What are the causes of PCOD? There are no definitive causes known but some of the suggestions by experts are that it can be hereditary, excess insulin levels, etc.

Some common symptoms of PCOD include irregular menstruation, heavy bleeding, acne, weight gain, hair growth on face, back or on belly, skin darkening.

There is no definite cure for PCOD however if managed carefully its effect can be lessened. One must keep consulting with a gynaecologist at regular intervals. The prescribed treatments might include birth control pills to regularise periods and other medications to control cholesterol, increase fertility. Along with this one should keep exercising to maintain a healthy lifestyle. 

What is Asthma ?                                                                                                               

Asthma is a chronic disease that affects the tubes that carry air in and out of your lungs, making it harder to exhale. It is basically a condition in which one’s airways narrows and swells which might result in extra mucus being produced. This can make breathing difficult which in turn triggers coughing, whistling and wheezing leading to shortness of breath.

 According to The Global Asthma Report, asthma affects more than 339 million people around the world. The recent Global Burden of Disease (GBD, 1990–2019) estimated the total burden of asthma in India as 34.3 million, accounting for 13.09% of the global burden. It also attributed that 13.2 thousand deaths in India were due to asthma. Asthma accounted for 27.9% of the disability-adjusted life years (DALYs) in Indians.

COVID 19 and Asthma

Currently, in India in the post COVID-19 world there are 2 % of adult and 6% of child population suffering from asthma.

WHO had conducted a rapid systematic review for evaluating any link between COVID 19 and Asthma. The review set out to assess the available peer-reviewed literature regarding whether People With Asthma are at increased risk of infection with the virus that causes COVID-19, and/or of experiencing complications or death. In particular, the review set out to analyse evidence on the following questions.

• Is asthma associated with increased risk of acquiring SARS-CoV-2 and COVID-19 disease?

• Is asthma associated with hospitalization with COVID-19?

• Is asthma associated with the severity of COVID-19 outcomes ?

None of the included reviews were able to conclude with any certainty whether asthma was associated with increased risk of infection with SARS-CoV-2.

None clearly signalled an increased risk of ICU admission in people with asthma with COVID-19.

In the three studies included in their review with over 200 participants that evaluated death, one found no association, one found them to be underrepresented in deaths from COVID-19, and one found a higher risk of COVID-19 hospital death in people with asthma, with a greater risk in those with recent use of an oral corticosteroid.

Whether asthma increases risk of infection or severe outcomes from COVID-19 remains unclear. Systematic reviews do not detect a clear increase in risk.

(WHO/2019-nCoV/Sci_Brief/Asthma/2021.1)

Why asthma become severe in winters?   

Cold, dry air and sudden shift in the weather can bother your airways, causing it to produce more mucus. Staying indoor always doesn’t help either, as this can lead to an increase in respiratory illnesses like colds and flu. This all adds up to flaring up severe asthma. Other reasons for severity of asthma in winters are pollution, dust mites and damp & mould conditions.

Some useful suggestions for people with asthma-

• Try to stay indoors when the temperature dips very low.
• If you do have to go outside, cover your nose and mouth with a scarf to warm the air before you breathe it in.

• Drink extra fluids. This can keep the mucus in your lungs thinner and therefore easier for your body to remove.
• Try to avoid anyone who appears to be sick.
• Vacuum and dust your home often to remove indoor allergens.
• Wash your sheets and blankets every week in hot water to get rid of dust mites.

To prevent asthma attacks when you exercise outdoors in cold weather:

• Use your inhaler 15 to 30 minutes before you exercise. This opens up your airways so you can breathe easier.
• Carry an inhaler with you in case you have an asthma attack.
• Warm up for at least 10 to 15 minutes before you work out.
• Wear a mask or scarf over your face to warm the air you breathe in.

