Every year on July 28, World Hepatitis Day is celebrated to bring attention to the dangerous liver condition known as "hepatitis." It is a liver condition that can be brought on by a number of different bacteria, viruses, or parasites. Hepatitis can be prevented in a variety of ways, but there is currently no treatment for the illness. On July 28, people around the world observe World Hepatitis Day to raise awareness of the disease's risks and encourage the actions against it. Additionally, the day strives to better manage, detect, and prevent the viral hepatitis and other related disorders. It also serves as a reminder of how crucial it is to raise the rate of hepatitis B vaccinations and also promotes the creation of an international action plan against hepatitis.

The day is marked in honor of the Nobel winning scientist Dr. Samuel Blumberg’s birthday who had discovered Hepatitis B, invented a test as well as the vaccination for the same. The purpose of the day is to raise awareness of the different types of hepatitis (Hepatitis A, B, C, D and E) and how they are spread.

Causes- Hepatitis is an inflammatory disorder of the liver and can have other probable origins besides viral infections. Viral Hepatitis is mainly classified into the following 5 main types:

1. Hepatitis A: It is caused by hepatitis A. (HAV). Hepatitis of this kind is an acute, transient illness. This hepatitis is caused due to contaminated food and water.

2. Hepatitis B: This is a chronic and ongoing hepatitis caused by the Hepatitis B Virus (HBV). It is blood borne caused due to blood transfusion with the infected persons, syringes etc.

3. Hepatitis C: It is caused by the Hepatitis C Virus (HCV) which results in significant liver damage by inflaming the liver caused by the contaminated blood.

4. Hepatitis D: This is an uncommon type of hepatitis that only develops when hepatitis B infection is present. Inflammation of the liver is caused by the hepatitis D virus (HDV) which is contagious only in the presence of hepatitis B infection. Around the world, HDV affects around 5% of the people those with chronic hepatitis B.

5. Hepatitis E: Waterborne hepatitis E is caused by exposure to the hepatitis E virus (HEV). It is often brought on by contaminated water supply and is primarily seen in unhygienic places. This hepatitis is usually acute but at times it can become fatal for the pregnant women.

Sometimes, hepatitis can also be caused by the alcohol consumption, medications or due to toxins. Autoimmune disorders can also sometimes cause damage to the liver and leads to hepatitis due to inflammation.

Symptoms-

1. Flu like symptoms like fever, cough, headache, fatigue and body ache.
2. Pale stool and dark colored urine.
3. Signs of jaundice- yellow skin and eyes.
4. Unexplained weight loss.
5. Abdominal cramps, vomiting, severe diarrhea and loss of appetite.

Diagnosis and Treatment-

1. Physical examination by the doctor to assess the signs of jaundice.
2. Pathological examinations like blood tests, urine culture, stool tests, Liver Function Tests etc.
3. Abdominal Ultrasound- With the aid of ultrasound waves, the organs inside the belly can be visualized and the use of this test can give a close-up view of the liver and the surrounding organs. It may also reveal the liver enlargement or damage, any tumor growth, abnormalities in the gall bladder and any fluid accumulation in the abdomen.
4. FibroScan- this is a more advanced and specialized ultrasound which is done instead of liver biopsy and tells the total amount of fat accumulation in the liver and finds out the scarred liver tissues.
5. Liver biopsy- It is a process where a sample of liver tissue is removed through the skin with a needle under the direction of an ultrasound scan. This test is used to assess the impact that inflammation or infection have had on the liver.
6. Periodic blood tests to identify the pathogens in order to start the medications.

Prevention and Control-

1. Always administer sterile injections in order to prevent the contact with the infected blood.
2. Own the razors and blades you use.
3. Practice safe sex.
4. Use only secure piercing and tattooing tools.
5. Immunize children against Hepatitis B.
6. Maintain proper hand hygiene.
7. Ensure the food is properly cooked before consumption.

