A new study has found that cardiopulmonary exercise testing (CPET) can be used for the early detection of respiratory disorders in overweight and obese individuals.

This is the main finding of a study by Brazilian researchers who set out to assess the influence of obesity on the physiological responses obtained in CPET. The findings of the study were published in the journal ‘PLOS ONE’. Most of the authors are researchers in the Department of Human Movement Sciences at the Federal University of Sao Paulo (UNIFESP) in Santos. The study was supported by FAPESP. Three physicians affiliated with the Angiocorpore Institute of Cardiovascular Medicine in Santos also participated.

CPET combines a conventional ergometric test with analysis of expelled air to obtain measurements of pulmonary oxygen uptake (VO2), carbon dioxide production (VCO2), respiratory rate, and pulmonary ventilation. It determines the level of aerobic conditioning and is indicated for an initial assessment in physical exercise programs, both in clinical practice and for amateur or high-performance athletes.

The study showed that the main ventilatory responses were unaltered in obese volunteers. For example, the ratio of minute ventilation (VE, the volume of air exhaled in one minute) to VCO2, averaged 25.4 for the obese group and 25.6 for the non-obese control group. The ratio corresponds to the quantity of ventilation used to eliminate a given amount of carbon dioxide during the test and is considered an indicator of respiratory efficiency.

The finding that obesity did not influence this variable means abnormal values can be useful for early detection of respiratory disorders and can point to potential problems before symptoms appear, regardless of obesity.

However, as expected, obesity impaired performance in almost all of the many maximal and submaximal variables analyzed in the study. The most influenced were the cardiovascular, metabolic, and gas exchange variables.

“CPET is insufficiently used for obese patients. It can bring to light several potential issues and has substantial diagnostic and pre-diagnostic potential, which isn’t adequately explored. Our study shows that if ventilatory efficiency is altered, the reason is highly likely to be an incipient respiratory disorder, rather than a consequence of obesity,” said Victor Zuniga Dourado, head of UNIFESP’s Epidemiology and Human Movement Laboratory (EPIMOV) and principal investigator for the study.

The test does not diagnose a specific disorder or disease, Dourado explained but can be used for early detection of exercise intolerance and to help identify its causes, so that the patient can be referred to a specialist for a more precise diagnosis.

As Diwali is around the corner the dominant worry in the minds of several people is their health of the lungs. This concern is more particularly prevalent among those who are recently afflicted with asthmatic like conditions and fibrosis of the lungs after two waves of Covid-19. Apart from those who have caught this terrible condition, there are those who have been suffering from asthma, bronchitis, allergic cough and lung cancer. The Festival of Lights has become a dread to all these members of our society.

Diwali the most widely celebrated festival in India is also synonymous with sound, colours, lights and of course, the bursting of firecrackers. But unfortunately, this auspicious festival has for the last half a decade or more has acquired negative overtones with all the pollution that it brings about. It is also the wintertime of the year. You hear of particulate matter like dust, pollen, soot, smoke, and liquid droplets suspended in the air. The atmospheric phenomenon also aggravates the condition of the air we breathe. Further with traffic fumes, crop burning along with the particular day of Diwali the pollution reaches its crescendo with the uninterrupted bursting of firecrackers.

In this way, pollution means an increased number of suspended particles in the air along with various poisonous gases. Further, in winter the speed of wind slows down and fog starts early in the morning. Pollutants mix with the fog which cannot circulate in the atmosphere and remains low in height. This atmospheric condition is also called Smog. Even normal and healthy people feel shocked by this phenomenon and what to say about the state of suffering patients mentioned above!

This is the time when one needs to be alert. If you are having dry hacking coughs, shortness of breath, chest tightness, wheezing, nasal complaints along with sneezing, you need to watch out. These are some of the most common complaints of patients during this time. It is to be noted that Smog affects not only your lungs but a human being as a whole which means your other organs can also take a beating. It becomes a chain reaction that will worsen the list of diseased symptoms.

With this blanket of Smog, certain groups of people are particularly vulnerable such as:

Children: Children spend a lot of time playing outdoors and this is the reason why they run a high risk of getting affected by smog. Regular exposure to air smog can cause conditions like asthma and even other harmful respiratory ailments.

People who take to everyday outdoor activities: Anyone who works outdoor is susceptible to respiratory problems. Regular exposure can affect their health causing several lung-related ailments.

People with Asthma and Respiratory disease: People with asthma or chronic respiratory diseases are most vulnerable and run a high risk of health hazards caused by smog. They will experience the adverse effects of air pollution much more quickly compared to others. Continuous exposure to smog can aggravate their existing problems.

