A new study led by The Society of Thoracic Surgeons has found that some patients with severe COVID-19 who are treated with extracorporeal membrane oxygenation (ECMO) might experience significant lung recovery and return to normal lives with meaningful long-term outcomes.
The research was published in the journal, ‘The Annals of Thoracic Surgery’. “Our work suggests that with appropriately selected patients and aggressive management strategies, the use of ECMO support for severe COVID-19 can result in exceptional early survival, and these patients who leave the hospital without the need for oxygen therapy are very likely to remain alive and well 1 year later,” said Deane E. Smith, MD, from NYU Langone Health in New York City, New York.
Dr Smith and colleagues identified 415 patients who were admitted to the intensive care unit (ICU) of NYU Langone Health from March 10, 2020, through May 1, 2020, with confirmed COVID-19 infection. Of these patients, 30 (7.2 per cent) received venovenous (VV) ECMO — an advanced life support machine that takes over the function of damaged lungs.
Most of the ICU patients — 323 (77.8 per cent) — were intubated for mechanical ventilatory support. However, according to Dr Smith, the ventilator may damage the lungs further and “create a vicious cycle” for patients with severe lung disease or damage who are intubated. In some cases, VV-ECMO may result in decreased support from the ventilator, minimizing damage to the lungs and allowing them to begin healing. Thus, 80 patients (19.3 per cent) were evaluated for VV-ECMO, with 30 (7.2 per cent) eventually receiving it.
“These patients received ECMO for severe COVID-19 during the height of the pandemic in New York City — at a time when very little was known about the likelihood for success,” said Dr Smith.
The researchers reported that 28 patients (93.3 per cent) survived VV-ECMO. These patients were hospitalized for a median of 45 days and supported on VV-ECMO for a median of 19 days. Importantly, 27 patients (90 per cent) were discharged home or to acute rehabilitation. No patients left the hospital dependent on a ventilator, and only one patient required supplemental oxygen.
According to Dr Smith, patient selection was a significant factor that impacted the success of VV ECMO. The selection philosophy was that this was not a “bailout” or salvage therapy to be employed in the absence of other options. Instead, VV-ECMO was offered to patients believed to have a reasonable chance for survival with this support.
“We were struck by the number of young, otherwise healthy patients who were dying from the disease. Because of this, we felt the patient selection was very important,” he said.
Dr Smith further explained that the decision to offer ECMO support also was impacted by the severity of lung disease and potential for survival.
“If there was one theme throughout our experience, it was how we would define success. We did not feel that using ECMO to have patients survive simply to go to long-term facilities debilitated and vent-dependent was successful, or not as successful as it could be. In other words, we began with the end in mind. If we were going to offer patients ECMO for severe COVID-19, it was because we believed that we could protect the lungs and allow patients to return to their normal lives at the end of it,” he said.
While the patient selection was important, a standardized approach to patient management and protecting the lungs was equally valuable. This included not deviating from lung-protective ventilation strategies, early tracheostomy (an opening surgically created through the neck into the trachea) and frequent bronchoscopy (a procedure to look directly at the airways in the lungs using a thin, lighted tube), treatment of coinfection, and standardization of an anticoagulation regimen (to help prevent blood clots). In addition, to help improve oxygenation, the team frequently positioned patients who were not recovering as quickly as expected on their abdomens, also known as “proning.”
“It’s worth noting that most of these things such as bronchoscopy or tracheostomy were not considered safe in patients with COVID-19 at the start of the pandemic,” said Dr Smith.
“Our team was aggressive with these interventions much earlier than most hospitals,” he added.
Importantly, at a median follow-up of 10.8 months since the patients were treated with VV-ECMO, survival was 86.7 per cent, including one patient who underwent lung transplantation. A 6-minute walk test was performed in 16 patients (59.3 per cent) with a median value of 350 meters, which the researchers called “encouraging.”
“We learned that lung recovery was actually possible. When the pandemic started, that was not clear,” said Dr Smith.