Hand hygiene includes nail hygiene which is a representation of our personal hygiene. Our fingers and toes' ends are protected from injury by our nails which also make it easier to pick things up. It is very vital to take proper care of our nails and keep them clean. Since we in India eat with our bare hands, maintaining good nail hygiene is very essential; otherwise, hand hygiene is insufficient. If not taken proper care, nails can develop into a haven for bacteria and other germs. This might lead to major health problems like bacterial and viral infections. Regular hand washing is considered to lower the incidence of diarrhea by up to 40%, respiratory issues due to viral infections by up to 21% and gastrointestinal diseases in children by up to 57%.

Good nail hygiene is not that tough to maintain. The health of our nails can be maintained with a little knowledge and maintenance. As part of good hand hygiene, it's important to carefully clean and trim our fingernails which can harbor bacteria and contribute to the development of some infections like pinworms etc. As longer fingernails harbor more dirt and bacteria than shorter ones due to their length and also promotes the spread of illness. Thus, keeping our fingernails short and washing periodically with soap and water on the undersides is a good practice to maintain the nail hygiene.

          Below are the Do’s and Don’ts for maintaining proper Nail Hygiene-

1. Chewing on your fingernails can harm the nail bed because even small cuts might harbor germs and infections. Additionally, when we bite, bacteria enter our mouths immediately. So refrain from eating your nails.
2.  Although sharing nail clippers is acceptable but people shouldn't. Nail clippers should never be shared since nails are a breeding ground for numerous germs, bacteria, and viruses. After trimming the nails, always wash the hands with soap and water.
3. Maintaining clean, dry fingernails will stop the bacterial and fungal diseases from developing under the nails. Rubber gloves with a cotton lining can be used while applying strong chemicals, dishwashing, or cleaning.
4. Pick the nail care supplies carefully to maintain proper nail hygiene.
5. Keep hands and nails hydrated to prevent the cuticles from growing out too much. After washing the hands for at least 20 seconds, moisturize the hands.
6. Never attempt to remove the hangnails. Instead, gently cut them off and avoid using nail-harming products. Always choose the products without acetone.
7. Lack of hand and nail sanitation can result in a number of health problems, increase the frequency of doctor visits and in some cases can also lead to hospitalization.

In order to keep the facility, patients, visitors, and staff safe, hand washing is the best line of defense against the transmission of disease. As the Healthcare Professionals (HCPs) move through and interact in so many various crucial places around the facility, healthcare staff bears the majority of the duty for maintaining good hand hygiene. Healthcare professionals must execute hand hygiene procedures often during the course of the day for a variety of reasons. It's challenging to remember all the exact situations in which a hand wash is required. The World Health Organization has developed the 5 Moments for Hand Hygiene strategy especially for the Health Care Professionals (HCPs) to reduce the possibility of microbial transmission between a healthcare provider, a patient and the environment.

          Below are the 5 Moments of Hand Hygiene which we often come across-

1. Before touching a patient:

Hand hygiene is required as soon as a healthcare professional enters a patient's room to avoid any infections that might have been transferred from any previous activities. They might come into contact with objects the patient later touches, even if they don't need to touch the patient, still there are chances of infection transmission.

• Before aseptic procedures:

Testing, taking blood, giving someone an IV, getting ready for surgery, etc. all call for an additional hand hygiene event before the task is carried out. Having a top-notch hand hygiene event is essential because patients are currently more vulnerable to hazardous germs.

• After bodily fluid exposure/risk:

Healthcare professionals frequently come into touch with bodily fluids from patients, such as blood, saliva, urine, and feces. After this kind of contact, hand washing is necessary to safeguard both the patient and the staff.

• After touching a patient:

After interacting with a patient, the healthcare provider must conduct a hand hygiene procedure. A pathogen that could endanger staff members, guests and other patients might get transmitted to the patient who is receiving treatment and care.

• After touching patient surroundings:

There is a chance of cross-contamination even if the healthcare worker does not physically interact with the patient for any length of time. To protect the health and safety of the rest of the facility, healthcare professionals must always remember to wash their hands after coming into touch with the patients.

