How can pregnant women protect themselves from COVID-19?

As the pandemic rages on, everyone has reason to be anxious and afraid¬—COVID-19 has claimed more than a million lives worldwide. If you are pregnant, it is natural to be afraid for the health of your baby. Since COVID-19 is a new disease, many risks and threats to particular demographic groups are still unknown. Some answers may still not be clear yet, but with the help of new research and studies, guidelines for pregnant women are getting clearer.

This blog answers some of the burning questions you might have as an expecting mother. These recommendations are based on the latest guidelines from international health organisations like the WHO, CDC, and ICMR - National Institute for Research in Reproductive Health. The links to these guidelines are available at the end of the blog for your reference.

Do pregnant women have a higher chance of getting the coronavirus (COVID-19)?

Pregnant women are not particularly susceptible as a group to the SARS-CoV-2 virus (the virus that causes COVID-19) any more than the general population is.

Pregnancy is known to alter the immune system and the way your body responds to viral infections. This may result in more severe symptoms of any infection in general and holds true for COVID-19 as well. For this reason, it is advisable that you be more cautious and reduce social contact during the pandemic.

Does COVID-19 pose an additional and higher risk to pregnant women?

Pregnant women who are older, obese, or suffering from pre-existing medical conditions such as diabetes, hypertension, and heart disease (congenital or acquired) are at a greater risk of developing severe symptoms of COVID-19. Statistically, when pregnant women acquire severe illnesses, they are more likely to require healthcare in intensive care units (ICU) than non-pregnant women of reproductive age.

With an altered immune response due to pregnancy, women may be affected more acutely by respiratory diseases. This is evidenced by the increased risk to pregnant women during the last trimester of pregnancy from other coronavirus infections like SARS and MERS. It is therefore strongly advised that you report any flu-like symptoms (cough, fever, or difficulty in breathing) to your doctor.

The coronavirus pandemic has also increased the risk of perinatal anxiety and instances of domestic violence. It is critical that support to the expecting mother and her mental health is strengthened and checked at every contact.

What effect does COVID-19 have on my pregnancy?

Currently, there is no data or reported cases that indicate an increased risk of miscarriage or pregnancy loss due to COVID-19. There is also no evidence to suggest that COVID-19 causes physical or functional abnormalities in the human embryo or foetus. Evidence regarding such instances will require long-term observations and data collection.

Overall, COVID-19 is not currently considered an indication for medical termination of pregnancy.

Can COVID-19 be passed from the mother to the foetus or a newborn baby?

Emerging evidence suggests that transmission of COVID-19 during the pregnancy or birth is probable. Newborn babies whose mothers have COVID-19 have been found to test positive for the novel coronavirus in some cases; however, this may be a correlation and not evidence of transmission during pregnancy or birth.

The proportion of pregnancies affected by COVID-19 is yet to be determined. At present, there are no recorded cases of COVID-19 being present in breast milk, amniotic fluids, or vaginal secretions.

A newborn baby can, however, catch the infection after birth. This is why doctors recommend temporarily separating the baby from mothers who test positive for COVID-19 at the time of delivery in addition to testing the baby.

What are the precautionary steps for pregnant women against COVID-19?

1. Wash your hands regularly. This is a message you may have heard over and over since the pandemic began, but it is sound advice. Hand hygiene really goes a long way in protecting you from COVID-19.

2. Adhere to social distancing norms. Avoid social contact outside of your family as much as possible. Maintain a distance of 6 feet or 2 meters from other people when you are in any public area.

3. Work from home if the option is available to you.

4. Avoid close contact with anyone showing flu-like symptoms such as coughing, sneezing, or fever. Symptoms of COVID-19 vary in intensity and it is very hard to differentiate non-Covid viral and bacterial respiratory diseases from COVID-19 without proper testing.

5. Get the recommended vaccines. The influenza/ flu vaccine will make you less susceptible to the flu, a respiratory illness that can cause complications during pregnancy. The whooping cough vaccine will protect your baby against whooping cough, which can be very dangerous in newborns.

6. Employ proper sneezing etiquette. Use a tissue or the inside of your arm when you sneeze or cough. Dispose of the tissue safely and wash your hands thoroughly.

7. Seek medical attention if you display any flu-like or respiratory symptoms. If you develop trouble breathing, fever, or a cough, talk to your doctor immediately. Your doctor will recommend you a COVID-19 test based on your medical history.

