DAILY NEWS BULLETIN LEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day Wednesday

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1 DAILY NEWS BULLETIN LEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day Wednesday Infertility Silent and infertile: The story of India s desperate couples (The Times of India: ) Between 10 to 15% of Indian couples are affected by infertility, with reasons ranging from pollution to obesity Seema Shah* had been married for six years before she decided to consult a gynaecologist. She had been too busy building a financial nest egg, helping her husband Sanjay set up his business, and taking care of her ill mother-in-law to worry about why she wasn t getting pregnant. I didn t have any health issues, but every month when I got my periods, I would be disappointed and wonder why was I was not conceiving, she says. A month after their sixth wedding anniversary on June 2016, the Shahs visited a gynaecologist. While 35-yearold Seema s test results were normal, her 34-year-old husband had a very low sperm count. Contrary to the image of India as a country with a booming population, fertility rates are actually declining. According to a 2015 study by Ernst & Young, nearly 10-15% (22 to 23 million) of married couples in India are affected by infertility. Though much of the social stigma is directed at women, around 40% of infertility cases among couples are attributed to men, another 40% to women, while the remaining 20% are due to both or indeter minate factors. While the most common causes of infertility among Indian women are polycystic ovarian syndrome (PCOS), low ovarian reserve, blockage of fallopian tubes, and endometriosis, among men it is because of low sperm count, poor motility of sperm, or problems with early ejaculation.

2 According to Dr Manish Banker, director of Nova IVI Fertility, both environmental and lifestyle factors can play a role in infertility. Insecticides, additives in food, and the quality of air and water can all lead to an impair ment in sper m production, he says. Lifestyle issues such as malnutrition, obesity, stress, alcoholism and smoking have an effect on both men and women, while stress and different working hours for the husband and wife can also affect personal life. My advice to couples is to stop alcohol and smoking, de-stress, and exercise. If one is sexually active, use a contraceptive barrier to prevent STDs, says Delhi-based IVF specialist Dr Rita Bakshi. Sexually transmitted diseases such as gonorrhea and chlamydia are also a common cause for infertility in India. Delaying the age of marriage and childbearing can also contribute to infertility, says Dr Banker. According to a recent study done by Nova IVI Fertility, Indian women are at a reproductive disadvantage because the ovaries of Indian women age six years earlier than those of Caucasian women. The ideal age of women to have their first child is by their early 30s. If they plan to defer it beyond 35, they should preserve their eggs, says Dr Banker. Around 18% of infertile women in India have genital tuberculosis, which can cause tubal blockage and endometrial damage, Many people don t realise that they have tuberculosis because they have no symptoms until they are trying to conceive, says Dr Bakshi. These underlying causes also determine the treatment of infertility. IVF is not necessary for around 80% of the couples who are unable to conceive. Instead, simple corrections, such as medicines, intrauterine insemination or IUI (in which sperms are placed inside the woman s womb), can help, says Dr Hrishikesh D Pai, Director IVF & Infertility at Fortis Bloom IVF Center. In cases of tubal blockages or severely low sperm count, more advanced treatments like IVF are required. After being diagnosed with low sperm count, the Shahs immediately began their treatment and went through two cycles of IVF. Seema conceived six months later, and gave birth to a healthy baby boy on August 15, Seema says that her family s support helped her. My in-laws were practical and supportive and told us to go ahead, says Seema, whose son is now 10 months old.

3 National Health Profile Data India s health spend just over 1% of GDP (The Times of India: ) Modicare To Cut Out-Of-Pocket Expense: Nadda India currently spends a little over 1% of GDP on health, far below Singapore which has the lowest public spend on health at 2.2% of GDP among countries with significant universal health coverage (UHC) service, according latest National Health Profile (NHP) data. India s per capita public expenditure on health increased from Rs 621 in to Rs 1,112 (around $16 at current exchange rate) in However, it is still nominal, compared to other countries. Switzerland spends $6944 on health per capita, whereas the US spends $4802 and UK spends $3500. But this could change as the centre plans to launch its ambitious National Health Protection Schem (NHPS) Ayushman Bharat to cover over 10 crore poor families with an annual health cover of Rs 5 lakh per family. Modicare, as it is called, is billed to be the world s largest such government-run insurance scheme. According to NHP (2018), around 43 crore individuals or 34% of the population were covered under any health insurance in Launching the NHP, health minister JP Nadda said NHPS will significantly bring down the out of pocket expenditure on health. Though the latest NHP data do not give figures for out of pocket expenditure, WHO s health financing profile for 2017 shows 67.78% of total expenditure on health in India was paid out of pocket. The world average is 18.2%. Total public expenditure on health in was Rs 140,054 crore.

