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Coronavirus pandemic: Post-Covid syndrome severely damages children’s hearts

Multisystem inflammatory syndrome in children (MIS-C), believed to be linked to COVID-19, damages the heart to such an extent that some children will need lifelong monitoring and interventions, said the senior author of a medical review.

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Multisystem inflammatory syndrome in children (MIS-C), believed to be linked to COVID-19, damages the heart to such an extent that some children will need lifelong monitoring and interventions, said the senior author of a medical review.

The review was published in EClinicalMedicine, a journal of The Lancet.

Case studies also show MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic infections, said Alvaro Moreira, MD, MSc, of The University of Texas Health Science Center at San Antonio. Dr Moreira, a neonatologist, is an assistant professor of paediatrics in the university’s Joe R. and Teresa Lozano Long School of Medicine.

“According to the literature, children did not need to exhibit the classic upper respiratory symptoms of COVID-19 to develop MIS-C, which is frightening,” Dr. Moreira said. “Children might have no symptoms, no one knew they had the disease, and a few weeks later, they may develop this exaggerated inflammation in the body.”

The team reviewed 662 MIS-C cases reported worldwide between January 1 and July 25.

Among the findings:- 71% of the children were admitted to the intensive care unit (ICU).- 60% presented with shock.- Average length of stay in the hospital was 7.9 days.- 100% had a fever, 73.7% had abdominal pain or diarrhoea, and 68.3% suffered vomiting.- 90% had an echocardiogram (EKG) test and 54% of the results were abnormal.- 22.2% of the children required mechanical ventilation.- 4.4% required extracorporeal membrane oxygenation (ECMO).- 11 children died.

“This is a new childhood disease that is believed to be associated with SARS-CoV-2,” Dr Moreira said. “It can be lethal because it affects multiple organ systems. Whether it be the heart and the lungs, the gastrointestinal system or the neurologic system, it has so many different faces that initially it was challenging for clinicians to understand.”

The amount of inflammation in MIS-C surpasses two similar pediatric conditions, Kawasaki disease and toxic shock syndrome. “The saving grace is that treating these patients with therapies commonly used for Kawasaki – immunoglobulin and glucocorticosteroids – has been effective,” Dr. Moreira said.

Cardiac abnormalities

Most of the 662 children suffered cardiac involvement as indicated by markers such as troponin, which is used with great accuracy in adults to diagnose heart attacks.

“Almost 90% of the children (581) underwent an echocardiogram because they had such a significant cardiac manifestation of the disease,” Dr Moreira said.

The damage included:

-Dilation of coronary blood vessels, a phenomenon also seen in Kawasaki disease.-Depressed ejection fraction, indicating a reduced ability for the heart to pump oxygenated blood to the tissues of the body.

Almost 10% of children had an aneurysm of a coronary vessel. “This is a localized stretching or ballooning of the blood vessel that can be measured on an ultrasound of the heart,” Dr Moreira said.

Children with an aneurysm are at the most risk of a future event. “These are children who are going to require significant observation and follow-up with multiple ultrasounds to see if this is going to resolve or if this is something they will have for the rest of their lives,” Dr Moreira said.

“And that’s catastrophic to a parent who had a previously healthy child and then he/she is in the very small percentage of individuals who developed MIS-C after COVID-19 infection,” he said.

Another finding from the case studies: Almost half of the patients who had MIS-C had an underlying medical condition, and of those, half of the individuals were obese or overweight.

“Generally, in both adults and children, we are seeing that patients who are obese will have a worse outcome,” Dr Moreira said.

When compared to the initial COVID-19 infection, inflammatory markers in MIS-C were far more abnormal. For instance, troponin, the marker used in adults to diagnose heart attacks, was 50 times its normal level in children with MIS-C.

“Evidence suggests that children with MIS-C have immense inflammation and potential tissue injury to the heart, and we will need to follow these children closely to understand what implications they may have in the long term,” Dr Moreira said.

Disaster

Official COVID-19 death toll probably underestimates true total – WHO

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World Health Organisation

GENEVA: The official global toll of deaths from COVID-19 probably underestimates the true total – suggesting it could be over a million already, a World Health Organization official said on Monday.

“If anything, the numbers currently reported probably represent an underestimate of those individuals who have either contracted COVID-19 or died as a cause of it,” Mike Ryan, the WHO’s top emergencies expert, told a briefing in Geneva.

“When you count anything, you can’t count it perfectly but I can assure you that the current numbers are likely an underestimate of the true toll of COVID,” he said.