8. Seek virtual consultations with your gynaecologist instead of in-person prenatal visits. Minimizing your time in your doctor’s or the hospital’s waiting room is advisable. However, do not deny yourself any healthcare that you may need; necessary tests like blood tests, ultrasounds, and foetal tests will require you to make a visit in person.

9. Reduce everyday stress as much as possible. Do things that make you happy, calm, and put you at ease. Maintain social contact virtually with friends and your support network. Do Kegel and squat exercises as recommended by your doctor.

Is it safe to go to a hospital to deliver my baby?

Yes. It is safer to deliver in a hospital, even during the COVID-19 pandemic.

Do not delay getting any emergency care because you are afraid of getting COVID-19; the benefits outweigh the risks. Planned deliveries in hospitals are safe—hospitals take necessary precautions and have systems in place to ensure minimal risk and exposure for the newborn and the mother. Most healthcare institutions segregate COVID-19 patients in isolation wards and buildings as a precaution as well.

If you have any more questions regarding your pregnancy, the risks, and a healthcare plan to manage an ongoing or upcoming pregnancy, book an appointment with our OB/ GYN specialists at the Department of Obstetrics and Gynaecology at Sagar Hospitals. To learn more about preventable diseases and illnesses like COVID-19 call our experts at the Department of Preventive Healthcare at Sagar Hospitals.

Sources:

WHO:

https://www.who.int/southeastasia/outbreaks-and-emergencies/novel-coronavirus-2019/protective-measures/pregnant-women-and-new-mothers

CDC:

ICMR:

Reinventing hospital care during the COVID-19 pandemic

As the world continues to battle the Novel Coronavirus (SARS-CoV-2) in homes, communities, the workplace, public areas, and pretty much anywhere where public life bustled with everyday normalcy, one institution has been a surprising and worrying battleground—the hospital. During the early months of the pandemic, hospitals struggled to control infection rates inside their premises. NHS England reported around mid-May that nearly 20% of patients hospitalised with COVID-19 contracted the disease while being treated for other illnesses in hospitals. Similar figures were reported around the world: in a study involving a tertiary care university hospital in Turkey (March-May 2020), positivity rates for SARS-CoV-2 among doctors, nurses, and support staff were found to be nearly 6%, 8%, and 11% respectively.

In such dire situations, it has been necessary for hospitals and healthcare leadership to quickly adapt and reinvent patient care to ensure the safety of their frontline staff, patients, and their communities. Though hospitals and healthcare systems did struggle initially with challenges, such as overwhelming patient inflow, near-capacity occupancy, and scarcity of protective equipment and ICU beds with ventilators, they have over time also been able to strengthen and improve measures to curb virus transmission inside their facilities.

Recent data now shows that rigorous and robust infection control measures implemented in hospitals can effectively prevent the transmission of COVID-19 to visiting or admitted patients. This is a promising development since a widespread fear of contracting COVID-19 in a hospital setting has discouraged many patients to seek essential care.

New preventive measures and COVID-19 infection control in hospitals

Crisis management teams (CMT) and similar leadership in hospitals play a major role in steering the healthcare system in difficult times like these. Operational updates are required in CMT policies, admission protocols, staff and resource utilization, and treatment guidelines to restrict the virus from spreading inside hospitals.

The following are the infection control measures to help hospitals safeguard their patients and medical personnel:

1. Universal masking of all hospital staff, patients, and visitors:

The foremost preventive measure against COVID-19 in public places remains the diligent and correct usage of face masks. Hospitals must ensure proper face coverings for patients/ visitors/ attendees and personal protective equipment (PPE) for all hospital staff.

2. Testing and screening measures/ admission protocols:

• For routine consultations, patient screening must begin at the hospital gate/ entrance with mandatory temperature checks and by providing sanitizer dispensers.

• Patients with special needs and attendants must undergo isolated screening outside the building.

• COVID-19 testing facilities should be located in blocks isolated from the main hospital building.

• Fever clinics should operate outside the main hospital building for patients with flu-like symptoms.

• All hospital employees (medical and non-medical) must be screened daily at separate staff entries.

3. Personal protective equipment (PPE) in accordance with the Ministry of Health and Family Welfare (MoHFW) recommendations:

• PPE must be available for all medical as well as non-medical staff.

• Specific zones and protocols for donning and doffing personal protective equipment by hospital stall must be created.

4. Daily symptom screening for doctors and patients:

• Any healthcare personnel that might be exposed to COVID-19 must be managed and monitored.