4 Govt spends paltry Rs 1,112 on health of every citizen (The Tribune: ) The government health spending per person per year in India is Rs1,112 and it has only marginally improved over the years. India s National Health Profile (NHP)-2018 unveiled on Tuesday says the per capita public expenditure on health in the country has gone up from Rs 621 in to Rs 1,112 in and was Rs 1,397 at the revised estimates stage of Budget. The document is produced annually by the Central Bureau of Health Intelligence under the Health Ministry. The profile acknowledges India s worst fears on attainment of Universal Health Coverage. Compared to other countries that have either universal health coverage or are moving towards it, India s per capita public spending on health is low, says the government s own production. The latest documentation is an eye-opener when the Narendra Modi-led NDA government is moving ahead with the ambitious Ayushman Bharat Mission wherein the National Health

5 Protection Scheme component seeks to provide Rs 5 lakh financial cover to 10 crore poor families, in a bid to boost UHC. Health Minister JP Nadda said, When we meet to release National Health Profile-2019, the situation on out-of-pocket expenditure on healthcare would have drastically improved as the National Health Protection Scheme would have been rolled out. Nadda s confidence notwithstanding, many states remain anxious about the financial sourcing of the ambitious health protection scheme that requires states to invest 40 per cent cost as against Centre s 60 per cent. That explains delays by states like Punjab in signing the related MoUs. Overall, the Centre-state share in public spending on health in India is 31:69. Child Health Why helicopter parenting is bad for children (The Times of India: ) Helicopter parenting which describes an overcontrolling behaviour of parents can negatively affect children s ability to manage their emotions and deal with the challenging demands of growing up, a study has found. Children need space to learn and grow on their own, without parents hovering over them, researchers said in a study published in the journal Developmental Psychology. Our research showed that children with helicopter parents may be less able to deal with the challenging demands of growing up, said Nicole B Perry from the University of Minnesota in the US. Children rely on caregivers for guidance. They need parents who are sensitive to their needs, recognise when they are capable of managing a situation and will guide them when emotional situations become too challenging. Managing emotions and behaviour are fundamental skills that all children need to learn and overcontrolling parenting can limits those opportunities, said Perry. The researchers followed 422 children over the course of eight years as part of a study of social and emotional development. Data was collected from observations of parent-child interactions, teacher-reported responses and self-reports from the 10-year-olds. During the observations, the research team asked the

6 parents and children to play as they would at home. Helicopter parenting behaviour we saw included parents constantly guiding their child by telling him or her what to play with, how to play with a toy, how to clean up after playtime and being too strict or demanding, said Perry. The kids reacted in a variety of ways. Some became defiant, others were apathetic and some showed frustration, she said. Parents can help their children learn to control their emotions and behaviour by talking with them about how to understand their feelings and by explaining what behaviours may result from feeling certain emotions, as well as the consequences of different responses. Then parents can help their children identify positive coping strategies, like deep breathing, listening to music, colouring or retreating to a quiet space. PTI Pregnancy Science can prevent preterm births (Hindustan Times: ) New low cost innovative solutions can help manage babies who are born too soon About 15 million babies worldwide are born preterm, having completed fewer than 37 weeks of gestation. These babies have immature lungs, a reduced ability to maintain a normal body temperature, feed poorly or not at all, and a weak immune system making them dependent on external support systems for survival. This is now the leading cause of death in the first month of life with over one million estimated deaths globally every year. Even those infants who survive have lifelong consequences including an increased risk of stunting, learning deficits, visual impairment and hearing abnormalities. As developing countries, including India, have made progress against other preventable causes of death, preterm birth has become an ever-increasing proportion of the burden. There is, therefore, an urgent need to invest in understanding what causes it, new ways to predict or prevent it, and innovative lowcost solutions to manage those babies born too soon. The first challenge is in the measurement of gestational age. The gold standard is through ultrasound imaging in the first trimester. However, using ultrasound appropriately requires training to obtain and assess the correct images. Since this is not a routine practice in many settings, mothers are simply asked the date of the last period, leading to widely inaccurate assessments of the date of conception, sometimes by more than six weeks. Recently, there have been potentially transformative changes in the ultrasound hardware with changes to the core technology such as moving from a traditional platform of piezo electric crystals to

