A difficult decision near death- try to ‘hold on’ or ‘let go’
The eternal human wish is to fight hard against age, illness, and death and holding on to life, to our loved ones, is indeed a basic human instinct. However, as an illness advances, “raging against the dying of the light” often begins to cause undue suffering, and “letting go” may instead feel like the next stage.
Tom Sizemore has no hope of recovery after he suffered a brain aneurysm, his family has said, confirming they are making an end-of-life decision for the Saving Private Ryan actor. The 61-year-old has been in a coma in the intensive care unit of Providence Saint Joseph Medical Center in Los Angeles since he was hospitalised on 18 February. On Monday night, Sizemore’s representative, Charles Lago, issued a statement revealing that there was no chance for his recovery. “Today doctors informed his family that there is no further hope and have recommended end of life decision. The family is now deciding end of life matters and a further statement will be issued on Wednesday,” Lago said.
Humans have an instinctive desire to go on living. We experience this as desires for food, activity, learning, etc. We feel attachments to loved ones, such as family members and friends, and even to pets, and we do not want to leave them.
When we realize that the end of life may be approaching, other thoughts and feelings arise. Fears arise, and may be so strong that they are hard to think about or even admit to: fear of change, of the dying process, of what happens after death, of losing control, of dependency and more. Both the person who is ill and the caregiver might also experience resentment, guilt, sadness, and anger at having to do what neither wants to do, namely face death and dying.
As death nears, many people feel a lessening of their desire to live longer. This is different from depression or thoughts of suicide. Instead, they sense it is time to let go. They may reach a point where they feel they have struggled as much as they have been called upon to do and will struggle no more. Refusing to let go can prolong dying, but it cannot prevent it. Dying, thus prolonged, can become more a time of suffering than of living.
Family members and friends who love the dying person may learn to accept a life limiting illness, and then accept the possibility of a loved one dying. They may see that dying is the better of two choices and accept the inevitability of death.
The dying may be cause distress and grief for those who love them. If a stage has reached when treatments are no longer working as well as before, and everyday life maintaining activities are becoming more and more burdensome. In a sense, life is disappearing. One has to look beyond the fears and wishes. What is really best for the one who is dying, and for the others around? Given that death is unavoidable, what is the kindest thing to do? It might be holding on or it might be letting go.
More of a law and order issue, the physical assault on doctors reflects that they are serving an uncivilized society. Such news is viewed by medical community anxiously and is definitely a poor advertisement for younger generation to take medicine as profession. The medical students need to think, why they wish to enter medical profession in such an unsupportive environment?
Strangely media, courts, prominent people, celebrities, human right commission, right activists are little concerned about the blatant injustice done towards doctors. This again brings forth the hypocrisy of our society and law enforcement agencies, which otherwise cry hoarse about human rights, but practically doctors (while they save others), need to fend for themselves when ugly situations arise.
NEW DELHI: The Central government has decided not to enact separate legislation for prohibiting violence against doctors and other healthcare professionals, the Rajya Sabha was informed on Tuesday.
In a written reply, Union Health Minister Dr Mansukh Mandaviya said that a draft of the Healthcare Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2019 was prepared and was also circulated for consultations.
“Thereafter it was decided not to enact a separate Legislation for prohibiting violence against doctors and other health care professionals,” he said to a question on the reasons for the withdrawal of the Bill, which intended to protect healthcare professionals and institutions.
Mandaviya said that the matter was further discussed with relevant ministries and departments of government as well as all stakeholders, and an ordinance namely The Epidemic Diseases (Amendment) Ordinance, 2020 was promulgated on April 22, 2020.
However, the government, on September 28, 2020, passed the Epidemic Diseases (Amendment) Act, 2020 under which acts of violence against healthcare personnel during any situation were considered cognizable and non-bailable offences.
Speaking with TNIE, Dr Rohan Krishnan, National Chairman, FAIMA Doctors Association, said that there have been many cases of violence against doctors and health professionals in the past few months inside the government hospitals, but the union health ministry has not taken their demand to have a separate law for providing safety and security to healthcare workers and doctors seriously.
“The government needed us during the Covid-19 pandemic and came out with rules and regulations. We also felt safe and secure. But now that Covid-19 is declining and we were able to bring normalcy, the government is showing its true colours. It is shameful,” he said.
“The government is not standing up to its promise of bringing a separate law to prohibit violence against doctors and healthcare professionals,” he added.
“On the one hand, it has failed to provide mental and physical safety and security to the doctors and healthcare professionals; on the other hand, instead of having verbal communication with us regarding this matter, the government is denying any scope of providing a separate law in the future. This is a very serious issue. We will raise this issue at every level,” Dr Krishnan said.
Under the Epidemic Diseases (Amendment) Act, the commission or abetment of acts of violence or damage or loss to any property is punishable with imprisonment for a term of three months to five years, and with a fine of Rs 50,000 to Rs 2,00,000.
In case of causing grievous hurt, imprisonment shall be for a term of six months to seven years and with a fine of Rs 1,00,000 to Rs 5,00,000.
In addition, the offender shall also be liable to pay compensation to the victim and twice the fair market value for damage to property.
Since, law and order is a state subject, State, and Union Territory governments also take appropriate steps to protect healthcare professionals/institutions under provisions under the Indian Penal Code (IPC)/Code of Criminal Procedure (CrPC), the minister said.
To another question on the number of security guards hired/outsourced by government hospitals in the country, the Minister of State for Health Dr Bharati Pravin Pawar said that public health and hospitals are state subjects, therefore no such data is maintained centrally.
Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).
Osteoporosis is a “silent” disease because you typically do not have symptoms, and you may not even know you have the disease until you break a bone. Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone but happen most often in bones of the hip, vertebrae in the spine, and wrist.
However, you can take steps to help prevent the disease and fractures by:
Staying physically active by participating in weight-bearing exercises such as walking.
Drinking alcohol in moderation.
Quitting smoking, or not starting if you don’t smoke.
Taking your medications, if prescribed, which can help prevent fractures in people who have osteoporosis.
Eating a nutritious diet rich in calcium and vitamin D to help maintain good bone health.
Who Gets Osteoporosis?
Osteoporosis affects women and men of all races and ethnic groups. Osteoporosis can occur at any age, although the risk for developing the disease increases as you get older. For many women, the disease begins to develop a year or two before menopause. Other factors to consider include:
Osteoporosis is most common in non-Hispanic white women and Asian women.
African American and Hispanic women have a lower risk of developing osteoporosis, but they are still at significant risk.
Among men, osteoporosis is more common in non-Hispanic whites.
Certain medications, such as some cancer medications and glucocorticoid steroids, may increase the risk of developing osteoporosis.
Because more women get osteoporosis than men, many men think they are not at risk for the disease. However, both older men and women from all backgrounds are at risk for osteoporosis.