To ensure optimal utilisation of resources to provide care to novel coronavirus patients, the Union Health Ministry has proposed classification of health facilities into three different categories.
Dr. Dilip Vaswani,  HABF clinician in Mumbai is our Corona warrior. 
He continues to provide services to his patients in Mumbai and ensures that patients with chronic illness and who are under his care do not miss out on regular health monitoring and medication. Apart from visits to his clinic, he provides tele-consultation. He makes home visit only for any emergency requirement.
During his interactions, he continues to reinforce safe-practices for protection against Covid19 to his patients and family members. He is careful to ensure his own protection through PPE and infection control measures.
We salute our Corona warrior.

The theme for this year, 2020 is ‘Support nurses and midwives’. This coincides with the 200^th birth anniversary of Florence Nightingale, the founder of modern nursing. The essential contribution of nurses and midwives to improving the health outcomes of individuals, families and communities cannot be denied. Nurses and midwives play a pivotal role in all areas of health service delivery: promotion, prevention, treatment and rehabilitation.  Nurses also are pivotal in providing health care services in the community and the individual levels in various PHCs, CHCs, District hospitals, Medical Colleges and tertiary care hospitals. India is a major contributor of trained nurses across the globe. They are often the primary-care givers and sometimes, the only point of contact with the health care delivery system. While the world is fighting an enormous battle to tame the Covid19 pandemic, nurses across the globe are at the forefront of healthcare delivery. Tertiary care and intensive care are largely manned by highly skilled critical care nurses who team up with the doctors and paramedics in very successfully managing many patients towards a successful cure. Our field level nurses, the Auxiliary Nurse midwives (ANM) are very well known for their contribution in primary care and MCH programs. They have risen to the task  again and are taking up difficult challenges in contact tracing of Corona positives through a ‘door-to-door’ campaigns. As Florence Nightingale, the ‘Lady with the Lamp’ has quoted – I attribute my success to this:—I never gave or took an excuse, nurses over the years have never stayed away from providing the best of care, wherever and whatever the conditions might be.

In the recent past, I had the privilege of working with nurses across India on a large scale capacity building program where we reached out and closely understood the efforts and contribution of around 1.5 lakh nurses across all states. In these difficult times, we salute and acknowledge the sacrifices of nurses across the globe who has succumbed while providing selfless care to Covid19 patients. Our homage and prayers. May you continue to be the angel that you were….

We need to understand our body own immune system before washing our hands or keeping social distance or precaution before sneezing. We have our skin, snot, (mucus in the nose) microbiome and helpful bugs (gut bacteria) which compete with pathogens for food and space. These in totality makes antimicrobial products & antiviral compounds that are quite hostile to deadly viruses – including Corona virus. If the pathogens moves beyond then the white blood cells attack them. There are others which we term as vaccine which remembers the germs, and confronts them without our knowledge. This happens when we get immunity and this is the base of vaccination. It bypasses all the defence system and protects the body with its own (RAM) memory system so that we don’t fall sick. At times our immune system might get some blind spots – it means they don’t recognise the bugs or the bugs might have evasion strategies. A healthy body and system ensures a good defence system. Our bodies contain more cells belonging to microbes, such as bacteria and yeasts, termed as microbiome – the Gut Bacteria. “We live in a symbiotic relationship with our gut bacteria.” “Having the right ones around is best for our health. Anything we do that alters the ecosystem of these microbiomes is detrimental or bad for our immune system.” To feed our gut microbiomes, we need more varied diet with lots of high-fibre foods”. Being vegetarian isn’t a prerequisite for microbiomes health, but the more plant foods one consumes, the better. “The gut microbiome floras are active from the food they derive from fibre, pulses and fermented foods.” Yoghurt (dahi) and Pickles an accompaniment in the Indian Cuisine are among the fermented delicacies now coming back to the plates of the Indian plates and vis-a-vis helping a healthy microbiome. It is not the end here it has to be a continuous process and not for a day or for that matter a fashionable touch. Rather it should be permanent fixture. We have our own fermented rice pancake (pitha) which has disappeared from the (Odisha) kitchen. These are the views of the author and curated with inputs from various sources Digital and Social Media Feeds.

