2020 is the year most of the world would like to forget and wish that on one is exposed to such a situation ever. Our understanding of Covid-19 and its impact is limited still and the treatment is based more on symptoms rather than targeting the virus itself. The route of infection is mainly through mouth, nose and eyes and the latest WHO information suggests that this virus can spread through the air. Therefore, it is advised to wear masks to protect us and others around.
When we see the patients around us, most fatalities due to Covid-19 is happening to elderly and those with comorbidities, indicating that the virus impacts multiple organs and can cause damage through various parts of the body. It’s a known fact that Covid-19 is mainly characterised by symptoms such as fever, dry cough, fatigue and sore throat and as per the current understanding, the primary organ targeted is lungs.
Covid-19 has demonstrated a wide spectrum of clinical manifestations from asymptomatic or paucisymptomatic forms to severe viral pneumonia with respiratory failure, multi-organ and systemic dysfunctions in terms of sepsis and septic shock and death.
Low oxygen, breathing difficulty
The virus enters the cells by binding to receptors Angiotensin-converting enzyme 2 or ACE2 which are found on it. These receptors act as the site of entry and are found in the cells of multiple organs, making it easy for the virus to enter. For instance, the human lungs contain tiny air sacs known as alveoli. These are responsible for the exchange of oxygen between lungs and blood vessels. These alveoli are rich in the ACE2 receptors. When the virus enters these cells, the immune system mounts an all-out battle against the virus. This disrupts oxygen transfer and makes breathing difficult, accompanied by cough.
The most frequent, serious manifestation of Covid-19 infection seems to be pneumonia, which is characterised by cough, fever, dyspnea and bilateral infiltrates displayed on radiographic chest imaging. Unfortunately, there are no specific clinical features that discern Covid-19 from other viral respiratory illnesses. Although most patients will only experience mild symptoms of the disease, some patients will experience rapid progression of their symptoms over a week.
ARDS is a cause of concern
One study found that 17% of their patients developed Acute Respiratory Distress Syndrome (ARDS) and among these, 65% rapidly worsened and died from multiple organ failure. In a study focusing on the associated risk factors, it was reported that ARDS was greatly associated with older age (over 65 years old), diabetes mellitus, and hypertension. For most cases, bilateral lower zone consolidation (identified through chest x-ray) peaked at 10-12 days from symptom onset.
Patients with CVD at greater risk
Patients with existing cardiovascular disease (CVD) are at a greater risk of suffering from severe Covid-19 and having poorer prognosis. A meta-analysis comprising 46,248 patients who were Covid-positive found that the most common co-morbidities were hypertension (17%), diabetes (8%) and CVD (5%). CVD and hypertension have also been more prevalent in the severe patient group as compared to non-severe cases. Existing CVD is also associated with higher mortality. On the other hand, it is widely agreed that coronavirus can also have adverse effects on cardiovascular health itself, causing or aggravating damage to the heart. There are reports of cardiogenic involvement in patients without known CVD as well as cases with solely cardiac presentations.
A significant number of patients reported GI symptoms such as diarrhoea, nausea, vomiting and abdominal pain, with some reporting these symptoms as their sole presenting complaint. The incidence of GI symptoms, alongside the detection of SARS-CoV-2 RNA in stool samples of infected patients, suggest that ACE2 receptors highly expressed in the GI tract are another target for SARS-CoV-2 infection.
Liver injury in corona patients
Mild and transient liver injury, as well as severe liver damage, can occur in Covid-19. Wong et al indicated that 14.8to 53.1% of Covid-19 patients had abnormal levels of alanine aminotransferase, aspartate aminotransferase and bilirubin during the course of the disease, with bilirubin showing the smallest elevation. Furthermore, they reported that the severity of liver damage is proportional to that of Covid-19. Gamma-glutamyltransferase was elevated in 54% of patients in one cohort study that included 56 Covid-19 patients.
There have been reports of strokes among patients. As blood vessels are present all over our body, any effects on them are not restricted to a specific organ such as lungs, kidneys and intestines. So if Covid-19 directly affects the blood vessels of a patient, they will cause blood clots more easily as they are damaged.
In autopsies done on deceased Covid-19 patients, blood clots are apparent throughout many organs in their bodies. This suggests that many blood vessels and organs are affected. Once you have blood clots, you may have complications like stroke where blood clots travel to the arteries of the brain and clog them up. Doctors have also observed patients with dizziness, confusion, delirium, altered mental state and muscle weakness. Blood clots can lead to a heart attack or a pulmonary embolism when a clot gets into your lungs.
We need to look into this pandemic in a detailed way and the studies will pave way for the right treatment options and more inside information about the virus and its treatment. We cannot just rely on temperature reading to be Covid-positive or negative. The community needs to take this pandemic seriously and continue practising social distancing and other preventive measures.