Some children and teens develop a rare form of idiopathic juvenile osteoporosis. Doctors do not know the cause; however, most children recover without treatment.
Osteoporosis is called a “silent” disease” because there are typically no symptoms until a bone is broken or one or more vertebrae collapse (fracture). Symptoms of vertebral fracture include severe back pain, loss of height, or spine malformations such as a stooped or hunched posture (kyphosis).
Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of:
Minor falls, such as a fall from standing height that would not normally cause a break in a healthy bone.
Normal stresses such as bending, lifting, or even coughing.
Causes of Osteoporosis
Osteoporosis occurs when too much bone mass is lost and changes occur in the structure of bone tissue. Certain risk factors may lead to the development of osteoporosis or can increase the likelihood that you will develop the disease.
Many people with osteoporosis have several risk factors, but others who develop osteoporosis may not have any specific risk factors. There are some risk factors that you cannot change, and others that you may be able to change. However, by understanding these factors, you may be able to prevent the disease and fractures.
Factors that may increase your risk for osteoporosis include:
Sex. Your chances of developing osteoporosis are greater if you are a woman. Women have lower peak bone mass and smaller bones than men. However, men are still at risk, especially after the age of 70.
Age. As you age, bone loss happens more quickly, and new bone growth is slower. Over time, your bones can weaken and your risk for osteoporosis increases.
Body size. Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger boned women and men.
Race. White and Asian women are at highest risk. African American and Mexican American women have a lower risk. White men are at higher risk than African American and Mexican American men.
Family history. Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.
Changes to hormones. Low levels of certain hormones can increase your chances of developing osteoporosis. For example:
Low estrogen levels in women after menopause.
Low levels of estrogen from the abnormal absence of menstrual periods in premenopausal women due to hormone disorders or extreme levels of physical activity.
Low levels of testosterone in men. Men with conditions that cause low testosterone are at risk for osteoporosis. However, the gradual decrease of testosterone with aging is probably not a major reason for loss of bone.
Diet. Beginning in childhood and into old age, a diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures. Excessive dieting or poor protein intake may increase your risk for bone loss and osteoporosis.
Other medical conditions. Some medical conditions that you may be able to treat or manage can increase the risk of osteoporosis, such as other endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.
Medications. Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as:
Glucocorticoids and adrenocorticotropic hormone, which treat various conditions, such as asthma and rheumatoid arthritis.
Antiepileptic medicines, which treat seizures and other neurological disorders.
Cancer medications, which use hormones to treat breast and prostate cancer.
Proton pump inhibitors, which lower stomach acid.
Selective serotonin reuptake inhibitors, which treat depression and anxiety.
Thiazolidinediones, which treat type II diabetes.
Lifestyle. A healthy lifestyle can be important for keeping bones strong. Factors that contribute to bone loss include:
Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. They also leave you in poor physical condition, which can increase your risk of falling and breaking a bone.
Chronic heavy drinking of alcohol is a significant risk factor for osteoporosis.
Studies indicate that smoking is a risk factor for osteoporosis and fracture. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis.
Doctors usually diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for:
Women over age 65.
Women of any age who have factors that increase the chance of developing osteoporosis.
Due to a lack of available evidence, the Task Force did not make recommendations regarding osteoporosis screening in men.
During your visit with your doctor, remember to report:
Any previous fractures.
Your lifestyle habits, including diet, exercise, alcohol use, and smoking history.
Current or past medical conditions and medications that could contribute to low bone mass and increased fracture risk.
Your family history of osteoporosis and other diseases.
For women, your menstrual history.
The doctor may also perform a physical exam that includes checking for:
Loss of height and weight.
Changes in posture.
Balance and gait (the way you walk).
Muscle strength, such as your ability to stand from sitting without using your arms).
In addition, your doctor may order a test that measures your bone mineral density (BMD) in a specific area of your bone, usually your spine and hip. BMD testing can be used to:
Diagnose osteoporosis.
Detect low bone density before osteoporosis develops.
Help predict your risk of future fractures.
Monitor the effectiveness of ongoing treatment for osteoporosis.
The most common test for measuring bone mineral density is dual-energy x-ray absorptiometry (DXA). It is a quick, painless, and noninvasive test. DXA uses low levels of x-rays as it passes a scanner over your body while you lie on a cushioned table. The test measures the BMD of your skeleton and at various sites that are prone to fracture, such as the hip and spine. Bone density measurement by DXA at the hip and spine is generally considered the most reliable way to diagnose osteoporosis and predict fracture risk.
Some people have a peripheral DXA, which measures bone density in the wrist and heel. This type of DXA is portable and may make it easier for screening. However, the results may not help doctors predict your risk for fractures in the future or monitor the effects of your medications on the disease.
Your doctor will compare your BMD test results to the average bone density of young, healthy people and to the average bone density of other people of your age, sex, and race. If your test results show that you have osteoporosis, or if your bone density is below a certain level and you have other risk factors for fractures, your doctor may recommend both lifestyle approaches to promote bone health and medications to lower your chance of breaking a bone.
Sometimes, your doctor may recommend a quantitative ultrasound (QUS) of the heel. This is a test that evaluates bone but does not measure BMD. If the QUS indicates that you have bone loss, you will still need a DXA test to diagnose bone loss and osteoporosis.
Treatment of Osteoporosis
The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures. Your health care provider may recommend:
Proper nutrition.
Lifestyle changes.
Exercise.
Fall prevention to help prevent fractures.
Medications.
People who develop osteoporosis from another condition should work with their health care provider to identify and treat the underlying cause. For example, if you take a medication that causes bone loss, your doctor may lower the dose of that medication
or switch you to another medication. If you have a disease that requires long-term glucocorticoid therapy, such as rheumatoid arthritis or chronic lung disease, you can also take certain medications approved for the prevention or treatment of osteoporosis associated with aging or menopause.
Nutrition
An important part of treating osteoporosis is eating a healthy, balanced diet, which includes:
Plenty of fruits and vegetables.
An appropriate amount of calories for your age, height, and weight. Your health care provider or doctor can help you determine the amount of calories you need each day to maintain a healthy weight.
Foods and liquids that include calcium, vitamin D, and protein. These help minimize bone loss and maintain overall health. However, it’s important to eat a diet rich in all nutrients to help protect and maintain bone health.
Calcium and Vitamin D
Calcium and vitamin D are important nutrients for preventing osteoporosis and helping bones reach peak bone mass. If you do not take in enough calcium, the body takes it from the bones, which can lead to bone loss. This can make bones weak and thin, leading to osteoporosis.
Good sources of calcium include:
Low-fat dairy products.
Dark green leafy vegetables, such as bok choy, collards, and turnip greens.
Broccoli.
Sardines and salmon with bones.
Calcium-fortified foods such as soymilk, tofu, orange juice, cereals, and breads.