7 semiconductors, making possible a lower cost and new hardware-software interfaces. In addition, advances in machine learning and augmented reality are promising to lead to the development of software technologies that can enable a point of care ultrasound to be used by less trained health care personnel. In the contexts in which sex selection is a major concern, these advances make development of automated ultrasound probes that can block sex selection while still being able to provide key lifesaving obstetric measurements potentially achievable. Another major challenge is that the preterm baby s lungs are poorly developed, leading to difficulties in breathing that may require oxygen or mechanical ventilation. In developed healthcare settings, the practice is to administer corticosteroids to the mother if she goes into preterm labour, which will promote lung development of the foetus. However, steroids can increase the risk of infection or reduce blood sugar levels, both of which can be life threatening especially to the baby, and can be difficult to manage in less-advanced settings. There are now promising new discoveries, which could lead to a reduction in the dose of the corticosteroids needed to treat this condition, thereby reducing these side effects. This could also enable the use of tablets instead of injections, making them much easier to administer. Preterm babies are low in surfactants. These are substances produced in the mature lung that help keep them inflated and allows for the absorbance of oxygen into the blood. Products currently on the market are expensive and need skilled administration, putting these beyond the reach of most developing healthcare systems. Innovations in surfactant products that would be more cost-effective and easier to administer are being tested now to help address this problem. For long-term sustainable progress, there is need to invest in research to prevent preterm births. There is a recent report that deficiency of selenium, a micronutrient also found in the soil, could be linked to increased preterm births. The investigators used a clever methodology called a genome-wide association study done in a large database and then validated with independent data, both from high resource settings. Efforts are now underway to assess if this finding holds true for Africa and Asia, where selenium deficiency is widely prevalent. Selenium containing proteins play crucial roles in our body functions such as production of antioxidants that prevent inflammation. Many adverse pregnancy outcomes such as preeclampsia and preterm birth have been linked to inflammation. If confirmed, a very promising public health intervention might be to supplement selenium at a population level, as is happening with folic acid. The birth of preterm babies is a global challenge. These exciting new discoveries offer great promise and could help both advanced as well as developing countries such as India, which, because of its sheer size, has the largest number of preterm births of any country, develop a serious response to this issue. This piece has been co authored, along with Nachiket Mor, by Jeffrey Murray, deputy director, family health and human development and Sindura Ganapathi, deputy director, MNCH, Bill & Melinda Gates Foundation.

8 Cardiovascular disease Keralites face highest risk of cardiovascular disease, finds study (The Hindu: ) Adults in urban areas and those with a higher household wealth are more at risk A study based on two recent national surveys of nearly 8,00,000 adults between 34 and 70 years, has found that people of Kerala across sexes were most at risk of cardiovascular diseases while those in Jharkhand were least likely to have the condition. A gender break down, however, puts the women of Goa at highest mean cardiovascular risk at 16.73% while men in Himachal Pradesh and Nagaland were most vulnerable with mean cardiovascular risk of 24.23%. The surveys carried out between 2012 and 2014, found wide variations in the average 10-year risk of a fatal or nonfatal cardiovascular disease event among States. A paper published on June 19 in PLOS Medicine found the risk ranging from a low of 13.2% for both sexes in Jharkhand to 19.5% in Kerala. Urban tendency

