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Doctors estimate 3-fold rise in deaths of patients waiting for organ transplant during lockdown

Prof Subhash Gupta, Chairman of Centre for Liver and Biliary Sciences, said that the government should step forward and roll out schemes to increase organ donation.

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New Delhi, Aug 13 : The nationwide lockdown imposed from March 24 has affected services across sectors, and key areas of medical care were also not left untouched due to the 68-day total shutdown.

In the grip of the coronavirus and lockdown, the life-saving organ transplant procedures had come to a standstill. The hospitals and transplantation centers have experienced a tremendous reduction in the number of organ donations and solid organ (kidney, liver, heart, and lung) transplant procedures, leading to an exponential rise in the deaths of patients who were waiting for critical transplants.

Doctors have estimated that they lost at least thrice the number of patients during lockdown than in normal times due to “waitlist mortality”.

“This is a heart-shattering fact. We have observed a lot of waitlist mortality during the lockdown. The people who expected transplantation have passed away just waiting for their surgery,” said Ushast Dhir, a surgeon in liver transplantation and gastroenterology at Sir Ganga Ram Hospital in New Delhi.

Dhir said that many patients have died during the lockdown. While it is challenging to assess nationwide figures in the absence of any register, he estimated that his hospital lost patients on the waitlist three times more during the lockdown than normal times.

However, multiple factors like stricter norms due to the Covid-19 pandemic, unavailability of donors, restriction on mobility in lockdown, and the fear of Covid among living donors and the patients, have also played a role in the delayed transplantation that eventually led to the deaths.

No accidents, no organs for transplantation

The doctors said that the primary reason behind the extended wait was the unavailability of organs. The live donors and the patients were hesitant to undergo transplant surgery due to the Covid scare. Meanwhile, the patients who did not have living donors, but needed surgery immediately, were unable to find deceased donors in the lockdown period.

“The majority of the deceased donors come from cases of road accidents. Since vehicles were not plying on the roads during the lockdown, it prevented accident deaths, leading to a huge scarcity of organs for critically-ill patients,” said Harish Manian, CEO of MGM Hospital in Chennai.

Manian also agreed with Dhir that the waitlist mortality was nearly thrice than the pre-lockdown period. “We do not have any exact figures since it is not published anywhere. However, observing the trend, this estimate does not seem like an exaggeration,” he added.

Unreachability to transplantation centres

Pradeep Joshi, who was GI and liver transplant surgeon at the King George Medical College (KGMC) in Lucknow, said that many patients, especially in small towns, would have suffered as they could not have accessed the transplantation centers during the lockdown as they are based in metro and bigger cities.

“The need for transplant is an indication that the patient is at the end-stage. The survival in this condition is up to 6 months, and such terminally-ill patients, who needed transplantation during the lockdown, were unable to get it due to restriction on mobility. Not everyone could afford an air ambulance,” he said.

Stricter norms after the onset of Covid

Apart from immobility and scarcity of donors, another factor that contributed to the waitlist mortality was stricter norms in organ transplantation enforced in view of Covid-19. The doctors opined that these norms had led to a substantial drop in deceased organ donation and transplantation.

As per the latest guidelines, the donor, the recipient, and the close relatives of both have to obtain negative status in the Covid-19 test, before the transplantation process.

Time is the key in transplantation surgery, said Manian.

“The latest norms have extended the whole process of organ transplantation. Earlier, the whole process used to be finished within 24 hours. Now, the documentation alone takes 24 hours. Then allocation and retrieval time and wait for the Covid-19 tests adds an extra 24 hours. Now, the complete process takes around 48 hours or more. It becomes detrimental for the patient and has led to deaths as well,” he said.

Dhir said that waiting for RT-PCR tests for Covid-19 becomes life-threatening for the patients.

“The interval between requesting the family of the deceased donor and procuring the organs already takes much time. Plus sometimes, the hemodynamic stability of the patient is so small that we cannot wait for RT-PCR reports which generally take a long time to arrive,” he said.