Vitamin D is necessary for the absorption of calcium from the intestine. It is made in the skin after exposure to sunlight. Some foods naturally contain enough vitamin D, including fatty fish, fish oils, egg yolks, and liver. Other foods that are fortified with vitamin D are a major source of the mineral, including milk and cereals.
The chart below shows how much calcium and vitamin D you need each day.
Recommended Calcium and Vitamin D Intakes
Life-stage group
Calcium mg/day
Vitamin D (IU/day)
Infants 0 to 6 months
200
400
Infants 6 to 12 months
260
400
1 to 3 years old
700
600
4 to 8 years old
1,000
600
9 to 13 years old
1,300
600
14 to 18 years old
1,300
600
19 to 30 years old
1,000
600
31 to 50 years old
1,000
600
51- to 70-year-old males
1,000
600
51- to 70-year-old females
1,200
600
>70 years old
1,200
800
14 to 18 years old, pregnant/lactating
1,300
600
19 to 50 years old, pregnant/lactating
1,000
600
Definitions: mg = milligrams; IU = International Units
Source: National Institutes of Health, Office of Dietary Supplements, November 2018
If you have trouble getting enough calcium and vitamin D in your diet, you may need to take supplements. Talk to your health care provider about the type and amount of calcium and vitamin D supplements you should take. Your doctor may check your blood levels of vitamin D and recommend a specific amount.
Lifestyle
In addition to a healthy diet, a healthy lifestyle is important for optimizing bone health. You should:
Avoid secondhand smoke, and if you smoke, quit.
Drink alcohol in moderation, no more than one drink a day for women and no more than two drinks a day for men.
Visit your doctor for regular checkups and ask about any factors that may affect your bone health or increase your chance of falling, such as medications or other medical conditions.
Exercise
Exercise is an important part of an osteoporosis treatment program. Research shows that the best physical activities for bone health include strength training or resistance training. Because bone is living tissue, during childhood and adulthood, exercise can make bones stronger. However, for older adults, exercise no longer increases bone mass. Instead, regular exercise can help older adults:
Build muscle mass and strength and improve coordination and balance. This can help lower your chance of falling.
Improve daily function and delay loss of independence.
Although exercise is beneficial for people with osteoporosis, it should not put any sudden or excessive strain on your bones. If you have osteoporosis, you should avoid high-impact exercise. To help prevent injury and fractures, a physical therapist or rehabilitation medicine specialist can:
Recommend specific exercises to strengthen and support your back.
Teach you safe ways of moving and carrying out daily activities.
Recommend an exercise program that is tailored to your circumstances.
Exercise specialists, such as exercise physiologists, may also help you develop a safe and effective exercise program.
Medications
Your doctor may prescribe medications for osteoporosis. The U.S. Food and Drug Administration (FDA) has approved the following medications for the prevention or treatment of osteoporosis:
Your health care provider will discuss the best option for you, taking into consideration your age, sex, general health, and the amount of bone you have lost. No matter which medications you take for osteoporosis, it is still important that you get the recommended amounts of calcium and vitamin D. Also, exercising and maintaining other aspects of a healthy lifestyle are important.
Medications can cause side effects. If you have questions about your medications, talk to your doctor or pharmacist.
Bisphosphonates. Several bisphosphonates are approved to help preserve bone density and strength and to treat osteoporosis. This type of drug works by slowing down bone loss, which can lower the chance of fractures.
Calcitonin. This medication is made from a hormone from the thyroid gland and is approved for the treatment of osteoporosis in postmenopausal women who cannot take or tolerate other medications for osteoporosis.
Estrogen agonist/antagonist. An estrogen agonist/antagonist, also known as a selective estrogen receptor modulator (SERM), and tissue-selective estrogen complex (TSEC), are both approved to treat and prevent osteoporosis in postmenopausal women. They are not estrogen, but they have estrogen-like effects on some tissues and estrogen-blocking effects on other tissues. This action helps improve bone density, lowering the risk for some fractures.
Estrogen and hormone therapy. Estrogen and combined estrogen and progestin (hormone therapy) are approved to prevent osteoporosis and fractures in postmenopausal women. Because of potential side effects, researchers recommend that women use hormone therapy at the lowest dose, and for the shortest time, and if ot
other medications are not helping. It is important to carefully consider the risks and benefits of estrogen and hormone therapy for the treatment of osteoporosis.
Parathyroid hormone (PTH) analog and parathyroid hormone related-protein (PTHrP) analog. PTH is a form of human parathyroid hormone that increases bone mass and is approved for postmenopausal women and men with osteoporosis who are at high risk for fracture. PTHrP is a medication that is also a form of parathyroid hormone. It is an injection and is usually prescribed for postmenopausal women who have a history of fractures.
RANK ligand (RANKL) inhibitor. This is an inhibitor that helps slow down bone loss and is approved to treat osteoporosis in:
Postmenopausal women or men with osteoporosis who are at high risk for fracture.
Men who have bone loss and are being treated for prostate cancer with medications that cause bone loss.
Women who have bone loss and are being treated for breast cancer with medications that cause bone loss.
Men and women who do not respond to other types of osteoporosis treatment.
Sclerostin inhibitor. This is a medication that treats osteoporosis by blocking the effect of a protein, and helps the body increase new bone formation as well as slows down bone loss.
Who Treats Osteoporosis?
Health care providers who treat osteoporosis include:
Endocrinologists, who treat problems related to the glands and hormones.
Geriatricians, who specialize in caring for all aspects of health in older people.
Gynecologists, who specialize in diagnosing and treating conditions of the reproductive system of women.
Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
Physiatrists (doctors specializing in physical medicine and rehabilitation).
Physical therapists, who help to improve joint function.
Primary care providers, such as a family physician or internal medicine specialist.
Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.
Living With Osteoporosis
In addition to the treatments your doctor recommends, the following tips can help you manage and live with osteoporosis, prevent fractures, and prevent falls.
Preventing fractures is important when you have osteoporosis because fractures can cause other medical problems and take away your independence. Exercise can help prevent fractures that occur as a result of falling and improve bone strength, when your health care provider tailors a program to your individual need. If you have osteoporosis or bone loss, it is important to talk to your doctor or physical therapist before beginning any exercise program.
In addition, preventing falls helps prevent fractures. Falls increase your likelihood of fracturing a bone in the hip, wrist, spine, or other part of the skeleton. Taking steps to prevent falls both inside and outside of the house can help prevent fractures.
Some factors that may contribute to falls include:
Loss of muscle mass.
Illnesses that impair your mental or physical functioning, such as low blood pressure or dementia.
Use of four or more prescription medications.
Poor vision.
Poor balance.
Certain diseases that affect how you walk.
Alcohol use.
Side effects of some medications, such as:
Sedatives or tranquilizers.
