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AN EASY GUIDE FOR HEALTHY LIVER

Doctors share problems associated with the liver, symptoms, diagnosis, treatment and ways to keep it functioning well.

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LIFESTYLE CHANGES FOR HEALTHY LIVER

• Maintain a healthy weight (Ideal BMI being around 23.5)

• Eat a balanced diet. Avoid high calorie-meals, saturated fat, refined carbohydrates (such as white bread, white rice and regular pasta) and sugars.

• Limit your alcohol intake (not more than 2 standard drinks a day in men and 1 standard drink a day in women, a standard drink being a pint of beer or a glass of wine or a peg of hard drinks like whisky)

• Exercise regularly for at least 30-45 min a day for at least 5 days a week

• Practice safe sex and avoid unnecessary sharing of toothbrushes, razors, needles and other personal care items• Avoid illicit drugs and contaminated needles

• Get vaccinated for Hepatitis A and Hepatitis B• Be careful with traditional/alternative medicines and weight loss pills By Dr Mrudul Dharod, Consultant, Gastroenterologist, Wockhardt Hospital Mira Road, Mumbai

GOOD AND BAD FOOD FOR LIVER

• We need to take care of our liver. It is one of the most important organs in our body and is responsible for ensuring bile production and excretion, excretion of bilirubin, cholesterol, hormones, drugs, metabolism of fats, proteins, carbohydrates, and enzyme activation.• Fatty liver and non-alcoholic fatty liver are the two main conditions that indicate that all is not well with our liver. Liver cirrhosis is when the liver is badly scarred or has/is on the verge of failure. These conditions are a result of excessive alcohol consumption, smoking, highly processed food, obesity, and a sedentary lifestyle. The liver does need to cleanse so that it can continue to perform at optimum capacity and to do so diet is essential.• If one has a fatty/ non-alcoholic fatty liver, they need to consume a lot of fruits and vegetables, legumes, and whole grains. Foods like fish, oatmeal, walnuts, avocado, and even coffee need to be included in the diet. In addition to this, garlic, milk products, olive oil, sunflower seeds, and tofu can be included in the diet to make it interesting.• Drinking lots of water prevents dehydration and helps your liver to function better.• Say no to sugar, salt, trans fat, refined carbohydrates, saturated fat, alcohol, white bread, red meat, fried food, raw or undercooked shellfish such as oysters and clams.• Depending on the type of condition one is suffering from they need to speak with their doctor about their consumption of protein, iron and copper.

The liver performs several key functions. It is essential for digesting food and getting rid of toxic substances from the body. There are many liver diseases including hepatitis, liver cancer and cirrhosis. The causes range from genetics to infection and autoimmune diseases. Dr Manish Kak, Senior Consultant, Gastroenterologist, Columbia Asia Hospital, Ghaziabad, says: “Liver disease can be inherited but can also be caused by a variety of factors such as viruses, alcohol use and obesity. Liver disease symptoms vary depending on the underlying cause. However, there are some general symptoms like jaundice, loss of appetite, itchy skin, dark urine, and improper digestion. Several conditions may affect the liver such as hepatitis, autoimmune disease, and genetic conditions like cystic fibrosis. Early diagnosis of liver problem help to start the treatment sooner and chances of cure is higher. Left untreated, it can cause permanent damage. Untreated liver disease may progress to liver failure that is a life-threatening condition. However, acute liver failure may happen suddenly, often in response to an overdose or poisoning.”

He adds that for some people, lifestyle changes such as limiting or abstaining from alcohol, maintaining a healthy weight, drinking more water, adopting a liver-friendly diet that includes plenty of fibre while reducing fat, sugar, and salt are enough to prevent liver disease. Dr Kak shares a piece of advice, “If you have any symptoms of a liver problem or are at risk of developing one, make sure to check with your doctor for routine checkups and screening tests.”

