Health emergencies that should not be put on hold due to COVID 19

Fear of getting infected with the novel coronavirus and the need for quarantine should not stop people from seeking medical help for non-COVID 19 related chronic and acute health emergencies. 

In the last two-three weeks, there have been cases reported where patients needing immediate medical attention very late to the emergency due to the fear of COVID 19. This should definitely not happen, says Dr Anupam Sibal, Group Medical Director, Apollo Hospital. 

Every minute you delay, the likelihood of having a worse outcome increases. For example, the sooner a person with heart emergency reports to the hospital, faster the procedure can be done. Any delay can make a difference of life and death. 

We talked to Dr Anupam Sibal from Apollo Hospital to know more about the type of health emergencies that should not be ignored and how people can find the best hospitals for their treatment.

The emergency can be divided into two categories - chronic and acute. Chronic conditions include diabetes, hypertension, kidney disease and thalassemia. Acute conditions include paralysis, weakness, chest pain, bleeding, loss of consciousness and accident. All these conditions need immediate attention and cannot be ignored, says Dr Sibal

Diabetes and high blood stress
If someone has uncontrolled diabetes, which has been going up and down, the person needs rapid assessment and treatment. Talking about blood pressure, if someone has soaring high BP, one must consult a doctor immediately, as uncontrolled high BP can lead to many other serious health issues.

Dialysis and chemotherapy
A person on dialysis needs to get his dialysis done in the same way he did earlier. Not doing so can deteriorate the condition of the person. And the same is applied for patients who are on chemotherapy or a child who is thalassemic.

Acute conditions
Paralysis
If someone develops paralysis on one side of the body or face, the person needs to be rushed to the hospital immediately.

Chest pain
Acute chest pain can be anything from a heart attack, angina or an emergency angioplasty.

How people can be fear-free?
People first need to talk to their doctors about what all systems they are experiencing. It is important to ask your doctor where COVID 19 patients are being treated in that hospital and if rules of social distancing can be safely maintained on your visit.

If your doctor is not available, you can try contacting another doctor but any kind of health emergency should not be ignored, adds Dr Sibal.

 

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Reaction to traumatic events can lead to post-traumatic stress disorder

While trauma in itself can pose risk to a child's healthy development, over thinking on such events makes the kid more prone to suffering from post-traumatic stress disorder (PTSD), says a recent study.

If they think their reaction to traumatic events is not normal, they become more likely to develop PTSD, the study published in a Journal  has found. Children begin down this route when they have trouble processing their trauma and perceive their symptoms as being a sign that something is seriously wrong.

While most children recover well after a traumatic event, some go on to develop PTSD that may stay with them for months, years, or even into adulthood. Lead researcher  said: "Symptoms of PTSD can be a common reaction to trauma in children and teenagers. These can include distressing symptoms like intrusive memories, nightmares, and flashbacks."

"Many children who experience a severe traumatic stress response initially can go on to make a natural recovery without any professional support. But a minority go on to have persistent PTSD, which can carry on for much longer," he said.

Researchers worked with over 200 children aged between eight and 17 who had attended a hospital emergency department following a one-off traumatic incident. These included events such as car crashes, assaults, dog attacks, and other medical emergencies. These young people were interviewed and assessed for PTSD between two and four weeks following their trauma, and again after two months.

The team split the children's reactions into three groups - a 'resilient' group who did not develop clinically significant traumatic stress symptoms at either time point, a 'recovery' group who initially displayed symptoms but none at the two months follow up, and a 'persistent' group who had significant symptoms at both time points.

They also examined whether social support and talking about the trauma with friends or family may be protective against persistent problems after two months. They also took into account factors including other life stressors and whether the child was experiencing on-going pain.

"We found that PTSD symptoms are fairly common early on, for example between two and four weeks following a trauma. These initial reactions are driven by high levels of fear and confusion during the trauma," said the researcher.

"But the majority of children and young people recovered naturally without any intervention. Interestingly, the severity of physical injuries did not predict PTSD, nor did other life stressors, the amount of social support they could rely on, or self-blame," he added.