The writer is director and HoD interventional cardiology at Max Super Speciality Hospital, Shalimar Bagh, Delhi.
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The Power of Seva
If I were to ask you as to what differentiates the human species from other species, your response would probably be that humans are bipedal, have the power of language, are self-aware, can think, but what really differentiates us is our capacity to do “seva”, our ability to help others. Only the human species has this capacity for helping all life forms, which we call altruism, prosocial and philanthropic behaviour. But the essence is captured in the word ‘seva.’
Seva is a Sanskrit word meaning selfless service and is perhaps considered the most important part of our existence. It asks us to serve others with no expectation of outcome. A parallel western concept is volunteerism/help/service/community/social service, philanthropy, and the more contemporary and chic Corporate Social Responsibility and Institutional Social Responsibility.
Seva is a motivational state that a person possesses with the goal of increasing the welfare of another living being. While Seva, on the surface, seems to benefit others, it is actually the individuals engaged in Seva who also benefit. Seva is positively correlated with happiness, health, and well-being. People who did Seva showed greater satisfaction in life and exhibited reduced rates of depression and anxiety. So when you feel depressed, lonely, or anxious, go out and do seva. It could be working with animals, humans, the environment, etc. It is therapeutic and all-consuming and leaves no room for negativity.
While many of us feel drawn to helping others, our ego tends to drop in and voice our own thoughts. We use it to promote ourselves, our brands, and flaunt our service, which makes it counterproductive. Ego can also judge how we serve others. It may tell us that some types of service are more noble than others. “Oh, you help your neighbour once a week with her groceries? Well, I run events that serve 500 people.” “Oh, you help animals. Why don’t you help old people or children? “ This is not seva but the ego at work, because the aim of seva is to silence the ego, dissolve the ego, as all mental diseases emanate from the ego and its fears.
When we serve with the essence of seva in mind, we begin to see the myriad ways the ego, the source of all our troubles, is standing in front of the heart. When we transition from the head to the heart, then Seva becomes a practice of purification, a spiritual act. It is also in listening to the heart that we begin to understand that our innermost nature is a giving one. While the ego mind may tell us we need to focus on ourselves and even when we serve, it is when we shift into the spirit of seva that we realise we are naturally kind. In other words, we are naturally moved to serve others. It is when we do seva that we realise that all life is connected and working for others is the only path to mental fitness, wellness, and wellbeing and the royal road to spiritual growth.
The question you need to ask yourself for your happiness is, “Did you do Seva today?”
Dr Chavi Sharma Bhargava is the founder and CEO of Indic Center for Psychological Wellness and Holistic Health and Conversationists-Talking Cures.
Dr. Vishali Gupta becomes the first Indian in Asia to become President of the global Uveitis body
In a rare feat, an ophthalmologist from India, the First in Asia outside US and Europe, has become President of the International Uveitis Society Group and has been able to mark PGIMER at the global level. Uveitis is a field of medical science in which rare specialists are found and trained. The Daily Guardian had a one-on-one conversation with Dr. Vishali Gupta on this and talked about her responsibilities as president of this prestigious society.
What is this society all about? What is Uveitis?
The International Uveitis Study Group was formed in 1978 by a small number of clinicians who shared a common interest in Uveitis. Over the next almost 40 years, the group has increased in size to over 180 Uveitis specialists from all over the world.
What is uveitis?
Uveitis is the name given to inflammation inside the eye that, in some patients, can lead to blindness. It can affect one or both eyes, and the inflammation involves the uveal tract (iris, ciliary body, and choroid), although inflammation of adjacent tissues, such as vitreous humour, retina, and optic nerve also occurs. It could be due to autoimmune disease and seeing no age.
How long has the PGIMER been treating Uveitis, and how many experts does the department have?
PGIMER, under the stewardship of Dr. Amod Gupta, has been working in the field of Uveitis since the 1990s. Then a team of five experts inducted Tuberculosis in Uveitis for the first time in the world. PGIMER has a special clinic for Uveitis patients, and these patients’ treatments are long, sometimes lifelong. Since PGIMER has Rheumatology, Microbiology, Research Scientists, and Pediatricians all under one roof, it is easy for the patients to get the best treatment. In the other sectors, it is not that easy.
Foods that can help you REDUCE headaches, migraine
Following a healthy diet can increase longevity, protect against disease, and improve your overall quality of life. Several nutrients in food promote health and protect your body from disease. The “Food as Medicine” concept generally refers to managing food and diet in an individual’s routine, with the aim of preventing, reducing symptoms of, or reversing a disease process. Research has shown that dietary habits can influence risk factors for disease. While certain foods can trigger and aggravate health conditions, others may offer significant medicinal and therapeutic advantages.