The novel Corona virus is a RNA virus and highly transmissible. There are 2 types of tests to detect the presence of the virus in the body.
The  antigen test, which detects the virus particle. The samples for this test are from nasal and throat swabs. This usually comes positive by the 5th day of infection
The antibody test which detects the presence of antibodies to the virus.   Antobody tests are done through a blood test. The antibody test shows the immune response by the body against the virus. The tests usually detect two types of antibodies. One, called IgM, is typically produced about a week after infection and could identify patients who may still be infected. This IgM is detected by day 7 of the infection.  Levels of IgM begin to wane as the body makes another type of antibody called IgG, which can persist for longer periods of time.. By Day 10 of infection, immunoglobin G or IgG is shows up. This presence of IgG suggests that the person has been infected for a long time.

The corona infections in India have crossed the 2.5 lakh mark with around 7000 deaths. The case fatality rate continues to be below the 3% mark.  With easing of lockdowns, many theories will be put forward. What started as a success story in the initial days of the pandemic and lockdown, seems otherwise now. The trajectory of the virus has followed a uniform pattern across the countries. While lockdown appears to be the point of debate. Lockdown with aggressive testing, has definitely contributed to minimal infections in many Southeast Asian countries.

Lockdown in India has not only minimised the explosion of infections but also staggered the spread of the infections, enabling a window for the healthcare system to be bettered prepared.  Instead of dwelling on the economic impact of the lockdown, better to focus on strengthening the intensive care facilities for the severe cases. This aspect appears to be collapsing. With increased testing, infections will continue to rise for some time. Reducing mortality is the need of the hour.

Extracorporeal membrane oxygenation (ECMO), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. ECMO was developed in the 1950s by John Gibbon, and then by C. Walton Lillehei. ECMO works by temporarily drawing blood from the body to allow artificial oxygenation of the red blood cells and removal of carbon dioxide. ECMO is now being used to support patients with the acute viral pneumonia associated with COVID-19 in cases where artificial ventilation is not sufficient to sustain blood oxygenation levels.
In early February 2020, doctors in China have increasingly been using ECMO as an adjunct support for patients presenting with acute viral pneumonia associated with COVID-19 infection, when, even after ventilation, the blood oxygenation levels remain too low to sustain the patient. The initial reports indicate that it is assisting in restoring patients’ blood oxygen saturation and reducing fatalities among the approximately 3% of severe cases where it has been utilized. For critically ill patients, the mortality rate reduces from around 59-71% with conventional therapy to approximately 46% with ECMO.
Support with ECMO is further not available in many low- and middle-income countries; therefore, ECMO might not seem to gain as much of a priority as personal protective equipment, correct management, diagnosis and quarantine, oxygen therapy alone, and mechanical ventilation in first stance.
Reproduced from – Kowalewski, M., Fina, D., Słomka, A. et al. COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review. Crit Care 24, 205 (2020). https://doi.org/10.1186/s13054-020-02925-3 Doi: https://rdcu.be/b5E5fMany other studies appear inconclusive in their recommendations to the use of ECMO in severe cases of COVID 19.
ECMO is a resource-intensive form of life support that can be used as a rescue therapy in critical patients. ECMO could be of use in COVID-19 patients with severe ARDS or cardiomyopathy in which conventional therapy has failed.
Pravda NS, Pravda MS, Kornowski R, Orvin K. Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic [published online ahead of print, 2020 Apr 17]. Future Cardiol. 2020;10.2217/fca-2020-0040. Doi: https://dx.doi.org/10.2217%2Ffca-2020-0040
In COVID-19, the decision-making is even more complex than usual. But with limited evidence to back their use and the amount of resources required, physicians on the front lines are urging a go-slow approach

The COVID 19 pandemic has renewed our interest in the presence of immunity boosting food in our daily diet. Immunity is not built up in a day. There are no magic pills. Eating a well-balanced diet and being physically and mentally active is important to remain healthy and keep your immune system in good health. Of particular interest are some common herbs that are used regularly in our food. Some of these herbs and their medicinal properties are mentioned here.