Sleeping pills.
Antidepressants.
Anticonvulsants.
Muscle relaxants.
Heart medicines.
Blood pressure pills.
Diuretics.
If you have osteoporosis, it is important to be aware of any physical changes you may experience that affect your balance or gait and to discuss these changes with your doctor or other health care provider. It is also important to have regular checkups and tell your doctor if you have had problems with falling.
Falls can also be caused by factors around you that create unsafe conditions. Here are some tips to help prevent falls outdoors and when you are away from home:
Use a cane or walker for added stability.
Wear shoes that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
Walk on grass when sidewalks are slippery; in winter, put salt or kitty litter on icy sidewalks.
Stop at curbs and check their height before stepping up or down.
Some ways to help prevent falls indoors are:
Keep rooms free of clutter, especially on floors. Avoid running electrical cords across walking areas.
Use plastic or carpet runners on slippery floors.
Wear shoes, even when indoors, that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
If you have a pet, be mindful of where they are to avoid tripping over them.
Do not walk in socks, stockings, or slippers.
Be careful on highly polished floors that are slick and dangerous, especially when wet, and walk on plastic or carpet runners when possible.
Be sure carpets and area rugs have skid-proof backing or are tacked to the floor. Use double-stick tape to keep rugs from slipping.
Be sure stairs are well lit and have rails on both sides.
Install grab bars on bathroom walls near the tub, shower, and toilet.
Use a rubber bathmat or slip-proof seat in the shower or tub.
Improve lighting in your home. Use nightlights or keep a flashlight next to your bed in case you need to get up at night. Install ceiling fixtures or lamps that can be turned on by a switch near the room’s entrance.
Use a sturdy stepstool with a handrail and wide steps.
Add more lights in rooms.
Keep a cordless phone or cell phone with you so that you don’t have to rush to the phone when it rings. In addition, if you fall, you can call for help.
Consider having a personal emergency-response system; you can use it to call for help if you fall.
Other tips that can help you manage your osteoporosis include:
Talking with other people who have osteoporosis.
Reaching out to family and friends for support.
Learning about the disorder and treatments to help you make decisions about your care.
he above article is for information purposes only and is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional for any questions you may have regarding your health or a medical condition.
Hyperlipidemia (high cholesterol) means your blood has too many lipids (fats) in it. These can add up and lead to blockages in your blood vessels. This is why high cholesterol can put you at risk for a stroke or heart attack. But you can make lifestyle changes like eating healthier and exercising to lower your cholesterol. Medicine can help, too.
Hyperlipidemia, or high cholesterol, can let plaque collect inside your blood vessels and put you at risk of a heart attack or stroke. The good news is that you have the power to reduce your risk of heart attack and stroke. Exercising more and eating healthier are just two of the ways you can improve your cholesterol numbers. Taking medicine your provider orders makes a difference, too.
Hyperlipidemia, also known as dyslipidemia or high cholesterol, means you have too many lipids (fats) in your blood. Your liver creates cholesterol to help you digest food and make things like hormones. But you also eat cholesterol in foods from the meat and dairy aisles. Since your liver can make as much cholesterol as you need, the cholesterol in foods you eat is extra.
Too much cholesterol (200 to 239 mg/dL is borderline high and 240 mg/dL is high) is not healthy because it can create roadblocks in your artery highways where blood travels around to your body. This damages your organs. Bad cholesterol (LDL) is the most dangerous type because it causes hardened cholesterol deposits (plaque) to collect inside of your blood vessels. This makes it harder for your blood to get through, which puts you at risk for a stroke or heart attack.
Think of cholesterol, a kind of fat, as traveling in lipoprotein cars through your blood.
Low-density lipoprotein (LDL) is known as bad cholesterol because it can clog your arteries like a large truck that broke down and is blocking a traffic lane. (Borderline high number: 130 to 159 mg/dL. High: 160 to 189 mg/dL.)
Very low density lipoprotein (VLDL) is also called bad because it carries triglycerides that add to artery plaque. This is another type of traffic blocker.
High-density lipoprotein (HDL) is known as good cholesterol because it brings cholesterol to your liver, which gets rid of it. This is like the tow truck that removes the broken down vehicles from the traffic lanes so vehicles can move. In this case, it’s clearing the way for your blood to get through your blood vessels. For your HDL, you don’t want to have a number lower than 40 mg/dL.
It’s important to know that providers consider other factors in addition to your cholesterol numbers when they make treatment decisions.
Is hyperlipidemia the same as high cholesterol?
Yes, hyperlipidemia is another name for high cholesterol, and so is hypercholesterolemia.
What is dyslipidemia vs. hyperlipidemia?
They are mostly interchangeable terms for abnormalities in cholesterol. Your cholesterol can be “dysfunctional” (cholesterol particles that are very inflammatory or an abnormal balance between bad and good cholesterol levels) without being high. Both a high level of cholesterol and increased inflammation in “normal” cholesterol levels put you at increased risk for heart disease.
Several things can put you at a higher risk of hyperlipidemia, including:
Having a family history of high cholesterol.
Having hypothyroidism.
Having obesity.
Not eating a nutritious diet.
Drinking too much alcohol.
Having diabetes.
Smoking.
How common is hyperlipidemia?
Hyperlipidemia is very common. Ninety-three million American adults (age 20 and older) have a total cholesterol count above the recommended limit of 200 mg/dL.
How serious is hyperlipidemia?
Hyperlipidemia can be very serious if it’s not controlled. As long as high cholesterol is untreated, you’re letting plaque accumulate inside your blood vessels. This can lead to a heart attack or stroke because your blood has a hard time getting through your blood vessels. This deprives your brain and heart of the nutrients and oxygen they need to function. Cardiovascular disease is the leading cause of death in Americans.
How does hyperlipidemia affect my body?
Hyperlipidemia (high cholesterol) that’s not treated can allow plaque to collect inside your body’s blood vessels (atherosclerosis). This can bring on hyperlipidemia complications that include:
Heart attack.
Stroke.
Coronary heart disease.
Carotid artery disease.
Sudden cardiac arrest.
Peripheral artery disease.
Microvascular disease.
SYMPTOMS AND CAUSES
What are the symptoms of hyperlipidemia?
Most people don’t have symptoms when their cholesterol is high. People who have a genetic problem with cholesterol clearance that causes very high cholesterol levels may get xanthomas (waxy, fatty plaques on the skin) or corneal arcus (cholesterol rings around the iris of the eye).
What causes hyperlipidemia?
Various hyperlipidemia causes include:
Smoking.
Drinking a lot of alcohol.
Eating foods that have a lot of saturated fats or trans fats.
Sitting too much instead of being active.
Being stressed.
Inheriting genes that make your cholesterol levels unhealthy.
Being overweight.