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A RISE IN THYROID DISORDERS IN INDIA
In India, there is a significant burden of thyroid diseases. According to various researches, 42 million people have thyroid disorders consisting of the five main thyroid diseases hypothyroidism, hyperthyroidism, goitre/iodine deficiency disorders and Hashimoto’s thyroiditis. Thyroid glands are responsible for making hormones that control the metabolism. Any irregularity with the thyroid can lead to various health problems in the longer run. Thyroid disease arises when the thyroid gland produces either too much or too little of these important hormones. May 25 is World Thyroid Day. Thyroid diseases are one of the most common endocrine disorders across the world.
COMMON THYROID DISORDERS
Hypothyroidism (underactive thyroid) is a condition in which the thyroid gland doesn’t produce enough thyroid hormone. In our country, hypothyroidism is the most common thyroid disorder affecting 1 in every 10 men & women. During the initial stage, it may not cause noticeable symptoms. If left untreated, it is associated with various health problems, such as obesity, joint pain, infertility and heart disease. Congenital hypothyroidism occurs when the thyroid gland fails to develop or function properly. The disease occurs in 1 out of 2640 neonates when compared with the worldwide average value of 1 in 3800 subjects.
Hyperthyroidism (overactive thyroid) is the opposite of Hypothyroidism. It occurs when the thyroid gland produces excessive hormone thyroxine. The excess hormones can accelerate the body’s metabolism, causing unintentional weight loss and a rapid or irregular heartbeat. It is estimated that hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Over 99% of affected patients suffer from primary hypothyroidism.
Goitre is the irregular growth of the thyroid gland due to iodine deficiency or inflammation of the thyroid gland. It is one of the most common thyroid disorders in India affecting more than 1 million cases per year.
Hashimoto’s thyroiditis is an autoimmune disease. The immune system attacks the thyroid which can lead to hypothyroidism. Without proper treatment, the condition can cause serious and even life-threatening complications.
PREVALENCE OF THYROID IS ON THE RISE
Environmental iodine deficiency is the most common cause of all thyroid disorders globally. In India, the number is on the rise owing to factors like the rising awareness of the disease, which means more patients with this condition are being diagnosed and autoimmunity (a common cause of thyroid triggered by stress). It tends to impact women between the ages of 18-35 during their prime reproductive period and this is also the time they tend to suffer the most stress.
The key to thyroid treatment is to help maintain the thyroid hormone levels to normal. Anti-thyroid drugs, Thyroid replacement medication, surgery, etc. are some of the treatment options. However, there are a variety of ways and specific treatments available depending on the cause of your thyroid condition.
TIPS FOR A HEALTHY THYROID
Consume more anti-oxidants & nuts: Since thyroid is very vulnerable to oxidative stress, it is important to increase the intake of anti-oxidants. Include fruits like strawberries, raspberries and colourful vegetables in your diet plan. Also, nuts have high selenium content which is an important component of the thyroid.
Exercise and try to stay lean and fit: Exercise has a whole host of benefits that impact not only your overall health, but can help reduce thyroid symptoms like mood problems, trouble sleeping, and weight gain.
Adequate iodine intake: Iodine is an essential substance in order to maintain thyroid health. Consuming an adequate amount of iodine may help reverse the effects of slow metabolism, as it can help the body make more thyroid hormones.
The writer is Consultant – Endocrinology, Aster CMI Hospital.
UNDERSTANDING BODY SHAMING AND WHY IT OFTEN BEGINS AT HOME
Most parents consider it normal to objectify their kids with verbal usages like mottu (fat), kaali (darker), naata (short) in their regular conversations. A child who is exposed to such humiliating remarks from his/her own family after a point tends to start believing in the statements and gradually becomes conscious of his shortfalls. Soon it begins to affect his self-esteem also and may lead to other disorders like body dysmorphia, depression, anxiety, and more.
Vandana hates being tagged on Facebook family photographs, for her, it reminds her of many horrifying memories and not-so-pleasant childhood. The reason is her elder sister Archana who happens to be fairer and better looking than her. Siblings are often compared to each other based on their academic grades, behaviour, and even their physical appearances. It gets even worse if the child happens to be a girl. Vandana was often reminded of her dusky complexion body and was subjected to mockery at family gatherings. Her mother unfortunately was in the lead of the pack. We are talking about ‘Body Shaming’ an act that involves mocking a person’s physical appearance in a derogatory way. People are usually body shamed for their skin tone; hair growth, height, body weight, and even their vocal tonality are not spared. Most parents consider it normal to objectify their kids with verbal usages like Mottu (fat), Kaali (darker), naata (short) in their regular conversations. A child who is exposed to such humiliating remarks from his/her own family after a point tends to start believing in the statements and gradually becomes conscious of his shortfalls. Soon it begins to affect his self-esteem also and may lead to other disorders like body dysmorphia, depression, anxiety, and more. Statistics reveal that even boys are not spared from body shaming. Gynecomastia for instance is a condition where boys/men develop enlarged breast tissues like women due to hormonal imbalance. And the ones who are suffering from such health conditions are often reluctant to be seen in public without a shirt and even shy away from participating in games and sports.