Over the past few years, there has been a lot of talk about the importance of often washing our hands as a way to safeguard our health, our well-being, and those around us. This is because hand washing is essential for preventing the spread of viruses and managing bacteria, both of which are crucial in the current climate. It may seem straightforward to wash your hands or put on gloves, but it's important to do so properly. Some hand hygiene routines may potentially lead to an increase in risk as opposed to keeping us safe. Even while everyone understands the value of good hand hygiene, how often do we know how to do it properly? Here, we will disseminate the several widespread misconceptions and myths about hand hygiene and give you the actual information.

          Below are the 7 myths of Hand Hygiene that we often come across-

1. It is more efficient to wash our hands with hot water:

FACT: Bacteria and viruses must be killed with soap in addition to hot water to be eradicated. Additionally, there is no evidence to support the idea that washing our hands at higher temperatures produces better results. Soap-based hand washing in warm water is enough to keep us safe. The ideal water temperature for washing your hands is between 35 °C and 45 °C. As a general rule, the water should feel about as hot as that used for a bath.

• The most hygienic way to dry our hands is with a hand drier:

FACT: Hand air dryers may be widely used in bathrooms and restrooms around the globe but they can increase the number of bacteria on our hands after we wash them. The interior of hand dryers is a damp environment making it the ideal place for bacteria to flourish. The air that is then emitted from the dryer to dry our hands may contain bacteria. Hand towels can also store bacteria and thus using a hand towel to dry our hands after washing, transfers the bacteria onto our hands. Using disposable paper towels to dry our hands is the safest option since they help stop the dangerous bacteria and viruses from returning to back to our hands.

• After washing our hands, we don't need to dry them:

FACT: The idea that we don't truly need to dry our hands after washing them is another myth regarding hand drying. This is incorrect because research has shown that wet hands are more conducive to the spread of germs than dry hands. As a result, we should always dry our hands preferably with a disposable paper towel.

• Instead of washing our hands, use alcohol hand sanitizers:

FACT: Use an alcohol-based gel or sanitizer with at least 60% alcohol if you are unable to wash your hands or if there are no facilities available. This will just kill the hazardous bacteria but sanitizers are less effective on greasy hands, which is why you shouldn't use them. Hand washing with soap is still the most effective way. The alcohol in the sanitizer can dry up the skin and bacteria can become lodged in the crevices and cracks on our hands.

• We should only use antibacterial soap to wash our hands:

FACT: The question of whether antibacterial soap is better than ordinary soap at killing bacteria and viruses has been the subject of numerous investigations. According to research, antibacterial soaps only slightly outperform conventional soaps in terms of effectiveness. The most crucial action we take when washing our hands is to remove the layers of fat that are there. By dissolving the fat, we aid in the removal of the bacteria that may be present there. This fat may also include viruses. Regular and antibacterial soaps both dissolve the fat, making them both efficient.

• It doesn't matter how long we wash your hands as long as soap is utilized:

FACT: It's quite crucial how long we wash our hands. It is advised to wash our hands for 20 seconds or about as long as it takes to sing "Happy Birthday" twice. This is because any harmful germs or viruses that may be on our hands can be efficiently eliminated in 20 seconds. Additionally, it means we have plenty of time to fully wash our hands.

• Only after using the restroom or before making meals do we need to wash our hands:

FACT: The removal of bacteria, viruses, and debris from the hands is crucial for preventing their spread to other individuals and items. We must keep in mind that we might catch germs from whatever we contact, making frequent hand washing and doing so after specific activities is very crucial.

As per a survey, only 5% of people properly wash their hands on a daily basis. Therefore we have decided to launch an awareness campaign from 25th June- 31st June to educate and encourage people about the benefits of hand washing.

First let us start by debunking the 7 Myths about Hand Washing.

1. I am using soap to wash hands. That means I am safe

FACT: Using soap alone is not sufficient to provide full protection during hand wash. First of all the duration for which hand is being washed. Research has shown that, hands should be washed for at least 30 seconds following the proper steps (refer to 7 Steps of Hand Hygiene).

Secondly, the soap itself matters. Some studies have shown that germs and infections may spread from soaps used by multiple people. Although chances and propensity may be low, still you should be aware of it.  