Elderly People: Several senior citizens have a weak immune system. Owing to this condition, elderly people are at increased risk of getting affected by smog, which can cause cardiac arrhythmias and heart attacks, asthma bouts and many more.

Cases of Those having fibrosis of the lungs: Recently diagnosed cases of fibrosis are amongst the most vulnerable population. The adverse impact of the Covid virus is still under serious evaluation. Suffice it to say that it is a lung-related condition and therefore possible of several problems with the patient as a whole too.

Five ways you to manage healthy lungs:

1. Know the dynamics of indoors: While air/wind outdoors makes an entry indoors which perhaps can not be avoided, our actions (what we do indoors) can change the quality of indoor air. We need therefore to manage our indoor air. Do not burn agarbatti, dhoopbatti while performing pooja but instead light the lamp. Make your kitchen airy with chimney and exhaust fans to air out all the cooking fumes. Please install room air purifiers especially in those houses that are having vulnerable people having lungs disease. Make your home strictly No Smoking Zone. Please keep indoor plants as well as keep them around your home too. Do not use mosquito repellants and creams and sprays rather use mosquito nets on windows doors and on beds too. While there are cost implications, there are also practical and easier ways to manage this through systematic planning and economising. After all, health is wealth.

2. Check your Green Zone: The community societies and colonies full of big trees are better protected than those that have no trees. Have an audit of trees around your area and make it the natural capital of your society or colony. We were safe because this capital was in abundance and never realised its value. It is now time to count, save and enhance the tree capital of your area. Please join hands and come together in which our senior citizens and children participate along with active members of each household. Make it Your mission and do it as a community service.

3. Monitor your locality: Creating awareness through constant monitoring and sensitising people about pollution will go a long way. One way could be to install pollution checking devices in your localities. These need to be installed not far away from your locality instead in your close vicinity so that members living around a particular area are aware of its existence and are able to join hands to keep their zones green and greener. Thus Education is better than law and punishment.

4. Monitor cleanliness in your area: Another important pollutant is the litter and garbage around your area. We add to the pollution by throwing garbage around. Put in place strict rules in your area and measures to motivate people to observe cleanliness and save your environment. It will also keep the air clean in your surroundings.

5. Install in your area Air Purifiers: As a community service, we build religious places, recreational centres etc. in our area. It is now time to find the possibilities of having an area serving Air Purifiers. This needs to be planned and thought about seriously by the local leaders by creating awareness among the people to keep the air clean in gatherings in which a large number of people assemble.

This is very essential and important as it will bring about a change in the living standards in cities like Delhi.

These collective and community measures are essential and important and need to be pursued with focus and vigour to keep our area clean, green and pollution-free. Apart from these General measures the system of medicine—Homoeopathy can alleviate and cure a lot of ailments arising out of pollution of the atmosphere brought about by the various causes mentioned above. Homoeopathic treatment is effective and can treat people who become targets of these seasonal illnesses due to weather and air pollution. Another important advantage is that appropriate diagnosis and right remedies prescribed by a homoeopathic doctor will play an important role to relieve your suffering without any side effects such treatment is also cost-effective. Here are some tips:

As soon as you notice the beginning of cold, coryza and cough etc. you can take four pills of Aconite 200 every three hours for two days and these symptoms should go away in most cases. You can save yourself from the need of consuming a number of anti-allergic chemicals that bring their own ill effects.

If you have severe pain in the throat which is stitching in nature and when even swallowing becomes very difficult take four pills of Hepar Sulph 200 every three hours for two days. Your problem should usually disappear without any discomfort.

In case you get affected by smog, you should have two important medicines with you. These are to be administered after ascertaining specific symptoms. These are, Hepar Sulph and Hypericum. Consult your doctor for the right prescription. Self-medication is always unsafe and could be harmful.

While the challenges of winter smog and pollution can be menacing let us face it and maintain our health and particularly our lungs during this season. By remaining alert and educating ourselves collectively and individually we can pass this winter with good health and cheer. Your determination and concern for the vulnerable members of your family like the elderly and children apart from your own health is important during Diwali. When there is a will, there is a way. Save yourself and your family by following some of these guidelines.

The writer is Senior Homeopath, Agrawal Homoeo Clinic.