9 The study, led by researchers at Public Health Foundation of India and Harvard T.H. Chan School of Public Health, found that adults in urban areas, as well as those with a higher household wealth, tended to have a greater cardiovascular risk. The study used the data from the District Level Household Survey-4 (DLHS-4) and the second update of the Annual Health Survey (AHS). The surveys covered 27 of the 29 States and five of the seven Union Territories. With 19.90%, adults living in urban areas in Kerala had the highest mean risk, followed by West Bengal (19.12%) and Himachal Pradesh (18.97%). In contrast, those living in urban areas of Daman and Diu had the lowest mean risk (12.60%), followed by Bihar (13.63%) and Arunachal Pradesh (14.71%). In general, the cardiovascular risk is lower in rural areas compared with urban areas. But Goa has bucked this trend with the rural areas showing a higher mean value (18.92%) than the urban areas (18.79%). In the case of Kerala, the difference between highest mean risk in rural (19.23%) and urban areas (19.90%) is meagre.the same questionnaire and methodology was used throughout to collect clinical, anthropometric, and biomarker measurements. While smoking was more prevalent in poorer households and rural areas, wealthy households and urban locations faced risks from high body mass index, high blood glucose and high systolic blood pressure. Why heart disease risk varies across states: wealth, facilities, other reasons (The Indian Express: ) "Our findings could be helpful in deciding how to allocate resources to prevent cardiovascular disease to those most in need, study author Dr Pascal Geldsetzer, of the Harvard T H Chan School of Public Health, said. Wealthier and more urbanised states tend to face a higher risk of cardiovascular disease (CVD). Kerala faces the highest risk at 19.5% and Jharkhand the lowest at 13.5%, a study published online Tuesday in PLOS Medicine has found. The study calculated the average 10-year risk of a CVD event using an index called the Framingham risk score. It analysed data for nearly 8 lakh adults and found that the risk

10 tended to be highest in the Northern, Northeastern and Southern states. Gujarat and Jammu and Kashmir were not part of the study, for lack of data. Cardiovascular disease risk varied widely among states and we also observed important variation of risk factors, such as smoking and diabetes, by adults socio-demographic characteristics. Our findings could be helpful in deciding how to allocate resources to prevent cardiovascular disease to those most in need, study author Dr Pascal Geldsetzer, of the Harvard T H Chan School of Public Health, said. Researchers of the T H Chan School and Public Health Foundation of India (PHFI) used data from the Annual Health Survey (round 2) and the District-level Household and Facility Survey (round 4) carried out between 2012 and In the North, Northeast and South, higher body mass index (BMI), hypertension, diabetes and smoking prevalence contributed to the risk. BMI and blood glucose and blood pressure were associated with wealth and living in an urban area. Also, the prevalence of high blood glucose and high BP was high in middle and old age among the poorer groups, and in rural areas. Smoking was more common in the poorer groups, in rural areas, and among males. It was most prevalent among males in the Northeastern states and West Bengal. Non-communicable diseases (NCDs) and communicable diseases (CDs) have an inverse relation, PHFI s Dr Ashish Awasthi, one of the authors, said. So states like Jharkhand have higher [prevalence of] CDs, while there is a low prevalence of NCD. Developed states have a higher NCD burden and lower CD burden.

11 In less developed states like Jharkhand, life expectancy at birth is less than in developed states like Kerala. Life expectancy is affected by disease pattern. Some states are at high risk of CVDs as they are ahead in development and have better healthcare facilities. Lifestyle, dietary patterns and other factors have played a role in the variations, Awasthi said. Another factor is obesogenic environment one that promotes weight gain and is not conducive to weight loss. Such an environment includes higher urbanisation, using a car rather than walking, or a lift rather than stairs, and easy availability of high-calorie food in the surroundings. Sexual Health Being transgender not a mental illness (The Hindu: ) Condition related to sexual health: WHO Transgender people, who identify as the opposite gender to the one they were born with, should no longer be considered mentally ill, according to a new UN categorisation. The World Health Organisation has issued a new catalogue covering 55,000 diseases, injuries and causes of death, in which it discreetly recategorised transgenderism. According to the new catalogue, so-called gender incongruence is now listed under conditions related to sexual health, instead of mental, behavioural and neurodevelopmental disorders. We expect (the re-categorisation) will reduce stigma, Lale Say, the coordinator of WHO s department of reproductive health and research, said. WHO says gender incongruence is characterised as a marked and persistent incongruence between an individual s experienced gender and the assigned sex. Several new chapters appear in the first update of WHO s International Classification of Diseases catalogue since the 1990s, including the one on sexual health. We think it will reduce stigma so that it may help better social acceptance for these individuals, said Ms. Say, adding that since the catalogue is used by doctors and insurers to determine coverage, the move away from a mental disorder could even increase access to healthcare.

