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Masks are not recommended while exercising

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  • According to the WHO, people should NOT wear masks when exercising, as masks may reduce the ability to breathe comfortably. Sweat can make the mask become wet more quickly which makes it difficult to breathe and promotes the growth of microorganisms. A report carried by a leading news channel in India elaborated with comments from Dr. P. Raghu Ram, President of The Association of Surgeons of India, that exercising while wearing a face mask can result in hyperventilation and reduce brain function.1
  • He further insisted that wearing a mask during exercise will act as a barrier to airflow, which can lower the oxygen levels in the re-circulated air. Also, more carbon dioxide exhaled during exercise can potentially get trapped by the mask and when it is re-inhaled, it can further cause excessive breathing or hyperventilation, and reduce brain function. This can manifest as confusion and loss of consciousness as well, he further concluded.2
  • Therefore, it is better to avoid wearing masks for long hours of exercise and the important preventive measure during exercise is to maintain physical distance of at least 3-4 feet from others.

Result: TRUE

Source:
Arora G. https://www.ndtv.com/health/should-you-wear-masks-while-exercising-during-COVID-19-expert-opinion-2252034
https://timesofindia.indiatimes.com/city/hyderabad/do-not-wear-mask-while-exercising-medical-experts/articleshow/77346719.cms

UIN: 15HP2R

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Coronavirus

Double masking offers better protection

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In January this year, we had carried out a story on how double masking can improve protection from the deadly Coronavirus. Top infectious disease specialist from the US, Dr. Anthony Fauci, Director, National Institute of Allergy, and Infectious Diseases (NIAID) and chief medical advisor on COVID-19 for President Joe Biden said that the trend of wearing two masks to prevent the spread of the coronavirus, can be considered the “common sense approach”.

Newer data from the US Centers for Disease Control and Prevention (CDC) had shown that double masking can significantly improve protection, wherein researchers found that layering a cloth mask over a medical procedural mask, such as a disposable blue surgical mask, can block 92.5% of potentially infectious particles from escaping by creating a tighter fit and eliminating leakage.

With the recent surge in COVID-19 cases in India, there are speculations around what exactly went wrong with the anti-COVID-19 measures we were taking including wearing masks, social distancing, and regular hand hygiene. A major contributory factor is the way we wear masks. The idea is to have a snugly fit mask that can prevent any sort of transmission – but were we doing this? Not exactly! More so, because most of the people have been wearing single layer, not to be reused masks or wearing it the wrong way (not covering nose or just pushed down to the chin and then reusing it to cover the mouth), etc. Double masking therefore sounds like a logical way out for a more optimum protection and better fit to cover the nose and mouth areas.

The Indian Ministry of Information & Broadcasting has released dos and don’ts for double masking which include the following:

Do’s

  1. Do use a surgical mask PLUS a double/triple layered cloth mask
  2. Do press the mask gently on your nose bridge to ensure a snug fit
  3. Do ensure breathing is not blocked and you are able to talk without feeling breathless

Don’ts

  1. Do not pair 2 masks of the same type together.
  2. Do not use the same mask for 2 consecutive days without washing
  3. Do not use an unwashed mask; always ensure one mask is disposable so you can discard it after use at the end of the day.

UIN: 264HP148R

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Coronavirus

What should I do about mucormycosis?

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Amid the rise in cases of mucormycosis or ‘black fungus’ infection among COVID-19 survivors, the government has released an evidence-based advisory for screening, diagnosis and management of the disease. Stating that it may turn fatal if not cared for, the government said mucormycosis is a fungal infection that mainly affects people who are on any kind of medication that reduces their ability to fight environmental pathogens. The common symptoms seen in patients of mucormycosis include sinuses or lungs affected with fungal spores inhaled from air. The advisory was prepared by the Union Health Ministry and ICMR and includes the following warning signs:

  • Pain and redness around eyes and/or nose
  • Fever
  • Headache
  • Coughing
  • Shortness of breath
  • Bloody vomits
  • Altered mental status

The most common group of patients who are found to be affected include patients with uncontrolled diabetes mellitus, immunosuppressed by steroids individuals, patients who have had a prolonged ICU stay, patients on voriconazole therapy or patients with comorbidities that can arise post transplants or in case of cancer or other malignancies. The advisory further adds the Do’s and Don’ts for treating clinicians of patients presenting with mucormycosis or black fungus disease. These are enlisted below:

Do’s

  1. Control hyperglycemia
  2. Monitor blood glucose level post COVID-19 discharge and in diabetics
  3. Use steroid judiciously – correct timing, correct dose and duration
  4. Use clean, sterile water for humidifiers during oxygen therapy
  5. Use antibiotics/antifungals judiciously

Don’ts

The advisory further highlights the importance of not missing out on the warning signs and symptoms. These include:

  1. Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
  2. Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
  3. Do not lose crucial time to initiate treatment for mucormycosis

For patients, the advisory contains preventive measures that include but are not limited to the following:

  1. Use masks if you are visiting dusty construction sites
  2. Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure
  3. Maintain personal hygiene, including thorough scrub bath

Management approach to mucormycosis includes measures to:

  1. Control diabetes and diabetic ketoacidosis
  2. Reduce steroids (if patient is still on) with aim to discontinue rapidly
  3. Discontinue immunomodulating drugs
  4. No antifungal prophylaxis needed
  5. Extensive Surgical Debridement – to remove all necrotic materials
  6. Medical treatment

Note: Mucormycosis is a rare condition and not all clinicians are equipped to handle them. In case you experience any of any signs mentioned, you should consult with an expert in the subject (ophthalmologist for eye complaints, ENT specialist for sinuses and nasal blockage, internal medicine specialist for headache, vomiting, altered mental status, etc.

UIN: 265HP13G

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Coronavirus

A new drug ‘2-DG’ can reduce supplemental oxygen dependence in COVID-19 patients

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The ongoing pandemic is threatening the global human population, including in countries with resource-limited health facilities, such as India. One of the main features of severe COVID-19 infection is severe bilateral pneumonia, which requires immediate ventilatory support for patient survival. Key message in the management approach to these patients includes supplemental oxygen as a first essential step for the treatment of hypoxemia. Over the last few weeks, India has seen an unprecedented rise in the number of COVID-19 patients requiring supplemental oxygen and the scarcity of oxygen cylinders.

In such trying times, the Defence Research & Development Organisation (DRDO) laboratory called Institute of Nuclear Medicine & Allied Sciences (INMAS) has come up with the therapeutic application of the drug 2- deoxy-D-glucose (2-DG) for emergency use. This has been done in collaboration with the Dr. Reddy’s Laboratories in Hyderabad, India.

The Drugs Controller General of India (DCGI) has granted permission for the emergency use of the drug 2-deoxy-D-glucose (2-DG) as an adjunct therapy in moderate to severe COVID-19 cases.

According to the INMAS Labs, clinical trials have shown that a significantly higher proportion of patients administered with the 2-DG drug “became free from supplemental oxygen dependence” by the third day of their treatment, in comparison to those who were not administered with the drug.This indicated an early relief from oxygen therapy/dependence, according to the Ministry of Defence.

In a release issued on Saturday, the Ministry of Defence said that as per the order, emergency use of this drug as adjunct therapy in moderate to severe COVID-19 patients is permitted. It added that being a generic molecule and analogue of glucose, it can be easily produced and made available in plenty in the country. 

Based on successful results, Drugs Controller General of India (DCGI) further permitted the Phase-III clinical trials in November 2020. The Phase-III clinical trial was conducted on 220 patients between December 2020 to March 2021 at 27 COVID hospitals in Delhi, Uttar Pradesh, West Bengal, Gujarat, Rajasthan, Maharashtra, Andhra Pradesh, Telangana, Karnataka, and Tamil Nadu. The detailed data of phase-III clinical trial was presented to DCGI. In 2-DG arm, significantly higher proportion of patients improved symptomatically and became free from supplemental oxygen dependence (42% vs. 31%) by Day-3 in comparison to standard of care, indicating an early relief from Oxygen therapy/dependence. A similar trend was observed in patients aged more than 65 years.

The drug comes in powder form in sachet, which is taken orally by dissolving it in water. It accumulates in the virus infected cells and prevents virus growth by stopping viral synthesis and energy production. Its selective accumulation in virally infected cells makes this drug unique.