• I am using a Hand Sanitizer. So I don’t need to wash my hands

FACT: Hand Sanitizer can never replace conventional handwashing with soap and water. The simple reason is that when we are using Hand Sanitizers, only the surface germs are being killed. But the dirt and grime on our hands are removed. This can cause problems if you ingest that when consuming food

• All Hand Sanitizers are the same

FACT: The simple answer is NO. Whenever you are buying Hand Sanitizer, check the alcohol percentage. 60% is the bare minimum and the percentage moves upto 90%. Any hand sanitizer which contains less than 60% alcohol content will not be effective

• After washing my hands, I should dry it with a towel or napkin

FACT: Most of us make this simple yet biggest mistake. We may follow all steps and properly wash our hands. But after that, we often dry it using a previously used towel or napkin. Therefore all the germs from the towel or napkin gets transferred back to our hands.

• Using hot water is better as it kills germs better

FACT: Lot of research has been conducted on whether using warm or hot water improves killing of germs on the hands. But the data is inconclusive. It can therefore be said that, there is no additional benefits of using hot water. Instead, persistently using hot water to wash can cause dryness to the hands

• Hand Dryers are a better option to dry hands

FACT: Researchers found that paper towels are superior to air dryers and can help remove bacteria, unlike air dryers which can increase bacteria counts. Because air dryers have been shown to spread bacteria between three and six feet from the device, paper towels are also far less likely to contaminate other restroom users.

• After touching something, I should wash my hands

FACT: It is not always necessary to wash our hands after touching something. Only thing we should try to avoid is unnecessary contacts of our hands to our face, especially, eyes, nose and lips. However, before eating something, we should definitely wash our hands, especially if we are using our hands. Unnecessary frequent hand washing can dry our skin and also remove the helpful commensal bacteria that thrives in our skin.

7 Steps of Hand Hygiene (as per WHO)

1. Wet Hands:

 Hands should be wet with soap or liquid soap applied for a good lather. The ideal temperature of the water should be between 35 ° to 45 ° C.

• Rub the Palms Together:

Hands should be rubbed palm to palm.

• Rub the back of Hands:

Rub the back of the left hand with the right palm, swap the hands and repeat for few times.

• Interlink the fingers:

Bring the hands facing each other and join the fingers together into clasped hands. Next, rub the palms and fingers together.

• Cup the fingers:

Interlock the fingers and rub the backs of them against the palms.

• Clean the Palms:

Enclose the right hand around the left thumb and rub along with the rotation. Swap the hands and repeat it.

• Rub the Palms with the Fingers:

Rub the right fingers in a circular motion in the left palm. Repeat the same with the left fingers.  

Few Tips for a Healthy Hand Hygiene

Nail Hygiene

• Keep nails short and trim them often.
• Scrub the underside of nails with soap and water (or a nail brush) every time you wash your hands.
• Clean any nail grooming tools before use.
• In commercial settings such as nail salons, sterilize nail grooming tools before use.
• Avoid biting or chewing nails.
• Avoid cutting cuticles, as they act as barriers to prevent infection.
• Never rip or bite a hangnail. Instead, clip it with a clean, sanitized nail trimmer.

Role of Ring Wearing with Hand Hygiene

A number of studies have shown that ring wearing increases the likelihood of bacterial contamination; in particular these studies have demonstrated that the skin under rings can be more heavily colonized than areas of skin without rings and can be a major contributor to hand contamination.

A quick and simple technique to stop infections is by washing our hands. Cleaning our hands can stop the transmission of germs particularly those that are hard, if not impossible, to treat and are resistant to antibiotics. Healthcare professionals don't wash their hands nearly as often as they should.

          The WHO Guidelines on Hand Hygiene in Health Care offer healthcare professionals (HCWs), hospital administrators, and health authorities a thorough analysis of the research on hand hygiene in healthcare, as well as specific recommendations to improve procedures and lessen the spread of pathogenic microorganisms to patients and HCWs. The current Guidelines are meant to be used in any circumstance when healthcare is provided to a patient or to a particular population group.

