Category: General

Influenza, often called the flu, is an infection of the nose, throat and lungs. The flu is caused by a virus. The reports of illnesses and deaths by the H1N1 virus and H3N2 virus reported in the news recently are various varieties of flu.

Most people with the flu get better on their own. However, influenza can cause severe complications for some groups of people. In general, people at higher risk for complications are young children, especially children aged 12 months and younger, pregnant women, adults over age 65 and people with certain medical conditions like asthma, diabetes, kidney & liver diseases, etc. Flu is well known to trigger heart attack and stroke in older people. In people 65 years of age and older, flu-related hospitalisation and deaths are increasing each year.

Flu vaccination prevents more than 100,000 flu-related hospitalisations annually. The flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 50%, resulting in less hospitalisation, fewer ICU admissions, and fewer deaths. Also, among people with diabetes and other chronic diseases, flu vaccination has been shown to be associated with reduced hospitalisations due to the worsening of their chronic conditions. More people getting vaccinated with the flu vaccine will prevent the spread of infection.

In many countries, flu vaccination is a part of their national immunisation program. This includes the USA, the UK, many European countries and Gulf countries. It is taken as an annual vaccination. Speak to your doctor whether you require a flu vaccine.

Dr. Tittu Oommen MD, DM

Herpes zoster (Shingles) is not a common infection. But once you get herpes zoster, you can never forget it. It starts with a burning and tingling sensation in a part of the body, followed by the appearance of rashes, redness, and blisters. There may be fever and tiredness along with that. In some people, the pain may become excruciating and unbearable, disturbing sleep. After the episode of shingles, the pain may remain for a long time (post-herpetic neuralgia)

 Herpes is caused by the varicella-zoster virus, which causes chicken pox. After chicken pox, these viruses remain in our body and activate after many years to cause shingles. Around 10 % of those who had chicken pox in the past develop herpes. Patients with chronic lung disease, diabetes, asthma, chronic kidney disease, or inflammatory bowel disease and older adults aged ≥ 50 years are at least two times more likely to experience herpes zoster or shingles.

 Two doses of the herpes zoster vaccine, taken 2-6 months apart, can effectively prevent herpes zoster. The vaccine is given to adults over 50 and is more than 90 % effective. It is beneficial for preventing shingles (herpes zoster) and post-herpetic neuralgia. It is currently available and approved in India for adults above 50. Speak to your doctor whether you require a shingles vaccine.

Just like you receive vaccinations in childhood for disease prevention, you need various vaccinations as an adult. The most common vaccination people take as adults is the tetanus toxoid (a vaccine!) You would have also received the COVID-19 vaccine to prevent COVID-19.

Vaccines train the immune system to fight diseases. When a vaccine for a specific disease is taken, the body recognises it as a minor infection. It generates antibodies and cellular immunity against that (the immune system training!). As and when the “real” infection arrives, the body is ready to fight it. This immune “memory “may last for a few years and may require some extra “boosters “occasionally.

Why do adults need vaccines? As people age, their immunity wanes, and various chronic diseases like diabetes and heart and kidney disease set in, which make people prone to new infections. Some infections like Herpes Zoster are common only in older ages and not in the young. For specific diseases like diphtheria and tetanus, immunity wanes as the person ages and repeated boosters may be needed. For influenza, the virus changes yearly; hence, annual vaccination is necessary to prevent infection from new viruses.

Since vaccinations involve a cost, people are sometimes hesitant to take them. But remember that diseases like polio and smallpox are not seen any more due to aggressive vaccination campaigns. The number of deaths due to influenza has reduced tremendously due to vaccinations, and many complications of pneumonia are rare. HPV vaccinations have reduced the risk of cervical cancers, and Hepatitis B vaccinations have reduced severe hepatitis and cirrhosis.

The standard treatment of PCOS involves weight loss, diet& lifestyle modifications and medications to attain regular menstrual periods and fertility and avoid the risks associated with PCOS. The traditionally used medications include Metformin or oral contraceptives. Recently, many women suffering from PCOS have been seeking alternative treatment options, including natural molecules and complementary medicines. Certain nutritional supplements, like curcumin, vitamin D & inositol, have been proven effective in patients with PCOS. Let us understand if they are scientifically sound:

A) Inositol is a natural sugar. Myo-inositol is the most common form in nuts, grains, beans and fruit. Myo-inositol can reduce insulin resistance and male hormone levels in women with PCOS. The latest studies with Myo-inositol show a definite effect on improving insulin sensitivity and ovulation. However, the effect is inferior to the current standards for treatment, such as Metformin.

B) Curcumin: is a natural polyphenol. Multiple small studies using curcumin show reduced inflammation and minor improvement in blood glucose and insulin levels. No definite benefits for periods or fertility have been found.

C) Vitamin D may improve markers of inflammation and glucose levels. It can be used if the person has Vitamin D deficiency.

D) CoQ: coenzyme Q is a natural antioxidant. It reduces the markers of inflammation but has no significant effect on menstrual periods or fertility.

E) Omega 3 /fish oils: minor effects in improving insulin resistance in PCOS. There are no definitive studies with important outcomes.

F) Others: supplements like N acetylcysteine, berberine, Zn and magnesium are not helpful.

In summary, you can consider using myoinositol or vitamin D (if there is a deficiency). Still, other supplements have limited scientific evidence to support their use. Since these supplements can interfere with other medicines you consume or diseases you have, consult with your endocrinologist before you consume them.

