.
  
• Filters: You might need to have a filter put inside the large abdominal vein, it helps prevent pulmonary embolisms by stopping clots from entering your lungs.
  

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Complications associated with thrombosis?
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You can develop a pulmonary embolism if a blood clot moves to your lungs and blocks a blood vessel. This can cause serious damage to your lungs and other parts of your body. You should get immediate medical help if you have signs of a pulmonary embolism. These signs include:

• rapid breathing
  
• dizziness
  
• rapid heart rate  
  
• sweating 
  
• coughing up blood
  
• chest pain that gets worse with coughing or inhaling deeply
  

Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis

More than 50 million adults and 300,000 children have some type of arthritis. It is most common among women and occurs more frequently as people get older.

Common arthritis joint symptoms include:

• Swelling and pain
  
• Stiffness
  
• Decreased range of motion.
  

Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints.

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There are different types of arthritis:

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Osteoarthritis:

Osteoarthritis is the most common type of arthritis. When the cartilage – the slick, cushioning surface on the ends of bones – wears away, bone rubs against bone, causing pain, swelling and stiffness. Over time, joints can lose strength and pain may become chronic. Risk factors include excess weight, family history, age and previous injury (an anterior cruciate ligament, or ACL, tear, for example).

When the joint symptoms of osteoarthritis are mild or moderate, they can be managed by:

• Balancing activity with rest
  
• Using hot and cold therapies 
  
• Regular physical activity 
  
• Maintaining a healthy weight 
  
• Strengthening the muscles around the joint for added support 
  
• Using assistive devices 
  
• Taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines 
  
• Avoiding excessive repetitive movements
  

If joint symptoms are severe, causing limited mobility and affecting quality of life, some of the above management strategies may be helpful, but joint replacement may be necessary.

"Osteoarthritis can prevented by staying active, maintaining a healthy weight, and avoiding injury and repetitive movements."

 Inflammatory Arthritis:

A healthy immune system is protective. It generates internal inflammation to get rid of infection and prevent disease. But the immune system can go awry, mistakenly attacking the joints with uncontrolled inflammation, potentially causing joint erosion and may damage internal organs, eyes and other parts of the body. Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis. Researchers believe that a combination of genetics and environmental factors can trigger autoimmunity. Smoking is an example of an environmental risk factor that can trigger rheumatoid arthritis in people with certain genes. 

With autoimmune and inflammatory types of arthritis, early diagnosis and aggressive treatment is critical. Slowing disease activity can help minimize or even prevent permanent joint damage. Remission is the goal and may be achieved through the use of one or more medications known as disease-modifying antirheumatic drugs (DMARDs). The goal of treatment is to reduce pain, improve function, and prevent further joint damage.

Infectious Arthritis:

A bacterium, virus or fungus can enter the joint and trigger inflammation. Examples of organisms that can infect joints are:

• Salmonella and shigella (food poisoning or contamination)
  
• Chlamydia and gonorrhea (sexually transmitted diseases)
  
• Hepatitis C (a blood-to-blood infection, often through shared needles or transfusions).
  

In many cases, timely treatment with antibiotics may clear the joint infection, but sometimes the arthritis becomes chronic. 

Metabolic Arthritis:

Uric acid is formed as the body breaks down purines, a substance found in human cells and in many foods. Some people have high levels of uric acid because they naturally produce more than is needed or the body can’t get rid of the uric acid quickly enough. In some people the uric acid builds up and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain, or a gout attack. Gout can come and go in episodes or, if uric acid levels aren’t reduced, it can become chronic, causing ongoing pain and disability.

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How is arthritis diagnosed?

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Orthopaedist will perform a physical exam to check for fluid around the joints, warm or red joints, and limited range of motion in the joints.  

Through extracting and analyzing inflammation levels in blood and joint fluids can help to determine the kind of arthritis. Blood tests that check for specific types of antibodies like anti-CCP (anti-cyclic citrullinated peptide), RF (rheumatoid factor), and ANA (antinuclear antibody) are also common diagnostic tests.

Commonly use imaging scans such as X-ray, MRI, and CT scans to produce an image of your bones and cartilage. This is so they can rule out other causes of your symptoms, such as bone spurs.

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Arthritis treatment

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The main goal of treatment is to reduce the amount of pain you’re experiencing and prevent additional damage to the joints. You’ll learn what works best for you in terms of controlling pain. Some people find heating pads and ice packs to be soothing. Others use mobility assistance devices, like canes or walkers, to help take pressure off sore joints. Improving joint function is also important.