12 The document, which member states will be asked to approve during the World Health Assembly in Geneva next May, will take effect from January 1, 2022, if it gets adopted. Several countries have already taken steps to reclassify transgenderism and take it off the list of mental disorders, including France and Denmark. Ms. Say said she thought the text, which is the result of years of discussion among experts, would easily win approval, despite lack of acceptance of transgender people in many parts of the world. Healthcare One allopathic doctor serves more than 11,000: NHP (The Indian Express: ) / The data, released by Union Health Minister J P Nadda on Tuesday, also highlights the huge gap between states while one doctor serves a population of 28,391 in Bihar, the ratio in Delhi is 1:2,203. The NHP data on the populations served by each government allopathic doctor reflects the overall health systems of states. (Representational Image) An allopathic government doctor in India on an average serves a population of 11,082, which is more than 10 times the recommended doctor-population ratio of 1:1000, the National Health Profile (NHP), 2018 a comprehensive annual compilation of data on disease incidence, health infrastructure and health finance has found. The data, released by Union Health Minister J P Nadda on Tuesday, also highlights the huge gap between states while one doctor serves a population of 28,391 in Bihar, the ratio in Delhi is 1:2,203. Nadda also launched the National Health Resource Repository, an ambitious plan to map every health facility in the country, both government or private, and also physically verify them. The NHP data on the populations served by each government allopathic doctor reflects the overall health systems of states. According to it, the states with the highest doctor-population ratio are Uttar Pradesh (19,962), Jharkhand (18,518), Madhya Pradesh (16,996) Chhattisgarh (15,916) and Karnataka (13,556). The ratio is lowest in Delhi (2,203) and northeastern states Arunachal Pradesh (2,417), Manipur (2,358) and Sikkim (2,437).

13 Officials attribute the better statistics in Delhi to the higher concentration of private hospitals and doctors, while they cite lower population density, and not better infrastructure, as the reason for the good performance in the NE states. In 2016, only 25,282 doctors had registered with the Medical Council of India or the state medical councils, while in 2017, the figure was even lower at 17,982. On the other hand, the number of dentists registered till 2017 were 2,51,207. Speaking during the launch, Nadda said that documents such as NHP are the basis of health policies like Ayushman Bharat, and in subsequent years NHP would be a reliable indicator of how the programme was functioning. This year, the NHP has used data from perhaps the largest screening exercise for noncommunicable diseases (NCD). Under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, 35 crore people were screened and the incidence of diabetes was found to be 8.4%, while hypertension was 10% and common cancers (oral, breast and cervix) was 0.1%. A total of 30,06,443 people were detected with diabetes, 3,654,099 had hypertension, 47,464 and 39,635 had common cancers. The health profile, however, has no data on cancer, except for the three that can be detected through screening. Among communicable diseases, rabies had 100% fatality (total 97 cases) and Japanese Encephalitis had a 12% fatality. The two were the most lethal communicable diseases in terms of fatalities. West Bengal earned the dubious distinction of maximum number of deaths due to malaria (29) and chicken pox (53). Bihar had 70% of the cases of Kala Azar a disease India had hoped to eliminate by 2017, but failed. The number of dengue cases went up from 1,29,166 in 2016 to 1,57,996 in Diarrhoea killed 1,555 people in 2016 and 1,331 in 2017.

14 Gaming Addiction Playing too hard (The Indian Express: ) WHO classification of gaming as an addiction points to challenges of intricate half-lives, lived out on consoles WHO classification video games he WHO s classification may well pave the way for a deeper exploration and a wider conversation on the stories young people are participating in. Since the turn of this century, an excessive and obsessive immersion in video games has been linked to mood swings, isolation, a single-minded pursuit of virtual goals and, most seriously, a number of deaths. If these symptoms appear familiar, it is because some or all of them have been associated with various forms of substance abuse. On Monday, the World Health Organisation (WHO) seems to have come to the same conclusion and has classified gaming disorder as a separate addiction. Predictably, and understandably, there has been some concern that the move will cause panic among parents: After all, it is bad enough that kids don t keep up with their schoolwork and refuse to play outside, but does an evening whiled away on a screen and a controller now mean that they are junkies? And, if not, does a simple, sedentary distraction really merit a separate classification as a disease? The fact, however, is that modern gaming is as close to the Tetris gameboys that young parents are familiar with as an abacus is to a supercomputer. There are movie-grade realistic graphics, involved storylines and in some cases, a level of hyper-real sex and violence that can make the real world pale in comparison. Then there s the fact that long hours on the console have been linked to epilepsy, depression and health problems associated with excessive sedentarism. The WHO classification is not, in any form, a ban or even an indictment of video games. Alcohol can be consumed responsibly and marijuana has never been directly linked to an overdose death yet, there is some justification for monitoring their use. The intricate halflives in fictional and virtual worlds present a new set of challenges and problems. These cannot necessarily be subsumed in the old definitions of substance addiction. But the WHO s classification may well pave the way for a deeper exploration and a wider conversation on the stories young people are participating in.

