Transmissible Spongiform Encephalopathy – Prion Protein – Kuru Disease

Transmissible Spongiform Encephalopathy – Prion Protein – Kuru Disease

Introduction: Prions or infectious protein were big news in 1980, when it becomes clear that these proteins cause diseases.

In year 1997, B. Pruisner received the noble prize in medicine for his discovery of prions “An     entirely new genre of disease causing agents.” Even though Prusiner’s work started in 1972, by 2017 we have got only a sort of understanding about prions.

Researchers from case Western Reserve University have synthesized an clear that artificial human prion in June 2018, which is deadly contagious and responsible for causing transmissible spongiform encephalopathy. Their works were published in the journal “Nature Communication” in the first week of June.

Now there may be arousal of a transmissible spongiform encephalopathy?

It is the rare form of brain wasting diseases and the name signifies ‘transmissible’ means infectious in nature, ‘spongiform’ means sponge like and ‘encephalopathy’ signifies disease process in brain or ‘infectious brain disease process where brain become sponge like.’

It is a fatal neurodegenerative conditions in human and animals where the healthy brain tissues are replaced by cluster of tiny liquid filled thin wall cavities and making the brain ‘sponge like’ due to accumulation of misfolded proteins i.e. Prion proteins.

After many years of discovery until now our understanding of prions in the brain has been limited and till now it is a curable, invariably fatal diseases.

History: It is a known for approximately 200 years and is proto-typical prion disease affecting sheep, goats had been known since 18th The crucial break through was achieved in the 1930s by the experimental transmission of Scrapie to goats.

Carleton Gajdusek demonstrated the kuru, a disease affecting the aboriginal people of Papua New Guinea was a TSE. The incubation period of the disease was longer than investigator’s persistence.

William Hadlow suggest that kuru resembled scrapie hence might exhibit a very long incubation period. After influencing by this Gajdusek achieved transmission of Creutz-feldt Jakob Disease(CJD).

History and discovery of prion disease
Pic.1- History and discovery of prion disease

 

Whereas, CJD in human was exceedingly rare. Its incidence is typically  inhabitants / years in Switzerland. However, several aspect of CJD epidemiology continue to be enigmatic and a screen for recognized / hypothetical risk factor for CJD has not exposed any causal factor to death.

 

  • Prion Protein: Prions are the natural human protein, coded by PRNP gene located on the short arm of chromosome no. 20 (between the end of the arm and position 12) known as CD230 (cluster of differentiation).

Expression of the protein is most pre-dominant in the nervous system (cell membranes of neurones), though it found in many other tissue of the body.

  • Structure of the Prion Protein: PrP is highly conserved through mammals consists of a globular domain with 3α-helix and a two strand anti-parallal β-sheet and -NH2 terminal tail and a sort -COOH

The primary sequence of Pr, 253 amino acids converts into mature protein having 208 amino acids long after post-translational modification.

PrP messenger RNA contains a pseudoknot structure (Prion pseudo-knot) which is thought to be involved in regulation of PrP protein translation.

Structure of PrP^c and PrP^sc
Pic.2- Structure of  Pr  and Pr

 

  • Functions of Cellular Form of Prion Protein: All though the exact functions of Pr is unknown and based on structural similarity, it has been proposed that Pr might function as a member of the Bcl-2 family of protein. It might have role in-

 

  • Synapse between neurons that can cause long term memory
  • Uptake of copper into the cell
  • Differentiation neuronal stem cell
  • Neurogenesis
  • Neuritogenesis
  • Neuronal survival via anti-/pro-apoptotic function
  • Red-ox haemostasis
  • Long term renewal of haemopoetic stem cell
  • Activation of T-cell
  • Differentiation and modulation of phagocytosis of leukocytes
  • Altering leukocytes recruitment to site of inflammation

 

  • Difference between Prand Pr:

 

Features   Pr (Normal cellular isoform) Pror Pr  (Scrapie isoform)
1.  Cellular dimorphism 43% α-helical and 3% β-sheet 30% α-helix and 43% β-sheet
2.  Sensitivity to enzyme protease Sensitive  Resistant
3.  Solubility in water Soluble Insoluble
4.  Location Located anchoring to the cell membrane Mainly present in cytoplasmic vacuoles

 

  • Transformation of Prfrom Pr: Prdifferent domains that play different roles in the conversion of PrPr. The first one is stable and ordered ‘core’ domain which contain GPI lipid anchor (Glycosyl Phosphatidyl Inositol) that tethers Pr to the plasma membrane, 3α- helix (helix A, band C) , 2 asparagines amino acid linked oligosaccharides and a protein binding sites capable of lowering the energy barrier for the conversion of Pr to Prwhen Prbinds to protein X (a species specific co-factor necessary for conversion of Prto Pr
Changes after transformation from Pr  to Pr
Pic. 3- Changes after transformation from Pr  to Pr

  

The second domain is a ‘variable’ or disordered domain which interact with Prand changes the Prconformation from unstructured form to the β-sheet of PrDuring conversion, helix A of the core domain of Pr also gets converted into β-sheet.

According to Sanley B. Prusiner’s theory,1997 once infected prion protein (Pr/ Pr) are carried to the neurones, they bind to the normal Pr on the cell surface, as a result, there is release of Pr from the cell surface followed by conversion into Pr/ Pr (as described before), by pot-translational modification by Pr.

When the cells synthesize Pr (new) by repeated cell cycle, a large no. of Pr is formed.

Pr being aggregated forms amyloid like plaques in the brain. As these plaques consist of host proteins, so there is no immune response or inflammation.

Abnormal misfolded proteins are internalized by neurones and get accumulated inside the cytoplasmic vacuoles mostly in the cells of the neurone. Thereby it enhances apoptosis with the help of 14-3-3 protein and large no. of cells are died off and cyst is formed in the brain that causes appearance of sponge form and it degenerates mainly cerebral cortex and cerebellum.

Due to above reasons there is following changes ultimately-

  • Vacuolation of the neurones
  • Formation of amyloid containing plaques and fibrils
  • Proliferation and hypertrophy of astrocytes
  • Fusion of neurones and adjacent glial cell
Coronal section of brain showing the vacuolation in brain due to prion disease
Pic. 4- Coronal section of brain showing the vacuolation in brain due to prion disease

 

  • Disorganisation of Prion Protein: Though it is hypothesized that Pr, the protease resistance forms are responsible for the prion disease, there is a protein sensitive (Pr) but disease associated translational form has also been described.

According to “Protein Only Hypothesis”, we are accepting Pr as the infectious agent, whereas there is “Not Only Protein Hypothesis”, because it is found that 25nm long virus like particle demonstrated in the cell culture with Creutz-feldt Jakob disease and Scrapie. Interestingly, these particles are similar to tubulo-vesicular structure found in all TSE form.

It is generally accepted that prion diseases are prion disease are transmissible, hence the name is transmissible encephalopathy and it is invariably fatal. Though transmissibility may fail in certain disease form associated with amyloidogenesis and there may be a sub-clinical carrier state in different species including human beings.

