OBESITY AND ITS IMPACTS ON HEALTH

 The dramatic increase in the prevalence of overweight and obesity in most countries has been a great concern globally. However despite the urgency of this problem still there are some loopholes about this subject. The instance prevalence of obesity is often estimated based on surveys or population studies. The increase in body mass presents public health challenges because of the attractive physical appearance of Normal bodies and poor health outcomes of overweight and obesity

PHYSICAL HEALTH IMPACTS

Health condition of obese person often worse than people with normal weight and the life span of obese people is an average is shorter by 2 years .. obesity along with a lot of health impacts some of the co-morbidities related to overweight and obesity include cancers type 2 diabetes, hypertension, stroke, coronary, artery diseases, congestive heart failure, asthma, chronic back pain, osteoarthritis, pulmonary embolism, gall bladder disease and also an increased risk of disability. All this leads to more than three million deaths worldwide annually. Studies have confirmed that obesity is a major public health problem which results in decreased life expectancy, especially in younger age groups.

IMPACT ON MENTAL HEALTH

Relationship between obesity and mental health disorder is something which has a great impact.. overweight is a stigma and obesity discrimination can lead to some mental disorder. Scientific evidence lays emphasize on an increased risk of low self-esteem mood disorders motivational disorders eating problems impaired body image interpersonal communication problems and all these directly or indirectly affect the quality of life, on the other hand, it also lead to the development of psychopathology and poor health behaviour that through a viscous cycle will enhance their overeating bulimia or other related problems obese individuals attribute to their appearance and their weight and encounter frequent difficulties in their sexual activities. Sexual activity and sexual health outcomes such as sexual satisfaction unintended pregnancy and abortion have been mentioned as relevant issues as such we need to emphasize on more comprehensive population-based studies to find out the impact of overweight and obesity on different aspects of mental health including mood disorders communication problems .. self-satisfaction and it's effect on sexual health besides different aspects of quality life.

IMPACT ON SOCIAL ASPECTS

Consequences of obesity-related physical comorbidity include psychological impairments and stigmatization experienced by obese patients. The overweight stigma and attributable discrimination is documented in all the key areas of living .. including growth and development. Educational process, employment structure, and provision of health care. The obese individuals are most often ridiculed by their teacher's physicians and public, at times they also suffer from discrimination ridicule social bias, rejection and humiliation. Even specific obesity diagnostic or therapeutic procedure such as related anthropometric assessments could potentially affect their care considering the importance of health risks of overweight and obesity and it's increasing prevalence all over the world there is a need for well-defined programs on control and prevention which should be a priority on the political health agenda. If this increase in its prevalence continues. It could lead to serious health-related outcomes and consequences. However, so far only a few comprehensive preventive programs have been developed with little reported success.

Ms. Kavya E.M, 5th semester B.pharm

SAFEGUARD YOUR HEART- LET IT’S LUB-DUB ECHO WITH THE PHARMACIST’S SIGNAL……

The human heart is an organ that pumps blood throughout the body via the circulatory system, supplying oxygen and nutrients to the tissues and removing carbon dioxide and other wastes. The tissues of the body need a constant supply of nutrition in order to be active," said Dr Lawrence Phillips, a cardiologist at NYU Langone Medical Center in New York. "If   the heart is not able to supply blood to the organs and tissues, they'll die."

The pharmacist, the drug expert plays a relevant role in primary and secondary prevention of cardiovascular diseases, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific cardiovascular risk factors (eg, blood pressure, blood glucose, serum lipids) and clinical outcomes.

In addition to medication dispensing, the pharmacist can provide more direct interventions (eg, medication education and disease management), as a support to the physician’s action, in order to improve medication adherence, to achieve the goals of desired therapeutic outcomes and to improve safe medication use and humanistic control. The direct pharmacist’s intervention in patients’ care, in alternative to the conventional approach, has proved to favourably affect therapeutic and safety outcomes in different diseases or conditions including diabetes, dyslipidaemia, arterial hypertension, obesity, asthma or chronic obstructive pulmonary disease, infective diseases (including influenza immunisation),

psychiatric conditions and osteoporosis prevention. A recent overview of systematic reviews has documented a positive impact on patients’ outcomes (blood pressure and haemoglobin A1c reduction) of clinical pharmacy services targeting specific cardiovascular conditions, such as hypertension or diabetes mellitus. 

