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Steam Inhalation for a week kills Coronavirus?

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The common misconception is that steam inhalation is beneficial in preventing and treating respiratory tract symptoms. Social media and home-made tutorials from unverified sources have a role in misleading patients, caregivers and most important parents of young children into practising this dangerous habit.1 A social media forward doing the rounds claims steam inhalation kills the Coronavirus because at different temperatures, the virus behaves differently and is ultimately weakened and dies. This is NOT TRUE.

As per a Cochrane Review2, while steam inhalation is traditionally used as a home remedy for common colds and upper respiratory tract infections, the evidence base of the practice is weak, with unproven theories that the steam loosens mucus, opens nasal passages, and reduces mucosal inflammation, or that the heat inhibits replication of viruses.This review found evidence to be equivocal but that it did lead to symptom relief in the common cold. However, overall it found that evidence supporting steam inhalation in the treatment of the common cold was inadequate to recommend it for routine clinical practice.

Whilst none of the trials in the review2 found steam inhalation to cause a worsening of respiratory symptoms, steam inhalation has been associated with other complications, most notably scald injuries. 

The National Institute for Clinical Excellent (NICE) currently recommends3 that steam inhalation may be used as a symptomatic remedy, which may “theoretically help congested mucus drain better and heat may destroy the cold virus, as it does in vitro”. An observational study conducted by Mahajan et al. also concluded that steam can be permitted as an adjunct to social distancing, sanitizers and masks and PPE for effective precaution as well as cure in COVID-19; but this study warrants further extended randomized controlled trials to see the effect of steam on larger groups of patients or healthcare staff.

It is important to note that steam inhalation has been a hazard to children as well. Resulting scalds can ultimately lead to hospital admission, surgery, and life-long disfigurement. Brewster et al. reported that the Burns Centre at Birmingham Children’s Hospital, Birmingham, UK, received a 30-fold increase in the number of scalds directly resulting from steam inhalation. The article published in The Lancet, further emphasized that parental education is paramount to preventing these injuries. Steam inhalation should be actively discouraged and parents should be taught about alternative treatments for their child.

Source:

1.Brewster CT, et al. Lancet. 2020;395(10238):1690. https://doi.org/10.1016/S0140-6736(20)31144-2
2.Singh M, et al. Cochrane Database Syst Rev. 2017; 2017CD001728
3.NHS Clinical Knowledge; 2016. What self-care advice should i give to someone with the common cold? [Internet]. Summaries. Available from: https://cks.nice.org.uk/common-cold#!scenario.
4.Mahajan HN. July 2020 Indian Medical Gazette. https://www.researchgate.net/publication/343262923_Indian_Medical_Gazette_Use_of_Steam_as_Adjuvant-treatment_in_Covid-19_Patients_An_Observational_Study

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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.

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Can we use Oxygen Concentrators on our own?

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The answer here would be a NO – because this should not be done without the supervision of a chest physician or pulmonologist. As per the World Health Organisation (WHO), oxygen therapy is recommended for all severe and critical COVOD-19 patients, with low doses from 1-2 litres per minute in children to starting with 5 litres per minute in adults using nasal cannula. This rate can be altered basis the patient’s condition—acute respiratory discomfort or if saturation drops. However, it is to be noted that this is not to be exercised without the supervision of a medical practitioner even if it is on a video call to assist you with the right way to handle oxygen concentrators.

Oxygen concentrator is a device capable of concentrating oxygen from ambient air i.e. 78% nitrogen and 21% oxygen. It accumulates air, filters it via a sieve, releases the nitrogen back into the air and collects the oxygen. This oxygen can be dispensed through a nasal cannula using a pressure valve that regulates its flow. It can deliver oxygen typically, at a flow rate between 1-10 litres per minute. Oxygen concentrator is a very useful medical equipment because of its size, portability, and no requirement of any kind of refilling.

Oxygen concentrators couId be used for non-severe conditions, or after discharge from the hospital for home care and for an interim use whilst waiting for medical guidance & supervision. They can even be a lifesaver for cases in which a patient needs appropriate oxygen flow and concentration based upon his/her condition. One way to look at it could be that using an oxygen concentrator effectively can also ensure reduced occupancy in hospitals as such patients can continue treatment at home.