• Communication should be effective within the hospital facility and external communication related to COVID-19 should be planned for the availability of accurate information to the wider community.

6. Dedicated non-Covid OPDs and wards:

• Separate wards, rooms, and bed spaces for non-Covid patients must be made available in separate hospital blocks/ buildings/ branches to prevent contact between patients.

• Distancing protocols must be maintained in OPDs with socially distanced seating arrangements.

• Regular sanitization of all waiting areas, consultation rooms, restrooms, and passageways must be carried out periodically.

7. Effective intra-hospital communication channels:

• The communication between frontline staff and the CMT must be continuous to mitigate and meet challenges.

• All additional/ pop-up ICUs and wards must be connected to communications systems for quick response.

8. Restricted visitor policy:

• With visitors not being allowed family meetings should be organized via web-based applications to reduce stress of the patients and their families.

9. Tele or video consultations:

Remote consultations or online appointments should be provided with doctors through video calling as per government guidelines for at-risk patients, senior citizens, and anyone hesitant to visit the hospital premises.

While the unprecedented pandemic has forced people to stay home and made them scared of visiting hospitals, the healthcare needs of patients remain ever-present and require professional care. In such a situation, reinventing hospital care and ensuring a safe environment with robust infection control protocols is an important duty for hospitals.

Carefully adapting, implementing, and following comprehensive infection control measures can prevent the spread of COVID-19 within a hospital. Educating the community about these safety and preventive measures will further help reassure patients and create confidence in the public to visit healthcare institutions. Sagar Hospitals are committed to the complete safety and health of their patients. The Jayanagar branch of Sagar Hospitals is dedicated exclusively to the treatment of non-Covid patients and out-patient consultations. Complete infection control measures, including proper distancing and sanitation protocols, have been implemented. Additionally, RT-PCR testing (the standard and reliable test for COVID-19) facilities have been kept outside the hospital premises to ensure safety for all patients and attendants. If you are suffering from non-Covid medical conditions, but are afraid to seek the required medical attention, please reach out to our experts at Sagar Hospitals for booking an appointment and receiving necessary safety-related information. Book an appointment with our experts at the Department of Preventive Healthcare at Sagar Hospitals for more information on preventive measures against dangerous illnesses and diseases.

Triggers of heartburn: what’s burning you?

Heartburn or acid reflux is the sensation of burning and pain in your chest that is often accompanied by a bitter taste. Oesophagus, the tube that connects your stomach and throat, gets irritated by stomach acid backing up, leading to burning discomfort in the area under your breastbone or upper abdomen. The condition draws its name from the region that it affects, which makes the sensation feel like your “heart is burning”.

Heartburn may occur more frequently after a large meal, while lying down, or bending. The specific factors that trigger heartburn can vary from person to person as well. Though heartburn symptoms are fairly common and can be managed at home, if they occur too frequently and interfere with you being able to swallow easily, there may be an underlying medical condition causing it.

The common symptoms of heartburn are:

• A bitter or strong, acidic taste in the mouth.

• A sensation of burning in the chest. It may usually occur after eating and at night.

• The discomfort increases upon lying down or bending.

What causes heartburn?

Heartburn typically occurs due to contents of the stomach backing up the oesophagus. This involves a problem with a valve called the lower oesophageal sphincter (LOS). The LOS is located where the oesophagus meets the stomach. The function of the LOS is to keep stomach acids and the contents contained to the stomach with the help of gravity and your natural upright posture. It opens to let food into the stomach or to allow gases out when you burp.

Sometimes, the LOS can open too frequently or not close tightly enough, allowing the stomach acid to back up into the oesophagus and leading to heartburn. The cause or factors that trigger this problem can be related to eating habits, lifestyle, diet, or even exercise. Let’s examine these factors in detail.

Heartburn triggers: diet

Certain kinds of food and drinks that can trigger heartburn in people who are susceptible to the condition:

• High-fat foods. They sit longer in the stomach longer and are the most common trigger for heartburn.

• Spicy foods such as red and green chillies, various kinds of peppers, garlic, and raw onions.

• Alcohol, red wine in particular.

• Carbonated drinks like flavoured sodas and colas.

• Caffeinated drinks such as coffee, tea, and energy/ sports drinks.

• Chocolate and other sweets.

• Citrus fruits such as lemon, grapefruit, and orange.

• Products made from citrus fruits such as juices and concentrates.