 

  • Classification of Prion Disease/Transmissible Spongiform Encephalopathy:

No distinct rules/theories can be applied for this classification. TSEs are classified on the basis of their pathogenesis mainly-

  • TSE in Animals:
  • Scrapie Disease: This phenotype of prion disease has been extensively studied. It is commonly found in sheep, goats, mouflons. They are of two types-
  1. Natural Scrapie: It is spreaded by vertical transmission i.e. parent to offspring or rarely by direct contact. After incubation period of 2 years, the affected sheep become irritable and develop intense pruritus, scraping themselves against trees and rocks and hence the name Scrapie . Gradually, emaciation and paralysis occur leading to death.
  2. Experimental Scrapie: The disease can be experimentally transmitted to various animals (research purpose) to several breeds of sheep and other animals by infection of natural tissues of infected sheep. In hamsters and mice, the incubation period is less and facilitated the study of the disease. Different breeds of sheep exihibit marked genetic defects in susceptibility to the infection 0-80% , whereas goats have 100% susceptibility.
  • Transmissible Mink Encephalopathy: Scrapie like disease in mink transmitted by feeding the mink on scrapie infected sheep meat.
  • Bovine Spongiform Encephalopathy / Mad Cow Disease: It commonly occurs in cows, lions, tiger, cheetah, puma, bison and exotic antelopes. It was enzootic in cattle in Great Britain since 1986. The epidemic in 1993 infecting over 1 million cattle with infection spreading to European countries. BSE in transmitted due to practice of feeding the cattle with meat and bone meal contaminated with Scrapie / BSE proteins.
  • Chronic Wasting disease: It occurs in captive and free range cervids of mule deer, elk.

 

  • Human TSE:
  • Familial CJD: It is the second most group of human prion disease. Disease prevalence rate is approx 10-15%. It occurs due to mutation in PRNP gene. Most common mutation occurs at 200th codon where glutamic acid is converted into lysine and as a result the entire potein is misfolded.

 

  • Variant of familial CJD: It runs in families. There are following variants-
  • Fatal familial insomnia: It is due to the germ line mutation in PRNP gene at 178th codon where aspartic acid is converted into asparagines. Therefore, misfolded prion proteins build up mainly in the thalamus, that regulates sleep rather than causing the typical spongiform degeneration in the cortex and cerebellum, occurs in most other types.
  • Gerstman- Straussler- Scheinker Syndrome: It is extremely rare form of neurodegenerative disorder of brain. It is almost always inheritent and is found only in few families around the world. Onset of the disease usually occur between the ages of 35 and 55 years. It slowly progresses and is usually lasting for 2-10 years. There may be polymorphism at codon 129/ codon 219 of PRNP gene and may associate with pro to lew point mutation at codon 102 of the PRNP gene, as found in large new Italian family in 1997.

 

  • Variant CJD: It is caused by eating the meat of animals having prion in the muscle tissues. Prions enter into blood stream after absorbing through intestine. Somehow these proteins crosses blood brain barrier and enters into the neurone by a process called adsorptive endocytosis, where the plasma membrane of the nerve cell folds inward to bring in substance otherwise not able to cross plasma membrane by themselves. As the prion is in the blood stream, this disease can be spread by blood transfusion. As it was occurred in UK, 1980. In Britain,1996, there was raised fears of infection through eating BSE infected beef among younger (below 45 years).

 

 

  • Iatrogenic CJD: It is caused by medical procedures or by equipment used for that procedures like-
  1. Corneal transplant gets contaminated and infects healthy individuals
  2. Electro-encephalogram (EEG) electrode implantation
  3. Duramatter graft implantation (>160 cases have been recorded
  4. Human growth hormone and pituitary gonadotropin therapy (>180 cases have been recorded)
  5. Mostly iCJD occurs in patient between 50-75 years.

 

  • Total cases of iatrogenic CJD world-wide:*
Mode Cases(n) Mean incubation period (years) Clinical
Neurosurgery 4 1.6 Visual/cerebella
Depth electrodes 2 1.5 Dementia
Corneal transplant 3 15.5 Dementia
Dura mater 136 6 Visual/cerebella
Human Growth Hormone 162 12 Cerebellar
Human Gonadotropin 5 13 Cerebellar

*Data courtesy of Dr P. Brown.

 

  • Sporadic CJD: It is the major type of human prion disease (85-90%). There is no clear cause behind it. It mainly occurs due to spontaneous mutation in the 129th codon of the PRNP gene where valine is converted into methionine.

 

Different types of Prions affecting different areas of brain
Pic. 5- Different types of Prions affecting different areas of brain

 

  • Kuru Disease: (‘kuru’ = tumor)

It was identified in 1957. Kuru was a mysterious disease seen only in the fore-tribe inhabitating the eastern highlands of New Guinea. The disease has incubation period of 5-10 years and led to progressive cerebral ataxia and tremors, ending fatally in 3-6 months.

The infection is believed to have been introduced through cannibalism and maintained by the trial custom and eating the dead bodies of relatives after death as a part of ritual. The disease disappears following the abolition of cannibalism in New Guinea. Carlton Gajdusek was awarded Noble prize for medicine in 1976 for his important contribution on Kuru.

 

  • Clinical manifestation of Prion Disease:

Prion disease is a slow virus infection. Incubation period of prion diseases from months to years (longest 30 years) but once the disease sets in, progression is very fast. There are 3 phases –

  • Pro-dermal phase (3-5 months)
  • Disease symptoms
  • Death

The disease symptoms vary depending on the type of prion disease-

  • Sporadic CJD: The symptoms mainly affect the workings of the nervous system (neurological symptoms) and these symptoms rapidly worsen in few months.
  • Variant CJD: Symptoms that affect a person’s behaviour and emotions (psychological symptoms) will usually develop first.
  • Initial neurological symptoms:
  1. difficulty in walking caused by balance and co-ordination problems
  2. ataxia
  3. numbness or pin and needles in different parts of the body
  4. slurred speech
  • Initial psychological symptoms:
  1. Severe depression
  2. Intense feeling of despair
  3. Difficulty in sleeping (insomnia)
  • Advanced neurological symptoms:
  1. Muscle twitches and spasms
  2. Loss of bladder and bowel control
  3. Swallowing difficulty (dysphagia)
  4. Loss of voluntary movements
  5. Extreme muscle weakness that causes inability to walk and stand
  6. Fatal familial insomnia
  7. Myo-clones (quick, jerky movement of the muscle)
  8. Exaggerated startle response
  • Advanced psychological symptoms:
  1. Dementia (no memory, power of decision making an reasoning)
  2. Loss of memory which is often severe
  3. Problems concentrating
  4. Feeling agitated
  5. Aggressive behaviour
  • Final stages: As condition progresses to its final stages, people with all forms of CJD will become totally bedridden. They often become totally unaware of their surroundings and require around the clock care.

Death inevitably follow, usually either as a result of an infection, such as pneumonia (a lung infection) or respiratory failure where the lung stops working and the person becomes unable to breathe.

 

  • Diagnosis: The diagnosis should be considered in any individual presenting with a rapidly progressive dementia. When other common causes have been excluded and there is other early neurological feature (especially cerebellum/visual). There are mainly 3 investigations of particular diagnostic utility – 1) Electroencephalogram (EEG)

2) CSF 14-3-3 protein

3) MRI

Testing the different types of human prion disease are distinguished by the clinical characters and classified according to internationally recognised published criteria, updated in 2010 and retrospectively applied to all referral since January 2010. The surveillance was last updated in January 2017.