          Below are the 7 steps of Hand Hygiene as recommended by the WHO -

1. Wet Hands:

 Hands should be wet with soap or liquid soap applied for a good lather. The ideal temperature of the water should be between 35 ° to 45 ° C.

• Rub the Palms Together:

Hands should be rubbed palm to palm.

• Rub the back of Hands:

Rub the back of the left hand with the right palm, swap the hands and repeat for few times.

• Interlink the fingers:

Bring the hands facing each other and join the fingers together into clasped hands. Next, rub the palms and fingers together.

• Cup the fingers:

Interlock the fingers and rub the backs of them against the palms.

• Clean the Palms:

Enclose the right hand around the left thumb and rub along with the rotation. Swap the hands and repeat it.

• Rub the Palms with the Fingers:

Rub the right fingers in a circular motion in the left palm. Repeat the same with the left fingers.  

Gallstones, a very prevalent issue has arisen in modern society as a result of lifestyle changes, the intake of junk food, and irregular eating patterns. The development of these stones usually starts in the gall bladder and sometimes these stones start coming upwards towards the common bile duct along with the secretion of bile during the digestion process. Usually, there is no onset of symptoms and these issues are sometimes mistaken for indigestion, which is a transient condition but if the size of the gallstones increases in number and size for an extended period, then this leads to the severity and might worsen the condition of the patient is not detected early.

What are Gall bladder and Gallstones?

The gall bladder is a little, pear-shaped structure situated beneath the liver on the upper right side of the belly. It holds the bile that the liver produces for digestion and releases it into the duodenum through the bile duct. Water, cholesterol, bile salts, and pigments like bilirubin and others make up this bile. The breakdown of lipids in our bodies is aided by bile.

          Gallstones or Cholelithiasis which originate in the gallbladder or bile ducts is solid masses resembling pebbles made of bile precipitates. They range in size from the size of golf balls to small sand grains. Gallstones are usually of two different types:

1.  Cholesterol stones- 80% of the gallstones are of this type and these are usually yellowish-green in color.
2. Pigment stones- these gallstones are usually smaller and darker in color. The color of these gallstones is determined by the excess production of the bile pigment bilirubin produced by the liver.

What are the causes? – There is no exact cause for the occurrence of gallstones, still, some of the causes which lead to the formation of gallstones are listed below:

1. Due to a bad lifestyle such as extreme junk food consumption rich in cholesterol regularly, skipping meals or eating irregularly, severe consumption of alcohol and smoking, etc.
2. Excess production of the bile pigment bilirubin by the liver in cases of cirrhosis, other liver disorders, and blood infections.
3. Self-medication like regular intake of NSAIDs to relieve chronic pain.
4. Bile reflux- It is a reflowing action when the bile bypasses the small intestine and instead rushes back into the stomach. This condition usually leads to ascending the gallstones towards the common bile duct from the gall bladder and finally results in obstructive jaundice due to the blockage at the bile duct.
5. People over the age of 40 years, obese or overweight, and diabetic people are at higher risks for cholelithiasis.

What are the common symptoms observed?-

1. Sudden intense abdominal pain usually at the upper right portion usually right after the consumption of meals.
2. Vomiting
3. Indigestion, gas formation, and heartburn.
4. Pain in the right shoulder, between the shoulder blades, or towards the back.
5. Jaundice-like symptoms like yellowing of the skin and white portion of the eye.
6. Dark-colored red urine and pale stool.
7. Fever and chills
8. Loss of appetite
9. Severe complicated causes include inflammation of the gall bladder (Cholecystitis), Pancreatitis, and inflammation of the bile ducts (Cholangitis).