Medications that are helpful for some problems can make your cholesterol levels fluctuate, such as:
Beta blockers.
Diuretics.
Hormonal birth control.
Steroids.
Antiretrovirals for HIV.
Medical problems can also affect how much cholesterol you have. These include:
Multiple myeloma.
Polycystic ovary syndrome (PCOS).
Hypothyroidism.
Primary biliary cirrhosis.
Chronic kidney disease.
Diabetes.
Lupus.
Sleep apnea.
HIV.
DIAGNOSIS AND TESTS
How is hyperlipidemia diagnosed?
Your provider will want:
A physical exam.
Your medical history.
Your family’s medical history.
To calculate your 10 year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score.
A blood test called a lipid panel will tell you these numbers:
Type of cholesterol
Best number to have
Total cholesterol
Less than 200 mg/dL
Bad (LDL) cholesterol
Less than 100 mg/dL
Good (HDL) cholesterol
At least 60 mg/dL
Triglycerides
Less than 150 mg/dL
What tests will be done to diagnose hyperlipidemia?
Your provider may also do these tests:
High sensitivity C-reactive protein (hs-CRP).
Lipoprotein (a).
Apolipoprotein B.
Coronary calcium scan.
MANAGEMENT AND TREATMENT
How is hyperlipidemia treated?
Changing their lifestyles may be all some people need to do to improve their cholesterol numbers. For other people, that’s not enough and they need medication.
Things you can do include:
Exercising.
Quitting smoking.
Sleeping at least seven hours each night.
Keeping your stress level under control.
Eating healthier foods.
Limiting how much alcohol you drink.
Losing a few pounds to reach a healthy weight.
What medications are used for hyperlipidemia?
People who need medicine to treat their high cholesterol usually take statins. Your provider may order a different type of medicine if:
You can’t take a statin.
You need another medicine in addition to a statin.
You have familial hypercholesterolemia, a genetic problem that makes your bad (LDL) cholesterol number extremely high.
Are there side effects of hyperlipidemia treatment?
Any medication can have side effects, but the benefits of statins far outweigh the risks of minor side effects. Let your provider know if you aren’t doing well on your medicine so they can develop a plan to manage your symptoms.
How soon will the hyperlipidemia treatment start working?
Your provider will order another blood test about two or three months after you start taking hyperlipidemia medication. The test results will show if your cholesterol levels have improved, which means the medicine and/or lifestyle changes are working.
PREVENTION
How can I reduce my risk of hyperlipidemia?
Even children can get their blood checked for high cholesterol, especially if someone in the child’s family had a heart attack, stroke or high cholesterol. Children and young adults can get checked every five years.
Once you reach middle age, you should have your cholesterol checked every year or two. Your healthcare provider can help you decide how often you should have a hyperlipidemia screening.
How can I prevent hyperlipidemia?
Changes you make in your life can keep you from getting hyperlipidemia. Things you can do include:
Stop smoking.
Stay active instead of sitting too much.
Keep your stress level down.
Get the right amount of sleep.
Eat healthy foods.
Cut back on eating fatty meats.
Don’t buy snacks that have “trans fat” on the label.
Stay at a healthy weight.
OUTLOOK / PROGNOSIS
What can I expect if I have hyperlipidemia?
If you have hyperlipidemia, you’ll need to keep using healthy lifestyle habits for years to come. You’ll also need to keep follow-up appointments with your provider and continue to take your medicine.
How long will you have hyperlipidemia?
Hyperlipidemia is a condition you’ll need to manage for the rest of your life.
What is the outlook for hyperlipidemia?
Although high cholesterol puts you at risk for heart attacks and stroke, you can protect yourself by living a healthier lifestyle and taking medicine if needed.
LIVING WITH
How do I take care of myself with hyperlipidemia?
Be sure to follow your provider’s instructions for making your lifestyle healthier.
Here are things you can do yourself:
Exercise.
Stop smoking.
Sleep at least seven hours each night.
Control your stress level.
Eat healthier foods.
Limit how much alcohol you drink.
Stay at a healthy weight.
Other things you can do:
If your provider ordered medicine for you, be sure to keep taking it as the label tells you to do.
Keep your follow-up appointments.
When should I see my healthcare provider?
You should see your provider if you have:
High blood sugar.
High blood pressure.
High cholesterol.
What questions should I ask my doctor?
Do I need to make lifestyle changes, take medication or both?
If I do what you tell me to do, how quickly can my numbers improve?
Painful story of Dr Archana Sharma Suicide unmasks the everyday struggle of the doctors in present era. Although not ideal but being undervalued, dis-empowered and demonized, forced to work as sub-servant to bureaucrats are considered new normal and is an accepted form of harassment. Fatigue and burnout are thought to be routine side effects of being a doctor or nurse. Venomous media, celebrities, film stars and prominent personalities have left no stone unturned in spreading hatred and creating an environment of mistrust against the medical profession. They project single stray incident as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors have become prone to the verbal, physical as well as legal assaults. Dr Archana Suicide unmasked an organised crime and propagators were local goons, politicians and vulture journalist, who usually managed an orchestrated racket to blackmail the doctors and extort money. Doctors being soft targets because of their nature of work as they deal with life and death. Any death gives them opportunity to all to blackmail the doctors on the pretext of negligence, a legal weapon used by law-enforcers.
Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’
JAIPUR: The husband of gynaecologist Dr Archana Sharma, who committed suicide on Tuesday, lodged an FIR against one Shiv Shankar Ballya Joshi for exerting pressure on the doctor and organising protests in her hospital. Hours before his transfer, Dausa SP Anil Kumar said police have seen the CCTV footage wherein Joshi was belting out abusive slogans against the doctor in the hospital. Police said they were investigating Joshi’s role in the case. The entire incident began when a 22-year-old woman was brought to Sharma’s Anand Hospital on Sunday night with labour pain. Though she was taken to the labour room, her condition deteriorated allegedly due to excessive bleeding and she died on Monday. On the same day, Dausa police registered an FIR under Section 302 (Murder) of the IPC which names Dr Archana Sharma and her husband Dr Suneet Upadhyay. The FIR put Rajasthan police in a tight spot because several doctors alleged that cops could have filed the FIR under Section 304A (causing death by negligence) of the IPC, instead of slapping murder charges on doctors. 4/1/22, 3:20 PM Rajasthan: Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’. Kumar, however, said the police only registered the FIR on the basis of the complaint filed by the patient’s family. In an emotional video message, Dr Upadhyay alleged that Joshi had promised the family a hefty compensation and brought them back with the body to the hospital. “Joshi called other BJP leaders to the hospital too. Joshi has been trying extortion and blackmailing in the hospital,” he said, adding that the police have been shielding Joshi due to a senior BJP leader of Dausa. Sharma’s husband Dr Suneet Upadhyay in his FIR said that some “vultures” played politics on the patient’s body as they gheraoed the hospital and forced the local administration to file a case of murder against the doctor. Upadhyay alleged that Joshi played a key role in this entire affair. He has been accused in the FIR of threatening the hospital multiple times in the past. As per the FIR, many complaints were filed against Joshi at the police station, but cops took no action against him, which further emboldened the accused. Upadhyay said Joshi was hurling invectives during the protest at the hospital and his wife could not tolerate such insults because she was a reputed surgeon who had saved the lives of several women and children. He said she was stalked by fears that Joshi could send her to jail even though she was innocent. The complaint also mentions that Sharma read a report of the incident in a local newspaper, but there was no mention of the hospital’s version there.