The truth is that body shaming can happen anywhere and it’s a reality that needs to be dealt with diligence right from childhood. And like all good things that begin in our homes, understanding and handling body shaming should also begin at home. Here are a few points that we all can drive home while dealing with body shaming.
Encourage body acceptance
Body acceptance is all about treating your body with respect and accepting it with its flaws. As parents, it is important to guide your children with the message that nobody is perfect and flawless. Also makes sure they know the truth that the photographs they see of their favourite celebrities on social media are often results of editing and photoshopping.
Avoid conversations about other people›s body
Avoid talking about the physical attributes of other people at home. Most parents tend to make passive comments about other people’s bodies in their daily conversations. A child who listens to such talks begins to consider body-shaming normal and soon becomes a perpetrator himself.
There is a reason why elders insisted on eating all together culture in every family. A dining table conversation often helps children to express their apprehensions to parents and vent out their emotions without letting them clogged within. Talking it out with family often helps young minds manage stress better. Knowing that your family is going to be by your side, come what may be acts as a reassurance and confidence booster for every child. Include topics like ‘body positivity and make the conversation relatable by quoting your own growing-up experiences to them and how you dealt with the situations back then.
Keep a check on your vocabulary
Children are often like blotting paper, they absorb your words and remarks as it is without weighing the pros and cons. In the fits of anger, most parents succumb to using offensive and disapproving words related to body shaming. It not only normalizes the menace but also gives away the wrong notion to the child that it is acceptable to convey negative emotions like anger, aggression, and rage through harsh words.
The writer is Medical Director, Medlounges.
WORLD IBD DAY CELEBRATED IN PGIMER TO RAISE AWARENESS
May 19 is celebrated across the globe as World IBD day. Inflammatory Bowel diseases (IBD) are chronic inflammatory conditions of the intestine and are of two main types: ulcerative colitis and Crohn’s disease. IBD is increasing in India and this increase is largely driven by changes in the diet and westernization of lifestyle. A recent editorial in Lancet Gastroenterology & Hepatology described South Asia (including India) as a new frontier of IBD. Some studies have shown that IBD is as common in North India as in the western world. Genetics, immune response, and changes in the dietary pattern also play a role in the causation of this disease. IBD can affect any age or gender. Usually, these patients have abdominal pain, diarrhoea, and bleeding in the stools. The diagnosis is often delayed because of the lack of awareness about the disease in the community, lack of access to colonoscopy, and confusion about other diseases like haemorrhoids, abdominal tuberculosis, and cancer.
The department of Gastroenterology, PGIMER, Chandigarh celebrated the day to raise awareness about the condition and improve the care and treatment of patients living with IBD. Prof Usha Dutta, Head, Department of Gastroenterology, informed that special lectures were organized where the patients with IBD were educated about the disease, the diagnostic tests, various treatment options, the role of diet, and health maintenance. A quiz was organized where patients were asked questions about their health and the top scorers were given IBD Day Prizes. Prof SK Sinha spoke on the nature and presentation of the disease, Dr. Vishal Sharma spoke about the treatment options of the disease, and Prof Usha Dutta spoke about the diet and lifestyle approaches for IBD. Patients who have inflammatory bowel disease asked questions and doubts about their disease and health, which were answered by experts. The patients were also able to visit stalls that provided patient education material and demonstrated methods to use enema, foam, and suppository therapies, which are a cornerstone in the treatment of this condition . On this occasion an IBD card designed by the Department of Gastroenterology, in association with Colitis and Crohn’s Foundation, India was released. This card will provide a snapshot of the disease state and drug therapies with education material and will help improve various aspects of care including diet, preventive health, and medication. The card is designed with suggestions from other experts from AIIMS, Delhi, DMC, Ludhiana, and SGPGI, Lucknow. The card will be available to clinicians and gastroenterologists across the country for use and will be launched through a web meeting on World IBD day.