• Medication:  A number of different types of medication treat arthritis. Consult orthopaedist.
• Surgery:  Surgery to replace your joint with an artificial one may be an option. This form of surgery is most commonly performed to replace hips and knees. If your arthritis is most severe in your fingers or wrists, your doctor may perform a joint fusion. In this procedure, the ends of your bones are locked together until they heal and become one.
• Physical therapy:  Physical therapy involving exercises that help strengthen the muscles around the affected joint is a core component of arthritis treatment.

Alcoholism – one step to danger.

Those individuals who consume an excessive amount of alcohol can cause a great deal of damage to their mental and physical health. This chemical can act as a toxin in the body and can start to destroy ever organ. The other problem with alcohol abuse is that it often leads to obesity and this creates further health problems for the individual. It is therefore vital that people learn to moderate their alcoholic intake or quit altogether.

The Dangers of Obesity

Obesity is viewed as one of the most preventable causes of death in the modern world. The dangers of carrying too much body fat include:

• It increases the likelihood of suffering from type II diabetes.
  
• Those individuals who are obese are far more likely to suffer from heart problems.
  
• It is a key symptom of metabolic syndrome and therefore increases the risk of developing cardiovascular problems, insulin resistance, and stroke.
  
• Obesity puts added pressure on the skeleton and this can lead to chronic conditions such as osteoarthritis.
  
• When people are carrying around a great deal of excess body weight it reduces their tolerance for physical activity. This is likely to mean that their life is less enjoyable than what it could be.
  
• People who are obese tend to suffer from low self-esteem.
  
• If people feel bad about themselves as a result of being obese it can lead to symptoms of depression. It could also encourage the individual to turn to alcohol for comfort.
  
• Many people who are obese suffer from sleep apnea. This means that they are not getting a good night sleep as a result.
  
• Those individuals who are obese are more likely to develop certain cancers – in particular breast and colon cancer.
  

Obesity and Alcoholic Drinks

Alcoholic drinks are usually said to contain an excessive amount of empty calories with no real nutritional value.

• One 12 ounce standard beer contains about 160 calories
  
• A glass of white wine can have as much as 300 calories.
  
• One gin and tonic can also have as much as 300 calories.
  

If people consume a few alcoholic drinks per week on top of their regular diet it can quickly put them on the path to obesity. One problem is that the calories in these alcoholic drinks do not satisfy hunger. In fact they can stimulate hunger so that the individual ends up eating more than normal on top of the calories consumed in these drinks. Those people who regularly go to the bar might also be missing out on healthier activities where they would be burning calories.

Obesity and Alcohol Abuse

• Alcohol can certainly lead to obesity. A alcohol drinker may be consuming an extra 1000 to 3000 calories per day on top of their diet. They are also likely to be engaged in a lifestyle that does not involve a great deal of physical activity. It is even possible for alcoholic people to be obese and still suffer from malnutrition. This is because although they are consuming plenty of calories they are not getting the right mix of nutrients that their body needs to stay healthy.
  
• Obesity can be used as a justification to abuse alcohol. Those who are overweight like this tend to suffer from low self esteem and this can lead to symptoms of depression. Alcohol offers a temporary reprieve from uncomfortable thoughts and emotions. This temporary comfort comes with a high price because it is likely to lead to further misery. Alcohol abuse can take people on a trip to alcoholism and further weight gain. They may lose everything they cherish along the way.
  

Avoid Alcohol Related Obesity but how?

There are things that people can do to avoid alcohol related obesity such as:

• Understand the calorific content of different alcoholic drinks.
  
• Keep to the recommended levels for safe alcohol consumptions. This is one drink per day for adult women and two drinks per day for adult men. For the purpose of these recommendations a drink would be considered a standard beer, a glass of wine, or a shot of spirits.
  
• If people are unable to keep to the safe levels for alcohol consumption it is advisable that they quit altogether. Inability to moderate is one of the symptoms of alcohol abuse.
  
• Keeping active can help people burn off some of the extra calories they consume while drinking alcohol.
  
• It is important to realize that just because an alcoholic is labeled as ‘lite’ or ‘low calorie’ does not that it is safe to drink in high qualities.
  
• Those people who drink need to pay special attention to their diet to make sure that the empty calories they are consuming with alcohol do not replace needed nutrients.
  
• If people with alcohol problems do enter recovery they need to be aware of turning to food for comfort. It is not uncommon for individuals to experience obesity in recovery if they are not careful.