Headaches are a common occurrence that is encountered routinely by individuals. A study conducted by Biman K Ray in 2017 revealed that the one-year prevalence of migraine in an Indian population was found to be 14.12%. Headaches can be triggered by several small incidents that might not be considered significant. Sleepless nights, skipping breakfast, work pressure or stress, and excessive blue-screen exposure are all examples of irregular routines that can cause headaches. Migraine is a disabling primary headache disorder experienced predominantly by women and triggered by hormonal, emotional, physical, dietary, environmental, and medicinal factors.
In individuals, migraine triggers can include specific foods or types of foods. Eating a healthy diet can help prevent migraines and headaches. Alternatively, certain foods can decrease the frequency of migraine headaches or lessen the intensity of their symptoms. Though no definitive ‘migraine diet’ has been described,’ individuals may be able to reduce their migraines by monitoring the food that they eat.
Foods to avoid
Nuts and certain seeds: Tyramine, present in nuts and certain seeds, can induce headaches and migraines.
Cheese: Aged cheese consists of high levels of tyramine, which aggravates migraines and headaches.
Caffeine: According to clinical studies, drinking more than one to two cups of coffee per day can cause migraines in 14% of patients.
Chocolate: Chocolate is the most common migraine food trigger, and it has been epidemiologically linked to migraine attacks, so doctors typically advise migraine patients to avoid it.
Tomato-based products: They contain a high amount of histamine or tyramine that can aggravate migraines.
Avoid processed (packaged) foods: Nitrates and nitrites present in processed foods cause swelling of the blood vessels and can trigger migraines.
Foods to consume
Dark green leafy vegetables: Study published in BMJ Case report revealed that inclusion of leafy vegetables in meals can play pivotal role in relieving migraine or chronic headache .
Turmeric: Curcumin present in turmeric helps in relieving migraine frequency and duration.
Coriander: Consumption of coriander leads to a greater reduction in the duration, severity, and frequency of migraines.
Citron: It has reported several benefits in clinical trials however it also helps in reducing migraine intensity and duration.
Clinical trials of several herbal medicines indicate that various foods, through their multifactorial physiological influences, present potential options to improve migraine treatment.
The author is MD, Clinical Pharmacologist and Nutraceutical Physician, Founder and CEO IntelliMed Healthcare Suctions.
Active Covid cases have decreased, with 3,947 cases reported in the last 24 hours
According to Union Health Ministry data updated on Friday, India’s COVID-19 case tally increased by 3,947 in a day to 4,45,87,307, while active cases decreased to 39,583.
The death toll has risen to 5,28,629, with 18 more deaths, including nine fatalities reconciled by Kerala, according to data updated at 8 a.m.
According to the health ministry, active cases account for 0.09 per cent of total infections, while the national COVID-19 recovery rate has increased to 98.73 per cent.
The daily positivity rate was 1.23 per cent, with a weekly positivity rate of 1.44 per cent.
The number of active Covid cases fell by 1,167 in a single day, while the number of people who recovered from the disease rose to 4,40,19,095. The case fatality rate was calculated to be 1.19 per cent.
According to the ministry, the Nationwide Vaccination Drive has resulted in the administration of 218.52 crore total vaccine doses (94.84 crores second dose and 21.19 crore precaution dose).
Two deaths were reported in Maharashtra and West Bengal, and one each in Uttar Pradesh, Punjab, Karnataka, Haryana, and Chhattisgarh. Kerala has made amends for nine deaths.
On August 7, 2020, India’s COVID-19 case tally surpassed 20 lakh, followed by 30 lakh on August 23, 40 lakh on September 5, and 50 lakh on September 16. It surpassed 60 lakh on September 28, 70 lakh on October 11, 80 lakh on October 29, 90 lakh on November 20, and one crore on December 19.
Last year, the country passed the two crore mark on May 4 and the three crore mark on June 23. On January 25, this year, it surpassed the four-crore mark.
PREVENTION: HOW TO KEEP YOUR HEART HEALTHY AT AGE 40
An individual becomes more concerned about their health as they reach a certain age. As the most vital organ of the body, the heart requires extreme care as its chances of developing cardiac diseases increase with age.
Among older people, heart disease is the leading cause of morbidity. To reduce the risk of CVD in middle age, it is recommended to maintain or increase physical activity. Dr AnbuPandian, Medical Advisor, Agatsa, shared some tips to keep the heart healthy at 40 with us.