ALCOHOL CONSUMPTION MIGHT BE MORE RISKY TO THE HEART
According to a study, levels of alcohol consumption currently considered safe by some countries are linked with the development of heart failure.
The study was published in the journal, ‘Cardiology’. “This study adds to the body of evidence that a more cautious approach to alcohol consumption is needed,” said study author Dr. Bethany Wong of St. Vincent’s University Hospital, Dublin, Ireland.
“To minimise the risk of alcohol causing harm to the heart, if you don’t drink, don’t start. If you do drink, limit your weekly consumption to less than one bottle of wine or less than three-and-a-half 500 ml cans of 4.5 percent beer,” he added.
According to the World Health Organization, the European Union is the heaviest-drinking region in the world. While it is well recognised that long-term heavy alcohol use can cause a type of heart failure called alcoholic cardiomyopathy, evidence from Asian populations suggests that lower amounts may also be detrimental.
“As there are genetic and environmental differences between Asian and European populations this study investigated if there was a similar relationship between alcohol and cardiac changes in Europeans at risk of heart failure or with pre-heart failure,” said Dr. Wong.
“The mainstay of treatment for this group is the management of risk factors such as alcohol, so knowledge about safe levels is crucial,” he added.
This was a secondary analysis of the STOP-HF trial. The study included 744 adults over 40 years of age either at risk of developing heart failure due to risk factors (e.g. high blood pressure, diabetes, obesity) or with pre-heart failure (risk factors and heart abnormalities but no symptoms).
The average age was 66.5 years and 53 percent were women. The study excluded former drinkers and heart failure patients with symptoms. Heart function was measured with echocardiography at baseline and follow-up.
The study used the Irish definition of one standard drink (i.e. one unit), which is 10 grams of alcohol. 8 Participants were categorised according to their weekly alcohol intake: 1) none; 2) low (less than seven units; up to one 750 ml bottle of 12.5 percent wine or three-and-a-half 500 ml cans of 4.5 percent beer); 3) moderate (7-14 units; up to two bottles of 12.5 percent wine or seven 500 mL cans of 4.5 percent beer), high (above 14 units; more than two bottles of 12.5 percent wine or seven 500 ml cans of 4.5 percent beer).
The researchers analysed the association between alcohol use and heart health over a median of 5.4 years. The results were reported separately for the at-risk and pre-heart failure groups. In the at-risk group, worsening heart health was defined as progression to pre-heart failure or symptomatic heart failure. For the pre-heart failure group, worsening heart health was defined as deterioration in the squeezing or relaxation functions of the heart or progression to symptomatic heart failure. The analyses were adjusted for factors that can affect heart structure including age, gender, obesity, high blood pressure, diabetes, and vascular disease.
A total of 201 (27 percent) patients reported risk of alcohol while 356 (48 percent) were low users and 187 (25 percent) had moderate or high intake. Compared to the low intake group, those with moderate or high use were younger, more likely to be male, and had a higher body mass index.
In the pre-heart failure group, compared with no alcohol use, moderate or high intake was associated with a 4.5-fold increased risk of worsening heart health. The relationship was also observed when moderate and high levels were analysed separately. In the at-risk group, there was no association between moderate or high alcohol use with progression to pre-heart failure or symptomatic heart failure. No protective associations were found for low alcohol intake.
MANY DENTAL MYTHS AND MISCONCEPTIONS DEBUNKED
Many dental myths and misconceptions exist today, including the usage of braces to make teeth symmetrical. Many people are afraid to use braces in this modern era due to concerns about wires being stuck inside the mouth for an extended period. Technological innovations, on the other hand, have shaped and modified the aligners. Clove Dental’s Chief Clinical Officer, Lt. Gen. Dr. Vimal Arora, who served in the Army Dental Corps for a long time, has debunked common misconceptions about the use of aligners and braces.
Q: When should one visit an orthodontist?
