The effectiveness of ‘proning’ for patients with Covid-19, and it impact on reducing mortality has gained much attention over the past year. Ministry of Health and Family Welfare (MoHFW) recently advised proning for self-care amongst patients who have tested positive for Covid-19, stating it to be extremely beneficial. Now, in the current scenario when the shortage of hospital beds, drastically increased demand for oxygen concentrators and medication, etc. is being seen, improvement in oxygen levels through proning may be very relevant to possibly reduce the necessity of hospital admission.
WHAT IS PRONING?
Lying face down is known as proning, it is a medically accepted position to improve oxygenation. If a patient’s oxygen levels drop below 94 (when measured at home on an oximeter), the patient can lie on their tummy; this position improves ventilation and enables comfortable breathing.
Physical position affects the distribution and volume of air in the lungs and can have direct effects on the expansion of the lungs to permit the exchange of oxygen & carbon dioxide in the blood. In the last few years, prone positioning has been used increasingly in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS) and this is now considered a simple & safe method to improve oxygenation. It is a medically accepted process that involves turning a patient with precise, safe motions, from their back onto their abdomen so that the individual is lying face down to improve breathing.
Proning is required only when the patient experiences difficulty in breathing and the SpO2 decreases below 94. Regular monitoring of SpO2, along with other signs like temperature, blood pressure, and blood sugar, is important during home isolation. Moreover, missing out on Hypoxia (compromised oxygen circulation) may lead to worsening of complications. Therefore, advice must be taken from the doctor on ways to effectively practice proning at home.
HOW TO CORRECTLY DO IT?
One may prone for up to 16 hours a day, in multiple cycles, suitable to a patient’s comfort and ability. Pillows may be adjusted slightly to alter pressure areas and for comfort. Keep a track of any pressure sores or injuries, especially around the bony prominence. If this done with a help of a caregiver:
• Place one pillow below the neck
• Place one or two pillows below the chest through the upper thighs
• Place two pillows below the shins
• You will need 4-5 Pillows
• Regular alterations in lying position
• It is best not to spend more than 30 minutes in each position, after 30 mins lie on each side, then sit up before going back to proning
What are the precautionary measures that need to be taken?
• Avoid proning if pregnant
• Avoid proning for an hour after meals
• Maintain proning for only as much time as easily tolerable
• Keep a track of any pressure sores or injuries, especially, around bony prominences
• Avoid proning if you have major cardiac conditions
• Avoid proning if you have an unstable spine, femur or pelvic fractures
The writer is an Infectious Disease Specialist at Fortis Hospital, Mulund.
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How Covid-19 could bring adverse complications for pregnant women
Assessing 2,471 women in the third trimester of their pregnancy, close to their delivery, researchers found “significant differences” for symptomatic covid positive patients including higher rates of gestational diabetes, lower white blood cell counts, and heavier bleeding during delivery, whilst respiratory complications were witnessed in their babies.
The peer-reviewed findings were published in The Journal of Maternal-Fetal and Neonatal Medicine. The study finds an increased risk of poorer outcomes for the newborns and symptomatic women with COVID-19, which adds further weight to the argument for pregnant women to be vaccinated for the virus.
Thankfully in the group of patients — which included 172 Covid positive women (56 of whom were symptomatic)– monitored at the Mayanei Hayeshua Medical Center in Israel, only one person needed mechanical ventilation, and there were no maternal deaths.
They show, lead Dr Elior Eliasi stated that COVID-19 in the third trimester of pregnancy “has clinical implications, albeit at lower rates than expected once asymptomatic patients are taken into account.”
The analysis found that there was no significant increase in cesarean delivery in women, who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups (healthy, covid positive asymptomatic, covid positive symptomatic). Most pregnancy and delivery outcomes were similar between COVID-19-positive and -negative parturients (a woman about to give birth; in labour).
Dr Eliasi said, “However, There were significant differences between the COVID-19-positive and healthy controls included higher rates of GDM (gestational diabetes), low lymphocyte counts (white blood cell count) which were significantly lower, postpartum hemorrhage (bleeding during birth), and neonatal respiratory complications.”
“Our findings support the importance of vaccinating all pregnant women at all stages of pregnancy,” he added.
The study looked at births at the hospital between 26 March and 30 September 2020. A total of 93 per cent of women admitted to the labour ward during this period were negative for COVID-19. Of the COVID-19-positive patients, 67 per cent were asymptomatic.
On average the increase risk of incidence of adverse outcomes was 13.8 per cent higher for asymptomatic covid patients and 19.6 per cent higher for those symptomatic.