Patients with multiple risk factors for coronary disease: The effectiveness of the pharmacist’s intervention to reduce risk behaviours and risk factors for coronary heart disease such as smoking, alcoholism helped to manage the lipid levels.

Effectiveness of the pharmacist’s intervention in diverse cardiovascular conditions

Hypertension: Community pharmacies may represent the ideal site for implementing community-based self-screening to detect hypertension in the population

Dyslipidaemia: common interventions included education, followed by drug therapy recommendations and adherence –lead to the decrease in LDL cholesterol.

Diabetes: Wubben and Vivian performed a qualitative meta-analysis of 21 studies (9 randomised controlled studies, 1 controlled clinical trial and 11 cohort studies) including 3981 diabetics. All interventions involved additional visits by pharmacists with expanded roles to care for adult patients with diabetes. An overall improvement in haemoglobin A1c was observed in different settings and across multiple studies designs: the differences in change for haemoglobin A1c ranged from an increase of 0.2% to a decrease of 2.1%.Diabetes education (69% of cases, consisting of verbal instructions on diet, exercise, drug therapy and the disease itself) and medication dosage adjustment (61%) were the most frequently used interventions

Heart failure: A first systematic review was published by Ponniah et al  and evaluated the prognostic impact of pharmacy services on post-discharge patients with heart failure: in six of the seven included studies positive outcomes, such as decreases in unplanned hospital readmissions, death rates and greater compliance and medication knowledge were demonstrated.

Pharmacy services for cardiovascular prevention and management

Ø  Educational activities directed at patients

oPatient education and counselling

oDrug safety management

Ø  Informative activities directed at healthcare professionals

oDocumenting adverse drug reactions occurring to the patient

oMonitoring patient’s adherence to physician’s prescription

Ø  Direct intervention in a multidisciplinary team

o Collaborative medication management (including drug     administration)

o Medication review and dose adjustment or titration

o Medication monitoring and reconciliation

o Definition and application of disease management pathways and protocols

o Detection, prevention or control of specific cardiovascular risk factors

Actionable tips you can do now to improve your heart health

 1.If you presently require heart medications, develop memorably habits to consistently take your medications as your physician has directed. Monitor your blood pressure regularly, and get cholesterol screenings on a regular basis.

2.Get active. Just 10 minutes of physical activity daily can lower your risk of having a heart attack significantly. Aiming for 30 minutes a day lowers your risk even more. If you sit much of your day, take a walk on your breaks, and possibly stand at your workstation part of your day if possible. 

3.Don’t wait until you’re older to address heart health. High obesity rates, high blood pressure and type 2 diabetes are happening at increased rates in our younger population, putting them at risk of heart disease earlier in life.

4.Let’s get personal. Watch your stress level as it leads to heart disease. Practice deep breathing to relieve stress, keep anger in check, and laugh more. Laughter helps your blood vessels to relax and expand, keeping your heart working properly. Get enough sleep too, as it lowers stress and your risk of heart disease.

5.Stop smoking. Smoking damages blood vessels and can cause heart disease. Ask for help if needed.

6.Maintain – or work toward – a healthy weight with diet and exercise. Develop heart-healthy eating habits low in trans-fat, saturated fat, added sugar, and sodium. As a rule of thumb fill at least half your plate with vegetables and fruit, and pick low sodium options.

As Helen Keller said, ”The best and most beautiful things in the world cannot be seen or even touched- they must be felt with the heart”. 

Let’s focus on the instructions given by the Pharmacist and other healthcare providers and protect our most vital organ –‘ THE HEART ’

Ms. ASHLEY ANN DILIP, PHARMD FOURTH YEAR 

ST JOSEPH’S COLLEGE OF PHARMACY, CHERTHALA

(This Blog article secured first prize for Blog writing competition conducted by College in association with World heart day)

 

Insight into COVID-19 & its Socio-economic Impact

 