• Peppermint

Heartburn triggers: lifestyle

Lifestyle choices or health conditions can exacerbate heartburn as well:

• Smoking

• Sustained mental stress and anxiety.

• Conditions that put pressure on the stomach, such as obesity, pregnancy, and constipation.

• Overeating, resulting in too much food in your stomach.

• Lying down or sleeping too soon after meals. It is advisable to sleep after 2 hours of eating. This allows the food to pass from the stomach into the intestines and not back up into the oesophagus.

• Consumption of NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin and ibuprofen, some types of blood pressure medication, and heart disease medicines such as nitrates and calcium channel blockers.

Heartburn triggers: exercise

Abdominal pressure due to exertion or body positions involved in certain exercises can cause heartburn:

• Exercise positions that involve bending over can increase pressure on the abdominal area and cause stomach acids to be pushed back into the oesophagus.

• Exercises that exert pressure on the abdomen, such as leg crunches, crunches, and other ab workouts.

• Positions and yoga moves such as headstands and the downward dog that can reverse the natural flow of stomach acids.

• High-impact exercises and sports, such as running, football, basketball, and aerobics, which jar your body and slosh stomach contents upwards if you suffer from a weak LOS.

• Exercising on a full stomach or before the food has not left the stomach and travelled down to the intestines.

When should you see your doctor for heartburn?

Heartburn that lasts for more than 2 weeks and does not respond effectively to medication can indicate an underlying medical issue. Heartburn can be a symptom for digestive conditions such as GERD (gastroesophageal reflux disease) or ulcers, which are sores in the stomach or oesophageal lining.

Consult your doctor if you develop the following issues with heartburn:

• Difficulty or pain while swallowing.

• Difficulty in breathing or shortness of breath.

• Pain that spreads outwards from your back to your shoulder.

• Sweating during discomfort in the chest.

• Dark tarry stools with or without blood.

• Dizziness or lightheadedness.

Preventions and treatment

Heartburn prevention mostly involves avoiding the triggers discussed above. The lifestyle or diet changes should suffice in most cases to alleviate a tendency to develop heartburn. Your doctor may also prescribe you medication to treat occasional instances of heartburn, such as antacids, H2 receptor antagonists to reduce the production of stomach acids, and proton pump inhibitors to block stomach acid production. You can also maintain a log of heartburn instances to track your heartburn triggers and decide appropriate portion sizes for yourself.

However, if these measures do not improve your symptoms and the condition persists, your gastroenterologist will have to conduct a few tests to diagnose your condition accurately for a timely intervention.

These include:

• An endoscopy to check for ulcers or signs of irritation in your stomach lining or the oesophagus.

• An x-ray of the abdominal region.

• A ph-test to determine the acid levels in your oesophagus.

Identifying and understanding what triggers your heartburns can go a long way in managing and avoiding the discomfort of heartburn. Occasional episodes of heartburn are easily managed at home and little cause of concern, but chronic heartburn can limit your food choices and interrupt daily activities and sleep. Keeping a record of when and what you eat can help your doctor diagnose your symptoms better to identify the root cause of the heartburn. If you are facing issues with heartburn too frequently and it is beginning to affect your daily activities, you are advised to consult the gastroenterologists at the Department of Gastroenterology and Hepatology at Sagar Hospitals.

When to see a Gastroenterologist?

Some gastrointestinal (GI) issues require more specialized care than that is typically provided by a primary care doctor. In such cases, patients are generally referred to a gastroenterologist for treatment. A gastroenterologist typically has specialized medical training and considerable experience with medical conditions that affect the digestive tract, including the stomach, oesophagus, intestines, liver, pancreas, colon, and rectum.

Gastrointestinal issues range in severity, and though it is prudent to see a specialist when you experience some of the more common and milder symptoms as well, you should seek immediate care from a gastroenterologist if symptoms of more complex and serious issues are noticed.

The following are the various reasons to consult a gastroenterologist:

1. Common symptoms

You should see a gastroenterologist if you are experiencing any of the common symptoms related to digestive issues:

• Bowel movements that are hard to control

• Pale coloured stools

• Bloating or abdominal pain

• Belching or excessive gas

• Loss of weight and appetite

• Lethargy

• Vomiting

• Changes in bowel habits that are beginning to concern you

• Leakage/ stains in underwear

• Urine of dark colour

• Oesophageal discomfort

2. Serious and specific symptoms

Severe symptoms often indicate serious digestive conditions. If you experience any of the symptoms mentioned for the conditions listed below, seek a consultation with a gastroenterologist immediately:

Persistent heartburn/ GERD:

The burning sensation in the throat or chest because of stomach acid backing up into the oesophagus is known as heartburn. While heartburn is fairly common and can occur with the consumption of spicy or acidic food, persistent heartburn several times a week is cause for concern. If you experience frequent heartburn for six months or more even after taking proton pump inhibitors (PPI), then you may require treatment for gastroesophageal reflux disease (GERD).