 

Diagnostic criteria NCJDRSU for CJD surveillance across the UK: (The National CJD Research and Surveillance Unit is part of the centre for Clinical Brain Science, University of Edinburgh and is a part of the Deanery of Clinical Science in the College of Medicine and Veterinary Medicine)

  • Electroencephalogram: The EEG shows a progressive deteriotion in the normal background rhythms and in around 2/3rd of cases, appearance of Periodic Sharp Wave Complexes (PSWCs). The important points to be noted-
  • The absence of PSWCs does not exclude the diagnosis
  • PSWCs may be in other conditions (for example hepatic encephalopathy drug toxicity and rarely Alzheimer’s disease)
  • If PSWCs are absent on an initial EEG, repeat EEG may show development. (repeat testing should be considered at around weekly intervals)

 

  • CSF 14-3-3 proteins: CSF 14-3-3 proteins is a normal neuronal protein that has no specific connection to CJD, being released into the CSF following neuronal damage. It has specific diagnostic utility in CJD. However, CSF 14-3-3 concentration can be reasonably readily differentiated from sporadic CJD on clinical grounds. A positive CSF 14-3-3 test may therefore strongly supported specificity and sensitivity (both 94%) are valid only in an appropriate clinical context.

 

  • MRI (Magnet Resonance Imaging): Cerebral imaging is a vital part of the exclusion of other diagnosis and normal brain imaging in the face of a rapidly progressive, devastating encephalopathy, may lead to a consideration of sCJD. However, in some cases MRI shows a characteristic signal change in putamen and caudate. Occasionally high signal may be seen in the cerebral cortex, generally focal and reflecting the particular clinical feature at the time imaging. Significant atrophy is usually if imaging is undertaken within 3 months of onset of disease.

 

  • Measurement of Pr: It is measured by conformation dependent immunoassay is the most definitive diagnostic tool for prion disease.

 

  • Neuropathological diagnosis in Brain biopsies: The pathologic hall-marks of prion disease seen under light microscopy, are spongiform degeneration and astrocytic gliosis with lack of inflammatory response.

 

  • Sequencing the PRNP gene: It is to identify the mutation – this is important in familial forms of prion disease.

 

 

  • Treatment:

There was no disease like prion before. So till now it is not clear which strategy will lead to a treatment or cure. Scientists are investigating a lot of different possible ways of treating these disease.

  1. Small molecules: Within the fields of molecular biology and pharmacology, a small molecule is a low molecular weight organic compounds (<9000 Daltons) that may regulate a biological process, with a size of 1nm. Most drugs are small molecules.
  2. Antibodies: Anti-PrP antibodies have shown to eliminate Pr from the cultured cell but they failed to do so in vivo.
  3. Gene Silencing
  4. Several drugs like quinacrine

 

  • Decontamination: Prions are resistant to most of common sterilization procedures.
  • Autoclaving at 134ᵒc for 1-1.5 hours
  • Treatment with 1(N) NaOH for 1 hour
  • Treatment with 0.5% sodium hypochlorite for 2 hours

If the prions bound to the stainless steel should be treated with an acidic detergent solution prior to autoclaving; rendering them susceptible to inactivation.

  • Conclusion: Though it is a rare form of neurodegenerative disorder, for example 300-350 cases are reported in the USA per year, but it often progresses rapidly and currently it is incurable. So, till now prions are scary ailment.

In this year June 2018, researcher from case Western Reserve University have synthesized an artificial prions, though a new strain of prion sounds terrifying, but this research could be a bold new step in helping to treat prion disease by discovering auxiliary factors and developing therapeutic approaches to block them.

Artificial prion protein
Pic. 6- Artificial prion protein

 

 

  • Reference:
  1. Essential of Medical Microbiology by Apurba Shankar Sastry and Sandhya Bhat k. Page no.- 521-524
  2. Ananthanarayan and Paniker’s text book of microbiology, 10th edition, Page no.- 560-561
  3. Transmissible spongiform encephalopathy from ‘Zoonotic Disease is in Northern Euresia ,2015’. Prion disease- Pawel P. Liberski, James W. Ircnsicle in ‘Neurobiology of Brain Disorder’; Prion disease- Adrano Aquzzi (M.D., PhD, DVM, hc, FRCP, FRC Path), Markus Glatzel (M.D.) in Neurobiology of Disease.
  4. ISRN Infectious Disease, Volume 2013, Article ID 387925, 11Pages
  5. Prion disease: Am J Pathol. 2008 March; 172(3) Page no.- 555-565
  6. Athena Yenko, June7, 2018
  7. GEN News Highlights, June 6, 2011
Throat Inflation can initiate to Rheumatic Heart Disease

Throat Inflation can initiate to Rheumatic Heart Disease

Introduction

In day-to-day life, one of the most commonly occurring contagions is a sore throat medically acknowledged as Pharyngitis or Streptococcal infection (strep throat). The cause is almost always by a bacterium called Group-A Beta-Hemolytic Streptococcus. The familiar symptoms are Discomfort or a prickly sensation in the throat, Dysphagia, scrambled voice. Generally, to overcome it many clinicians advise taking bed rest with a soft diet and plenty of fluids intake, in case severe unruly condition the prescribed medicine is antibiotics, analgesic, corticosteroids, and etc. The interesting doubt ascends i.e. why & how strep throat is it related to heart diseases? In general, the heart diseases are classified into various types such as atherosclerotic diseases, heart arrhythmias, cardiomyopathy, and congenital heart defects etc. Rheumatic Heart Disease is precisely triggered due to Rheumatic Fever.

Roughly 97-98 percent of the population can overcome to sore throat infection but for remaining, it can lead to Rheumatic Fever at post-sore-throat infection. This article mainly deals with a sore throat leading to Rheumatic fever. Which further may lead to chronic rheumatic heart disease, and comprises of numerous symptoms of this disease.

Initiation of Rheumatic Fever

Rheumatic fever is a non-contagious acute fever, marked as inflammation & pain in the joints. The word rheumatic generally termed as rheumatism which means inflammation and pain in the joints, muscles, or fibrous tissue stained by disease. And fever is an abnormal rise in body temperature.

All in all rheumatic fever caused to a very small percentage of the population, the prone individuals are children (5-15 years) and is rare after age 35 years. Rheumatic fever is an autoimmune inflammatory process that progresses as a corollary of streptococcal infection. The most significant complication of rheumatic fever is Rheumatic Heart Disease, which usually occurs after frequent bouts of severe illness.

Rheumatic Heart Disease

Initially, the human is attacked with Streptococcal Pharyngitis leading to Rheumatic Fever, typically occurs several weeks after Pharyngitis. Streptococcus cell membrane consists of a protein called M-Protein and the bacteria is highly antigenic to human. The immune system identifies the antigens through macrophages and counter attacks by producing antibodies against the M-protein cell membrane of Pharyngitis bacteria. But these antibodies also attack body own cells consist of M-protein which is similar to foreign body protein (this similarity is known as molecular mimicry) and finally leads to damage of body organs, which is known as the type-2 hypersensitivity reaction. The similar M-protein body cells or organs are myocardium of the heart, joints, subcutaneous layer (skin), Basal ganglia of the brain.

In rheumatic fever, there is a variety of clinical findings Jones’ criteria further classified as major and minor as follows

Minor

  • Fever: the Abnormal rise in body temperature.
  • Arthralgia: Pain in regular joints.
  • In blood, there is an increase in ESR/CRP.
  • The ECG shows a prolonged PR interval in heart-block.
  • Previous repetitive episodes of Rheumatic fever.