Coronavirus is a large family of viruses that are zoonotic in nature that is, transmitted from animals to humans. The first case of COVID-19 infection was reported in Wuhan and the studies state that it was an animal sold at the seafood market which is considered to be the host of COVID-19. The 2019 novel coronavirus was recognised as the causative pathogen of coronavirus outbreak in 2020. There were previous outbreaks of coronavirus infection; it was SARS (Severe Acute Respiratory Syndrome) which was emerged in the year of 2002 in Guangdong, China and MERS (Middle East Respiratory Syndrome) in 2012 in Saudi Arabia which was also known as atypical pneumonia. SARS-Cov has an affinity towards Angiotensin-Converting Enzyme-2 receptor (ACE-2) and Dipeptidyl peptidase-4 (DPP-4) is the receptor to which MERS-CoV is having the highest affinity. The mode of transmission these viruses was known to be: via the bat, the outbreak of SARS-CoV was originated and MERS-CoV has emerged through transmission from dromedary camels.

Description of Coronavirus

 The coronavirus belongs to the family Coronaviridae and the subfamily Orthocoronaviridae. 2019-n-CoV has virions which measure approximately 50-200nm in diameter_. The n-CoV is consisting of a single positive RNA genome which has a size approximately from 27 to 34 kilobases. As in fig.1, coronavirus has a crown-like a shape due to the presence of club-shaped glycoprotein spikes on the envelope of n-CoV. It is this spike protein which plays a major role in the pathogenicity of coronavirus infection. There are certain structural proteins like M-protein, N (Nucleocapsid) protein, E protein which is involved in the virulence of COVID-19. The N protein is related to the replication of coronavirus and host cellular response against the infection. M protein defines the shape of the viral envelope and it is the centre of coronavirus assembly. The E protein which is the smallest structural protein that contributes to replication and E protein together with M protein makeup virion release. Similarly, when M protein binds with N protein, it stabilises the N protein. The 2019-n-CoV has a high affinity to ACE-2 receptors.

The virion RNA seems to be infectious which serves as both genome and viral messenger RNA. The pathogenic effect is exerted by n-CoV through various steps: 1) Attachment of viral spike protein to the host receptors by the process of endocytosis. 2) Fusion of viral membrane to endosomal membrane. 3) Proteolytic cleavage occurs. 4) Release of new virions after replication. The COVI-19 infection is having uniqueness compared to other viral infection. Patients with respiratory diseases, cardiovascular diseases and along with other comorbid conditions are more prone to COVID-19. The entry of virus can cause the release of cytokines leading to cytokine storm resulting in an imbalance between TH1 &TH2 immune responses. The increased levels of neutrophils, leucocytes, SGPT, SGOT, and decreased levels of haemoglobin, prothrombin time etc. can be observed in laboratory investigations. Elevation in infection biomarkers like procalcitonin, IL-6, serum ferritin can also occur_.  

 

 

This virus can spread through respiratory droplets. The causative agent is present within the respiratory droplets which have the capability to cause the infection. Rarely, the transmission can occur through the faecal matter. The airborne transmission can also occur during mechanical ventilation, manual intubation, nebulizing treatment for patients, non- invasive positive presence ventilation. Novel coronavirus can spread in following ways: coughing and sneezing without covering the mouth can result in the transmission of respiratory droplets into the air, touching/ shaking hands with an infected person, then making surface contact with objects that has the virus and then touching the eyes or nose with same hands. The symptoms of COVID-19: systemic symptoms include fever and fatigue, kidney failure, diarrhoea, respiratory symptoms like sneezing, runny nose, dry cough & dyspnoea

How to overcome COVID-19

Antiviral treatment of duration 3 to 14 days or antibiotic treatment of duration 3 to 17 days are given to the patients. Antiviral drugs include oseltamivir (75mg every 12hours), ganciclovir, lopinavir, and ritonavir tablets (500mg BD) which are given orally. The antibiotics like cephalosporin, quinolones, linezolid, tetracycline etc. Lopinavir drug seems to be useful for SARS-CoV_. The combination of lopinavir-ritonavir show some adverse effects like diarrhoea, inflammation GIT. The arbidol and arbidol mesylate are more effective than ribavirin in suppressing viral replication. Favilavir was an FDA approved drug, it is an antiviral drug which can be used to treat COVID-19. Chloroquine and Remdsivir are other drugs which are used as treatment options for COVID-19. Plasma therapy is a method in the blood plasma of patient recovered from this infection is infused into the victim as the blood of recovered patient contains antibodies against the virus and boost up the immune system of the victim. The DNA vaccines and recombinant measles virus vectored vaccines are under process of development. Protease inhibitors, replicase inhibitors, host-based anti-CoV, membrane-bound viral RNA synthesis inhibitors are also the upcoming treatment options. The preventive measures against COVID-19 infection: wash hands regularly with soap and water, do not touch or shake hands with others, cover the mouth while coughing or sneezing with a disposable tissue or flexed elbows. The health professionals should have to wear personal protective equipment to protect from the infection.