"The young people who didn't recover well, and who were heading down a chronic PTSD track two months after their trauma, were much more likely to be thinking negatively about their trauma and their reactions - they were ruminating about what happened to them," he explained.

According to him, kids perceived their symptoms as being a sign that something was seriously and permanently wrong with them, they didn't trust other people as much, and they thought they couldn't cope.

In many cases, more deliberate attempts to process the trauma, for example, trying to think it through or talk it through with friends and family, were actually associated with worse PTSD. The children who didn't recover well were those that reported spending a lot of time trying to make sense of their trauma. While some efforts to make sense of trauma might make sense, it seems that it is also possible for children to get 'stuck' and spend too long focusing on what happened and why.

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Witnessing fear in loved ones can cause PSTD

A study reveals that if a person hears about a serious incident -- such as a gunfire exchange - from his/her loved ones or even strangers, it may change how information flows in the brain and can lead to post-traumatic stress disorder.

Scientists in the study, published in Neuropsychopharmacology, observed that fear in others may change how information flows in the brain.

Post-traumatic stress disorder, also called PTSD, is an anxiety disorder that can develop in some people after they experience a shocking, scary, or dangerous event, according to the National Institute of Mental Health. "Negative emotional experience leaves a trace in the brain, which makes us more vulnerable," said lead study author Alexei Morozov from Virginia Tech Carilion Research Institute in the US. "Traumatic experiences, even those without physical pain, are a risk factor for mental disorders," Morozov added. 

The team observed that most people, who live through dangerous events, do not develop the disorder, but about seven or eight out of every 100 people will experience post-traumatic stress disorder at some point in their lives. "PTSD doesn't stop at direct victims of illness, injury, or a terrorist attack; it can also affect their loved ones, caregivers, even bystanders -- the people who witness or learn about others' suffering," Morozov stated.

Based on these findings, the researchers investigated whether the part of the brain responsible for empathising and understanding the mental state of others, called the prefrontal cortex, physically changes after witnessing fear in another.

Lei Liu, a post-doctoral researcher in the lab, measured transmission through inhibitory synapses that regulate strength of the signals arriving in the prefrontal cortex from other parts of the brain in mice who had witnessed a stressful event in another mouse. 

"Liu's measures suggest that observational fear physically redistributes the flow of information," Morozov said, "And this redistribution is achieved by stress, not just observed, but communicated through social cues, such as body language, sound, and smell."

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Skin too can be preserved to save burn and accident victims

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It is not just eyes and blood that can be preserved; the same applies to the skin too. Karnataka got its first skin bank, the sixth in the country, on Wednesday. The unit is at the State-run Victoria Hospital and Bangalore Medical College and Research Institute. Doctors hope that the skin bank may help save the lives of countless burn victims, as harvested skin is the best form of ‘biological dressing’ available today.

The skin is collected within six hours of a person’s death and preserved for future use, after taking consent from the donor’s family. “Without harvested skin, even patients with 50 per cent burns don’t usually survive,” said Smitha Segu, associate professor and head, plastic surgery, Victoria Hospital.

“The main cause of death in accident and burn victims is infection. Grafting artificial or harvested skin on wounds is an effective way to improve healing,” said Dr. Devadass P.K., Dean, Victoria Hospital.

Mahabodhi Burns Centre at Victoria Hospital receives around 160 cases a month.

St. John’s Hospital in Madiwala procures harvested skin from the National Burns Centre, Mumbai, for treatment of severe burn victims. “The skin has to be couriered and reaches the next day. There is the possibility of transit delay,” said Sunderraj Ellur, additional professor, department of plastic reconstructive surgery and burns, St. John’s Hospital.

Although artificial skin is available, it is prohibitively expensive. The government has agreed to fund all skin grafts at the skin bank, which was inaugurated by Minister for Medical Education Sharan Prakash Patil. “A nominal charge may be levied,” said Dr. Segu.

The Rotary Bangalore Midtown and Ashirvad Pipes have funded the infrastructure of the skin bank.

It will take a month for the lab to be sterilised and the first skin harvest to be made. The first specimens will need to be tested for two to three months before the skin is ready for treating patients.