Major

  • Migratory Polyarthritis: Multiple large joints Inflammation one after another in a symmetric way.
  • Subcutaneous nodules: These are firm lumps under the lining of the skin made of collagen which is painless and extensor.
  • Erythema marginatum: These are the reddish rash ring formed on trunk and arms.
  • Sydenham’s chorea: It is categorized by rapid or awkward jerking moment primary affecting face, hands, and feet caused by the destruction of basal ganglia of the brain.

The Carditis/Pancarditis caused by Rheumatic Fever

In the main, the heart is affected by auto-immune response during Rheumatic fever known as Rheumatic Heart Disease. This occurs when attacks of Rheumatic fever cause scarring and damage to the heart. Normally heart consists of three layers namely: pericardium, myocardium, and endocardium, these consist of M-protein in their tissue cells. But the antibodies released from immune system cause inflammation to the layers of heart leads to Carditis/Pancarditis. The inflammation is fibers type due to an accumulation of fibrin.

Pericarditis

Inflammation of outer covering of heart is called Pericarditis, leading to sharp localized chest pain and reliefs on flexion of the spine (forward bending). On auscultation doctors can notice friction rub/pericardial rub in additional it weak heart sound is observed. When fever subsites there is no long-term pericarditis issue is seen in future.

Myocarditis

Another effect of Rheumatic Heart Disease is Myocarditis, caused due to inflammation in Myocardium of heart. In Myocardium there is a formation of Aschoff body, it is very small pin head inflammatory lesions and these are the immune-mediated granuloma. It also contains large ribbon-like nucleated macrophages called Anitschkow cells. Myocarditis is the most dangerous and recorded most common cause mortality in children if it is untreated. The Myocardium becomes loose and flabby, unable to contract which may lead to other complications like congestive heart failure. This complication is not a long-term issue.

Endocarditis

The serious and long-term complication is Endocarditis, inflammation of endocardium of heart and attacks specifically on valves of the heart. During fever, tachycardia occurs that leads to rapid closing and the opening of valves. Due to inflammation, there is a rupture or erosion of leaflets at valves. However, ruptures lead to deposition of platelets and fibrin which results in the formation of multiple small vegetation (sterile) on the valves. During post-fever healing occurs but this vegetation leads to fibrosis due to this the valves become fibrotic and distorted.

Above three conditions Pericarditis, Myocarditis, and Endocarditis usually leading light to Acute Rheumatic Heart Disease during Rheumatic fever in children. Whereas Endocarditis leads to severe complications like mitral stenosis, mitral regurgitation, and aortic stenosis and regurgitation in adults because of untreated recurrent episodes of Rheumatic fever which finally result in Chronic Rheumatic Heart Diseases.

General treatment

  • Take bed rest, Intravenous fluids and a healthy diet.
  • Conventional medications such as antibiotics (without carditis up to age 18/21 years, with carditis up to age 25/45 years), anti-inflammatory drugs.
  • In-take of Cardiac drugs on doctor’s prescription.
  • In severe, case surgical treatment of heart is required.

References

http://rhdaction.org/

https://emedicine.medscape.com/article/236582-overview

Rheumatic Fever

https://www.medgag.com/anatomy-10-years-2018-2017-question-papers-1st-prof-mbbs-wbuhs/

What Is Liver Cirrhosis ? Symptoms, Treatment & Causes

What Is Liver Cirrhosis ? Symptoms, Treatment & Causes

What is Liver Cirrhosis?

Cirrhosis is a type of chronic disease (slow processing) that’s relative to the liver. Cirrhosis is identified when the cells of the liver are getting replaced by fibrosis (i.e. fibrous thickening of tissue) or the replacement of normal tissue with scar tissue. Basically, cirrhosis leads to damage to our liver and their functions. The liver plays a significant role in metabolism, detoxifying harmful substances, purify the blood and also including bile production and excretion too. Mostly, cirrhosis caused in alcoholic person and also more chances in a patient of viral hepatitis (B and C).

By examing and performing various experiments the medical science finds out a way to limit the further effects of cirrhosis but still cannot be able to cure. The ultimate way to rescue from cirrhosis is liver transplantation.

Globally, At present, there are more than 1 million cases of liver cirrhosis are.

 

Symptoms of Liver Cirrhosis

  • Joint pain
  • Fever
  • Fatigue
  • Vomiting
  • Abnormal personality
  • Neurologically deprived
  • Hepatic encephalopathy
  • Peripheral neuropathy
  • Asterixis
  • Integumentary
  • Jaundice (icterus)
  • Spider angiomas
  • Palmar erythema
  • Purpura
  • Caput medusa
  • Itchy skin
  • Gastrointestinal
  • Dull abdomen pain
  • Dyspepsia
  • Fetor hepaticus
  • Flatulence
  • Varices
  • Gastritis
  • Gynecomastia’ testicular atrophy
  • Hematemesis
  • Feel like overeating
  • Hemorrhoidal varices
  • Digestion problem
  • Increase size of liver
  • Loss of appetite
  • Hematologic
  • Anemia
  • Thrombocytopenia
  • Leukopenia
  • Coagulation disorders
  • Splenomegaly
  • Metabolic
  • Hypokalemia
  • Hyponatremia
  • Hypoalbuminemia
  • Fluid retention
  • Peripheral edema
  • Ascites

 

Causes of Liver Cirrhosis

  • Hepatitis B
  • Hepatitis C
  • Biliary atresia
  • Wilson’s disease
  • Fat accumulated in the liver
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Infection (schistosomiasis, peritonitis)
  • Enlargement of the spleen (splenomegaly)
  • Portal hypertension
  • Esophageal varices
  • Malnutrition
  • Bone disease
  • Gallstones
  • Heart failure
  • Obstructed blood flow
  • Hormonal imbalance
  • Production of toxins
  • Prevent the functions of protein and drugs too
  • Non- alcoholic fatty liver disease (NAFLD)
  • Non- alcoholic steatohepatitis (NASH)
  • Greater chance of Liver cancer

 

Prevention of Liver Cirrhosis

  • Stop or reduce intake of alcohol
  • Focus on the balanced diet
  • Less intake of salt
  • Less intake of sugar too
  • Prevent from taking of non-veg and spices.

Tests to be Performed for Liver Cirrhosis

  • Blood test
  • Liver function test ( ALT, AST, ALP)
  • Creatinine
  • Hepatitis B And C
  • Imaging test (CT, MRI, ultrasound, MRE)
  • Biopsy
  • TREATMENT
  • Endoscopy
  • Medication
  • vaccination
  • Rehabilitation
  • Consume diet with low sodium content
  • Avoiding nonsteroidal anti-inflammatory drugs
  • Hemochromatosis (reduce the levels of iron)
  • By the excretion of copper in urine
  • Liver transplant

 

Conclusion

The liver is the most workable organ within our body, performs various functions relating to circulation too. The liver performs both functions like production and excretion too.

LIVER CIRRHOSIS is the most advanced form of liver disease that’s related to generally drinking alcohol and viral hepatitis B and C. Liver cirrhosis occurs when the liver cells are killed or injured, and after that when the inflammation occurs, the injured want to repair itself by forming scar tissue that consequences in forming new liver cells in clusters form that leads to regeneration of nodules of liver within the scar tissue.