Since with early diagnosis of liver diseases, chances of cure are higher, Dr Ravi Mohanka, Chief Surgeon and Head of Department, Transplant and HPB Surgery, Global Hospital, Mumbai shares the warning signs and treatment:

– Jaundice (yellowness of eyes and urine) treated with some medicines and observation

– Swelling of feet and abdomen (Ascites) can be controlled with diuretics (medicines) that causes patients to make more urine

– Excessive sleepiness, irrelevant talking or even coma, treated by keeping ammonia level low with some medicines and passing frequent stools

– Blood vomiting or very dark black stools, controlled by endoscopy

– Secondary kidney failure

Adding to it, Dr Mrudul Dharod, Consultant Gastroenterologist, Wockhardt Hospital Mira Road says, “the warning signs of underlying liver disease are: Jaundice (yellowish discolouration of eyes and skin), nausea/vomiting, itchy skin (especially over hands and legs, and more at night), chronic fatigue, distension of abdomen (due to water collection in the abdomen), swelling over legs, easy bruising, blood in vomiting and altered behaviour. The foremost treatment for liver diseases is identifying the causative factors like Viruses (HAV, HEV, HBV, HCV), alcohol, drugs or other rare causes and then specifically target the inciting factor. The rest of the treatment is supportive of medical management.”

To ward off liver diseases, Dr Mohanka opines, “people should not consume alcohol or have it in moderation, undergo Hepatitis C or B test and if positive opt for treatment, control obesity, diabetes and high cholesterol.”

CHRONIC LIVER DISEASE AND COVID-19

Does chronic liver disease increase your risk of severe Covid-19? Dr Praveen Jha, Consultant, Gastroenterology, Regency Superspeciality Hospital, Lucknow replies, ‘’People need to be extra cautious if they have any chronic liver disease such as hepatitis B, hepatitis C, fatty liver or cirrhosis as they have a greater risk than other individuals for severe Covid-19 and the occurrence of complications including prolonged hospital stay and mortality. The pandemic is having a major effect on the management of patients with chronic liver diseases, in particular those with cirrhosis, hepatocellular carcinoma and liver transplantation programmes.”

“The potential onset of Covid-19 in patients with chronic liver disease raises two questions: will patients with chronic liver disease develop a more severe form of Covid-19; and will Covid-19 aggravate the course of their liver disease and induce liver-related mortality. Patients with cirrhosis seem to be at greater risk than other individuals for severe Covid-19 and the occurrence of complications including mortality regardless of the aetiology of liver disease. If these patients have associated metabolic comorbidities that include obesity, diabetes, and hypertension, then they are at higher risk of developing severe Covid-19. Therefore, it is crucial to monitor liver enzymes in Covid-19 patients. This is especially true because the liver is the only organ that can regenerate after an injury so patients do not show symptoms of a liver disease till the liver is about 80% damaged,” he adds.

Dr Manjunath Malige, Lead Consultant – Bariatric Endocrinology & Diabetes, Aster RV Hospital, Bengaluru says, “Severe Covid-19 can impact the liver, particularly in those who are already suffering from co-morbidities or liver disease. The exact impact is yet to be fully understood but people with chronic liver disease are at a high risk of suffering from severe Covid-19.”

Dr Sharad Malhotra, Specialist- Gastroenterology Hepatology & Therapeutic Endoscopy, Aakash Healthcare, New Delhi says that the Covid-19 has taken a toll on people who are suffering from liver diseases. The dreaded infection can cause direct inflammation of the liver, deterioration of the existing liver disease, and in some serious cases liver failure also. Dr Malhotra asserts, “In our hospital, we have come across several such patients having liver damage in mild to severe cases of Covid-19. Consuming alcohol should be completely stopped as it can lead to alcoholic hepatitis, fatty liver, liver cirrhosis, and liver cancer.”

How can alcohol consumption impacts liver health, Dr Jha answers, “Alcohol and drug use can translate into a substantial increase in blood-borne virus transmissions as well as in alcoholic liver disorders and decompensations, resulting in many more patients with cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related death.’’