However, Dhir and Manian added that the process is mandatory to follow as it ensures the safety of the patient, as if a patient contracts the virus, his or her survival chances decrease by 90 per cent.

Asymptomatic donors pose a significant threat

The doctors also said that the asymptomatic donors are another hurdle in the organ transplantation.

“The RT-PCR test’s false negativity is assumed to be 30 per cent, and that is why the transplants went down substantially in April and May as there was extreme concern about the living donor’s COVID status. If the donor is an asymptomatic carrier and we somehow miss it, the patient would suffer from a lung infection, and it would be difficult for him to survive,” said P.N. Gupta, Head of Nephrology and Kidney Transplant, Paras Hospital in Gurugram.

Despite all this, the experts agreed that the government should step in to facilitate the organ donation service.

Prof Subhash Gupta, Chairman of Centre for Liver and Biliary Sciences, said that the government should step forward and roll out schemes to increase organ donation.

“India’s annual requirement of organ transplantation is nearly 3 lakh but it does only 2,000 to 3,000 transplants. It is a costly surgery, and the governments should subsidise it like other forms of treatment. Besides, they can also make a provision for the donors, or their kin (in case of death) could receive some health benefits against the noble cause of organ donation,” he added.

Health

8 risk factors that can lead to heart failure

People should also develop a habit of regular health screening to ensure that any possible heart disease could be diagnosed at an early stage, to ensure timely treatment.

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heart failure heart attack

September 20, 2020 : Heart failure is one of the most under-diagnosed heart diseases in our country, contributing to a high number of death rates. The National Heart Failure Registry recently revealed its one-year data, which shows that close to 17 percent of patients die within 90 days of being diagnosed with heart failure. These high death rates are comparable to mortality associated with cancers of the breast and cervix.

There is lot of ambiguity when it comes to understanding heart failure. The disease is often confused with heart attack, or its symptoms are ignored as signs of old age or other diseases. Currently, it’s the leading cause of mortality and repeat hospitalisations amongst all CVDs, with close to 10 million patients in India, Dr Sandeep Seth, Professor of Cardiology, AIIMS, New Delhi told IANSlife.

What is Heart Failure?

Dr Seth explains, heart failure is a chronic and progressive disease in which the heart muscle weakens or stiffens over time, making it difficult for the heart to pump normally. This leads to symptoms like shortness of breath, need for elevated pillows to breath properly while lying down, swelling in the ankles, legs and abdomen, sudden weight gain and constant tiredness or fatigue.

What causes Heart Failure?

Several comorbid conditions and risk factors can cause heart failure. A prior heart attack is one of the key reasons. Sedentary lifestyle, lack of exercise, stress, smoking, excessive consumption of alcohol, drug usage etc., that leads to lifestyle diseases, increases the risk of developing heart failure in the future. Dr Seth lists the factors.

  • Hypertension or high blood pressure makes the heart work harder than it must. Over time, this puts pressure on the heart muscle responsible for the pumping action.
  • Coronary artery disease: Narrowed arteries limit the supply of oxygen-rich blood. The heart pumps harder to meet the need of the limited blood flow resulting in weakened heart muscle.
  • Heart attack: Heart attack and Heart Failure are not similar. Heart attack is a sudden cardiac event that has a direct effect on the basic functioning of the heart. A prior heart attack can majorly cause damaged and mean that the heart will never be able to pump as effectively as it did earlier, leading to Heart Failure.
  • Diabetes: Chronic condition like diabetes increases the risk of high blood pressure and coronary artery disease which in turn increases risk of acute heart failure.
  • Cardiomyopathy: Cardiomyopathy is a disease of the heart muscle caused due to alcohol consumption and/or smoking or drug abuse or other yet to be discovered causes.
  • Obesity: Being overweight increases risk for abnormal heart function and puts one at the risk of high blood pressure, diabetes etc. In the long run, excessive fat deposition can affect the flow of blood through heart muscle, leading to heart failure.
  • Heart Valves disease: In this ailment, one or more of the valves in your heart doesn’t work properly. This can cause the blood flow through your heart to your body to be disrupted and cause various complications in your body which can lead to heart failure.
  • Irregular heartbeats: Abnormal heart rhythms, especially if they are very frequent and fast, weakens the heart muscle and could cause heart failure.