The disease is a part of the progression. It may start with the fatty liver disease, then progress to alcoholic hepatitis, and then to liver cirrhosis.

Liver cirrhosis main identified by jaundice, loss of appetite and fatigue. There are various types of complications occur in liver cirrhosis including liver cancer.

Diagnosis of liver cirrhosis can be started firstly with examing patient history, family history also, the vital signs (physical examination), blood test, and we can also perform complete diagnosis by confirming liver cirrhosis by performing the liver biopsy.

Treatment of liver cirrhosis prevents further damage to the liver, liver cancer, other complications related to liver cirrhosis and other adjacent organs from any damage. By suppressing the immune system by prescribed medications like prednisone and azathioprine to prevent further inflammation related to the liver in such as autoimmune hepatitis.

We can’t cure liver cirrhosis, but we can provide treatment to the patient as medication and further types of test like endoscopy. The best recommendation for the liver cirrhosis patient is to liver transplant surgery, still, the medical science working on the curing of liver cirrhosis by medications and some other remedies.

 

ROADS LESS TRAVELLED

ROADS LESS TRAVELLED

One fine morning as I was going on my routine rounds, my eyes were particularly fixated on an old man. It was onco-surgery ward. A ward so infamous, so notorious for all the gloom it possesses. And among all that dejection and despair filling up the atmosphere of the room, this patient was smiling brightly. I went through each of the patient writing up their notes, plans for the day and as I reached the patient in consideration, he was still smiling. I politely asked him, “Sir, how are you feeling this fine sunny morning?” He replied cheerfully that he was feeling great and more so as he was being discharged that day. I opened up his file and saw that he was a case of oesophageal carcinoma. His oesophagus had been resected but only too late. The cancer had metastasized everywhere and he was admitted with the sole purpose of attempting to prolong his life. I asked the patient again, “Sir do you know why you have been admitted here for these past days?” The patient confidently replied he was suffering from some minor ailment that caused him sore throat and vomiting of blood and now that those symptoms had been less frequent, he had healed and was ready to return to his village. So it was only natural when I asked him who had told him about the discharge and his medical condition. Of course, it was his son. And his son on being questioned why he simply replied that he wanted to see his father happy and he couldn’t gather enough courage to break the news and deal with the breakdown it ensues. So I turned back to the patient again, smiled and immediately regretted for asking that if he had any plans after returning to his village. So unaware of the certain death that lurks him, so hopeful of the future, so full of plans and so full of optimism. I too didn’t have the courage to break his heart right away. I walked out silently with a heavy heart not knowing at that very moment what it was that I should have done.

On another instance, it was this woman in her fifties. She was being wheeled into the operation theatre for a major surgery. The patient party had already given their informed consent after being explained about the whole procedure, its risks, benefits and complications. So during the course of the conversation, the attending anesthesiologist asked her how she was feeling and if she was anxious at all. The woman promptly replied that she isn’t scared at all and she thought that all those preparation and precautions were an overkill for a small injection. She casually said the injection could have been given outside as well and they didn’t need to bed her and drag her into some special place. The anesthesiologist sprung up with rage on hearing it. The operation was delayed and the patient party and the attending surgeon were summoned and inquired about the matter. The surgeon mentioned that the patient party had requested him multiple times to let them be the ones to break the news to their patient. On other hand, the patient party replied feebly that they thought all she was going to remember was an injection of anesthesia before she passed out. In their words, they didn’t want to burden her with such grave news and they couldn’t bring them self to let her know about the dangers she is facing.

These are just two instances which I experienced personally. Most of us might have been through it ourselves too. In a country like ours where a significant portion of the population is still illiterate and yet more unaware about health and medical conditions and even a huge portion of people gullible to what others say, it can very easily be projected that the huge chunk of patients do not know what afflicts them even after a correct diagnosis has been made. Of course it is the duty of the attending physician/surgeon to make a diagnosis and explain it to the patient in an understandable language but when the patient hails from a downtrodden table of society with little or no educational background (which is fairly common in our setting) often the final and the only message that gets delivered across to him is “You are DYING”.

So after a patient comes to know he is dying, a different set of dynamics comes into play. It is a gray area really. Not black, nor white. But a plain shade of frustrating, depressing, discouraging and demoralizing gray.

How do you explain hope and define optimism to someone who has never believed once that life has been fair to them and it will ever be…

OR

How do you lie or let the relatives lie to someone who might have important things as managing his family, properties, making his last will and testaments or fulfilling his final desire and wishes? But with all the researches published that have found out optimism in a patient certainly does prolong the life and bring about favorable outcomes in the patient, you certainly tend to think twice.

So what is it that we really should do???

To go against the wishes of the patient party who suggest you to not disclose the news or to do what is ethically right and let the patient know and decide how they want to deal with the disease. In the present context, in our setting not complying by the wishes of the patient party might invite a whole new set of problems with risk of physical, social and psychological trauma for you. But even after you reveal the despairing news to the patient they might opt to abstain from any forms of treatment to save money and not become a burden for his family. They might give up all hope on life which might adversely affect at any chance of having a better prognosis. But this issue can be very much be ameliorated by a slight change in our approach to one aspect of medicine we rather choose to ignore, “counseling”. From what has been extensively researched and from what is being practiced by our counterparts on the other face of the world, counseling itself is a major factor that determines the entire outcome of the treatment.

With suitable and effective counseling, the view of the patient towards the disease and treatment process can be exceptionally altered. It is better if you let the patients know that they are not alone suffering from the disease and share the experiences of how others coped with the situation. You could always suggest picking up yoga, meditation or any other means to calm the mind. How they should utilize the time they have tying up any loose knots. And if needs be how you are always there to support him with any palliative care they may need. With a proper counseling, the compliance and adherence of patient to treatment increases, optimism in patients rise to new heights and the overall prognosis and outcomes have favorably fluctuated.

The disease the patients are suffering from is a truth, its prognosis/outcome also a truth, right to information of a human being and your responsibility to respect his sovereignty also a truth and what I firmly believe is only the revelation of this truth and a competent counseling and treatment course will be in the best interests of the patient and the treating physician/surgeon himself. And only then can we rise from the ranks of common people and truly be what the people expect us to be…

“An ethically and morally impeccable human being”.

A Doctor’s View on Doctor – Patient Relationship

A Doctor’s View on Doctor – Patient Relationship

MBBS (Bachelor of medicine and bachelor of surgery ) the most inspiring and attractive word for me throughout my whole childhood. But it becomes toughest on 5th June 2015 when the first time I was successfully failed to get an eligible rank in my West Bengal joint entrance examination for medical. Though the word inspiring was existing in my life for MBBS. I desperately accumulate all my courage and restart my preparation to crack the same examination for the next year.  And that time I successfully able to get the entry in my childhood wish. I was started my journey as an MBBS student at the BURDWAN MEDICAL COLLEGE, WEST BENGAL and from the beginning of that, I was an active part of the world medical association.

‘Doctor Babu ‘when I heard the word indicating to me for the first time it was such a pleasure to feel that astounding feeling. In the first year one day I went to visit the hospital for the first time with my white apron. Then a short height, an unhygienic man came towards me and ask for ECG room. But at that time I was not able to help that man because I also didn’t know this. As a doctor, my duty was to help that man.

