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Published on: Oct 28, 2020
2 minute read
By: Dr Rajan ( Medical Second Opinion Cell)

Hepatitis C Nobel Prize

Earlier this month the Nobel Prize in Physiology and Medicine was jointly awarded to Harvey J Alter, Michael Houghton and Charles M Rice for the discovery of the Hepatitis C virus. This helped push our understanding of blood-borne hepatitis, a major global health problem that is one of the leading causes of cirrhosis and liver cancer alongside Hepatitis B. It led the way in introducing new tests for chronic hepatitis as well as new treatments that have saved the lives of millions.

HEPATITIS

Hepatitis is the inflammation of your liver, the largest solid organ in your body. Though there are numerous other causes of hepatitis, including alcohol abuse, drugs and toxins (including paracetamol overdose), and autoimmune disorders (such as Wilson’s disease), viral infections are the most common worldwide causes for hepatitis. Hepatitis A was the first to be discovered, transmitted by polluted food and water, and results in a short-term transient hepatitis. Hepatitis B on the other hand is transmitted through blood and is more of an issue as it can lead to chronic cirrhosis and possible liver cancer. It can remain indolent in a person, causing disease long after the initial infection.

Blood borne hepatitis was first discovered in the 1960s, when it was found that some patients would become ill after receiving blood transfusions. Despite this discovery and new tests for Hepatitis B reducing the number of transfusion related hepatitis, a large number of cases remained.

NOT A, NOT B

Harvey Alter, working at the US National Institute of Health, was studying the occurrence of hepatitis in blood transfusion patients. His team showed that blood from these infected patients could transmit the disease to chimpanzees, resulting in hepatitis. This agent had the properties of a virus, one that was “non-A, non B” hepatitis.

Further investigation into the virus would require the input of Michael Houghton, working for Chiron pharmaceutical. His team created a collection of DNA fragments found in the blood of infected chimpanzees. Though the majority of these fragments were from the chimpanzee, enough were from the virus. They were able to utilise this information to identify antibodies against the suspected virus, and ultimately identify it as the flavivirus Hepatitis C.

The final piece of the puzzle was shown by Charles M Rice, a researcher at Washington University, St Louis – could the virus alone cause hepatitis. He studied the RNA of Hepatitis C to identify regions that may be used for replication, and areas that might hinder replication. This was key as the virus can lay dormant for years, replicating at a slow rate before causing damage to the liver. For researchers, this was an issue as it was not feasible to wait years and see if the suspected virus caused hepatitis. By genetically engineering the viral genome, he developed a variant of Hepatitis C that would only multiple rapidly and have no mechanism to inactivate itself for dormancy. This strain caused rapid changes to the livers of infected chimpanzees; the same changes seen in hepatitis patients.

. ;.,hrvxzThe impact was significant. Prior to this, receiving a blood transfusion was like Russian Roulette. You were receiving life saving therapy, but it coZuld also be a hidden death sentence. Now that hepatitis had been discovered, it became possible to screen patients prior to donation, to screen blood transfusion bags, and to start developing treatments for the virus.

The fight is not over yet. There are still over 70 million people who still live with the virus, and it still kills around 400,000 a year. Its only very recently that we have found treatments that can reduce the viral load in patients to levels that they are considered cured. This treatment remains expensive, and we are very far away from eradication itself.

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Shortness of Breath Causes: From Common Triggers to Serious Health Conditions

Shortness of breath, medically known as dyspnea, is a symptom that ranges from mild discomfort during exertion to a distressing sensation of not getting enough air. In India, increasing air pollution, lifestyle diseases and respiratory infections have made breathlessness a frequent complaint across age groups. Understanding shortness of breath causes is essential to identify when it is harmless and when it signals a medical emergency.

What Is Shortness of Breath?

Shortness of breath refers to difficulty breathing or a feeling of air hunger.

It may present as:

rapid breathing
shallow breathing
tightness in the chest
inability to take a deep breath

The sensation can develop suddenly or gradually.

Common and Benign Causes of Shortness of Breath

Physical Exertion

During exercise, the body demands more oxygen.