It’s again that time of the year when people used to wear masks even before corona was a threat. As air pollution levels rise in North India due to farm stubble burning, people are expected to extra care of them especially when you have any existing pulmonary disorder. Since Diwali is around the corner and since we all know, Diwali is one of the most extensively observed festivals in India and is celebrated by Lighting Diya’s and Lamps, making rangolis and eating great food! Around Diwali, there is a Surge in Air pollution levels also leading to an increase in respiratory disease and more hospital visits and admissions. Patients usually visit with complaints of severe respiratory ailments during the Diwali festival and the cases have been increasing for the last five years. These include asthma, RADS, and exacerbations of chronic lung disorders, all associated with breathing in polluted and toxic air.

The problem of pollution is because of the effects of fireworks on Diwali. It is more severe in cities as the growing number of vehicles adds to the problem. Air quality takes a deep fall as the problem gets multiplied. Depending on the size of these particles, they cause a variety of illnesses ranging from mild temporary irritation to serious chronic diseases such as cancer.

Lighting firecrackers at Diwali also cause a serious health hazard which may lead to high production of PM (Particulate matters) which can result in both short and long term side effect such as Coughing wheezing, Shortness of breath, exacerbation of preexisting diseases like Asthma and COPD.

So to protect the lungs during Diwali:

1) Avoid lighting candles and diyas indoor, use LED lights. Don’t open the window and doors to avoid pollutants entering the house.

2) Avoid stepping out of the house, if you have to go then do wear N95, N99, N100 masks as they are highly efficient in filtering out the tiny particulate matters from Air.

3) Eat healthily and consume food loaded with antioxidants and Vitamin C rich food, Vitamin E, Vitamin D, and Omega 3 fatty acids as they may help neutralise the effect of pollutants in the body by reducing the oxidative spree.

4) People with preexisting respiratory conditions must keep their emergency medicines, Nebulisers and other things ready at all times and must take medicines regularly

5) Wear thick cotton cloths as they protect your body from pollutants.

After the Diwali period, we usually witness a surge in the number of people with complaints of irritation in the eyes and throat, dry cough and fever. While last year smog also remained in the atmosphere and many people who normally remain healthy, also experienced irritation in the eyes and chest and a general feeling of suffocation. So be very cautious while celebrating the festival this year as many of our near and dear ones have gone through a lot during this pandemic.

The writer is Pulmonologist, Sri Balaji Action Medical Institute.

In a shocking revelation, the ICMR recently released a report stating that the proportion of all cancer cases has been higher in males (52.4%) than women. The report said that cancers of the head and neck region accounted for nearly one third (31.2%) of the cancers among males. The highest proportion of cancer from all sites was reported in the 45-64 age group, except for prostate cancer, which was higher in those over 65 years.

India, for a long time, has been battling the rising incidence of cancer. Early this year, the National Cancer Registry Programme (NCRP) released its estimate, stating that the number of cancer cases will likely increase from 13.9 lakh in 2020 to 15.7 lakh by 2025, an increase of nearly 20%. National Cancer Awareness Day is observed on 7 November in India highlighting the significance of increased awareness about cancer prevention and early detection for public. Cancers such as oral, lung and colorectal have been affecting more people in the age group of 20-50yrs—a few of the most productive years of life. This increasing rate will cause a substantial financial and economic impact on patient families and the nation. While India sees a higher occurrence of oral and lung cancers among young men, nearly six types of cancers are linked to obesity and are slowly on the rise among people under 50. These are colon or rectal cancer, pancreatic cancer, kidney cancer, gallbladder cancer, uterine cancer, and multiple myeloma. These cancers are often not discovered in younger people until the disease is advanced and harder to treat. A study conducted by the American Cancer Society revealed that people’s risk of cancer typically rises as they age. So, these young people at higher risk due to obesity could face even greater risk as they grow older. To understand the damage that obesity is already causing, consider that one in six cancer deaths in men and one in seven cancer deaths in women are related to the condition!

HOW ARE OBESITY AND CANCER CO-RELATED?

Now, you might wonder how obesity causes cancer. Fat is dynamic, and it doesn’t just sit in one place. It can become dysfunctional, resulting in inflammation, which increases the risk of developing cancer. Many of the cancers linked to obesity are in organs that are embedded in pads of fat. Also, excess fat can influence the whole body causing a systemic effect. For instance, people with dysfunctional fat tissue often have altered levels of hormones such as Insulin and Estrogen. These changes can damage DNA and lead to several cancers including some organs and even blood cancers. But the at least one-third of common cancers are preventable.

We all know that oral and lung cancer that affects our male population to the maximum can be prevented by curbing smoking and tobacco consumption. We need to start thinking of some unhealthy foods similar to what we think about tobacco—unnecessary, addictive, and harmful.