“More data is now needed to better delineate the differences between pregnancy outcomes seen in certain populations, potentially related to different viral characteristics (subtypes, viral load), patient epigenetics, or other factors. Additionally, the effects of maternal infection on the fetus both in terms of symptomatic maternal illness and vertical viral transmission remain to be further investigated,” the authors stated.
Limitations of this study include it being retrospective; whilst another is that the sample includes a relatively healthy population admitted to just a single community hospital. “Therefore,” the authors stated their findings, “may not be generalizable to all populations.”
STUDY DETERMINES SENSE OF SMELL IS BODY’S MOST RAPID WARNING SYSTEM
Researchers at Karolinska Institutet in Sweden have been able to study what happens in the brain when the central nervous system judges a smell to represent danger.
The study indicated that negative smells associated with unpleasantness or unease are processed earlier than positive smells and trigger a physical avoidance response. The findings of the study were published in the journal ‘Proceedings of the National Academy of Sciences’. The ability to detect and react to the smell of a potential threat is a precondition of our and other mammals’ survival.
“The human avoidance response to unpleasant smells associated with danger has long been seen as a conscious cognitive process, but our study shows for the first time that it’s unconscious and extremely rapid,” said the study’s first author Behzad Iravani, a researcher at the Department of Clinical Neuroscience, Karolinska Institutet.
The olfactory organ takes up about five per cent of the human brain and enables us to distinguish between many million different smells. A large proportion of these smells are associated with a threat to our health and survival, such as that of chemicals and rotten food. Odour signals reach the brain within 100 to 150 milliseconds after being inhaled through the nose.
The survival of living organisms depends on their ability to avoid danger and seek rewards. In humans, the olfactory sense seems particularly important for detecting and reacting to potentially harmful stimuli.
It has long been a mystery just which neural mechanisms are involved in the conversion of an unpleasant smell into avoidance behaviour in humans. One reason for this is the lack of non-invasive methods of measuring signals from the olfactory bulb, the first part of the rhinencephalon (literally “nose brain”) with direct (monosynaptic) connections to the important central parts of the nervous system that helps us detect and remember threatening and dangerous situations and substances.
Researchers at Karolinska Institutet have developed a method that for the first time has made it possible to measure signals from the human olfactory bulb, which processes smells and in turn, can transmits signals to parts of the brain that control movement and avoidance behaviour.
Their results are based on three experiments in which participants were asked to rate their experience of six different smells while the electrophysiological activity of the olfactory bulb when responding to each of the smells was measured.
“The results suggest that our sense of smell is important to our ability to detect dangers in our vicinity, and much of this ability is more unconscious than our response to danger mediated by our senses of vision and hearing,” said the study’s last author Johan Lundstrom, associate professor, Department of Clinical Neuroscience, Karolinska Institutet.
BRIEF COUNSELLING BY DOCTOR CAN PRODUCE USEFUL REDUCTIONS IN DRINKING
WASHINGTON : A recent study found the alcohol-targeted brief interventions when delivered in medical settings, can produce useful reductions in drinking.
Published in the scientific journal ‘Addiction’, the findings suggest that structured, one-to-one, short conversations about drinking, designed to motivate changes in risky behaviour, when delivered in doctors’ offices and similar medical settings, might produce small but useful reductions in drinking.
Alcohol-targeted brief interventions yielded small beneficial effects on alcohol use, equivalent to a reduction in 1 drinking day per month. Interestingly, the findings were inconclusive for brief interventions delivered in the emergency department/trauma centres but were effective when delivered in other general medical settings (e.g., a primary care clinic).
There was limited evidence regarding the effects of drug-targeted brief interventions on drug use. Lead author Emily Tanner-Smith comments: “A reduction of one drinking day per month may not sound like much, but small individual reductions can add up to a substantial reduction in population-level harms. Given their brevity, low cost, and minimal clinician effort, brief interventions may be a promising way to reduce alcohol use, one patient at a time.”
Study finds Covid-19 related parenting stress impacts eating habits of children
Researchers found that stress resulting from uncertainty about the job and financial security was associated with psychological distress, while concerns over family safety and stability led to anxiety
A new study has found that the stress experienced by parents during the Coronavirus pandemic has a negative impact the eating habits of children. The findings were published in the journal Current Psychology.
When stay-at-home mandates were ordered and the school went virtual at the onset of the pandemic, many parents suddenly had to juggle multiple roles such as caregiver, employee and educator. Leslie Frankel, associate professor of human development and family studies, said all those responsibilities took a toll on parents’ mental health, and in turn, what and how much their children were consuming.
Previous research has shown that stress, in general, is known to have a negative impact on parent-child feeding interactions, but new findings reveal COVID-19 only magnified the problem.