UIN: 263HP147R

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Coronavirus

Unnecessary CT scans raise cancer risk

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Computed tomography, also known as computed axial tomography or CT scan, is a tool doctors use to diagnose several types of health problems. It creates detailed images of structures inside your body which helps doctors get a look at your internal organs and then advise further treatment. A CT scan exposes your body to some radiation that involves an amount of risk.

During the second wave of COVID-19 in India, there has been a rampant rise in the number of CT scans being done at various centers in India. A rising concern here is because a lot of these centers do not require a prescription or do not validate the prescriptions before posting a patient for the scan. Considering these developments and unnecessary CT scans being done, experts have warned against unnecessary CT scans by patients having mild Covid-19 symptoms and said that overuse of CT scans increases exposure to radiation which in turn escalates the risk of cancer. This is also because the treating physicians know better about the timing of the HRCT and whether it is required at all or not.

A lot of patients are going for CT scans as soon as they receive a positive RTPCR report and some of these patients go for repeat CT every 3-4 days, to check progress of their recovery or infection, which does more harm than good. This is not the first time that experts have cautioned against the misuse or dangerous effects of CT scan which may lead to cancer.

Harvard Health had also reported that scans expose people to X-rays, and this can damage cells and lead to cancer down the road. In one of its reports, it said most of the increased exposure in the United States is due to CT scanning and nuclear imaging, which require larger radiation doses than traditional X-rays. A chest X-ray, for example, delivers 0.1 mSv, while a chest CT scan delivers 7 mSv — 70 times as much.

In another report, Harvard Health described the risks by mentioning the body regions where CT-related cancer is most likely to occur and these include the chest, abdomen, and pelvis, where faster-growing cells are more vulnerable to radiation.

Similarly, a report by the Yale School of Medicine reported each CT scan exposes patients to between 100-500 times the amount of radiation in an X-ray.

A WebMD report also concurs and reports one chest CT scan delivers the same radiation amount as 100-200 X-rays.

The American College of Radiology recommends limiting lifetime diagnostic radiation exposure to 100 mSv. That is equal to 10,000 chest x-rays, or up to 25 chest CTs.

Harvard Health also adds that even though the benefits of CTs in adult men, particularly those older than 50, may outweigh the risks, no one—even a man in his 70s or 80s—should have CTs without a good reason because caution with ionizing radiation is always recommended. If you don’t need it, why get more of it? they ask!

In conclusion, a single scan may rarely be concerning, but the way people are going about getting their scans done without the supervision of a registered medical practitioner, multiple or unnecessary repetitive CT scans can turn out to be hazardous and may increase the risk of developing a cancer in the near future.

UIN: 261HP145R

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Coronavirus

Steroids can cause mucormycosis, but it is a treatable condition

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There is a recent scare around something known as the ‘black fungus’ and how it has complicated COVID-19 infections – whether this is true or not?

YES, it’s true. Is it always fatal? NO!

Mucormycosis is a treatable condition if checked and diagnosed well in time.

COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis, the black fungus. Recent reports suggest it is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. High index of suspicion, early diagnosis, and appropriate management can improve survival.

Black Fungus is a serious but rare fungal infection and mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. For e.g., uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection, is which can develop during the course of the illness or as a sequelae.

Doctors believe mucormycosis, which has an overall mortality rate of 50%, may be triggered using steroids, a life-saving treatment for severe and critically ill COVID-19 patients. How does this happen? Well, steroids reduce inflammation in the lungs for COVID-19 and help stop some of the damage that can happen when the immune system is working overtime to fight off the coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic COVID-19 patients. It is believed that this drop in immunity could be triggering these cases of mucormycosis.

Is it dangerous? While it is a serious condition if not detected in time, mucormycosis is treatable.

The Indian Council of Medical Research (ICMR) has released an advisory around “When to Suspect” mucormycosis. Enlisted below are the signs to watch out for:

  • Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone
  • One sided facial pain, numbness or swelling
  • Blackish discoloration over bridge of nose/palate
  • Toothache, loosening of teeth, jaw involvement
  • Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
  • Chest pain, pleural effusion, hemoptysis, worsening of respiratory symptoms

In case of any or all the above signs, please contact your clinician or nearest hospital immediately.

UIN: 262HP146R

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