Socio-economic impacts of COVID-19

COVID-19 has a greater impact on different aspects of life. There is a global effect happening due to pandemic condition of COVID-19. The economy, environment, social impact is present in our society. Considering the impact on the economy, the countries globally have decided to undergo complete lockdown. And due to this, the transportation becomes suspended, that is, all the domestic flights, railway services, bus, truck & vehicle transportation were closed. So that all the types of business transports have been deferred amid different countries. India’s growth in the fourth quarter of the fiscal year 2020 went down to 3.1% according to Ministry of statistics. The major outcomes of lockdown in India are sharp rise in unemployment, stress on the supply chain, decrease in government income, the collapse of the tourism industry, reduced consumer activity, plunge in fuel consumption, rise in LPG sales etc. Studies state that unemployment rose from 6.7% on 15Marchto 26% on 19 April. 140 million people lost their jobs while salaries were cut for others. Major companies in India are temporarily suspended.

Partial or complete shutdowns will be felt across the economy: Selected G7 countries, in % of GDP at constant prices.

The primary sector includes economy, agriculture, petroleum & oil etc. There is a drop in demand from hotels for the agricultural commodities. The countries are going through protective measures like social distancing, avoiding unnecessary travel & a ban on congregations. Self-isolation is also been practised. So the transportation of agricultural products is stopped. The markets are closed. “Panic buying” is further complicating shortages beyond supermarket shelves. The viral outbreak is dampening the demand for oil and this war have grave implications for global economy any increase to consumer activity is likely to be outweighed by damage caused to population reliant on revenue from other forms of energy such as Shale gas. The secondary sector includes manufacturing industries. Over 80% of respondents anticipated a decline in turnover over the next 2 quarters, with 98% admitting concern about the negative impact of the pandemic on business operations. Since the transportation is been suspended it leads to importation issues & staffing deficiencies are the key concerns for business and it is not a viable option for working from home in the case of manufacturing industries. COVID-19 has affected all levels of the education system. COVID-19 has an impact on social mobility whereby schools are no longer able to provide free school meal for children from a low-income family. The impact on postgraduate’s research community is different as it gives many opportunities to work on COVID-19 related issues. Many of the conferences have been cancelled, these conferences are key to scientific research in many disciplines, allowing dissemination of research as well as providing networking opportunities for collaborations and job seeking. COVID-19 has affected communities, business & organisations globally, inadvertently affecting the financial markets and the global economy. In China, there is reduced production of goods from factories while quarantine and self-isolation process, decreased demand, consumption and utilisation of products. 10 years US Treasury bond yields have dropped to 0.67%. There is sharp in the well-being and economics status of financial companies worldwide. There are unprecedented challenges for healthcare system globally. The healthcare workers are the most vulnerable group for this pandemic condition. The health professionals are guided to use personal protective equipment (PPE) but the shortages of PPE including the N95 facemasks, low number of ICU beds in hospitals is leading to a weakened healthcare control system. Profound changes to the dynamics of healthcare are likely to ensue leading to massive investment into disease prevention infrastructure and the accelerated digital transformation of healthcare delivery. In the US active pharmaceutical ingredients are imported largely from India (18%), EC (26%) & China (13%). Hospitality, tourism & aviation have perhaps been most hard-hit. Since the hotels are temporarily suspended there is a greater impact on hotel industries. Tourism had a greater impact on travel supply and demand. The tourism sector had to implement urgent measures such as temporary state aid for tourism from the national government as well as fast and easy access to short & medium terms loans to overcome liquidity shortages, including funds made available. Since all the airports were closed and the reduction of unnecessary travel globally produced an impact on aviation. There are many daily wages workers or business persons depending on the real state or housing sector who become unemployed through these times. The sporting events had also been postponed due to COVID-19 which was a way to figure out the new talents in the world. The IT, media research & development are giving update information regarding this pandemic condition. With the WHO raising COVID-19’s status to a pandemic, 35 companies and academic institution are racing to develop an effective vaccine. Food distribution and retailing is under strain due to panic buying & stockpiling food by people. Considering the social impact, there are increasing fears of domestic violence which can be physical or emotional. UK’s domestic abuse charities reported a 25% increase in such cases. But the lockdown period helps to bring out new talents hidden inside people which can be considered as a positive impact of COVID-19.