The most effective way to prevent heart disease at 40 is to adopt a healthy lifestyle. If you work nine hours in an office job, take short breaks every two hours. Taking the stairs instead of the lift, walking short distances instead of using a vehicle or public transportation. Exercise, meditate, swim, play basketball, dance, and do yoga—whatever you love.
Physical exercise has been shown to have a positive effect on heart health in comparison to sedentary lifestyles in various studies. A great quality of life is dependent on a healthy heart. Maintaining a regular exercise routine will keep the heart healthy for years to come.
Regular Heart Health Check-ups
A heart health check-up is essential at every stage of life, but becomes especially crucial after age 40. There are several factors that determine how often a person should get a check-up, including smoking, alcohol consumption, heart disease in the family, being overweight, and diabetes. Blood sugar and cholesterol levels should also be monitored closely. Heart diseases can be better treated if they are detected early. Once a person crosses the age of 40, a yearly checkup is mandatory. The physician may recommend more frequent check-ups if heart disease is detected.
As age increases, metabolism tends to decrease by 5 % every decade after 40. Hormonal imbalance and bone density are two other significant changes that the body registers while getting old. Increase the intake of fruits rich in Vitamin C. All citrus fruits, for that matter, have a bonus heart-healthy benefit. The best diet for preventing cardiac disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils. Individuals who follow their dietary pattern have a 31% lower risk of heart disease than those who consume junk food.
Remote Monitoring Machines
Remote monitoring machines have been around for years but have gained significant prominence recently, thus resulting in high demand. Such devices are used on a daily basis to monitor diseases such as heart attacks, hypertension, and diabetes. These devices are very portable, user-friendly and capture patients’ health parameters via cables and sensors. These devices are cost-effective for patients because they reduce medical care costs and provide more timely intervention for chronic conditions. No one can slow down the ageing process. However, with proper care, one can be more fit, look younger, and lead a more energetic and active life. Life doesn’t end, but begins afresh again at 40!
The author is a Medical Advisor at Agatsa.
Why heart attacks are on the rise among women
Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Heart diseases are no longer a “men’s problem” and women too are equally prone to them. According to a recent report published by the National Family Health Survey, it was found that the overall prevalence of undiagnosed hypertension in women of the age group 15–49 years is 18.69% in India, which busts the myths that heat conditions are most prevalent among men.
Several other international studies have also indicated that heart ailments are now a leading cause of death among women, resulting in ten times more fatalities than breast cancer. Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Why are heart diseases going undetected in women? While ensuring the well-being of their loved ones, women in India tend to ignore their own needs and often neglect their health. For instance, if a woman has mild chest pain, she would rather ignore the symptoms and focus on managing the work/household chores rather than visiting a doctor. The patriarchal setup of our society also expects women to keep the well-being of others at the forefront rather than taking care of themselves, which results in late diagnosis and is one of the primary causes of increasing heart ailments among women in the country.
As the symptoms of a heart attack are different in both men and women, many women often don’t know if they have already suffered one or two heart attacks in the past until eventually, they visit a doctor. While in men, a heart attack usually results in extreme and sudden chest pain and breaking out in cold sweats, whereas in women, the symptoms are usually mild and heart attacks can be frequent and smaller. The symptoms in women can range from jaw pain to fatigue to pain in the neck and back to sweating or just heartburn, indicating the need for them to undergo regular health check-ups and take proactive measures to ensure overall well-being.
Which age group is most susceptible to heart attacks and what are the major concerns?
Women of the age group 45–55 years are at a high risk of experiencing a heart attack due to low levels of estrogen post menopause, work and family-related stress, loneliness, and lack of physical activity. More women in this age group may go undiagnosed and have atypical symptoms compared to men.
The second most affected age group is 60 years of age, where the biological deterioration makes both men and women more susceptible to heart attacks. High cholesterol, blood pressure, obesity, smoking, sedentary lifestyle, and diabetes are also some of the main concerns that make women more prone to cardiovascular diseases.
How can women take care of themselves and keep heart attacks at bay?
There are several steps that women can take to prevent heart ailments, such as:
- Educate yourself and increase awareness about the risk factors that can lead to blockages.
- Avoid smoking or the use of tobacco.
- Engage in physical activities like yoga, dancing, running, and walking for 30–45 minutes every day to maintain heart health and overcome obesity.
- Avoid junk food, aerated drinks and adopt a balanced diet. Healthy heart diets that include complex carbohydrates, legumes, fruits, vegetables, and less sugar, salt, and fat can have a positive impact on heart health.
Lastly, it is important to note that gender has nothing to do with heart attacks, and the condition affects both men and women equally. However, adopting a healthy lifestyle and undergoing regular health checkups can help you get the gift of good health.
The author is a Senior Consultant at Interventional
Cardiology, Aster CMI
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