FATTY LIVER DISEASE

Fatty liver is a condition where excess fat builds up in the liver. Dr Malige says, “Fatty liver does not have very obvious symptoms and often gets detected when it is in a severe state. A liver biopsy is required to determine the extent of fatty liver disease. Often people attribute the symptoms to something else. Bloating or pain in the abdomen, appetite loss, uncharacteristic weight loss, sometimes jaundice, swelling in the legs, fatigue and inability to concentrate are some signs of fatty liver disease. Heavy drinkers, people with type 2 diabetes, and obese people are all at a high risk of developing fatty liver disease.” Talking about the treatment, he says lifestyle changes play a key role in reversing the damage. In people suffering from type 2 diabetes, or obesity, addressing these conditions will help treat the fatty liver. Options such as a weight loss management programme, medications to lose weight, or bariatric surgery will help address fatty liver as well. Alcoholics must quit the habit and follow a healthy lifestyle with a well-balanced diet and sufficient exercise.By Daljit Kaur, Chief Dietitian, Fortis Escorts Heart Institute, New Delhi

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Health & Wellness

REASONS TO MAKE THE SWITCH TO MENSTRUAL CUP

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Q. How menstrual cups are better than sanitary pads?

A. Menstrual cups are new and safe as compared to sanitary pads. They collect the period blood instead of absorbing the blood and hence there are no chances of vaginal infection. Depending on the flow, one cup can last for four to 12 hours. With lesser chances of leakage, one can sleepy freely with menstrual cups. Sanitary pads tend to give you rashes. They are cost-effective as well, as one cup sanitised the right way, can last for years.

Q. What are the benefits of using menstrual cups for both females and the environment?

A. Menstrual cups are safe and effective as they are cost-effective as well. As cups collect the blood and do not absorb them, so there are no chances of vaginal infection. In terms of environment, Menstrual cups are environment friendly as well as they reduce waste and water usage. Women can reduce plastic waster by using a menstrual cup. One cup produces an estimated 0.4% of the plastic waste that single pads build up or 6% of them is created by tampons in 10 years.

Q. Tell us about the change in the consumer demands of the menstrual cups?

A. With women understanding the usage of menstrual cups and their benefits, there has been a considerable increase in the demand for menstrual cups. A cup could cost roughly five to seven per cent of the cost of using 12 pads (on average $ 0.31 each) or tampons (on average $ 0.21 each) per period. 

Q. What are the things one should keep in mind while buying the cup?

A. Here are the key factors which one should keep in mind while buying the cups:

• The material of menstrual cups, as to what it is made of. Is it medical grade silicone, latex, plastic or rubber? Cups made of medical-grade silicone are the best ones

• Thesize of the cupas per your requirement is small or large. Small-sized cups are good for women below the age of 30 and large size cups are recommended for above 30 women

• Functionalities of the cup in terms of stem, firmness, shape, and seams

Stem: Most menstrual cups have a stem on the bottom. It acts as a guide, which helps you to locate your cup easier while removal.

Firmness: Finding the right firmness for your body, makes a huge difference in comfort and effectiveness.

Shape: Determine the shape of the cup depends on the cervix height as everybody is different.

Seams:In some cups, the seams are around the rim, some have a seam running from stem to rim, while some are seamless. It is important to understand the seam as in some cases a rough seam can cause irritation or scratch in the vaginal wall.

Q. Share some tips to keep the cup clean and sanitised?

A. Tips to keep the cup clean and sanitised:

1. Wash your hands properly before touching the cup.

2. Since silicone cups are bacteria resistant, you don’t need to wash yours every time you empty them. Simply rinsing it in the sink is enough to clean it out before reinserting. To avoid stains, you can initially rinse with cold water, then follow it up with a hot rinse to disinfect.

3. Once your period is over, you might want to give your cup a good clean before you store it, both for peace of mind and to remove any stains.

4. Boil three cups of clean water on the stove. (Tap water is fine if you’re in a place with safe water but if not, use bottled water instead.) Submerge your cup but make sure the cup isn’t touching the bottom or sides of the pot. One way to do this is to put your cup inside a whisk to hold it away from the sides. Boil for five to eight minutes then drain the cup and let it air dry. It is completely safe to boil the cups, but don’t boil the pot dry as this will destroy the silicone. If you feel strange about using a pot you cook with, you can buy a small one specifically for boiling your cup and store it separately.

5. Sterilising tablets for baby bottles isgreat because you can use them in cold water so they’re ideal if you live in a dorm room with no access to a stove or just don’t feel comfortable boiling your cup in a shared kitchen. Follow the manufacturer’s instructions. These tablets are also great at removing stains.