• Ajwain seeds(Caraway seeds) – contain niacin and thymol, two essential compounds that have anti-inflammatory and other benefits that boost the health of your heart. Its magical properties also helps stimulates nerve impulses and improves blood circulation in the heart.
• Basil(Tulsi) – is used to treat many conditions, including H1N1 (swine) flu, diabetes, the common cold, headache, fever, stress, upset stomach, earache and more. It has also been used as a mosquito repellent and topically (on the skin) to treat ringworm.
• Black Pepper(Kali mirch) – is rich in a potent antioxidant called piperine, which may help prevent free radical damage to your cells.
• Cayenne(Lal mirch) – contains a substance known as capsaicin that has a therapeutic effect, triggering a biochemical reaction that is both analgesic (pain-relieving) and anti-inflammatory
• Cinnamon(Dalchin) – contains large amounts of highly potent polyphenol antioxidants. The antioxidants in cinnamon have anti-inflammatory effects, which may help lower your risk of disease
• Clove(Laung) – are low in calories but a rich source of manganese. Manganese is an essential mineral for maintaining brain function and building strong bones

• Coriander(Dhania) – is filled with fibres that improves digestion and is good to improve bowel movement. It has anti-diabetic properties and promotes insuline growth. It is known for its medicinal properties, used to cure allergies, eye infections, anaemia etc.
• Cumin seeds(Jeera) – contain naturally occurring substances that work as antioxidants. That means that these substances (called apigenin and luteolin) keep the tiny free radicals that attack healthy cells from being successful. Antioxidants help you feel healthier and more energetic, and they help keep your skin from looking aged.
Fennel(Saunf) – is a good source of potassium, phosphorus, and calcium. When it comes to vitamins, fennel is highest in vitamin C and folate. Fennel also offers essential minerals like manganese, chromium, copper, iron, and zinc.
• Fenugreek(Methi) – used to treat digestive and respiratory ailments, and it has a long history of use in women’s health—to induce labor and help with childbirth, and as a treatment for gynecological issues like painful menstruation and uterine problems
• Ginger(Adrak) – is used as a remedy for diabetes, indigestion, and colds, and can help balance a person’s kapha (physical and emotional energies). It is also a common ingredient in chai tea and cinnamon tea, both of which are believed to improve digestion. It eases post-surgery nausea and vomiting, the herb also reduces motion sickness and morning sickness symptoms. Ginger tea is used to treat sore throat and cold inflammation.
• Garlic(Lasun) – has potent anti-oxidant properties, and helps in reducing stress and high blood pressure. It also helps to enhance thiamine (vitamin B1) absorption in the body and prevents beriberi. It is always best to chop or crush garlic before consuming it, because it works better when in contact with oxygen
• Mint(Pudina) – may also be effective at relieving other digestive problems such as upset stomach and indigestion.
• Mustard seeds(Sarson) – are rich in a nutrient called selenium, known for its high anti-inflammatory effects.  The high source of magnesium in mustard seeds helps reducing the severity of asthma attacks and certain symptoms of rheumatoid arthritis and lowering blood pressure.
• Turmeric(Haldi) – The Golden spice. Turmeric is used as an herbal medicine for rheumatoid arthritis, chronic anterior uveitis, conjunctivitis, skin cancer, small pox, chicken pox, wound healing, urinary tract infections, and liver ailments. It is also used for digestive disorders; to reduce flatus, jaundice, menstrual difficulties, and colic; for abdominal pain and distension (Bundy et al. 2004); and for dyspeptic conditions including loss of appetite, postprandial feelings of fullness, and liver and gallbladder complaints. It has anti-inflammatory, choleretic, antimicrobial, and carminative actions.

(Reproduced from multiple sources – poshan.outlook.com; healthline.com; medlife.com etc..)