A healthy doctor patients relationship is the most important part of treatment. Healthy means professional. Some foremost characters should have to be developed to become a successful doctor. At first, a doctor must have to be helpful towards his patients but obvious within his professional limit. Secondly, justice with patients, equality among patients, and equal division of limited resources only and only based on priority need and next one is fidelity means the ability to truths about our each and every action because mistakes are forgiven but lies are strongly punishable. We must have to be understood that patients are not help-seeking rather we are the help provider.

Doctor patients relationships are of different types. One may be doctor-centric in which doctors are superior and patient must have to follow doctors advice and another one is patients centric in this doctors are flexible in their point of views and they give opportunities to his patients to choose their options.

A doctor can play different roles in appearance to influence his patients. We must have to be flexible in our behavior and it will be the strongest ladder to achieve effective care. The term ‘placebo’ is a substantial term conjoin with the medical profession. Sometimes we have to use strongly directive approach to make better treatment. Some pessimistic patients are not aware of their health so they ignore the treatment process. It is our duty to strongly put our advice and make the better health of the patient. But as besides this, it is also important to remember that the right to refuse is the personal choice of the patient. We can’t pressurize them in any aspect rather we can motivate them. As a good doctor, we have to use tremendous politeness and respect during the treatment of geriatric patients and it is an appropriate doctor-patient relationship.  Another one is protectively paternalistic approach and this is maximally used in pediatric treatment. A doctor can advise his patients by gathering kindness, protection, strength, and patience. Because pain is the fearest foe of a child and as a doctor, our responsibility is not to destroy the fear but to achieve the power to fight against it so that he can tolerate it in his upcoming life. Some other aspect is the supportively directive approach. In this type, doctors believe in patient’s choice along with providing reassurance and guidance. Another example of the perfect doctor-patient relationship is the relationship between doctor and female patients. Most of the female patients always choose female gynecologists for their treatment but as a male doctor also our duty is to provide equal safety and security to them so they can trust us . A doctor can play an active role in the treatment of terminally ill patients. As a doctor, our responsibility not only in cure purpose but also provide the hand in care. In the case of terminally ill patients, we can’t stop our treatment by accepting upcoming death but it is our duty to provide a peaceful death to our patients.

Relationship means the mutual connection between two peoples. So both sides effort is necessary to make a relationship healthy. Patients also have to believe in the doctor to make the relationship more trustworthy. Some people told that feel your patients as your family members but I think rather it is important to feel our family members as our patients when they suffer from disease because a professional relationship can handle effective treatment rather than a coherent relationship. As besides the importance of establishing relationships, it is also important to perfectly terminate our relationship with our patients because we can’t expose us as available and as sympathetic so that we become emotional during termination.

As a future doctor, I will definitely maintain these in my working phase and I wish my other co-workers who are reading this may also influence through my words.

 

 

Five Years of My MBBS Life

Five Years of My MBBS Life

I had joined the medical college with all the excitement that is humanly possible. Getting merit-based scholarship and not having to pay a single penny as a donation to college, I had made my parents proud. Not that I had always wanted to be a doctor. Being a doctor is the epitome of success academically in our society. The toppers of the country would choose to be a doctor. More than me, my parents were happy that I was studying Medicine. What more could I do than to make my parents proud. Not that I was forced to study medicine. Personally, I was indifferent. I wanted to go through the tough road that elites chose. Deep down inside, I still wanted to explore passion in life. But I was far too lucky (and thinking now maybe unlucky) that I got my name in the successful candidate name list in the MBBS entrance examination.

First year: Crushed euphoria

I was so happy to sign in the admission forms and submit all my certificates. More than that I was happy to see my dad’s smile while I was signing. Getting my hostel room key and filling a small sheet of paper for college identity card filled me with utmost pride.

As classes started, the happiness curve went down. All my expectation of med school became upside down with the reality. As happy I was to get the key to my hostel room, I was more disappointed to open the room of the hostel that was located 3 kilometers away from the hospital right next to the public bus park. Unlike the photos are shown on the website of the college, the hostel was a temporary rented hotel, with zero facilities. The hostel corridor had a leaking terrace and in the monsoon flooded our room if we opened our door for long. The soaked carpet smell mixed with our own sweat smell during the power cuts was in the air. Love definitely wasn’t in the air.

Second year: Exams

Literally, the second year was nothing but the exams. We had monthly big exams, and countless small posting examination. The syllabus was vast and time very limited. On top of that, we would hear about the terror of HODs of departments during practical Viva examinations. Our only aim was to pass every internal examination so that we would not be barred from giving board examination.

Third year: Honeymoon year

We were posted in the hospital. We had our first share of exposure to the patients. Only two subjects whose exam would be there. Taking history and learning physical examination. It was far different kind of learning compared to learning from the cadavers of first-year anatomy class. For the least, all we had to do was to maintain our attendance to 80 percent.

Fourth Year: Minors

We had already spent a year in the hospital wards and OPDs. The place felt familiar and we had been quite familiar with the history taking and physical examination. Watching POP casts and slabs in the Orthopedics OPD was exciting. Learning to use an Otoscope and be able to visualize the perforated eardrum gave all of us some happiness of sorts.

Final Year: The real exams

We were the same as the third year and our posting was the same. But the way our teachers treated was entirely different and that increased the fear. They would constantly remind of us being the ‘exam giving batch’ and that we had to cover each and every topic. Everyone was seriously studying except for the legends who still got time to flaunt the new bike they had bought.

Time passed in a blink of an eye. There was so much to study and so less of time. Nothing except the syllabus mattered. The frequency of mom and dad calling to ask about my whereabouts decreased. Going out for parties were almost nil. Birthday parties got postponed.

Internship: Three Ds

Dressing. Discharge. Daru (alcohol). The dressing of wounds and especially of the burn patients was really difficult and time-consuming. Making discharge sheets of patients who were admitted for delivery of babies was hectic as hell as the number many a time crossed half-century. And a chilled beer once in a while was the answer for releasing the frustration of doing ‘clerk-type’ work every day.

Right now, I am almost halfway through my internship. The days are so varied. Some days, we get all the time in the world to talk about all the things that are shitty in this country. Other days, we are so tired we fall asleep right as we close our eyes. The way we are treated also varies greatly. Some patients treat as if we are magicians wearing white gloves applying elixirs in their wounds and heal them. Other patients treat as if we don’t even exist there.

Final Note:

With all the free ‘no-need-to-read-compulsorily’ time that I have got in the internship, I get plenty of time to introspect. I think about the situation in the country. I talk with the residents and learn about the things I could do during my internship days to make the future a little bit easier when I would be working in a hospital far from cities. And some nights when I am alone in my room and it is raining outside, I wonder with one question on my mind:

Would I be a good doctor?

LIFE OF A DOCTOR AS AN ANATOMIST

LIFE OF A DOCTOR AS AN ANATOMIST

 

What is life if full of care!!
We have no time to stand and stare!!