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such as Blood tests and urine culture.
2. Upper abdomen ultrasonography- it is a non-invasive test to check the location of the gallstones. However, only large-sized gallstones and the stones present in the gall bladder are visible in this diagnostic test. Smaller-sized gallstones like pigment stones and the gallstones present in the bile ducts are undetected, thus it is not an accurate test.
3. An MRI technique called Magnetic Resonance cholangiopancreatography (MRCP) especially visualizes the bile ducts. It produces highly detailed images of our biliary system including the common bile duct and is non-invasive. MRCP provides a clear picture and also rules out the possibility of tumors or cancer. Depending upon the number, size, and location of the gallstones, the doctor finally decides which surgical procedure needs to be performed on the patient for the removal of the gallstones.
4. Endoscopic retrograde cholangiopancreatography (ERCP) is a more advanced and more non-invasive procedure that is effective in locating gallstones if any of them are lodged in the ducts and can also be removed using this technique. It is very useful in the detection of smaller-sized pigment gallstones. It employs a combination of X-rays and endoscopy which entails inserting a small camera into the upper gastrointestinal (GI) system through the mouth.
5. What is ERCP?

ERCP is both diagnostic as well as a therapeutic technique for gallstones which consists of an endoscope inserted through the mouth with an attached camera that passes through the food pipe and reaches the top of the small intestine, then the technician inserts another smaller tube into the first one to reach further down into the bile ducts. They will inject a special dye through the tube and then the video X-rays (fluoroscopy) are taken as the dye travels through the ducts. Through ERCP, a clamp-like tool is inserted through the tube to remove the stones which are present in the duct. The large-sized gallstones are removed by lithotripsy in which the gallstones are first crushed or broken down into smaller pieces and then each piece is taken out through the scope. The 190 series ERCP (Endoscopic Retrograde Cholangiopancreatography) is cutting-edge technology in the earliest identification of biliary tract neoplasm, cholangiocarcinoma, and pancreatic ductal adenocarcinoma.
 

• Endoscopic Ultrasound- this combines both ultrasound and ERCP for the detection of gallstones.

Cholecystectomy- is laparoscopic keyhole surgery for the removal of the gall bladder when the gallstones are accumulated in this sac. It is an ICG Enhanced Fluorescence Guided procedure that requires a small incision, high resolution, minimal blood loss, and a very low risk of infection.

• Medications as prescribed by the medical practitioner.

Prevention and Control-

1. Avoid consumption of oily, fried, and spicy foods.
2. Intake of a healthy diet rich in high- fiber such as fruits, vegetables, and whole grains.
3. Consuming several little meals throughout the day.
4. Reduction of alcohol consumption and caffeine.
5. Management of stress.
6. Maintaining a healthy weight, exercising, etc.

Liver is the second largest organ in the body which produces bile and helps to process the nutrients from food and drinks, further it filters the harmful substances from the food. Liver also helps to resist the infections by removing toxins and bacteria from the blood.

There is a modest amount of fat in a healthy liver. When fat equals 5% to 10% of your liver's weight, it becomes an issue. Steatosis, also known as fatty liver disease, is a common disorder brought about by an accumulation of too much fat in the liver.

Fatty Liver condition isn’t bad until and unless the condition becomes worse and reaches the stage when there is inflammation in the liver (steatohepatitis) along with the extensive damage of liver tissues (cirrhosis). The liver's function starts slowing down by the tough scar tissue that has replaced the healthy liver tissue and eventually the functioning of the liver completely stops. Severe cirrhosis can lead to Liver failure and Liver cancer.

Stages of Fatty Liver-

1. Normal Fatty Liver- excess fat accumulation in the liver due to higher levels of cholesterol. This condition is also known as Simple Fatty Liver.
2. Steatohepatitis- this occurs when along with the fat accumulation in the liver leads to inflammation. This condition is a bit severe than the previous one.
3. Fibrosis- Along with the inflammation, slowly scarring and damage of the liver tissues occur. In this condition, the liver still functions normally.
4. Cirrhosis- This is the most severe and irreversible condition where the scarring of liver tissues starts affecting the liver functions.

What are the causes? –

1. Due to bad lifestyle such as extreme junk food consumption rich in cholesterol at regular basis, skipping meals or eating irregularly, severe consumption of alcohols and smoking etc.
2. Overweight and obesity
3. Due to physical and mental stress
4. Self- medication like regular intake of NSAIDs to relieve the chronic pain
5. Bile reflux- It is a reflowing action when the bile bypasses the small intestine and instead rushes back into the stomach.