GERD develops from stomach acids irritating the oesophageal lining and can cause serious complications, such as chronic inflammation in the oesophagus or breathing issues. Though GERD is more common amongst smokers and overweight people, pregnant women are prone to develop it as well.

2. Rectal bleeding/ blood in stool:

Rectal bleeding or the presence of blood in the stool is a sign that things are definitely not right. Though rectal bleeding can occur due to haemorrhoids (swelling of veins in the rectum) or an anal fissure, rectal bleeding for two or three days accompanied by abdominal pain can be a sign of a more serious issue. Such an issue can also present itself as heavy bleeding or bleeding with a fever. In such cases, consult a GI doctor immediately or seek a referral from your primary care doctor.

3. Inflammatory bowel disease (IBD):

Inflammatory bowel disease (IBD) represents a group of disorders, including Crohn’s disease and ulcerative colitis, which cause inflammation of the digestive tract. Though IBD can occur in any part of the digestive tract, the inflammation most commonly occurs in the small intestine.

IBD may occur due to a genetic predisposition or an autoimmune response, where the immune system mistakes food and other substances in the digestive tract for infection and attacks the body’s own cells.

If you experience any of the listed symptoms related to IBD, see a GI doctor:

• Diarrhoea

• Chronic or severe abdominal pain

• Joint pain

• Rectal bleeding

• Sudden weight loss

• Loss of appetite

4. Gallstones:

Gallstones are small and hard deposits that form in the fluid of the gallbladder. They develop due to imbalances in the chemicals that form bile, the digestive fluid made by the liver. Shooting or sudden pain in the right side of your abdomen can indicate the presence of gallstones. Generally, pain from a gallstone subsides as it moves.

Obese people, pregnant women, and people of age are prone to develop gallstones. Gallstone treatment can include medication that dissolves the stones. In many cases, patients who develop gallstones have to undergo surgery to remove their gallbladder.

5. Coeliac disease:

Coeliac disease is a genetic autoimmune condition that impedes the body’s ability to process gluten, a protein found in wheat, barley, and rye. When patients with Coeliac disease consume products containing gluten, their body responds by attacking their small intestine. It also interferes in the absorption of some nutrients.

Coeliac disease is different from gluten sensitivity in that the latter does not cause damage to the intestines even though both conditions share many symptoms. Coeliac disease can be confirmed by a gastroenterologist with a blood test or a sample of the small intestine (by looking for signs of damage).

3. Colon cancer screenings:

Once you reach the age of 50, you should start seeing a gastroenterologist for screening colonoscopies every 10 years. Also known as colorectal cancer screenings, colonoscopies are the most effective tools GI doctors have to detect colorectal cancer in early stages.

Colonoscopies involve the GI inserting a thin tube with a camera into the rectum to examine the colon. Imaging scans and stool tests can also be performed to help diagnose colon cancer. Early detection and diagnosis of cancer is easiest to treat and can be life-saving.

Though your primary care doctor can help you successfully navigate most of the common abdominal issues, consulting a gastroenterologist often leads to quicker and accurate diagnosis of complex gastrointestinal conditions. A quick diagnosis followed by the correct treatment plan reduces the risk of complications and lowers the chances of having to undergo procedures at the hospital. If you think you are experiencing any symptoms related to digestion that warrant a visit to a specialist, or want to know more about the risks, treatments, and various procedures related to gastrointestinal conditions, book an appointment at the Department of Gastroenterology and Hepatology at Sagar Hospitals to talk to our GI experts.

When is an endoscopy necessary?

Your primary care doctor may refer you to a gastroenterologist if a digestive complication is suspected. The gastroenterologist may want to conduct a procedure called an endoscopy to diagnose possible conditions that affect the intestinal tract, stomach, colon, and other organs of the digestive tract. These conditions can be certain kinds of cancers, ulcers, biliary tract disease, and irritable bowel syndrome (IBS). The gastroenterologist can employ various kinds of endoscopic procedures to perform a thorough examination of your digestive system, such as an upper gastrointestinal endoscopy, colonoscopy, endoscopic ultrasound and enteroscopy, to name a few.