These are my favorite lines. I feel those lines invariably especially after choosing
to be in the medical profession.
I had been totally unwary all throughout my medical journey which ended up being
an Anatomist. Repeating for getting into the medical profession and then for post-graduation
!! And then still the life is yet to settle!! But, I am always keeping the
hope to get a good opportunity. This reminds lines from the stalwart M. S.
Dhoni, “Kharagpur ki Government naukri mei phas gaya toh aghe kuch nahi ho
payega. Sirf 9 to 5 ki duty karte rehna padega.” (Meaning that,”If I join the
Government as a permanent employee as a ticket collector in the railways at
Kharagpur, then I will have to remain satisfied doing the 9 am to 5 pm duty. I will
be unable to satisfy my inner voice, be unable to fulfill the dream I cherish as a
cricketor.”)
And now we are not even able to get that. No satisfactory job nor salary!! Post PG
long wait; no result! MPSC was hope, but it was as if wanting to taste poisonous
honey!! It being preclinical subject is given last priority. Later on only to realize
that all preclinical vacancies are being directed to clinical subjects. I really fail to
understand why preclinical subjects are being looked down so much. To add on to
the existing struggle, MCI has reduced the requirement of staff members to be
recruited. Most of the time, pan India vacancies are available, but not where one
stays!! Ab kya pura India ghume? No family life.
But being a teacher, I encourage students. So how do I lose hope? Where there is
a will, there has to be a way. So, just need to keep patience and wait for the right
time to come.
And then by the grace of God a ray of hope is seen.
Job in a private college!! Everyone knows how it is!! Actually, it’s an open secret. But
sometimes to achieve something in life, some risks and compromises have to be
made. One needs to come out of the comfort zone as my husband puts it. It was slightly skirmished
for me. Not used to the local train travels, those fight to get
seats and phone calls to railway helpline numbers and many more. But, then I made
great lifetime friends in due course of time as well. Also, I got to learn a lot from
them. How everyone is struggling and yet so happy!!
I learned a lot as an Anatomist. I have my own innovative and unique style of
teaching. But at the same time, I am eager to learn from students as well. Although
it’s really funny to listen to their answers (entertainment time), it teaches lots
of lessons as well. For example, most of the time students are confused between
the lungs and liver. So, one can stress on this mistake. Thus, in future students can
avoid these errors. Also, if students are aware of the system wise different trays
kept in the examination, they can avoid mixture of two topics. In addition, one must be
aware that for dental students, knowledge on HNF is to be imbibed more.
Exercise science, Occupational therapy and Physiotherapy students, limb study is
to be focused. For MBBS students, mnemonics and stories help a lot to catch
their attention.
Ultimately, one has to choose a profession of our liking or like the one in which he
or she is into. I would like to reiterate on the winning statements of our beloved
MISS INDIA WORLD MANUSHI CHILLER, “Profession is not just about being
paid. It’s the respect and love one gets by doing whatever one has focused on.
Mothers’ life is full of sacrifice and doesn’t expect anything in return. And so that
is the highest paid profession.” And yes, of course, I could better understand
these words as I am because of the sacrifices and struggles of my mother and my
elder brother. Had they not been selfless, can’t even imagine my fate.
In the meantime, one has to be vigilant and look out for the opportunity. It does come
and in a special way unfolds the divine plan of God. Of course our efforts and hard
work matters!! And that opportunity did come thanks to the Modi government. Pan
India Central government is opening new medical colleges.
So, I am feeling positive and hopeful for the future. As Bob Hope rightly says, “I’ve
always been in the right place and time. Of course, I steered myself there.”

 

” THE GOOD PHYSICIAN TREATS THE DISEASE , THE GREAT PHYSICIAN TREATS THE PATIENT WHO HAS THE DISEASE”

” THE GOOD PHYSICIAN TREATS THE DISEASE , THE GREAT PHYSICIAN TREATS THE PATIENT WHO HAS THE DISEASE”

 

The doctor-patient relationship has been and remains a keystone of healthcare in community. In ancient era people would seek medical remedies from ‘vaidya’ and had faith in him. He was family physician for the people. The guidance ,co-operation and to lesser degree mutual participation were distinguishing patterns of doctor-patient relationship.

For medical profession , Hippocratic oath established a code of ethics for doctor ,it also provided ’Bill of Rights’ for patients. The code emphasized the doctor’s attitude towards patient, “The regimen I adopt shall be for the benefit of my patients according to my ability and judgement ,and not for their hurt or for wrong…Whatsoever house I enter ,there will I go for the benefit of the

Sick ,refraining from all wrongdoing or corruption and especially from any seduction,of male or female ,of bond free. Whatsoever things I see or hear concerning the life of men,in my attendance on the sick or even apart there from,which ought not be noised abroad ,I will keep silence thereon ,counting such things to be as sacred secrets”.

Previously doctor would be called as GOD and his word was final for the patients.Patients never used to doubt doctor’s skill and approach towards patient.

Becoming a doctor was considered to be a noble profession but scenario has changed for last two decades. The doctor who was treated respectfully by society is now beaten by that society.People don’t think of sacrifices which he/she made for becoming a doctor.

“Stethoscope is the costliest jewellery to wear in the world ,it costs your whole youth”

Currently the scenario changed from GOD to people thinking of him now selfish person. Still many doctors are praised for their service but very little section of society holds this attitude. Doctor used to treat patients on the basis of his clinical knowledge which he acquired through years of practice and hard work and this created good rapport between doctor and patient. Now a days ,due to advances in diagnostic technology ,doctors are relying on tests and advising investigations added to financial burden on patient and this is one of the reason creating bitterness in doctor-patient relationship. After implementation of Consumer Protection Act, doctors included under provisions of act also widened gap in doctor-patient relationship. Communication gap is widening between doctor and patient as less time given to patient’s complete history taking and discussion to create good rapport. Inspite of all efforts if something untoward happens, the relatives hold doctor responsible. People should realise that under certain critical conditions of patients, every patient can’t be saved even by greatest doctor. Sometimes there might be negligence from doctor side but such incidences are very few.

Some political persons or media person also make doctor ,a soft target to get publicity by creating negative picture of medical profession in society. Political or some public comments like doctors are charging at higher rates ,doing unnecessary surgeries, writing expensive drugs widens gap in doctor –patient relationship. Political persons instead of directly talking in public,they should discuss issues with medical committees or governing bodies so that further bitter consequences can be avoided.

Another contemporary effect on doctor-patient relationship has been the exponential increase in the use of internet by patients. Better patient education has obvious advantages for mutual relationship ,there are concerns that information on the internet might not always be accurate and reliable. This poses a new challenge for the medical professional-that of revising any misinformation the patient has found him or herself.

For a community to get good healthcare services, doctor-patient relationship needs to be in harmony .Increasing communication between two sides is an important step to improve relationship. Keeping patient and relatives aware of critical conditions that might occur during disease course will help to avoid unnecessary misunderstanding .Media should project positive and good aspects of medical profession also. If any patient or relatives have complaint of doctor ,then they should approach appropriate authority or governing bodies instead of taking law in hand .There is provision of legal action for misbehaving with medical professionals but it has not created much impact in society. The law should be strictly implemented to safeguard medical profession.

By dispensing information in a manner that maximizes understanding is a prerequisite for more equal participation. Shared decision making between the doctor and patient will determine the most appropriate and best course of action for an individual patient.

Doctor is human being and needs to be treated as human ,not required to be a GOD. Good doctor-patient relationship is need of hour for healthy society.