Obesity is a epidemic defined by the World Health Organisation (WHO) as an abnormal or excessive fat accumulation that can have a negative impact on health.

does junk food really play a role in this problem?

Junk food is high in calories but low in nutritional value. It often contains high amounts of sugar and fat without providing many minerals, vitamins or nutrients that are essential to good health.

In order to reduce your risk of obesity, it is essential to reduce your intake of these unhealthy processed foods and replace them with fruit, vegetables, legumes, whole grains and nuts.

However, more and more people are opting to eat junk food as it appeals to our base needs. Why? Junk food is able to stimulate the reward system in our brain, which means we are primed to consume more of it. Your body releases “feel-good” chemicals when you eat these foods, so it’s no wonder they have increased in popularity!

Excess sugar and fat can accumulate in your body causing weight gain. This has other affects on your body – it can increase your risk of developing type 2 diabetes, heart disease and arthritis.

Doing a 28 day detox program can help get you on the right path towards leading a better lifestyle. You may lose weight afterwards and feel generally happier and healthier. Plus, you can learn to get pleasure from eating healthier treats and wean your body from its sugar and fat addiction.

In addition to this, it is important to exercise if you want to reach or maintain a healthy body mass index (BMI). You must work off the energy you have eaten in order to maintain a steady and healthy weight. BMI is the measurement generally used to calculate obesity and it calculated by dividing your weight in kilograms by your height in metres squared. A BMI between 18.5 to 24.9 is healthy.

Breast cancer is the most commonencroachingcancer and the second main cause of cancer death in women.

In cancer, the body's cells multiply uncontrollably. It is the excessive cell growth that causes cancer.

Breast cancer  ?

Breast cancer can be:

• Ductal carcinoma: This begins in the milk duct and is the most common type.
• Lobular carcinoma: This starts in the lobules.

Invasive breast cancer is when the cancer cells break out from inside the lobules or ducts and invade nearby tissue, increasing the chance of spreading to other parts of the body.

Non-invasive breast cancer is when the cancer is still inside its place of origin and has not broken out. However, these cells can eventually develop into invasive breast cancer.

Breast cancer  symptoms ?

The first symptoms of breast cancer are usually an area of thickened tissue in the breast, or a lump in the breast or in an armpit.

 Other symptoms include:

• a pain in the armpits or breast that does not change with the monthly cycle
• pitting or redness of the skin of the breast, like the skin of an orange
• a rash around or on one of the nipples
• a discharge from a nipple, possibly containing blood
• a sunken or inverted nipple
• a change in the size or shape of the breast
• peeling, flaking, or scaling of the skin on the breast or nipple

Most lumps are not cancerous, but women should have them checked by a health care professional.

Breast cancer  diagnosis ?  

A diagnosis often occurs as the result of routine screening, or when a woman approaches her doctor after detecting  symptoms.

Some diagnostic tests and procedures help to confirm a diagnosis.

Breast exam

• The physician will check the patient's breasts for lumps and other symptoms.
  
• The patient will be asked to sit or stand with her arms in different positions, such as above her head and by her sides.
  

Imaging tests

• A mammogram is a type of x-ray commonly used for initial breast cancer screening. It produces images that can help detect any lumps or abnormalities. A suspicious result can be followed up by further diagnosis. However, mammography sometimes shows up a suspicious area that is not cancer. This can lead to unnecessary stress and sometimes interventions.
• An ultrasound scan can help differentiate between a solid mass or a fluid-filled cyst.
• An MRI scan involves injecting a dye into the patient, so find out how far the cancer has spread.
  

Biopsy

A sample of tissue is surgically removed for laboratory analysis. This can show whether the cells are cancerous, and, if so, which type of cancer it is, including whether or not the cancer is hormone-sensitive.

Treatment ?

Treatment will depend on:

• Chemotherapy can be an option for breast cancer.
  
• Chemotherapy can be an option for breast cancer.
  
• the type of breast cancer
  
• the stage of the cancer
  
• sensitivity to hormones
  
• the patient's age, overall health, and preferences
  

The main options include:

• radiation therapy
  
• surgery
  
• biological therapy, or targeted drug therapy
  
• hormone therapy
  
• chemotherapy
  

Factors affecting the choice will include the stage of the cancer, other medical conditions, and individual preference.

Book appointment with Surgical Gastroenterologist and Liver Transplant Surgeon

Book appointment with Surgical Gastroenterologist and Liver Transplant Surgeon

Book appointment with Surgical Gastroenterologist and Liver Transplant Surgeon