What are the common symptoms observed?-

1. Abdominal pain especially in the upper right side of the abdomen.
2. Nausea
3. Edema- Swollen abdomen and legs.
4. Bloating
5. Loss of appetite.
6. Jaundice- Yellowish skin and white portion of the eyes.
7. Unexplained weight loss
8. Fatigue

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such Blood tests and urine culture.
2. Upper Gastrointestinal tract endoscopy- An endoscope is a lengthy, thin tube with a camera attached inserted from the mouth and passes through the food pipe and gives the images till the upper part of the small intestine.
3. Upper abdomen ultrasonography or CT Scan to check the possibility of epigastric hernia or suspicion of any abnormality in the digestive tract.
4. Liver biopsy- this is done by collection of the liver tissue samples to check the progression of the disease.
5. FibroScan- this is a more advanced and specialized ultrasound which is done instead of liver biopsy and tells the total amount of fat accumulation in the liver and finds out the scarred liver tissues.
6. Medications as prescribed by the medical practitioner.

What is FibroScan?

Transient elastography, another name for fibroscan, gauges the velocity of ultrasound waves as they pass through the liver. The normal liver tissue and the areas of fibrosis are both viewed by the ultrasound waves' varying velocity. FibroScan results are available right away after the scan. It is a non- invasive test and used to determine the degree of fibrosis in the liver. This is even done to assess the health of the liver.

Prevention and Control-

1. Avoid consumption of oily, fried and spicy foods.
2. Consuming a number of little meals throughout the day.
3. Reduction of alcohol consumption and caffeine.
4. Management of stress.
5. Avoid resting down for two to three hours immediately after a meal.

Adults frequently complain of joint pain, which is typically brought on by regular wear and tear from daily activities including walking, bending, standing, and lifting. Running and sports involving jumping or fast pivots increase the risk of knee pain and other related issues in athletes. But whether joint pain is brought on by ageing or an injury, it can be bothersome and even crippling in some cases.

Common joint pain typically manifests in the hands, foot, hips, knees, or spine. Pain may be ongoing or intermittent. Joint pain can sometimes be described as discomfort, inflammation, soreness, stiffness, or pain. Joint discomfort can be acute (lasting only a few days) or chronic (lasting more than three months). The joint may occasionally feel stiff, achy, or sore. A searing, throbbing, or "grating" feeling is reported by some patients and furthermore the joint could be stiff in the morning but get looser and feel better with activity.

What are the causes of orthopedic joint pain? –

1. Sprained or strained knee ligaments or muscles- Those who have had any joint injuries or repeated overuse of the muscles.
2. Another cause of stiffness and painful joints is age. This results in the strain and wear and tear of the joints.
3. Osteoarthritis- a prevalent type of arthritis which develops over time when the cartilage (the protective cushion in between the bones) wears away and the joints start to hurt and stiffen. It is a degenerative disease that progressively worsens with age and is irreversible.
4. Torn cartilage which occur with sprains.
5. Joint dislocation due to injury or accident.
6. Rheumatoid arthritis- A persistent condition that injures the joints and causes swelling. This results in the deformation of joints (usually occurring in the fingers and wrists).
7. Gout- Crystals from the body build up in the joint which results in excruciating pain and swelling. Usually, the big toe experiences this.
8. Due to physical and mental stress

What are the common symptoms observed?-

1. Intense pain
2. Swelling of joint, redness and fever
3. Difficulty in walking
4. Joint inflammation and cartilage decay due to arthritis
5. Reduced mobility and joint stiffness
6. Numbness
7. Noisy joints like clicking, grinding or crackling sound during movement.
8. Visible deformity of the affected joint

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such as Blood tests, hormone tests, tests to detect the function of adrenal glands and Urine culture.
2. X-rays, CT scan or MRI scan.
3. Arthroscopy- A minimally-invasive diagnostic and treatment procedure used for joint conditions. An arthroscope—a tiny, illuminated optic tube introduced through a tiny incision in the joint. Images of the inside of the joint are projected onto a screen in order to analyze any arthritic or degenerative changes in the joint, to find tumors, to identify the source of bone pain and inflammation. This procedure is also used for ACL (anterior cruciate ligament) surgery.
4. Replacement surgeries like Total Knee Replacement, Total Hip Replacement, Spinal surgeries to relieve the unbearable pain and also adds new shelf life to the joints. This is usually suggested for severe osteoarthritic patients.
5. Physiotherapy as suggested by the physician for post-operative patients and also suggested exercises for restoring movement to the numb joint.
6. Medications as prescribed by the medical practitioner.