Conclusion

COVID-19 is an epidemic disease which is the rising threat worldwide with many social and economic impacts globally. So the preventive measures as well as the treatment options can be used for controlling the spread of COVID-19. Thereby we can reduce the mortality rates day by day.

 

Miss Camila .A. Carlman, III Pharm.D

TRIPLE THERAPY FOR ASTHMA

 

To breathe we do not need only air and lungs, but also the freedom. Yes, I actually support the above statement. How many of you think that you have the freedom to take a breath? The majority opinion for the restriction is, we humans itself and finally get diseased.

In respiratory medicine, the term overlap syndrome has been applied both to the association between obstructive sleep apnea and chronic obstructive pulmonary disease (COPD) and to patients with features of both asthma and COPD (asthma–COPD overlap syndrome – ACOS).  Asthma and COPD are major public health problems. Asthma is a condition in which the airways narrowed, swelled and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound when we breathe out and shortness of breath.

 COPD is defined as a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory responses in the airways and the lungs to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. Certain studies have proved that asthma and COPD may coexist or at least one condition may evolve into the other creating a condition commonly described as Asthma COPD Overlap Syndrome. It is a syndrome in which older adults with a significant smoking history have features of asthma in addition to their COPD or non-smoking asthmatics have persistent airflow obstruction. According to GINA 2016, ACOS is characterized by persistent airflow limitation with several features usually associated with asthma and several features.

ACOS is characterized by TH2-mediated eosinophilic inflammation, bronchodilator reversibility and corticosteroid responsiveness in a COPD a subset, even in the absence of a clinical history of asthma. A subset of treated non-smokers with moderate to severe asthma has persistent expiratory airflow limitation, despite partial reversibility. This is attributed to large and especially small airway remodelling and recently the theory of reversible loss of lung elastic recoil leading to hyperinflation and centrilobular emphysema has been proposed. However, the mechanism(s) responsible for the loss of lung elastic recoil and persistent expiratory airflow limitation in non-smokers with chronic asthma consistent with ACOS remain unknown in the absence of structure-function studies. Both asthma and COPD are heterogeneous diseases and comprise various phenotypes.

The pharmacotherapeutics consideration requires an integrated approach, first to identify the relevant clinical phenotypes, then to determine the best available therapy.

 

Mild intermittent patients, those who have symptoms infrequently would benefit from as needed albuterol triple combination asthma medication would be most appropriate for moderate to severe asthmatic patients.  If symptoms become more persistent your doctor may use an inhaled steroid.  If the asthma is still not controlled, adding a LABA is an option.  If all of that doesn’t work, a combination medication like Trelegy would be a possibility. This medication would be most appropriate for moderate to severe asthmatic patients.   Triple therapy / Trelegy is approved for people with COPD, including those with chronic bronchitis and emphysema. It combines three inhaled COPD drugs: a corticosteroid to bring down the swelling in your airways, a long-acting beta-agonist to relax the muscles around your airway and an anticholinergic drug to widen the large airways. It is a new asthma medication by GlaxoSmithKline (GSK) is currently being developed for the treatment of asthma and COPD and consist of 3 medications, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).   The medication will be delivered once daily as a dry powder inhaler.

There is an urgent need for more research on this topic, in order to guide better recognition and appropriate treatment. This should include a study of clinical and physiological characteristics, biomarkers, outcomes and underlying mechanisms, starting with broad populations of patients with respiratory symptoms or with chronic airflow limitation, rather than starting with populations with existing diagnoses of asthma or COPD.  Further research is needed to inform evidence-based definitions and a more detailed classification of patients who present overlapping features of asthma and COPD and to encourage the development of specific interventions for clinical use.

Ms. BENITA JOHN, III rd PHARM D