Quit smoking to avoid succumbing to Rheumatoid Arthritis

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A diet rich in bone healthy food is a must

New Delhi, 19 June 2018: A recent study has suggested that those with increased levels of gum disease are at risk of developing rheumatoid arthritis (RA). This could be a key initiator of RA-related autoimmunity. Autoimmunity in RA is characterized by an antibody response to citrullinated proteins. The oral bacterium Porphyromonas gingivalis (Pg) is the only human pathogen known to express an enzyme that can generate citrullinated proteins.

RA is a chronic inflammatory disease that affects a person’s joints, causing pain and disability and can also affect internal organs. Over long periods of time, the inflammation associated with this condition can cause bone erosion and joint deformity.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, Heart Care Foundation of India, said, “Rheumatoid factor is a protein in the blood which is seen in about 2 out of 3 people with rheumatoid arthritis. However, it can also be positive in about 5% to 10% of healthy individuals. Rheumatoid factor can also be positive in other disease conditions which cause joint pain. So, a mere positivity of rheumatoid factor doesn’t mean that one has rheumatoid arthritis. Rheumatoid arthritis should not be viewed as a disease that affects purely the joints. It can involve various internal organs including the eyes, lungs, heart and the kidneys. A rare patient with rheumatoid arthritis can also have inflammation in the blood vessels called vasculitis, which if not treated promptly can even be fatal.”

The most common symptoms of this condition are joint pain and stiffness. Stiffness is most marked in the early morning hours affecting one’s ability to do daily routine activities. Swelling of the joints is another important symptom of rheumatoid arthritis which differentiates it from other causes of joint pain.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “There is no cure for rheumatoid arthritis yet. However, modern treatment can control the symptoms and help the patient in leading a normal life. But it is important to start treatment at the earliest to reduce joint damage. There are medications called disease-modifying antirheumatic drugs (DMARDs). These drugs not only reduce the symptoms but modifies the disease process in such a way that the joint damage is prevented.”

Some tips from HCFI

Quit smoking: This is one of the main reasons for bone problems among the young and the old alike. The earlier you quit this habit, the better.

Lose extra weight: Excess weight can put pressure on the joints and cause inflammation as well.

Eat healthy: Like any other condition, this preventive tip holds true for RA as well. Eat foods that aid bone health.

Prevention and adherence to medication is key to eradicating lymphatic filariasis in India

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Targeted interventions across districts and increased stakeholder participation is also a must

New Delhi, 18th June 2018: An Accelerated Plan for Elimination of Lymphatic Filariasis (APELF) is being launched by the Ministry of Health and Family Welfare. LF is a mosquito-borne parasitic disease and has been endemic in India since long. Of the 256 endemic districts in the country where it is endemic, 99 have successfully tackled filariasis. Despite this, 8.7 million cases of the disease were reported in India till 2016, with 29.4 million recorded as suffering from associated disability.

LF is a parasitic disease caused by microscopic, thread-like worms. The adult worms only live in the human lymph system. The lymph system maintains the body’s fluid balance and fights infections. India needs to work on a fast-forward mode to meet the global LF elimination target of 2020.
Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, Heart Care Foundation of India, said, “Filariasis, also called hathipaon in colloquial terms, can cause limbs, usually the leg, knee downwards, to swell enormously, or hydrocele (swelling of the scrotum), causing disfigurement and disability. About 99.4% of the cases in India are due to the species Wuchereria bancrofti. The worms produce about 50,000 microfilariae (minute larvae) that enter a person’s blood stream — and get passed on when a mosquito bites an infected person. People with microfilariae in their blood can appear healthy but are infectious. The larvae that develop into adult worms can live for about 5 to 8 years and more in humans. Although there may be no visible symptoms for years, these can damage the lymphatic system.”
The health ministry has been carrying out mass drug administration campaigns since 2004 as part of the Hathipaon Mukt Bharat (Filaria Free India) programme for preventive medication. Under this, about 65% of the population in endemic districts is administered with two drugs: tablets of diethylcarbamazine citrate (DEC) and albendazole once a year for five years.
Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “There are several challenges due to which India has not been able to inch closer to the target of eliminating LF as mandated internationally.
There is a need for greater coordination amongst all the stakeholders, incorporating necessary realignments and considering recent advances in technology to achieve this target.”
Mass treatment
• Mass drug administration reduces the bloodborne reservoir of microfilariae to a level below that required for sustained transmission by local mosquito vectors.
• The period of microfilaremia has been estimated to be four to six years, corresponding with the reproductive lifespan of the adult parasite. W. bancrofti has been designated as a target for elimination since there are no animal hosts.
• Mass drug administration using DEC, ivermectin, and albendazole is the n ew strategy.
• Suppression of transmission to <1 percent (the predicted threshold for elimination) is the aim in all districts.
Some prevention tips from HCFI.
• Preventing mosquito bite is the best form of defense.
• Refrain from going outdoors at dusk or dawn when the carriers are highly active
• Sleep inside an insecticide-treated mosquito net
• Cover yourself with long sleeved shirts and trousers
• Refrain from sporting strong perfume or cologne which can draw the attention of mosquitoes

Extensive palliative care training should be an important part of medical curriculum

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There is also a need to bring back the culture of family physicians in India

New Delhi, 17 June 2018: Only about 1% to 2% of the people have access to palliative care or pain management in India, according to research. Though there is a national programme for palliative care, even today, medical students do not learn pain management in their curriculum. Only two states have palliative care policies in India: Kerala and Karnataka. Maharashtra drafted a similar policy in 2015, which is yet be finalized.

Palliative care is treatment aimed at improving the quality of life of patients and their family members when they face serious health problems. It also aims at handling psychological, social, or spiritual issues such as depression and social isolation. Pain is the most common symptom. It affects the body and the mind. Unless we treat pain, we cannot take away the emotional stress or the suffering completely.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, Heart Care Foundation of India, said, “It is not an uncommon wish to attain a peaceful death especially in those with a critical/terminal illness. Many cultures and religious beliefs offer practical ways to enhance having a peaceful death. Dying in an intensive care unit is unnatural and oftentimes painful for the patient and their loved ones. Caregivers and nurses can help promote peaceful death through a three-dimensional process: awareness of dying, creating a caring environment, and promoting end-of-life care. Most of medical education in India is about diagnosis and cure; and maySbe prevention to some extent. However, there is little or no training on the psychological aspects of dealing with a disease – the associated anxiety, depression, and the rest.”

In 2014, the World Health Assembly asked all countries to integrate palliative care into health systems, at all levels (primary, secondary and tertiary) across the continuum of disease-related suffering from the time of diagnosis, along with disease-focused treatment.

Adding further, Dr K K Aggarwal, who is also the Vice President of CMAAO, said, “The concept of Family Physician or the General Practitioner of the olden times is fast vanishing in this age of super specialization. Every day new specialties are coming up. What was once the domain of a family physician has been now divided among different specialties. This has created a gap in communication between patient and doctor. Family physicians were aware of the entire medical history of a family, most often also dealing with their anxieties and worries about a health condition. We need to bring back this culture.”

It is the Vedantic principle of “welfare of the society” which makes doctors special and different in the society. The day this aspect of welfare is lost, society may not accord us the same respect as they have been doing so till now. Principles involved in acting towards the welfare of the society includes giving 10% of our time to charity; not charging any fee from those who cannot afford; charging less from the middle class and charging normal from people who can afford and where reimbursements are available. Integrating training in palliative care into the medical curriculum will also pave the way for better trust on doctors by patients.

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