“These parents do not have the time, energy or emotional capacity to engage in optimal feeding behaviours, so they resort to maladaptive feeding behaviours such as using food as a reward or pressuring their kids to eat,” said Frankel, the study’s lead author and expert in parent-child relationships. “As a result, their children are not able to self-regulate what or how much food they are putting into their bodies, which could have harmful consequences in the long run.”
Frankel and study co-authors Caroline Bena Kuno, a doctoral student in the UH College of Education and UH Honors College student Ritu Sampige, surveyed 119 mothers and fathers of children ages two to seven between April and June 2020.
The researchers analysed two different types of COVID-related parenting stress and found that stress resulting from uncertainty about the job and financial security was associated with psychological distress, while concerns over family safety and stability led to anxiety. The mothers surveyed reported experiencing higher levels of stress and anxiety compared to fathers who participated in the study.
“The stress doesn’t just go away. Many parents are still feeling uneasy and a parent who is overwhelmed and experiencing symptoms of depression and anxiety may not pay attention to or acknowledge their children’s cues of hunger and fullness,” Frankel explained.
To ensure children are optimising their eating habits in the event of another public health emergency or natural disaster, the research team says policymakers or non-profit organizations interested in improving outcomes for children and parents should provide support systems to help parents manage their daily stressors.
OSTEOPOROSIS: THE SILENT DISEASE
Osteoporosis is a disorder in which the density of bone decreases, causing it to lose strength and become brittle. Osteoporosis causes unusually porous, collapsible bone, similar to that of a sponge. The skeleton is weakened by this condition, which leads to frequent fractures (breaks) in the bones. A normal bone is made up of protein, collagen, and calcium and they all contribute to its strength. Osteoporosis-affected bones can shatter (fracture) even with small traumas that would not usually cause a bone to break. Although osteoporosis-related fractures can occur in nearly every skeletal bone, they are most commonly found in the spine, hips, ribs, and wrists.
Symptoms of osteoporosis- there are no indicating symptoms hence the title ‘The Silent Disease’. But one can look out for the following indications; height loss (getting shorter by an inch or more), change in postures, asthma (smaller lung capacity due to compressed lung capacity), fractures in bones, lower- back discomfort.
Some of the factors that increase the risk of developing osteoporosis are:
1. Gender: Women have a higher chance of having osteoporosis as they have smaller bones and lower peak bone mass compared to men. Men still are at risk particularly after the age of 70.
2. Age: Bone loss accelerates as you become older, but new bone formation slows. The bones may deteriorate over time, increasing the chances of developing osteoporosis.
3. Size of the body: Slender, thin-boned women and men are more likely to develop osteoporosis than larger-boned women and men because they have less bone to lose.
4. Race: Osteoporosis is more prevalent among Caucasian and Asian women. African-American and Hispanic women, on the other hand too face this. In fact, after a hip fracture, African-American women are more likely to die than white women.
5. Genetics: Researchers have shown that if one of your parents has had an osteoporosis or hip fracture, your chance of developing osteoporosis and fractures may be increased.
6. Hormonal changes: Certain hormone deficiencies might raise your risk of getting osteoporosis. As an example: After menopause, women’s estrogen levels drop. Low estrogen levels caused by an atypical lack of monthly cycles in premenopausal women owing to hormone abnormalities or high amounts of physical exercise. Men’s testosterone levels are low. Men who have diseases that induce low testosterone are at risk for osteoporosis.
7. Diet: A diet deficient in calcium and vitamin D might raise the chances of developing osteoporosis and fractures. Excessive dieting or a lack of protein may also raise the risk of bone loss and osteoporosis.
8. Lifestyle: Low levels of physical activity and lengthy periods of inactivity can both contribute to accelerated bone loss. They also put you in poor physical shape, increasing your chances of falling and fracturing a bone. Chronic excessive alcohol use is a substantial risk factor for osteoporosis. According to research, smoking is also a risk factor for osteoporosis and fracture.
Treatment for Osteoporosis includes proper nutrition, changes in your way of life, exercise, fall avoidance is important in order to avoid fractures, medications.
DIAGNOSIS FOR OSTEOPOROSIS
Before any problems arise, your healthcare practitioner might schedule a test to provide you with information about your bone health. Dual-energy X-ray absorptiometry (DEXA or DXA) scans are other names for bone mineral density (BMD) examinations. These X-rays utilize extremely small quantities of radiation to evaluate the strength of the bones in the spine, hip, and wrist. Regular X-rays will only reveal osteoporosis if the illness has progressed significantly. Women over the age of 65 should undergo a bone density test. For women who have osteoporosis risk factors, a DEXA scan may be performed sooner. Men over the age of 70, as well as younger men with risk factors, should get a bone density test.