According to Upadhyay, the family members of the deceased patient had returned from the hospital with complete satisfaction because they had witnessed the doctors struggling for nearly two hours to save her life. He said the family of the deceased patient were preparing for her last rites when Joshi stepped in and brought the body back to the hospital. Joshi allegedly called up people over the phone and gathered a large crowd at the hospital. He wanted to file a case of murder against the doctor even though the family of the patient had not given any complaint. The FIR states that vultures like them have made the lives of doctors in the country very difficult and told cops to act against such blackmailers. Dausa police said they have booked Joshi under Section 306 (abetment of suicide), 304 (extortion) and 384 (extortion by threat of accusation of an offence punishable with death or imprisonment for life, etc) of the IPC. Police said Joshi is a local leader, whereas, they are probing the journalist’s involvement.
High blood pressure (hypertension) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. A blood pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.
Top number (systolic pressure). The first, or upper, number measures the pressure in your arteries when your heart beats.
Bottom number (diastolic pressure). The second, or lower, number measures the pressure in your arteries between beats.
You can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.
When to see a doctor
You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.
Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.
Your doctor will likely recommend more-frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.
If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.
Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
Obstructive sleep apnea
Kidney disease
Adrenal gland tumors
Thyroid problems
Certain defects you’re born with (congenital) in blood vessels
Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
Illegal drugs, such as cocaine and amphetamines
Risk factors
High blood pressure has many risk factors, including:
Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
Family history. High blood pressure tends to run in families.
Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood flow through your blood vessels increases, so does the pressure on your artery walls.
Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don’t get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.
Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.
The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels as well as your organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:
Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndrome is a group of disorders of your body’s metabolism, including increased waist size, high triglycerides, decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol), high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.
Diagnosis
Blood pressure measurement
Your doctor will ask questions about your medical history and do a physical examination. The doctor, nurse or other medical assistant will place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff.
Blood pressure measurements fall into several categories:
Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg.
Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.
Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
Stage 2 hypertension. More-severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
Hypertensive crisis. A blood pressure measurement higher than 180/120 mm Hg is an emergency situation that requires urgent medical care. If you get this result when you take your blood pressure at home, wait five minutes and retest. If your blood pressure is still this high, contact your doctor immediately. If you also have chest pain, vision problems, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack, call local emergency medical number.
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more important. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a common type of high blood pressure among people older than 65.
Because blood pressure normally varies during the day and may increase during a doctor visit (white coat hypertension), your doctor will likely take several blood pressure readings at three or more separate appointments before diagnosing you with high blood pressure.
Microsoft Corp. said Zain Nadella, son of Chief Executive Officer Satya and his wife Anu, died Monday morning. He was 26 years old and had been born with cerebral palsy. The software maker told its executive staff in an email that Zain had passed away. The message asked executives to hold the family in their thoughts and prayers while giving them space to grieve privately.
Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It’s caused by damage that occurs to the immature, developing brain, most often before birth.
Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with exaggerated reflexes, floppiness or spasticity of the limbs and trunk, unusual posture, involuntary movements, unsteady walking, or some combination of these.
People with cerebral palsy can have problems swallowing and commonly have eye muscle imbalance, in which the eyes don’t focus on the same object. They also might have reduced range of motion at various joints of their bodies due to muscle stiffness.
The cause of cerebral palsy and its effect on function vary greatly. Some people with cerebral palsy can walk; others need assistance. Some people have intellectual disabilities, but others do not. Epilepsy, blindness or deafness also might be present. Cerebral palsy is a lifelong disorder. There is no cure, but treatments can help improve function.
Signs and symptoms of cerebral palsy can vary greatly from person to person. Cerebral palsy can affect the whole body, or it might be limited primarily to one or two limbs, or one side of the body. Generally, signs and symptoms include problems with movement and coordination, speech and eating, development, and other problems.
Movement and coordination
Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
Variations in muscle tone, such as being either too stiff or too floppy
Stiff muscles with normal reflexes (rigidity)
Lack of balance and muscle coordination (ataxia)
Tremors or jerky involuntary movements
Slow, writhing movements
Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
Difficulty with fine motor skills, such as buttoning clothes or picking up utensils
Speech and eating
Delays in speech development
Difficulty speaking
Difficulty with sucking, chewing or eating
Excessive drooling or problems with swallowing
Development
Delays in reaching motor skills milestones, such as sitting up or crawling
Learning difficulties
Intellectual disabilities
Delayed growth, resulting in smaller size than would be expected
Other problems
Damage to the brain can contribute to other neurological problems, such as:
Seizures (epilepsy)
Difficulty hearing
Problems with vision and abnormal eye movements
Abnormal touch or pain sensations
Bladder and bowel problems, including constipation and urinary incontinence
Mental health conditions, such as emotional disorders and behavioral problems
The brain disorder causing cerebral palsy doesn’t change with time, so the symptoms usually don’t worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.
When to see a doctor
It’s important to get a prompt diagnosis for a movement disorder or delays in your child’s development. See your child’s doctor if you have concerns about episodes of loss of awareness of surroundings or of unusual bodily movements or muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues.
Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn’t known. Many factors can lead to problems with brain development. Some include:
Gene mutations that result in genetic disorders or differences in brain development
Maternal infections that affect the developing fetus
Fetal stroke, a disruption of blood supply to the developing brain
Bleeding into the brain in the womb or as a newborn
Infant infections that cause inflammation in or around the brain
Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought
Risk factors
A number of factors are associated with an increased risk of cerebral palsy.
Maternal health
Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby’s developing brain.
Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth defects if a mother has her first active infection during pregnancy.
German measles (rubella). This viral infection can be prevented with a vaccine.
Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
Syphilis. This is a sexually transmitted bacterial infection.
Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
Zika virus infection. This infection is spread through mosquito bites and can affect fetal brain development.
Intrauterine infections. This includes infections of the placenta or fetal membranes.
Exposure to toxins. One example is exposure to methyl mercury.
Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid problems, preeclampsia or seizures.
Infant illness
Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:
Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of “used” blood cells aren’t filtered from the bloodstream.
Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.
Factors of pregnancy and birth
While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:
Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors’ risk of cerebral palsy increases.
Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
Delivery complications. Problems during labor and delivery may increase the risk of cerebral palsy.
Complications
Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or in adulthood, including:
Contracture. Contracture is muscle tissue shortening due to severe muscle tightening that can be the result of spasticity. Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation. These can include hip dislocation, curvature of the spine (scoliosis) and other orthopedic deformities.
Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavioral problems can also occur.
Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing disorders. Problems with swallowing can result in respiratory problems, such as aspiration pneumonia.
Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
Osteoporosis. Fractures due to low bone density can result from several factors such as lack of mobility, inadequate nutrition and anti-epileptic drug use.
Other complications. These can include sleep disorders, chronic pain, skin breakdown, intestinal problems and issues with oral health.
Prevention
Most cases of cerebral palsy can’t be prevented, but you can reduce risks. If you’re pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:
Make sure you’re vaccinated. Getting vaccinated against diseases such as rubella, preferably before getting pregnant, might prevent an infection that could cause fetal brain damage.
Take care of yourself. The healthier you are heading into a pregnancy, the less likely you’ll be to develop an infection that results in cerebral palsy.
Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.
Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.
Asthma is a major noncommunicable disease (NCD), affecting both children and adults.
Inflammation and narrowing of the small airways in the lungs cause asthma symptoms, which can be any combination of cough, wheeze, shortness of breath and chest tightness.
Asthma affected an estimated 262 million people in 2019 and caused 461000 deaths.
Asthma is the most common chronic disease among children.
Inhaled medication can control asthma symptoms and allow people with asthma to lead a normal, active life.
Avoiding asthma triggers can also help to reduce asthma symptoms.
Most asthma-related deaths occur in low- and lower-middle income countries, where under-diagnosis and under-treatment is a challenge.
What is asthma?
Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms: cough, wheeze, shortness of breath and chest tightness. These symptoms are intermittent and are often worse at night or during exercise. Other common “triggers” can make asthma symptoms worse. Triggers vary from person to person, but can include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps, and perfume.
The impact of asthma on daily life
Asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries.
People with under-treated asthma can suffer sleep disturbance, tiredness during the day, and poor concentration. Asthma sufferers and their families may miss school and work, with financial impact on the family and wider community. If symptoms are severe, people with asthma may need to receive emergency health care and they may be admitted to hospital for treatment and monitoring. In the most severe cases, asthma can lead to death.
Causes of asthma
Many different factors have been linked to an increased risk of developing asthma, although it is often difficult to find a single, direct cause.
Asthma is more likely if other family members also have asthma – particularly a close relative, such as a parent or sibling.
Asthma is more likely in people who have other allergic conditions, such as eczema and rhinitis (hay fever).
Urbanisation is associated with increased asthma prevalence, probably due to multiple lifestyle factors.
Events in early life affect the developing lungs and can increase the risk of asthma. These include low-birth weight, prematurity, exposure to tobacco smoke and other sources of air pollution, as well as viral respiratory infections.
Exposure to a range of environmental allergens and irritants are also thought to increase the risk of asthma, including indoor and outdoor air pollution, house dust mites, moulds, and occupational exposure to chemicals, fumes, or dust.
Children and adults who are overweight or obese are at a greater risk of asthma.
Reducing the burden of asthma
Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life.
There are two main types of inhaler:
bronchodilators (such as salbutamol), that open the air passages and relieve symptoms; and
steroids (such as beclometasone), that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death.
People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.
It can be difficult to coordinate breathing using an inhaler – especially for children and during emergency situations. Using a “spacer” device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. A spacer is a plastic container with a mouthpiece or mask at one end, and a hole for the inhaler in the other. A homemade spacer, made from a 500-ml plastic bottle, can be as effective as a commercially-manufactured inhaler.
People with asthma and their families need education to understand more about their asthma, their treatment, triggers to avoid, and how to manage their symptoms at home. It is also important to raise community awareness, to reduce the myths and stigma associated with asthma in some settings.
If the initial data is correct, the Omicron-Variant of Covid is proving to be of Highly Contagious – Low Virulence.
The Omicron variant is less likely to lead to less severe disease in people who have taken vaccines or had Covid-19 in the past, two studies from the UK have said.
Taken together with findings from South Africa – all three studies were released on Wednesday – there is now sound scientific basis to conclude the variant is less virulent than others, especially Delta, which caused a devastating outbreak in India last summer and sparked new waves in other countries.
The findings are the first encouraging scientific evidence linked to the variant of concern (VOC) discovered last month when it started tearing through parts of South Africa at a rate not seen with any other Sars-Cov-2 variant. Scientists soon discovered it was also the most resistant configuration of the coronavirus, leading to higher odds of repeat and vaccine breakthrough infections.
If the Omicron variant was to be as virulent, or more, than Delta, the implications would have been dire, although its high transmissibility and resistance still pose a threat.
“Our analysis shows evidence of a moderate reduction in the risk of hospitalisation associated with the Omicron variant compared with the Delta variant. However, this appears to be offset by the reduced efficacy of vaccines against infection with the Omicron variant. Given the high transmissibility of the Omicron virus, there remains the potential for health services to face increasing demand if Omicron cases continue to grow at the rate that has been seen in recent weeks,” said professor Neil Ferguson of Imperial College London, which released the analysis of Omicron and Delta cases in England.
Two UK studies, similar severity findings
The Imperial College study included all RT-PCR-confirmed Covid-19 cases recorded between December 1-14 in England. It found that Omicron cases have, on average, a 15-20% reduced risk of needing to visit a hospital (the lowest level of severity) and an approximately 40-45% reduced risk of a hospitalisation resulting in a stay of one or more nights.
It also found that a past infection offered approximately a 50-70% reduction in hospitalisation risk compared. All of these comparisons were made against risks of hospitalisation seen with the Delta variant.
The researchers estimate that in unvaccinated people being infected for the first time, the risk of hospitalisation may be lowered by 0-30%, suggesting the severity in completely immune-naive people may not be very different from those who had a Delta infection for the first time, without any vaccine.
The other UK study was from Scotland. Although based on a small number of hospitalisations, the study made similar findings: those with Omicron infections were 68% less likely to need hospitalisation compared to people infected with the Delta variant.
Both reports, as well as the South African study, are yet to be peer-reviewed.
The Imperial College researchers also said in their study that Omicron infections in people with vaccination may be even less likely to require ICU admission or lead to death when compared to Delta variant, “given that remaining immune protection against more severe outcomes of infection are expected to be much higher than those against milder endpoints”.
Need for vaccines, boosters
The detailed findings corroborate lab studies that show people with booster doses have a more adequate immune response to counter the Omicron variant. In their real-world analysis, the Scotland report found a 57% reduction in the risk of symptomatic infection in people who were infected with the VOC compared to those who just had two doses at least 25 weeks prior.