The writer is Director, Namyaa Skincare.

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COMMON MYTHS ABOUT PROTEIN YOU SHOULD STOP BELIEVING

RITIKA SAMADDAR

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Protein is an essential nutrient present in every single cell in our body and is required for the growth and repair of the body. Approximately one-fifth of our body weight is protein. The protein requirement for an adult is 0.8g per kg body weight per day for adults. You have to eat protein every day. The body can’t store protein like it can store carbohydrates and fats. The Protein Week is observed from 24 to 30 July to spread awareness about the need to incorporate protein in our daily diet.

There are many myths around protein consumption. The most common myth is protein is only for muscle development and not so important for the general population. On the contrary, protein is an essential nutrient that is key to building immunity and for growth and immunity. It is required not only for muscle but also for bone, joints, tendons, ligaments, hair, antibodies, hormones, and enzymes. The body is made of muscle mass, fat mass, bone and water. A healthy body should have more muscle mass and less fat mass. And replacing our diet with healthy proteins instead of fats and carbohydrates is the ideal way to have a healthy body. 

The other common myth is intake of protein can lead to kidney damage. Most believe that taking a protein-rich diet puts loads on the kidney and damages it. On the contrary, protein is an essential macronutrient and is needed for survival. Also, the common perception is that with age one should reduce protein intake as it can damage the kidneys. Muscle loss is a natural part of ageing, and if one doesn’t take adequate proteins, it leads to reduced energy levels and low muscle strength. The recommended dietary allowance is 0.8 to 1 g /kg body weight, for a healthy adult which is around 50g to 60g per day grams daily, whereas the daily need increases during illness or increased activity level. Deficiency of protein can lead to impaired physical development, oedema, low immunity, and low muscle mass. One can meet the daily needs of protein by eating eggs, fish, dairy, legumes, meat, poultry, and nuts. 

Another very common myth is intake of protein leads to weight gain. Proteins are the key to losing weight the healthy way. Taking good amounts of good quality proteins like eggs and poultry can help healthy weight loss, by increasing satiety, boost up metabolism and loss of fat mass and build-up of muscle mass. Consuming insufficient protein on the other hand can actually make it harder to lose weight. Even if one loses weight by cutting the protein, chances are that its muscle — not fat — will lose. Not eating enough protein can lead to side effects including fatigue, weakness, and a low immune system. Including protein in daily diet is essential and 10% to 15% of the total calories should come from protein. So let’s pledge this Protein Week that we all will make protein a part of our diet plan.

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WHAT IS THE LINK BETWEEN PREGNANCY & HEPATITIS E?

Dr. Premashis Kar

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Hepatitis E Virus (HEV) causes acute hepatitis and is a hepatotropic pathogenic virus. Due to insufficient sanitation, this infection is endemic in several impoverished nations, especially in India. HEV infection is one of the leading causes of acute viral hepatitis. This disease is mainly spread orally by contaminated drinking water. World Hepatitis Day is observed on 28 July every year, to raise awareness of the problem of viral hepatitis and how viral hepatitis impacts over 354 million people worldwide.

In India, HEV genotype 1 and genotype 2 which is mostly responsible for the cases of viral hepatitis and is feco-orally transmitted. Viral hepatitis has been a major public health problem in India. HEV infection is responsible for most of the pandemics that have occurred in India and is responsible for 30% to 70% of the sporadic cases of viral hepatitis and the major cause of acute liver failure. It has been observed that viral hepatitis is the most common cause of jaundice during pregnancy and causes HEV infection. Classically acute viral hepatitis occurs during the second and third trimesters of manifesting with malaise and jaundice.

It is not clear why HEV infection has a predilection to occur specifically during pregnancy. Severity had been attributed to the variable immune response or hormonal factors. Many patients are contemplating whether the occurrence of viral hepatitis has a safe course during pregnancy. Most of the patients with viral hepatitis during pregnancy will recover within four to six weeks of the onset of jaundice. However, these patients need to be instructed that they should continue to be under the supervision of physicians and gynaecologists till jaundice settles down clinically and biochemically.