What is Total Knee/ Hip Replacement surgery?-

It could be challenging to walk or climb stairs if the knee or hip joint has been seriously affected by arthritis or another accident. So, even while sitting or lying down, one could start to experience pain. Replacement surgery is recommended for the patients with bowed knee deformity. The average surgical procedure lasts between 1-2 hours and requires very less hospital stay for about three days. After three to six weeks of rest, the patient can resume back to his daily routine. To correct the alignment and function of knee/hip joint, the orthopedic surgeon will remove the damaged bone and cartilage and then places the new metal implants which are made up of titanium dioxide highly polished with cobalt chromium. These implants mimic the exact the knee/ hip joint and offers the same movement as that of a natural joint. These replacement surgeries do not have any age or weight restrictions and can be performed at any stage of the life. Having a knee/hip replacement surgery improves mobility, reduces pain, and improves the quality of life. Additionally, the majority of these replacements provide a shelf life longer than 15 years.

Prevention and Control-

1. Activity modification such as weight loss.
2. Walking aids such as walking sticks, safety bars, or handrails across the staircases for those with disrupted movement.
3. Viscosupplementation injections and nerve ablation for immediate pain relief. Viscosupplementation involves injecting a gel-like fluid called hyaluronic acid which provides lubrication and may provide immediate pain relief. But this procedure has not been found to be effective and often causes side effects like redness, and swelling in the injected part and may develop a local allergy-type reaction.
4. Avoid using low-floor toilets and the use of western commodes is recommended.
5. Physiotherapy exercises for restoring the movements and strengthening the joint post-operation.
6. Management of stress.

Nowadays with the change in lifestyle, consumption of junk food, eating irregularly has led to a very common problem among us – gastric problems such as stomach pain, loss of appetite, bloating, and nausea. These gastric problems arise due to inflammation in the mucosal lining of the stomach, any bacterial infections such as Helicobacter pylori etc. Sometimes these problems are often confused with indigestion which is temporary but prolonged infection in the gastrointestinal tract can lead to severity of the diseases if not detected at the earliest.

What are the causes? –

1. Bacterial infection- which causes the destruction of the stomach cells and leads to peptic ulcers.
2. Due to bad lifestyle such as extreme junk food consumption at regular basis, skipping meals or eating irregularly, severe consumption of alcohols and smoking etc.
3. Due to physical and mental stress
4. Self- medication like regular intake of NSAIDs to relieve the chronic pain
5. Bile reflux- It is a reflowing action when the bile bypasses the small intestine and instead rushes back into the stomach.

What are the common symptoms observed?-

1. Abdominal pain
2. Vomiting
3. Bloating
4. Loss of appetite.
5. Unexplained weight loss
6. Blood in the stool
7. Stomach ulcers

What are the Diagnostic tests and Treatments available?-

1. Pathological examinations such Blood tests and Stool tests for the detection of the pathogen.
2. Upper Gastrointestinal tract endoscopy- An endoscope is a lengthy, thin tube with a camera attached inserted from the mouth and passes through the food pipe and gives the images till the upper part of the small intestine.
3. Upper abdomen ultrasonography to check the possibility of epigastric hernia or suspicion of any abnormality in the digestive tract.
4. Medications as prescribed by the medical practitioner.

Prevention and Control-

1. Avoid consumption of oily, fried and spicy foods.
2. Consuming a number of little meals throughout the day.
3. Reduction of alcohol consumption and caffeine.
4. Management of stress.
5. Avoid resting down for two to three hours immediately after a meal.