15 Yoga (The Asian Age: )

16 Mental Health (The Asian Age: )

17 Diabetes (The Asian Age: )

18 Stroke (The Asian Age: ) Pollution (The Asian Age: )

19 Pain What does having both chest pain and headache mean? Today: ) (Medical News Causes Hypertension Heart attack When to see a doctor Treatment Outlook When chest pain and a headache happen at the same time they are usually unrelated, though some conditions can cause both symptoms. Experiencing chest pain and a headache at the same time may be related to the heart, the immune system, or psychological factors. The cause is usually not serious, but people may be concerned that these symptoms indicate a problem with high blood pressure or a heart attack. In this article, we look at conditions that can cause chest pain and a headache. We also explain whether or not they are serious and when to see a doctor. Causes and other symptoms As many as 5.5 million people will seek medical advice for chest pain in a given year. In most cases, there is no cause for concern. Below, we discuss various conditions that can cause both chest pain and a headache at the same time. Anxiety or panic attacks Woman with chest pain and headache looking in bathroom mirror in dressing gown Anxiety may cause chest pain and headaches together. According to the Anxiety and Depression Association of America (ADAA), anxiety can cause both headaches and chest pain. A panic attack can often feel similar to a heart attack, which can further increase a person's anxiety. Symptoms of a panic attack include: chest pain shortness of breath a rapid heartbeat

20 dizziness sweating trembling a feeling of losing control Panic attacks can arise spontaneously and without warning, or can occur as a result of a stressful event. Learning to recognize the symptoms of a panic attack can ease a person's worry when they arise. Migraines A migraine is a type of headache that typically causes severe pain on one side of the head. A small-scale research study from 2014 suggests that chest pain can be a migraine symptom too, though not a common one. When a migraine does cause chest pain, antimigraine medication seems to relieve the pain. The other symptoms of a migraine often include: pain around one or both temples pain behind one or both eyes nausea or vomiting sensitivity to light or sound an aura, which can cause a person to see flashing lights or lose their vision A person can experience a migraine with aura and other symptoms without actually developing a headache. The ADAA suggest that there may be a link between migraines and anxiety disorders, including generalized anxiety disorder (GAD), panic disorders, and post-traumatic stress disorder (PTSD). Lupus Lupus is an autoimmune disorder that causes the immune system to attack otherwise healthy tissue. It can target the heart, which can lead to chest pain. If it also targets blood vessels, a person may experience a headache as well. Additional symptoms of lupus include: fever loss of appetite blurry vision

21 neurological symptoms Unrelated causes It is possible that a person may experience two unrelated conditions or issues. In this case, one condition will cause a headache, while the other causes chest pains. For example, dehydration can cause someone to have a headache. They may also have an upper respiratory infection that could cause the chest pain. Both conditions may require medical attention. Other possible conditions In addition to the above, a person may also experience a combination of chest pain and a headache with any of the following conditions: fibromyalgia carbon monoxide poisoning subarachnoid hemorrhage a peptic ulcer sarcoidosis stroke pneumonia tuberculosis costochondritis Can high blood pressure cause both symptoms? Nurse measuring patients blood pressure. High blood pressure does not usually have any symptoms. Some people believe that high blood pressure can cause headaches, chest pain, and dizziness. However, the American Heart Association (AHA) say that high blood pressure usually has no symptoms at all, unless a person is having a hypertensive crisis, which refers to a blood pressure of 180/120 or higher. A hypertensive crisis is a medical emergency, so it is vital to call the emergency services if the following symptoms occur: chest pain a headache