YOUR HEART KNOWS THINGS THAT YOUR MIND CAN’T EXPLAIN

YOUR HEART KNOWS THINGS THAT YOUR MIND CAN’T EXPLAIN

 

 

     Days passed by hearing the sudden death news of Celebrities like Michael Jackson, Sri Devi, Sema Lagoo, Om Puri due to Heart Disease. Heart disease can occur in 2 ways:  One by birth, family history, diabetes mellitus type 1. Second by cholesterol, lack of exercise, overweight, smoking, diabetes mellitus type 2.  Nowadays a heart attack by diabetes mellitus is getting worse. If we think twice or thrice, the common effect for this disease can be the mistakes and discipline of our daily life activities.

Recently, ‘diabetic heart disease’ is the highly ranked disease crawling among the adults with an age of 45 to 55. Sadly, this evil that will be been weaving around us at the youthful age. As laziness and unhealthy diet take a major place in your life, the art of heart disease gives birth in your body.

Every profession got its own way of stress, tension, sleepless tasks in simpler word ‘difficulties’ as an employee pressurized by the boss, as a boss stressed in maintaining company statistics, as a student tensed about career and future, a doctor diagnosing patients’ diseases we cannot blame anyone for this. But by these effects of stress, tensions, staying in a stationary position for extended periods of time, our body will be prone to chronic disease like diabetes. Diabetes mellitus type 2 is the most entertained disease in our body. How about the stress of the work which damages your nervous system, increases your blood pressure, constricts your blood vessels? Have you ever thought that not only the junk in your body but even the stress, fear, tension taken up during the work affects your body in a soothing way?

How Diabetes Mellitus type 2 starts?

You get to work and end up the day with an entire body filled with tiredness. All this time the brain helped in thinking, calculating, decision making; digestive system extracted some enzymes from food which helps the other organs to work in a proper way and energy distributed all over so that you may not faint in the middle of your work, but stress disturbed them. As tension and stress make your heart beats fast soon blood pumps fast and your blood vessels constrict by pressure, as the blood moves fast in your body the organs of your body attempts to work fast. This means the body is working more than needed. Eventually, the pituitary gland (master gland of the body) secretes hormones in large amount which means hyperfunction takes places in the organ. As concerned to the pancreas, sometimes it cannot be capable of secreting insulin and the glucose cannot be converted into glycogen that brings changes to the blood sugar level. By this, you will be affected by diabetes mellitus type 2.

Symptoms of Diabetes Mellitus type 2:

If you have diabetes mellitus type 2 you will have an Increased thirst and frequent urination (Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues), Increased hunger, Weight loss (Calories are lost as excess glucose is released into the urine), Fatigue, blurred vision (If blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus), Slow-healing sores or frequent infections, Areas of darkened skin (patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance). These symptoms of diabetes mellitus type 2 can affect your heart.

 

How Diabetes Mellitus type 2 affects your Heart?

By regular fast pumping of the heart, it can become weak and irregularity of heartbeat takes place, which may lead to arrhythmia (irregularity of heartbeat) or dilated cardiomyopathy (heart chambers become dilated because of heart muscle weakness and cannot pump blood properly) sometimes heart failure(insufficient supply of oxygen).

As a foodie, a chicken burger with extra cheese in right hand and a cola in the left hand or trying out new fast food seems to be a magic ‘mantra’ for after work stress-relief. You may enjoy that plate of delicious food and get back to sleep. What about the fat summed up in your body?  There is no way for the calories to burn up!

First, calories pile up and there will be no scope to run out of the body. These tiny calories turn and convert into a thick creamy unwanted layer of fat in the body. The unwanted fat slowly turns into cholesterol and lead to obesity. Some of the diluted fats go around the body and stays at a place like heart, bundles up into cholesterol, mostly in a coronary artery, one of the main arteries of the heart. This leads to improper pumping of the blood leading to coronary heart disease. Sometimes, myocardial infarction (heart attack) caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms occur.

 

Symptoms of Heart Disease:

You should be aware of what is happening in your body.

When you feel an unbearable pain that travels through the body (for example from the chest to the arms, neck, back, abdomen, or jaw) light-headedness and dizzy sensationsprofuse sweating nausea, and vomiting clearly shows that your heart is in trouble. It is not getting enough oxygen to pump up the blood. Immediately run to the hospital.

 

Medications for Heart Disease:

The main medications in use are statins (for lowering cholesterol), aspirin, clopidogrel, and 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). The doctor will work to find a medication that is safe and effective. They will also use medications to treat underlying conditions that can affect the heart, such as diabetes before they become problematic.

 

‘Prevention is better than cure’

The only way to get rid of the disease is proper diet and regular exercise. When you wake up a 5-minute meditation or yoga will give fresh start and calmness to your mind which controls your anxiety, stress, tension for the entire day, regular breakfast, minimum 30-minutes exercise per day, power naps, healthy diet, avoid smoking, avoiding or reducing junk food and soda will be helpful to get a good health. By this, you will be healthy and have a great immunity in your body.

THE IMPACT OF CURRENT HEALTH CARE SITUATION ON MEDICAL STUDENTS AND YOUNG DOCTORS OF NEPAL

THE IMPACT OF CURRENT HEALTH CARE SITUATION ON MEDICAL STUDENTS AND YOUNG DOCTORS OF NEPAL

 

The current situation of doctors in Nepal is one of the major factors that is causing the doctors of our generation to practice medicine in a foreign country. At least we won’t have a fear to be beaten up by an angry mob when the patient dies (even after the doctors did all they could).

This type of situation is highly demotivating and will have an impact on the health sector of Nepal for a long time. Lack of Professional security, unfair wages are some of the few reasons that implant the dream of USMLE(USA), GMC(UK), AMC(AUS) in the mind of the young medical students and doctors who don’t see or don’t want a future here.

And when all the competent Doctors leave the country for a place with better job security, job satisfaction, paygrade, respect then the country will be left with lack of manpower and will go through a medical crisis with lack of manpower.

People may argue “Doctors should not work for money, they should do good to the society,” I ask WHY? Does anyone tell an engineer to build houses/roads for “betterment of the society”? OR ask the banks to give away money for the same cause. No!

Then why should we do that? Is it wrong that I would want luxuries of modern society after doing my job to the best I can? If I paid a large sum of money for my education is it wrong that I would like to earn a lot more?

So someone who spends their better part of their life and a large sum of money to be a doctor, why would he/she like to remain in a place with minimal pay, lack of freedom to practice their skills and fear. of getting beaten! And they know they have way better alternatives abroad.

I don’t believe Doctors are next to God, I don’t want to be called that either. The medical profession is like just another profession and we are just like other people. We have our own set of skills and limitations just like any other professionals and people seem to forget this.

I am not denying the fact that there is no medical negligence and some doctors are responsible for the wrong outcomes and they are at fault. But it’s not the angry mob or the saddened family of the patient who decides who was at fault.

We have proper laws and the government and Nepal Medical Council(NMC) to investigate it and decide whose fault was there if any. And one can even be banned to practice medicine for life if any major negligence is found. But No! Here, the mob decides that ALWAYS the doctor is at fault. It’s like saying that if some students fail in exams/do bad then the teachers are ALWAYS at fault! If the student doesn’t study properly then whatever the teachers do that student will fail and it won’t be the fault of the teachers. The same analogy applies in case of a doctor and a patient.

If the situation continues like this we will see a decline in the competent people wanting to join medicine in the first place let alone practice here and the quality of the services will degrade causing more mishappenings and the vicious cycle will continue.

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