A: Firstly, it is essential to understand the difference between a dentist and an orthodontist. Orthodontists undergo an additional 3 years of training that specialises in the alignment of teeth. Here, one is equipped with better diagnosis and treatment planning, and an orthodontist treats misaligned teeth, crowded teeth, and bite issues (overbite and underbite).
There is no specific age to visit an orthodontist for better-crooked teeth alignment. However, the earlier the better. Whenever you spot both aesthetic and functional issues with your teeth, you must make an appointment to visit an expert.
Q: Does tooth extraction weaken eyesight?
A: This is a common myth that exists. Tooth extraction has no direct connection with eyesight. There are times when eyes are swollen or red when people suffer from toothaches, making people think that teeth and eyes are connected, but this is not true.
Q: What is the difference between braces and aligners?
A: There are traditional and modern treatments related to tooth alignment options. Braces are traditional, whereas aligners are modern alignment options. Braces can be used to treat all crooked teeth cases, whereas aligners can treat only a few. Hence, it is important to consult an orthodontist on what applies to you. As braces are fixed to your teeth, unlike aligners where you have to wear them regularly. Any severity category, be it mild, morbid, or severe, can be taken into consideration to treat any malocclusion.
However, with progression in the healthcare system, we have the option of aligners. We can still manage mild to morbid cases with aligners. However, a lot of advancement is needed to select them for the severe category.
Q: Do braces serve better than aligners.
With technological advancement, aligners are more comfortable, to begin with. There is no change in lifestyle, especially related to your brushing and eating habits. You can do all your activities normally. Incidentally, step-by-step post-treatment results as seen before are not required and there is less human error as hi-tech computers scientifically design most treatments. And importantly, aligners have appeal that is more aesthetic.
Q: Can teeth move back into their original positions after treatment?
A: This is partially true that in orthodontics if teeth are once moved, they will get back to their original positions. If proper measures have been taken after correction, to hold the teeth in their positions and the ideology has been taken care of while doing the treatment, we can minimise the chances of teeth going back to their original positions.
Study details benefits of turmeric compound
According to a new study by the University of California, a compound found in turmeric called Curcumin helps grow engineered blood vessels and tissues.
The findings of the study were published in the journal, ‘ACS Applied Materials & Interfaces. The study indicated that a finding by UC Riverside bioengineers could hasten the development of lab-grown blood vessels and other tissues to replace and regenerate damaged tissues in human patients.
Curcumin has anti-inflammatory and antioxidant properties and is known to suppress angiogenesis in malignant tumors.
The magnetic hydrogels embedded with curcumin-coated nanoparticles promote the secretion of vascular endothelial growth factors.
Curcumin’s possible use for vascular regeneration has been suspected for some time but has not been well studied. Huinan Liu, a bioengineering professor in UCR’s Marlan and Rosemary Bourns College of Engineering, led a project to investigate curcumin’s regenerative properties by coating magnetic iron oxide nanoparticles with the compound and mixing them into a biocompatible hydrogel.
Bioengineers at UC Riverside have now discovered that when delivered through magnetic hydrogels into stem cell cultures this versatile compound paradoxically also promotes the secretion of vascular endothelial growth factor, or VEGF, that helps vascular tissues grow.
When cultured with stem cells derived from bone marrow, the magnetic hydrogel gradually released the curcumin without injuring the cells.
Compared to hydrogels embedded with bare nanoparticles, the group of hydrogels loaded with curcumin-coated nanoparticles showed a higher amount of VEGF secretion.
“Our study shows that curcumin released from magnetic hydrogels promotes the cells to secrete VEGF, which is one of the most critical growth factors to enhance the formation of new blood vessels,” said co-author Changlu Xu, a doctoral candidate in Liu’s group who focused on hydrogel research.
The researchers also took advantage of the nanoparticles’ magnetism to see if they could direct the nanoparticles to desired locations in the body.
They placed some of the curcumin-coated nanoparticles in a tube behind pieces of fresh pig tissue and used a magnet to successfully direct the movement of the nanoparticles.
The achievement suggested the method could eventually be used to deliver curcumin to help heal or regenerate injured tissue.
In fact, the best curcumin supplements contain piperine, and this makes them substantially more effective.
In addition, animal and cellular studies suggest that curcumin may block the action of free radicals and may stimulate the action of other antioxidants. Further clinical studies are needed in humans to confirm these benefits
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