The liver function tests and serological tests (IgM anti-HEV) are the key tools for the diagnosis. In India, HEV infections (genotype 1 and 2) have a fulminant course during pregnancy compared to developed countries where genotypes 3 and 4 are believed to have mild disease. The follow up of the cases during pregnancy is needed to detect complications like acute liver failure, stillbirth and eclampsia, postpartum haemorrhage. Those cases of viral hepatitis during pregnancy that have a severe downhill course, the outcome is associated with premature delivery, stillbirth and abortions.

If there is any indication that the patient has persistent vomiting and altered mental status, it indicates the possibility of acute liver failure and the patient needs immediate hospitalisation and with intensive care, they may recover.

In such a situation the physician and the patient should understand that the termination of the pregnancy does not alter the course of the disease. Early liver transplant has been carried out in some centres even for patients of ALF during pregnancy. This is also possible in some of the centres involved in liver transplantations in India. All patients with viral hepatitis during pregnancy should be advised to have hospital delivery. In conclusion, though viral hepatitis cases during pregnancy may have a safe course, yet it needs close monitoring to detect complications that could be effectively treated.

The writer is a Senior Director & HOD – Gastroenterology, Max Super Speciality Hospital, Vaishali.

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A POST-COVID SIDE EFFECT: ALL YOU NEED TO KNOW ABOUT GUILLAIN-BARRÉ SYNDROME

Guillain-Barré syndrome is a rare neurological and potentially life-threatening disorder. Let’s learn about the causes, symptoms, dos and don’ts, and how early detection can help save lives.

Dr Shobha N

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Guillain-Barré syndrome (GBS) is a rare neurological disorder in which the body’s immune system mistakenly attacks part of its peripheral nervous system, that is, the network of nerves located outside of the brain and spinal cord. From very mild cases with brief weakness to critical stages of paralysis that can cause a disability to breathe independently, patients can face a wide range of complications with GBS.

It has been observed that Guillain-Barré syndrome is a potentially serious hurdle associated with Covid-19 today. Many patients developed the GBS three weeks after testing positive for Covid-19. As Covid-19 is also a viral infection caused by a neurotropic virus, it can trigger this syndrome in a patient. The increase in Covid-19 cases has significantly resulted in many Guillain-Barré syndrome cases. People within the age group of 25 to 35, and 50 to 70 are most commonly affected.

It is essential for family members to keep a watch out for any of the symptoms.

Below are the indications:

1. Pricking or pins and needles sensations in the hands and feet

2. Instability and lack of coordination

3. Difficulty swallowing, speaking or chewing

4. Muscle twitching

5. Vision and eye muscle difficulties

6. Abnormal heartbeat/rate or blood pressure

7. Problems with digestion and/or bladder control.

As soon as a person notices any signs of Guillain-Barré syndrome, he or she should see a doctor for a definitive diagnosis. Early detection can aid in the treatment process and make it easier. A neurologist (a specialist who specialises in nervous system illnesses) will be involved in the treatment and may perform certain tests like nerve conduction studies (NCS) electromyography (EMG) that measures the electrical activity of nerves and muscles, lumbar puncture (spinal tap) and analysis of spinal fluid, along with breathing and blood tests.

1. Patients demonstrated considerable improvement after five days of IVIG treatment and plasmapheresis

2. If ventilator assistance is required, the patient must be admitted to an intensive care unit

3. It has also been observed that there is a residual disability at the time of discharge

Here is a list of do’s and don’ts if you are diagnosed with GBS:

1. Do understand that Guillain-Barré syndrome can be devastating because of its sudden and unexpected onset

2. Do realise that recovery isn’t necessarily quick. It might take a few weeks, sometimes months, or even years to recover from GBS.

3. Do call your health care provider if you notice muscle weakness

4. Do call your healthcare provider if you develop numbness or tingling feelings, have trouble swallowing or breathing, feel depressed or get a fever

5. Don’t be afraid to ask for social and emotional support

6. Don’t miss any follow-up appointments after being discharged from the hospital

It is essential for people to be aware of this syndrome as the diagnosis becomes more challenging when the patient visits the hospital at later stages for treatment. More awareness can indeed save lives.