Dr. Tittu Oommen MD, DM

More than 50 % of women with PCOS are overweight or obese. One of the driving forces of PCOS is excess body fat. Women with PCOS who are obese are also more likely to have other medical problems like diabetes mellitus, hypertension and fatty liver disease. Further obesity makes them prone to diseases like sleep apnea, heart disease and cancers.

Scientific studies have shown that even 5% weight loss can lead to improvements in menstrual periods in women with PCOS. Weight loss can improve fertility rates and ovulation in women.

Weight loss in women can be achieved by

1. A calorie-restricted diet

2. Metformin (minor effects)

3. Medicines like Semaglutide and

4. Bariatric surgery.

However, not all symptoms of PCOS may be affected equally with weight loss. Menstrual regularity, ovulation, fertility and abnormal glucose levels may improve with weight loss. However, high testosterone levels and hirsutism may show only a limited improvement. Hence, weight loss is not a cure for PCOS, but it may control many of the symptoms.

Mrs.Rejitha Jagesh M Sc

Many metabolic abnormalities and menstrual periods improve when women with PCOS lose weight. We recommend that every woman with PCOS consult a nutritionist and follow a healthy, individualized, and tailored diet.

There is no one-size-fits-all diet. The quantity and frequency of the recommended foods is very much individualized and must consider age, body weight, allergies, gastric issues, lifestyle diseases, and other diseases that the person may have.

Overweight women and individuals with marked signs of insulin resistance will benefit from a calorie-restricted diet. A weight loss of more than 10 % should be targeted. Weight loss will reduce inflammation and improve glucose metabolism.

Including non-starchy vegetables (green leafy vegetables, Brussel sprouts, cucumber, mushrooms, tomato, turnips, zucchini), and fruits (melons, oranges, grapefruit, peaches, plums, strawberries, cherries, pear, lemons), whole grains and legumes(red lentils, beans, soy, peas), omega-3 fatty acid rich fish (sardine, salmon, tuna) and nuts and seeds (olive oil, walnuts, almonds, pumpkin seeds, sunflower seeds, sesame seeds), lean meat and low-fat dairy products (yoghurt, cottage cheese, buttermilk) are found to be beneficial in women with PCOS.

Reducing the frequency of red meat, oily, high-sugar, processed, and ready-to-eat foods will help improve PCOS.

Research has shown that dietary changes under professional supervision can achieve results such as weight loss, decreased levels of insulin, improved testosterone levels, reduction in hirsutism and acne, improvement in cholesterol levels, and menstrual irregularities.

Mrs. Rejitha Jagesh M Sc

If you ever thought that the risks associated with PCOS improve once you pass your reproductive age, you are wrong! PCOS is a metabolic disorder and is associated with an increased risk of cancer, diabetes and heart disease.

PCOS is associated with an increased risk of endometrial cancer. There are also some reports of an increase in ovarian cancer in women with PCOS after menopause. Women with PCOS are also at increased risk of diabetes in pregnancy and type 2 diabetes later in life. Heart disease and fatty liver are also more common in women with PCOS as they age.

To reduce this risk, it is crucial to adopt the following measures:

a) Ensure regular periods: consider using medicines to regularize periods if required
b) Weight loss with lifestyle or medical measures as necessary
c) Manage risk factors that may lead to heart disease.
d) Screen for diseases as recommended by your endocrinologist

Dr. Deepa G, MHSc (Diab), Dip (Diab)

Polycystic ovary syndrome (PCOS) is widespread, affecting 10-25 % of women in the reproductive age group. If you look at just women with diabetes, around 70% may have PCOS. Most women with PCOS have insulin resistance. This means that their tissues cannot function properly at insulin levels that are considered normal for an individual. Insulin resistance can lead to abnormalities in glucose levels (like diabetes and pre-diabetes), cholesterol levels, high blood pressure and even heart disease. This could be a reason for hirsutism (abnormal hair growth), irregular periods and dark pigmentation in the neck. Even lean individuals with PCOS can experience hyperinsulinemia, but it’s more pronounced in obese individuals.

Insulin resistance is seen in both lean and obese people with PCOS. The ways to tackle insulin resistance include a calorie-deficit diet, weight loss, exercise and medicines like Metformin and Pioglitazone.

Many women with PCOS will benefit from the use of Metformin. It is beneficial if you have

1. Diabetes or any abnormal glucose levels
2. Higher body weight
3. Signs of insulin resistance (mentioned above)
4. If you are planning pregnancy (to improve ovulation)

Dr. Deepa G, MHSc (Diab), Dip (Diab)

Laser hair removal is a procedure to remove unwanted hair from your body. Laser hair removal uses a concentrated beam of light (laser). During laser hair removal, heat produced from the laser is absorbed by the pigment in the hair. This damages the hair follicles that produce hairs thereby delaying future hair growth. It’s non-invasive, which means it doesn’t require any cuts in your skin. Laser hair removal is usually safe and effective for most people. Only an experienced specialist should perform the procedure. There can be mild reactions after laser treatment, such as skin irritation, darkening, or lightening of the affected skin. These changes are usually temporary.

A single session usually doesn’t result in permanent hair removal. Multiple laser hair removal treatments are typically needed. Some hair will grow back, but it’s generally lighter and thinner than before. The results of laser hair removal last longer than shaving, waxing, tweezing or plucking.

Laser hair removal has not been studied adequately in pregnancy. So, it is preferable to avoid it in pregnancy. Although most specialists prefer to use lasers only after the age of 16-18 years, laser hair removal is safe for children. Still, any unwanted hair growth in children should be investigated thoroughly by an endocrinologist before going for a laser.

Dr. Tittu Oommen MD, DM