The detailed Imperial College findings made similar findings. For instance, people with two doses of the AstraZeneca vaccine (used in India as the Covishield vaccine), had a higher risk ratio of 0.37 than those with three doses of the same vaccine (0.21). These risk ratios mean two doses reduced the risk of hospitalisation by 63% while three doses cut it by 79%.
Crucially, the report added, people who took the AstraZeneca vaccine had a lower risk in needing to visit a hospital if infected by the Omicron variant when compared to the equivalent risk in the case of a Delta variant infection. In the case of Pfizer-BioNTech or Moderna vaccines, the likelihood of requiring a hospital visit – defined as the lowest level of severity – were similar between Omicron and Delta infections.
The report also stressed on the need to vaccinate the unvaccinated, especially those who did not have a past infection. “The proportion of unvaccinated individuals infected is likely to be substantially higher. In that context, our finding that a previous infection reduces the risk of any hospitalisation by approximately 50% and the risk of a hospital stay of 1+ days by 61% (before adjustments for under ascertainment of reinfections) is significant,” the report said.
With reports of new cases surfacing, the overall number of Omicron cases in India has now reached 33. According to experts, the spread of the new variant is less concerning than that of Delta as the symptoms are mild. While this is partly because of the nature of this new variant, another reason might be the high rate of seropositivity of Indians, experts have said.
“India has the advantage of a very high rate of ‘seropositivity’ of 70, 80 per cent, and in big cities more than 90 per cent people already have antibodies,” Rakesh Mishra, former Director of CSIR-Centre for Cellular and Molecular Biology (CCMB) here, told PTI. Even if people get infected by Omicron, it will be very mild and mostly asymptomatic, Mishra said.
A fresh wave of the pandemic may come even without Omicron, Mishra said referring to the fresh waves in Europe. Ruling out the possibility of a surge in hospitalisation, he said wearing the mask, maintaining social distancing and getting vaccinated remain the three major weapons against future waves.
All Omicron cases in India are mild and there has been no report of Omicron death in India and in any country of the world. The common symptoms are weakness, sore throat etc. Many Omicron patients of India have already recovered and tested negative for Covid.
Capital Delhi reported a new Omicron case on Saturday as a Zimbabwe-returnee tested positive. Reports said the patient only complained of weakness.
The old adage “All that glitters is not Gold” is particularly relevant in current era of media domination where media projection shapes the perception and may defy the reality. Media has dominated our lives and can sway the opinion formation of masses. Written media, television, social media can collectively influence the mass opinion.
Society, in general, needs to be wise enough to realize the importance of getting rid of these blinders in real life . One such factor that causes an illusional mist in the thoughts of masses is projection in films. They create a mirage of illusional glitter wherein there is blurring of real life from the reel life of heroes. The larger-than-life unreal persona of the celebrities on screen looks too charming and sometimes becomes undeniable and dominates mind of masses. The super-human characters played out in films appear to be real. The problem arises when the imaginary characters of the reel life stories are emulated in real life. Individuals as projected character fill in peoples’ imagination and are perceived as real and becomes ingrained in mind. The naivety of masses to perceive the projected character as real one goes beyond a reasonable thought process and imagination.
These roles played in films are not really act of inspiration in real life as the actual purpose accomplished in the end of a movie is entertainment of society and business for themselves. A recent candid admission by the actor Mr Irrfan Khan that film stars should not be role models was impressive (Hindustan times) .
At the best, a particular projected character (and not individual acting star) may be a role model. An actor or super star, is simply doing his work of “acting” in the end. This work of acting may bring an entertainment of few hours at the most.
One cannot stray away from the wisdom to choose between what we consume merely for our entertainment and what we believe or face in real life. One needs to differentiate between rationale truth behind the celebrity gimmicks in the media and exaggerated sensationalism. Sensation created merely for a commercial successful venture should not be allowed to overpower the judgments of real life.
But the problem starts, when these false perceptions created merely by a projected glimmer takes the shimmer away from the real worthy. The real professionals and people who are worthy of glory become invisible behind the glittery mist, a haze, which is unreal and unhelpful in real life.
A soldier contributes to our society much more in real terms. Even a junior doctor saves many lives in a day in emergencies as compared to work of a superstar in films. A teacher, nurse or scientist have contribution which is more fruitful to our generation. Also the scientists, who contribute immensely and bring about the real change in our lives. Their contribution is huge to our society and much more than doing just acting on screen. The reel actor merely imitates the real life lived and actual work done by real heroes like soldier, doctor or teacher. Someone who only acts and behaves like one, is respected and paid thousand times or more than the real one. In reality, people need more than mere entertainment and reel role models and actors in their real lives.
Compare the trivial amount of remuneration, fame and respect the real worker gets as compared to the film stars, who merely imitate their actions. Reel projection for purpose of entertainment is more easier to enact and more profitable than actual performance in real life. It is easier to become a reel hero, as it requires little hard work or just connections to get an opportunity. Some one can be a reel hero just by dynastic factor easily. Hard work is definitely required but that may or may not be prerequisite.
Even good films may raise some social problem, which everyone knows already and offer no practical solution in reality. Therefore what good it brings to the public, beyond entertainment, is any body’s guess. The persona, actors usually project on screen, may actually be far from his or her real personality. In most of cases, what he does in movies and reel life, is actually away from possibility of real life . But strangely in present era, people lose sight of what is mere perception. It is clearly a story, tale, a drama, a myth and is not the real identity of the people, we see on-screen.
In present era, real contributions by people, who are saviours of human life and the real heroes, remain unappreciated. People are so besotted by fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero just imitates a doctor, soldier, dacoit or a street hooligan and just pretends to be one on the screen.
But there are real life heroes that exist around us. Doctors awake at night saving lives every minute or soldier in freezing cold are worthy of more respect and are real heroes. And it is up to the society to look beyond the superficial and reel story, and focus on the real life actors. There has to be an true effort to make, respect and appreciate real heroes.
Point to ponder is that whether society needs people just acting like doctors, soldiers and not the actual and real ones, who saves lives. Does Society need only entertainment, because respect which is paid to someone who is just an actor, is not extended to real doctors, soldiers or other altruistic professions.
A reel hero who acts like a soldier, is famous and richer and than the actual soldier, who dies unnamed and in penury. Children of today’s times will strive to become, who is worshiped and paid respect by society and therefore will prefer to become reel heroes.
A society truly needs the real people, who work and act for them, more than just entertainment. It will need total change in attitude of people to deconstruct the perceptions, which are based on mere projections and are away from reality.
It is time to recreate and worship real heroes, who have become invisible behind the glittery mist.
Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.
The perception of the projection will decide, what does the society actually need- or desire-or deserve , “Reel Heroes or Real Heroes”.
Evolution of Medical profession-Extinction of good doctors 