22 a nosebleed severe anxiety shortness of breath back pain changes in vision What could cause chest pain? What could cause chest pain? Chest pain can have many different causes. Here, learn about 26 possible causes of chest pain and when to see a doctor. Can a headache be a sign of heart attack? A headache is not a common symptom of a heart attack. Severe chest pain is the primary symptom. According to the AHA, the additional early signs of a heart attack may include: a feeling of fullness or tightness in the chest that may come and go shortness of breath pain or discomfort in the jaw, stomach, back, or one or both arms cold sweat nausea or vomiting lightheadedness The AHA also noted that women are more likely than men to experience other symptoms of a heart attack. The other symptoms can be confusing and prevent a person from realizing that they are having a heart attack. It is essential for anyone experiencing a feeling of tightness or pressure in the chest to seek medical attention immediately. Early help during a heart attack can help the outcome. When to see a doctor Doctor and patient both female talking over desk Consult a doctor if other symptoms accompany chest pain and headaches. A person should seek medical attention if they experience additional symptoms alongside their headache. Some symptoms that indicate a more significant issue include:

23 an inability to think clearly a stiff neck nausea or vomiting bleeding fever dizziness slurred speech weakness The National Headache Foundation provide a guide explaining when to seek medical attention for a headache. Treatment The treatment for chest pain and a headache will depend on the cause. A doctor will initially need to rule out any underlying severe causes. They may ask about any additional symptoms, the severity of the symptoms, and possible risk factors. They may also use diagnostic tests such as an electrocardiogram (EKG) to monitor the heart or blood tests to look for underlying conditions. If there are no underlying conditions, or they are benign, a person may try some home remedies. Some examples include: reducing stress by limiting stressful activities and practicing relaxation techniques resting as much as necessary using over-the-counter (OTC) pain medication to help alleviate the pain using a warm compress on the head or relevant muscle groups to help relieve stress trying behavioral therapies to help with anxiety or panic attacks Outlook If there are no serious underlying conditions, a person can expect their headache and chest pain to subside with minimal intervention. In these cases, long-term effects are unlikely. If there is an underlying condition, treating this should provide the individual with symptom relief. However, the recovery from other conditions can take a long time. People should seek medical attention immediately if they have unexplained pain in the chest or if other symptoms are present.

24 Colon Cancer Colon cancer: Scientists find new predisposition mechanism (Medical News Today: ) New research finds a novel mechanism that interferes with our DNA's ability to repair itself, genetically predisposing some people to colon cancer. To prevent illness, DNA repair proteins bind to the DNA's double helix (depicted here). The new study was published in the journal Nature Chemistry, and the first author of the paper is Kevin J. McDonnell, from the Norris Comprehensive Cancer Center, based at the University of Southern California in Los Angeles. Study co-author Jacqueline Barton the John G. Kirkwood and Arthur A. Noyes Professor of Chemistry at the California Institute of Technology in Pasadena was the first researcher who, over 2 decades ago, identified a DNA process called "DNA charge transport." DNA charge transport refers to the process in which electrons move through our DNA's double helix, sending signals to so-called DNA repair proteins and "telling" them to start fixing damage found along the way. In the new study, the researchers show how a genetic variant commonly found in colon cancer disrupts this DNA charge transport process. The findings may have important implications for colon cancer prevention, explain the scientists. New mechanism of cancer predisposition McDonnell and his colleagues focused on a mutation in a gene called MUTYH. Normally, MUTYH provides instructions for creating a DNA repair protein. Genetic mutations in MUTYH, however, affect the DNA's ability to repair its own errors. MUTYH mutations have also been associated with polyposis, or the formation of polyps in the colon that may later lead to cancer. In this study, the researchers focused on a MUTYH mutation called C306W, which affects MUTYH's ability to retain and keep a tiny cluster of iron and sulfur atoms together inside the protein. Colorectal cancer: Some cells are 'born to be bad'