The writer is a Consultant – Neurologist and Stroke Physician, Manipal Hospitals, Malleshwaram.

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CORONAVIRUS PANDEMIC: THE TRIGGER FOR AYURVEDA RENAISSANCE

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When a seemingly innocuous virus entered the city of Wuhan in the last month of the last decade, nobody could predict that the whole world would be paralysed for the next entire year and more! Moreover, the ordeal is far from over and the medical and healthcare fraternity world over is still struggling to find the viral antidote, pinning all the hopes on the highly anticipated vaccine. However, with the collapse of the conventional medicinal system, the general population has realised that a sturdy immune system is the best defence against any pathogen and to achieve this, natural health alternatives are being explored vigorously. 

The oldest of all medicinal systems, Ayurveda, has proved its mettle in the pandemic already! Under the guidance of the AYUSH ministry, many Ayurvedic institutions throughout the country have shown excellent results in the management of Covid-19 infections, both in acute and post-Covid phases. Numerous trials are going on and the results look promising.

The science of life, Ayurveda, has generated enormous curiosity in the last few years and many people have shifted to the Ayurvedic way of living and managing disease as it is holistic and believes in reversing the pathology without any side effects. The two-folded aim of Ayurveda is ‘prevention’ and ‘cure’ for which discrete guidelines are given in the stipulated clinical texts about aahar (healthy eating), vihara (healthy lifestyle), nidra (sleeping habits), dinacharya (daily regimen), ritucharya (seasonal regimen), and various treatment modalities incorporating scientific nutrition, thousands of herbo-mineral formulations and detoxifying treatments such as panchakarma.

With the advent of the pandemic can Ayurveda turn this opportunity and redeem itself to its lost glory? Let’s explore in this article:

1. Preventive holistic aspect of Ayurveda in the pandemic – Cellular health support, Immune health support, neuroendocrine support, Nutritional support through phytonutrients

2. Covid-19 and effective Ayurvedic protocol – no side effects, decongestant and lung-protective medications, cardioprotective, immunomodulator, cellular repair, mental support, Rasayan therapy etc. There are numerous successful trials throughout the country.

3. Change in societal perception about health and disease – Recent awareness about the rise and prevalence of metabolical and lifestyle disorders like obesity, diabetes, hypertension, hypercholesterolemia etc and the limitations of conventional medicine to treat them, whereas Ayurveda successfully managing and reversing them.

4. Governmental recognition and approval – The current government with its pro-Swadesi approach has renewed its efforts in reinforcing the traditional Indian medical system. Ayurveda is being given a crucial place in the annual health budget and rigorous steps are being taken to integrate Ayurveda in the present healthcare infrastructure at the ground level.

5. Rise in popularity outside India – Worldwide, Ayurvedic medicine and products are increasing in popularity. Many students have been coming to India in recent years to learn Ayurveda and practice and propagate it back in their countries.

6. Rise in demand for Herbal supplements – With health and wellness being the biggest priorities now, the demand for nutraceuticals and immunity boosters is globally increasing. Many companies like Patanjali and Himalaya have given reports of a phenomenal rise in sales of immune-boosting supplements and respiratory medication. 

7. Refurbished standardisation protocol of Ayurvedic medications and supplements – There have been tremendous upgrades in the standardisation protocols for Ayurvedic medications and nutritional supplements making them safer for a bigger audience and an easy entry into the global market. The required regulations are under the FSSAI, FDA, Good Manufacturing Practices (WHO-GMP), ISO 9000 and Hazard Analysis and Critical Control Points (HACCAP) certifying boards.

8. India as an emerging leader in the global herbal drug market – India is currently the number 1 producer, manufacturer and exporter of herbal raw material and end products. Even the modern pharma industry relies largely on the herbal raw material supplied by India for its active ingredient extraction that is used in numerous modern medications. 

9. Vast scope for the investment in Ayurveda – Multisectoral industries like health, pharma, food, agriculture, media and trade are renewing their investment interests in Ayurveda looking at the current growth patterns in the market trends. 