Temporary breathlessness during:

climbing stairs
running
heavy physical work

is normal and resolves with rest.

Anxiety and Panic Attacks

Stress and anxiety alter breathing patterns.

Symptoms include:

rapid breathing
chest tightness
dizziness

These episodes often resolve with calming techniques.

Respiratory Causes of Shortness of Breath

Asthma

Asthma causes airway narrowing and inflammation.

Symptoms include:

wheezing
chest tightness
breathlessness during exertion or at night

Asthma is a leading cause of chronic breathlessness.

Chronic Obstructive Pulmonary Disease

COPD includes chronic bronchitis and emphysema.

Risk factors include:

smoking
indoor air pollution
occupational exposure

WHO identifies COPD as a major cause of breathlessness in adults.

Respiratory Infections

Infections such as pneumonia and bronchitis reduce lung capacity.

Breathlessness may be accompanied by:

cough
fever
chest pain

Severe infections require urgent treatment.

Heart-Related Causes of Shortness of Breath

Heart Failure

The heart fails to pump blood efficiently.

This leads to:

fluid accumulation in lungs
breathlessness on exertion
breathlessness while lying flat

ICMR data shows heart disease as a major contributor to unexplained breathlessness.

Coronary Artery Disease

Reduced blood supply to the heart can cause:

breathlessness
chest discomfort
fatigue

This may occur even without chest pain in some individuals.

Blood and Metabolic Causes

Anemia

Low hemoglobin reduces oxygen delivery.

Common symptoms include:

fatigue
breathlessness on mild activity
pale skin

NFHS-5 highlights anemia as highly prevalent in India.

Thyroid Disorders

Hyperthyroidism increases metabolic demand, causing breathlessness.

Hypothyroidism may contribute indirectly through weight gain and reduced stamina.

Lung Circulation Disorders

Pulmonary Embolism

A blood clot in the lungs causes sudden, severe breathlessness.

This is a medical emergency and may be accompanied by:

chest pain
coughing blood
fainting

Immediate treatment is critical.

Lifestyle-Related Causes

Obesity

Excess body weight restricts lung expansion.

Breathlessness occurs due to:

increased oxygen demand
reduced lung volumes

Weight management improves breathing efficiency.

Sedentary Lifestyle

Poor physical conditioning reduces respiratory muscle strength.

Even mild exertion may cause breathlessness.

Environmental and Occupational Factors

Air Pollution

Pollutants irritate airways and reduce lung function.

Urban populations experience higher rates of breathlessness.

Workplace Exposure

Dust, chemicals and fumes increase respiratory risk.

Protective measures are essential in high-risk occupations.

When Shortness of Breath Is a Warning Sign

Seek urgent care if breathlessness:

starts suddenly
worsens rapidly
occurs at rest
is associated with chest pain, bluish lips or confusion

These may indicate life-threatening conditions.

How Shortness of Breath Is Diagnosed

Evaluation may include:

physical examination
chest imaging
blood tests
lung function tests
heart evaluation

Diagnosis focuses on identifying the root cause.

Preventive Measures and Lifestyle Care

Prevention includes:

regular physical activity
pollution protection
smoking cessation
weight control
managing chronic conditions

Preventive healthcare reduces long-term risk.

Importance of Early Medical Evaluation

Delayed diagnosis can worsen outcomes, especially in:

heart disease
lung infections
anemia

Early care improves treatment success.

Conclusion

Shortness of breath causes range from temporary exertion and anxiety to serious heart, lung and blood disorders. While occasional breathlessness may be harmless, persistent or sudden symptoms should never be ignored. Understanding the underlying causes and seeking timely medical evaluation can prevent complications and save lives. Paying attention to changes in breathing is an essential step toward protecting overall health and wellbeing.

References

Indian Council of Medical Research (ICMR) – Respiratory and Cardiac Health Reports
World Health Organization (WHO) – Breathlessness and Chronic Disease Guidelines
National Family Health Survey (NFHS-5) – Anemia and Respiratory Health Data
Lancet – Dyspnea Evaluation and Outcomes Research
NITI Aayog – Non-Communicable Disease Prevention Reports
Statista – Respiratory Disease and Air Pollution Trends

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