It’s advisable to adopt an overall healthy lifestyle. One should exercise on a regular basis, refrain from smoking, drinking or drug abuse and eat healthy and nutritious meals. People should also develop a habit of regular health screening to ensure that any possible heart disease could be diagnosed at an early stage, to ensure timely treatment.

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Health Outreach Services during Covid-19

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Anganwadi Healths Outreach

New Delhi: The Government has been regularly reviewing the situation in consultation with States/UTs. In order to improve the nutritional status of Women and Children, Ministry of Women and Child Development is implementing Supplementary Nutrition Programme under Anganwadi Services and Scheme for Adolescent Girls under the Umbrella Integrated Child Development Services (ICDS) Scheme to children (6 months to 6 years), Pregnant Women, Lactating Mothers and out-of-school Adolescent Girls (11-14 years).

As per the directions issued by Ministry of Home Affairs, under Disaster Management Act, 2005, all the Anganwadi Centres across the country were closed to limit the impact of COVID-19. However, to ensure continuous nutritional support to Anganwadibeneficiaries, Anganwadi Workers and Helpers have been distributing supplementary Nutrition at the doorsteps of the beneficiaries. Further, this Ministry has issued necessary directions to the States/UTs to ensure distribution of food items and nutrition support by Anganwadi workers, once in 15 days, at the doorstep of beneficiaries. In addition, Anganwadi Workers and Anganwadi Helpers have been assisting the local administration in community surveillance, creating awareness or other works assigned to them from time to time.

Ministry of Health and Family Welfare issued the guidance note on “Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition (RMNCAH+N) services during & post COVID-19 Pandemic” with States and UTs which states that campaign mode services such as – mass Vitamin a prophylaxis, campaigns for Intensified Diarrhea Control Fortnight (IDCF), National Deworming Day (NDD) and Anemia can be provided on an alternative mechanism like through home delivery of essential services & commodities etc. based on local situations. The continuation of outreach services through modified VHSNDs and Home visits by health workers was recommended in area beyond buffer zone and green zone. The activities in the containment and buffer zone were recommended through the routine visits of COVID workers. Essential medicine like IFA, ORS, calcium and Zinc are home delivered in containment zones. Specific guidance notes on the provision of the outreach services with all States and UTs to ensure continuity of essential outreach services has been issued and Webinars on implementation of outreach services related to Anemia, Nutrition Rehabilitation Centers (NRCs), Special Newborn Care Units (SNCUs), Diarrhoea prevention, NDD and IYCF practices etc have been organized.

This information was given in a written reply by the Union Minister of Women and Child DevelopmentSmt. Smriti Zubin Irani in Lok Sabha today.

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Mandatory daily antigen test for reporters, Parliament staff

Journalists covering the Monsoon session from press galleries of Lok Sabha and Rajya Sabha also have the option to undergo the RT-PCR test which is valid for 72 hours.

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Parliament

New Delhi: Amid fresh cases of coronavirus among MPs, reporters and parliamentary staff entering the Parliament complex will have to undergo mandatory antigen test on a daily basis, according to a new protocol put in place.

Members of both Houses are undergoing RT-PCR test on regular intervals on a voluntary basis, said a senior Parliament official.

A member of Parliament can undergo RT-PCR test as many times he or she likes.

Journalists covering the Monsoon session from press galleries of Lok Sabha and Rajya Sabha also have the option to undergo the RT-PCR test which is valid for 72 hours.

Since the report of the much reliable RT-PCR takes time, antigen test has been made mandatory on a daily basis.

Government officials accompanying their respective ministers during bill discussions also have to show a negative report of RT-PCR test taken within the last 72 hours of their visit to the complex. – PTI

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