There is a need for more public health campaigns that focus on increasing awareness about the growing health hazards due to obesity, pollution, adulteration of food, etc. Just like for a decade, we have been telling young people that smoking and tobacco chewing are harmful to health. We need to sensitise people about obesity and an unhealthy lifestyle that can cause cancers.

The writer is Director-Advanced OncoSurgery Unit, Fortis Hospitals Mumbai.

During a recent qualitative study, six strategies have been identified that recovering alcoholics use to negotiate social situations and remain sober, depending on how they feel about stigmas associated with drinking and alcoholism.

The paper, “How People in Recovery Manage the Stigma of Being an Alcoholic,” appears in the journal Health Communication. The paper was co-authored by Mary Obiol, an undergraduate researcher at NC State. “There is a stigma in the United States associated with not drinking socially,” says Lynsey Romo, corresponding author of the study and an associate professor of communication at North Carolina State University.

“There really is no clear guidance for people in recovery on how to deal with stigmas associated with drinking and alcohol abuse, and a lot of people in recovery grapple with shame and other issues associated with these stigmas..”

For the study, researchers conducted in-depth interviews with 22 U.S. adults who have been sober for at least 10 years.

The researchers identified six strategies for managing stigma. Specifically, the researchers found that the strategies study participants chose depended both on whether they believed there was a societal stigma against alcoholism and whether they felt such a stigma applied to them. The six strategies were: Accepting the stigma: In this strategy, participants felt there was a societal stigma and that it applied to them, essentially incorporating the stigma into their identity. Coping behaviours here might include using self-deprecating humour about the subject. The second one is evading responsibility for the stigma: This strategy involved participants accepting that the stigma applied to them, but minimizing their personal responsibility. That means, for example, blaming it on hereditary factors or other factors beyond their control.

Third: Reducing offensiveness of stigma: This involved accepting that a stigma applied to them but focusing on the value and importance of recovery, as well as how they have changed for the better since entering recovery. Fourth: Avoiding the stigma: In this strategy, participants accepted that the public stigmatizes alcoholism, but did not think the stigma applied to them. This distances the individual from the stigma because they don’t identify with the label of alcoholism.

The fifth one is Denying the stigma: This strategy challenges both the public understanding of stigma and whether it applies to them. Essentially, participants utilizing this strategy believe that nobody is perfect and other people don’t have the right to judge them. They also focus on the fact that they’re in recovery, which is an accomplishment in itself.

And the sixth one is ignoring/displaying the stigma: This strategy also challenges both the public understanding of stigma and whether it applies to them. Participants using this strategy are open about their experiences and engage in advocacy to educate others and combat stereotypes about alcoholism and recovery.

This study is part of a larger body of work that makes clear alcoholism is still stigmatized in society. And other research suggests that the more people buy into these stigmas, the more likely they are to struggle with relapses.

The world’s largest study of the link between temperature changes and kidney disease has revealed that 7.4 per cent of all hospitalisations for renal disease can be attributed to an increase in temperature.

The findings of the study were published in ‘The Lancet Regional Health – Americas’ journal. In Brazil – where the study was focused – this equated to more than 202,000 cases of kidney disease from 2000-2015.

The study, led by Professor Yuming Guo and Dr Shanshan Li, from Planetary Health at Monash University, for the first time, quantifies the risk and attributable burden for hospitalisations of renal diseases related to ambient temperature using daily hospital admission data from 1816 cities in Brazil.

The study comes as the world focuses on the impact of climate change at the COP26 conference in Glasgow from October 31.

In 2017, a landmark article in ‘The Lancet’ declared renal diseases a global public health concern, estimating that almost 2.6 million deaths were attributable to impaired kidney function that year. Importantly the incidence of death from kidney disease had risen 26.6 per cent compared to a decade previously, an increase that this study may indicate was, in part, caused by climate change.

The study looked at a total of 2,726,886 hospitalisations for renal diseases recorded during the study period. According to Professor Guo, for every 1 degree Celsius increase in daily mean temperature, there is an almost 1 per cent increase in renal disease, with those most impacted being women, children under 4 years of age and those 80+ years of age.

The associations between temperature and renal diseases were largest on the day of the exposure to extreme temperatures but remained for 1-2 days post-exposure.

The authors – who are also from the University of Sao Paulo – argue that the study “provides robust evidence that more policies should be developed to prevent heat-related hospitalisations and mitigate climate change. In the context of global warming, more strategies and policies should be developed to prevent heat-related hospitalisations.”

The authors advise interventions should be urgently incorporated into government policy on climate change, targeting specific individuals, including females, children, adolescents, and elderly, as they are more vulnerable to heat with regard to renal diseases.