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Health

Treating the heart with scientific breakthroughs, lifestyle changes

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Heart Exercise

New Delhi, Sep 27 : From the time the first Coronavirus case was recorded in China, to India’s numbers crossing four million, COVID-19 has millions of lives under its ambit. Now, for a country like India, where the cardiovascular disease burden is already at an alarming high, these are threatening facts. Moreover, pandemic-induced lockdowns have also raised stress levels which can induce heart related ailments.

On this World Heart Day, here are some thoughts by Dr Viveka Kumar on the importance of understanding cardiovascular diseases (CVDs), what they mean today, how we can protect ourselves, and the technologies that help us significantly improve patient outcomes.

A Closer Look at Heart Diseases

According to the World Health Organisation (WHO), “CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause. In 2016, CVDs took approximately 17.9 million lives, out of which 85 percent were due to stroke and heart attack.” Now, let’s understand what CVDs constitute. CVDs are a group of disorders of the heart and blood vessels. According to statistics, four out of five deaths caused by CVDs happen due to strokes or heart attacks.

The most common cause of heart attacks and strokes is a sedentary lifestyle. Alcohol consumption, unhealthy diet, hypertension, diabetes, and obesity are contributing factors. Heart attacks and strokes are also caused due to a blockage that interferes with the blood flowing to the brain or heart. These blockages are caused by the build-up of fatty deposits on the walls of blood vessels that carry blood to the two organs. In some cases, internal bleeding in the brain or blood clots can also cause strokes.

Fighting Against the CVD Burden

The simplest way to tackle the CVD burden is to create awareness about its most common symptoms and not ignoring them. For instance, keep a check on your diabetes levels, cholesterol intake, watch out for symptoms like frequent chest pain, irregular heartbeat, pain in the elbows, left shoulder, or discomfort in the arms or back. The most common symptoms of a stroke are numbness in arms or legs, especially on one side of the body, dizziness, difficulty in speaking, loss of balance, or severe headache with an unknown cause.

Since these are common symptoms that are often ignored by patients, it is advisable to consult a doctor if they are regular. Taking measures like maintaining proper weight, keeping regular check on diabetes, cholesterol and blood pressure at home is imperative, but we must not forget the importance of regular health check-ups. If you have symptoms of diabetes, your doctor will likely test your blood sugar level. If you have any conditions that put you at risk of heart disease, manage them with lifestyle changes and medications.

However, in extreme cases, where a patient feels their medications are not just enough to treat the ailment so in these cases patients may require a stent to unclog a blocked artery.

The Breakthroughs in Heartcare

What’s interesting is the way technology has transformed the treatment of blocked arteries. For the longest time, we have relied on drug-eluting stents (DES) and bare-metal stents to treat blocked arteries. Over the years, the quality of these stents has improved substantially. The latest generation platinum chromium stents have smaller profiles, thinner struts and clinical data of more than 10000 patients which help in good procedural outcomes for the patients.

An important thing to understand here is that the pandemic is far from waning and health situations like these will continue to exist for as long as humans live on the planet. For better healthcare situations and heart healthy lives we need is to prepare for smarter tools and technologies.

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Prince Charles highlights Covid-19 impact on youngsters

Prince Charles, who had tested positive for the virus earlier this year, has set up the Young People Relief Fund to provide extra support to young people affected by the impact of the virus.

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Prince Charles

London, Sep 27 : The UK’s Prince Charles on Sunday highlighted the impact of the global coronavirus pandemic on young people, saying it was a “particularly difficult time to be young”.

“For anyone, this is a difficult time – but it is a particularly difficult time to be young,” the BBC quoted the Prince of Wales as saying in an article published in the Sunday Telegraph.

He compared the current situation to “other times when hope was scarce”, citing concerns over youth unemployment in the 1970s that prompted him to set up his charity, the Prince’s Trust which helps people aged between 11 and 30 seek employment opportunities and life skills.

“This year, we celebrate the fact that over the last nearly 45 years, we have helped a million young people to change their lives for the better,” he wrote in the article.

“Over all these years since the trust was launched, there has never been an easy time.

“However, there has never been a time as uniquely challenging as the present, when the pandemic has left perhaps another million young people needing urgent help to protect their futures.

“The task ahead is unquestionably vast, but it is not insurmountable,” he was quoted as saying.

Prince Charles, who had tested positive for the virus earlier this year, has set up the Young People Relief Fund to provide extra support to young people affected by the impact of the virus.

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