When you have osteoporosis, it’s critical to avoid fractures since they can lead to other medical issues. When your health care practitioner tailors a programme to your specific needs, exercise can help avoid fractures caused by falls and increase bone strength. Before beginning any fitness programme, speak with your doctor or physical therapist if you have osteoporosis or bone loss. Furthermore, avoiding falls helps to avoid fractures. Falls raise your chances of breaking a bone in your hip, wrist, spine, or other skeleton.
This author is a Lead Consultant – Orthopedics & Joints Surgery, Aster RV Hospital
RESEARCH: INTERMITTENT FASTING WORKS FOR WEIGHT LOSS, HEALTH CHANGES
According to a new study review led by University of Illinois Chicago researchers, intermittent fasting can produce clinically significant weight loss as well as improve metabolic health in individuals with obesity.
The findings of the study were published in the journal Annual Review of Nutrition. “We noted that intermittent fasting is not better than regular dieting; both produce the same amount of weight loss and similar changes in blood pressure, cholesterol and inflammation,” said Krista Varady, professor of nutrition at the UIC College of Applied Health Sciences and author of “Cardiometabolic Benefits of Intermittent Fasting.”
According to the analysis published in the Annual Review of Nutrition, all forms of fasting reviewed produced mild to moderate weight loss, 1 to 8 percent from baseline weight, which represents results that are similar to that of more traditional, calorie-restrictive diets.
Intermittent fasting regimens may also benefit health by decreasing blood pressure and insulin resistance, and in some cases, cholesterol and triglyceride levels are also lowered. Other health benefits, such as improved appetite regulation and positive changes in the gut microbiome, have also been demonstrated.
The review looked at over 25 research studies involving three types of intermittent fasting: alternate-day fasting, which typically involves a feast day alternated with a fast day where 500 calories are consumed in one meal, 5:2 diet—a modified version of alternate-day fasting that involves five feast days and two fast days per week, time-restricted eating—which confines eating to a specified number of hours per day usually four to 10 hours with no calorie restrictions during the eating period.
Various studies of time-restricted eating show participants with obesity losing an average of 3 percent of their body weight, regardless of the time of the eating window.
Studies showed alternate day fasting resulted in weight loss of 3% to 8% of body weight over three to eight weeks, with results peaking at 12 weeks. Individuals on alternate day fasting typically do not overeat or binge on feast days, which results in mild to moderate weight loss, according to the review.
Studies for the 5:2 diet showed similar results to alternate-day fasting, which surprised the study’s reviewers. The subjects who participate in the 5:2 diet fast much less frequently than alternate-day fasting participants do, but the results of weight loss results are similar.
Weight loss in both the alternate day and 5:2 fasting are comparable to more traditional daily calorie-restrictive diets. And, both fasting diets showed individuals were able to maintain an average of 7% weight loss for a year.
“You’re fooling your body into eating a little bit less and that’s why people are losing weight,” Varady said.
Varady added the review set out to debunk some myths regarding intermittent fasting. Intermittent fasting does not negatively affect metabolism, nor does it cause disordered eating, according to the studies reviewed.
“Fasting people are worried about feeling lethargic and not being able to concentrate. Even though you are not eating, it won’t affect your energy,” Varady said. “A lot of people experience a boost of energy on fasting days. Don’t worry, you won’t feel crappy. You may even feel better.”
The study review includes a summary of practical considerations for those who may want to try intermittent fasting. Among the considerations are:
Adjustment time—side effects such as headaches, dizziness, and constipation subside after one to two weeks of fasting. Increased water intake can help alleviate headaches caused by dehydration during this time.
Exercise—moderate to high-intensity endurance or resistance training during food abstention can be done, and some study participants reported having more energy on fast days. However, studies recommend those following alternate day fasting eat their fasting day meal after exercise.
Diet during fasting—there are no specific recommendations for food consumption during intermittent fasting, but eating fruits, vegetables, and whole grains can help boost fibre intake and help relieve constipation that sometimes accompanies fasting.
Alcohol and caffeine—for those using an alternate day or 5:2 fasting plan, alcohol is not recommended on fast days as the limited calories should be used on healthy foods that provide nutrition.
There are several groups who should not intermittent fast, according to the studies. Those individuals include: those who are pregnant or lactating, children who are under 12, those with a history of disordered eating, those with a body mass index, or BMI, less than 18.5, shift workers—studies have shown they may struggle with fasting regimens because of shifting work schedules, and those who need to take the medication with food at regimented times.
“People love intermittent fasting because it’s easy. People need to find diets that they can stick to long term. It’s definitely effective for weight loss and it’s gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto,” Varady said.
It’s definitely effective for weight loss and it has gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto.
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