Experts from a webinar titled ‘COVID-19: Myths Versus Reality’ that was organized by Press Information Bureau, in collaboration with the Government College of Arts, Science and Commerce, Goa, to tackle the infodemic situation said that a lot of people are thinking that having an oxygen concentrator at home can help them to tide over the crisis. This may be true for patients whose oxygen saturation is less than 94 which classifies as a moderate COVID, so giving supplemental oxygen will be beneficial for the interim period before hospital admission.

Speaking on the appropriate usage of concentrators, Professor and Head of Department Anesthesia, B. J. Medical College, Pune, Prof. Sanyogita Naik said: “Oxygen concentrators can be used only in moderate cases of COVID-19, when the patient experiences drop in oxygen levels, where the oxygen requirement is a maximum of 5 litres per minute.” The professor added that oxygen concentrators are also very useful for patients experiencing post-COVID complications which necessitate oxygen therapy.

However, the big problem is that people tend to use it themselves without accurate guidance from a chest physician or an internal medicine specialist. Doing this can potentially be harmful. This is because some people having long-term respiratory diseases may have normal oxygen saturation between 88 to 92 but due to the over-exchange of information and availability of doctors online, patients and caregivers really need to be told how and when to raise the alarm.

Note:

  1. Oxygen concentrator is not a replacement for oxygen cylinder or ventilator.
  2. Patients with moderate and severe health conditions will need higher doses of oxygen and this device cannot meet those requirements.
  3. Experts advise against the use of oxygen concentrators for patients who have oxygen saturation below 85%.

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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.

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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.

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You can fight COVID-19 with a healthy diet

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This is true, especially for mild cases of COVID-19 or asymptomatic cases. There is no doubt that the outbreak of the current pandemic has affected the lives of people, their health, and wellbeing. In the absence of any prescribed treatment, governments of most countries and several authorized international health agencies like the World Health Organisation, the British Dietetic Association, and the UD Food and Administration are emphasizing on maximum use of raw vegetables and fruits, nuts, and seeds; pulses and wholegrain foods; unsaturated oils; limit the intake of soda, salt, sugar, and trans fats; and stop eating junk and sugary food. Apart from food, guidelines also recommend physical exercises, meditation and adequate sleep, and good exposure to sunlight.

The Ministry of Science and Technology has published a set of food items to consider for faster recovery in COVID-19 patients; the list also comprises food items to avoid and those that are completely not recommended.

The guidelines of the Ministry of AYUSH, Government of India recommend self-care guidelines for preventive health measures and boosting immunity, which is proven to be extremely effective in treating and curing COVID-19 patients and for faster recovery of disabling symptoms such as fatigue, palpitations, etc.

Food choices during the current pandemic

Recommended FoodAvoid (but can be taken occasionally to satiate the taste-buds)  Not Recommended
Raw or freshly cooked vegetables and fruits Less spicy and oily food; Garlic, onion, unseasonal veggies in a limited amount  Fried, over spicy and overcooked, or stale food
Pulses and wholegrain foods Brown breadRefined, processed grain foods (pasta, rice and white bread), frozen foods
Curd, yoghurtWhite meats like poultry and fish that are generally lower in fats than red meat; processed meatRed meat
Unsalted nuts and seeds (like pumpkin, sunflower, and flax).Homemade low fat/sugar snacks like idli, dosa, dhokla, upma, daliya, brown bread and peanut butter sandwichSnacks that are high in salt and sugar (cookies, samosa, cakes, and chocolate, pickles, jams)
Egg yolks, and fortified breakfast cereals 
Unsaturated fats (e.g., found in fish, avocado, nuts, olive oil, soy, canola, sunflower and corn oils).Saturated fats (e.g., found in fatty meat, butter, coconut oil, cream, cheese, and lard)  Trans-fats (processed food, fast and fried food, snacks, frozen pizza, pies, cookies, margarines, and spreads)
Fresh fruit juices, low fat lassi, chhach, lemonade, coconut water/ hot water, herbal tea    Soft drinks or sodas and other drinks that are high in sugarAlcohol, tobacco, drugs
 Honey and jaggeryBrown sugarWhite sugar
Indian herbs: Coriander (Dhaniya), turmeric (contain Curcumin), fenugreek (methi), tulsi (Basil), cumin (jeera), fennel (sonph), cloves, black pepper (Kalimirch, contain Piperine), cinnamon (dalchini), ginger and curry leaves.  Iodized saltNon-iodized salt  

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