10. Rediscovering and redefining marketing strategies – All that Ayurveda needs right now is an on-point marketing strategy to reach the masses and the capitalists. There have to be scientific studies, researches and relevant clinical trials that can show the documented potential of Ayurveda to the world. The preventive aspect of Ayurveda should reach the common stakeholders through proper educational channels and the various treatment modalities within Ayurveda should be researched and re-established through relevant institutions and hospitals making it easier for the common man to embrace Ayurveda. 

 The writer is the Founder of Nyrrvana Cosmetics.

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POST-COVID COMPLICATION: MIS-C GETS PARENTS WORRIED

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Covid-19 was not known to affect children in the first wave. However, it has not been the same in the second wave, as children and youngsters have been affected by the coronavirus. Though they are experiencing mild or moderate symptoms of the infection, post-Covid complications are what worry the parents. 

COVID-19 AMONG CHILDREN

Adults were mostly affected by Covid-19 in the first wave. The immediate lockdown and closure of schools helped children to skip Covid’s radar. Though few children got infected, the symptoms among them were mostly mild or were asymptomatic. However, in the second wave, the number of children getting infected due to coronavirus has increased. The most concerning part are the increasing cases of MIS –C (Multi-system inflammatory syndrome in children). 

MIS-C IN CHILDREN

Children affected by Covid-19 in the second wave are experiencing mild or moderate symptoms. However, post their recovery from Covid within two to four weeks or in few cases even beyond, they are found to develop high-grade fever and other complications which are known as MIS-C. This Multi-system inflammatory syndrome in children affects multiple organs like the heart, lungs, and brain. A child can experience different symptoms like:

• Rash on the body

• Conjunctivitis

• Abdominal pain 

• Swelling in the neck

• High-grade fever

• Diarrhoea 

• Vomiting

• Feeling tired 

Some of the severe symptoms of the MIS-C could be trouble in breathing, pain or pressure in the chest, pale, grey or blue-coloured skin, lips, or nail beds, and severe abdominal pain. In few children, these symptoms may go to an extent of seizure or septic shock. 

MIS-C mostly affects children after two to three weeks of testing positive for Covid-19. It is to be noted that, MIS-C is not a life-threatening condition and can be treated effectively if it is identified early. MIS-C is considered as an immunological reaction to a past Covid infection. Children with the condition may commonly test negative for RT-PCR/antigen test and will only be antibody positive. In one-third of infected children, MIS-C can mimic another disease called Kawasaki Disease associated with inflammation of the blood vessels to the heart. While most children with MIS-C recover extremely well with no significant long term sequelae, a small proportion can develop complications related to the heart.

MIS-C can occur in children of any age, however, it is mostly seen in kids in the age group of 3 to 12 years. Babies or older children may also have the risk of developing MIS-C. 

COMPLICATIONS OF MIS-C

MIS-C is a complication that occurs due to Covid-19. Therefore, identifying the symptoms is crucial. A delay in treatment or inappropriate management can lead to severe problems to the vital organs like the heart, lungs, and kidney. In rare cases, MIS-C can lead to permanent damage to the organs or could be even fatal. 

STEPS TO BE TAKEN TO KEEP THE CHILDREN AWAY FROM INFECTION: 

• Hand hygiene –Ensure kids wash hands often with soap and water for at least 20 seconds. If soap is not available, use a hand sanitiser with at least 60% alcohol content.

• Keep children away from people who are sick –It is suggested to keep children away from unwell people, in particular, people who are coughing and sneezing. 

• Social distancing – Ensure that your child maintains social distancing when outdoors. 

• Wear face masks when in the outdoors – There is a high risk of Covid transmission when you and your child are outdoors. Make sure both of you wear a face mask that covers both nose and mouth. 

• Avoid touching your nose, eyes and mouth – Encourage your child to follow your lead and avoid touching his or her face without washing hands. 

• Cover your mouth when you sneeze or cough – Advise the kids to practice covering their mouths when they sneeze or cough to avoid spreading germs.

• Disinfect surfaces –Clean and disinfectareas of your home such as doorknobs, light switches, remotes, handles, countertops, tables, chairs, desks, sinks and toilets.

The writer is a Consultant, Columbia Asia Referral Hospital, Yeshwanthpur (A unit of Manipal Hospitals).

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