25 This new study may help physicians to better identify polyps that may eventually lead to cancer of the colon. Several electrochemical experiments in the study revealed that the C306W mutation makes the iron-sulfur cluster degrade when it comes into contact with oxygen. Iron-sulfur clusters are key for DNA repair, so this degradation prevents the MUTYH protein from doing its DNA-fixing job. The iron-sulfur clusters are crucial for DNA repair because they provide the electrons that proteins need in order to "cling on" to the DNA's double helix and "scan" for damage. "We have found that a mutation [C306W] to a DNA repair protein associated with cancer [MUTYH] can disrupt electron transport through DNA," explains Prof. Barton. In the paper, McDonnell and colleagues conclude, "[W]e have documented and provided an explanation for a novel mechanism of colonic polyposis and cancer predisposition linked to electrochemical compromise of the MUTYH [iron-sulfur] cluster." Phillip Bartels, a postdoctoral researcher in chemistry and one of three co-lead authors of the study, comments on the findings. He explains, "This is only the tip of the iceberg [...] There may be other mutations in cancer patients besides C306W that similarly disrupt this charge transport process." Prof. Barton is hopeful that the new study paves the way for novel prevention strategies against colon cancer. "The work provides a strategy for thinking about how to possibly stabilize these repair proteins and restore their ability to carry out long-range signaling through DNA, so that the repair proteins can find and fix the mutations in DNA before they lead to cancer." Prof. Jacqueline Barton

26 ȯ ǐ दव ऐस क स ȯ ȡ ȯ ǐ दव ओ क बढ़ व? त न स ल Ʌ99 जन k Ʌġ खल, 25 ब द ह गए (Dainik Bhaskar: ) सरक र न अब सभ ǐ ȯ è Ȫ पर ȯ ǐ दव ओ ȧअलग स ] ȡ ȣ ȧ\ Ǔ ȡ [ ȡल ग ȧह सरक र न सभ ǐ ȯ Ĝ è Ȫ पर ȯ ǐ दव ओ ȧअलग ] ȡ ȣरखन क आद श Ǒ f ɇ@अब सव ल यह ह È ȡ इस आद श स ȣ ɉ क è Ȣ व È ȡ ȣ स ǕÈ ȯ ȯǐ दव ` Þ करव न क मकसद प र ह प एग? सव ल ^ f ह, È ɉ Ĥ ȡ Ȳğ Ȣ भ रत य जन k ǐ Ȫ ȡक तहत Ĥ ȯ Ʌख ल गए जन k Ʌġ ȣखद ब म र पड़ ɇ@ ȡè न जब इन Ʌġɉ ȧपड़त ल ȧत स मन आय Ĥ ȯ Ʌय जन क तहत ȯ ǐ दव ए मह य कर न क f 99 जन k Ʌġ ख ल गए थ ^ Ʌस 25 जन k Ʌġ त ब त त न स ल Ʌब द ह चक ɇ@अक ल जयप र जल Ʌऐस 16 Ʌġ खल थ, ǔ Ʌस छह पर त ल लग चक ɇ@य म नसर वर, स ग न र, ǒğ Ȫ ȡब ज र, æ ȡ[^Ȳ ǔèě f ǐ ȡ, च म व Ȫ Ȳ ± Ʌथ इसक अल व अलवर, क ट व ज धप र ] Ǒ क भ आध स Ï ȡ ȡजन k Ʌġ ब द ह चक ɇ@ĥ ȯ Ʌहर स ल दव ओ क ȣ 500 कर ड़ क क र ब र ह त ह ȯ त न स ल Ʌजन k Ʌġɉपर महज 25 ल ख ǽ f ȣ ȯ ǐ दव ए ȣ ǒ प ई थ ȡ ȡ ɉ क कहन ह जब प र न अन भव स सबक ल कर ȯ ǐ दव ओ ȧǒ Đ ȧबढ़ न क ` उप य ȣȳ f ज ए ग, तब तक नए आद श क ल भ ȣ ɉ क ȡ Ǖǔæ ह ȡÏ Ʌ ȯ ȯûġ ȡÏ ȲÉ ȡ य प 484 क रल 319 गज र त 260

27 ȡ Ǖ256 ȡ[ 242 ȡ ȡçĚ 205 Ȣ ± 194 ] ȲĢ Ĥ ȯ 120 ȡ è ȡ 99 ǒ ȡ 85 त ल ग न 75 प ज ब 73 Ú Ĥ ȯ 71 ओड श 70 ǐ ȡ ȡ69 असम 50 झ रख ड 46 ǔæ ब ग ल 40 Ǒ ã ȣ38

28 Breast Cancer (Hindustan: )