What is an endoscopy?

An endoscopy involves the insertion of a thin and flexible tube into the throat or rectum for a close inspection of the intestinal tract. The end of the endoscopic tube holds a light and a camera which allows the gastroenterologist to see the lining and find signs of bleeding, lesions, inflammation, ulcers, and other signs of damage to the stomach or intestinal lining on a monitor.

There are a few kinds of endoscopic procedures:

Upper endoscopy: During an upper endoscopy, one of the most common endoscopic procedures, the specialist inserts the endoscope through the mouth into the throat and then on beyond the oesophagus to view the stomach lining, the oesophageal lining, and the upper section of the intestinal tract.

Colonoscopy or sigmoidoscopy: An endoscope can be passed through the rectum to the colon to examine the colon and that section of the large intestine.

Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a special kind of endoscopy performed to capture images of the gallbladder, pancreas, and the surrounding areas and to perform biopsies and stent placements.

Endoscopic ultrasound (EUS): This technique combines upper endoscopy and ultrasound techniques to capture images and gather information about different parts of the digestive tract.

Signs of bladder problems

Symptoms of bladder problems can be varied, some causing a lack of control while others are marked by pain. It is important to be aware of the health of your bladder and symptoms that may indicate issues that require timely medical intervention.

The following are the common conditions that can affect your bladder:

1. Urinary incontinence (bladder control problems): Urinary incontinence can be a mild inconvenience or a major disruptor in your daily activities. Without proper management, it can lead to an unwillingness to participate in a normal routine.

Urinary incontinence is a condition that affects the ability of a person to control (hold or release) urine. Accidental loss of urine, or uncontrolled leaking, is the most common of bladder-related problems. It is not a disease, but rather a condition that is usually indicative of an underlying health condition, such as prostate issues in men and pregnancy, childbirth, or menopause in women.

Under the guidance of your doctor, the symptoms of the condition can not only be managed but, in cases, be cured as well.

Symptoms of urinary incontinence:

• Uncontrolled leakage of urine (without any feeling any urge or warning).

• Experiencing a strong urgency to urinate immediately.

• Losing or leaking urine during everyday activities, such as exercising, coughing, and bending.

• Losing urine because of being unable to control your bladder and reach a toilet in time.

• Wetting the bed while sleeping.

When should you see a doctor?

You should seek assistance from your doctor if you start observing the following:

• You pass urine too frequently, 8 or more bathroom visits, in a day.

• You are unable to pass urine or to empty your bladder.

• You observe and blood in your urine.

• You experience urination to be uncomfortable or painful.

2. Urinary tract infection (bladder infection): A urinary tract infection (UTI) is often marked by pain or discomfort during urination. Though a (UTI) can occur in any part of the urinary system, such as the kidneys, ureters, urethra, and bladder, it is most common in the bladder. Women are much more prone to UTIs than men.

A UTI is most commonly caused by bacteria, though it can, in rare cases, be caused by fungi and viruses. It can be diagnosed by your doctor with a urine sample and treated with a course of antibiotics. Plenty of fluids are also prescribed to help flush out the bacteria out of the urinary tract.

Symptoms of urinary tract infections:

Symptoms of a UTI are presented depending on the part of the urinary system that is infected. Lower tract UTIs occur in the bladder and urethra. Upper tract UTIs occur in the kidneys and can be potentially life-endangering as the infection can travel from the kidneys into the bloodstream.

Symptoms of a lower tract UTI are:

• A burning sensation or pain while urinating.

• An increase in frequency to urinate without passing much urine.

• An increase in the sensation of urgency to urinate.

• Cloudy or bloody urine.

• Urine with a strong or foul smell.

• Discoloured or dark-coloured urine.

• Rectal or pelvic pain in cases of men or women respectively.

Symptoms of an upper tract UTI are:

• Fever

• Chills

• Vomiting

• Nausea

• Tenderness and pain in the abdomen, sides, and upper back.

3. Interstitial Cystitis (painful bladder syndrome): Interstitial Cystitis (IC), also known as the painful bladder syndrome is a chronic condition where the bladder becomes irritated and suffers inflammation. The inflammation makes it difficult for the bladder to fully expand while filling up with urine, causing pain. IC can be caused by many reasons, such as a trauma to the bladder, a defect in the bladder lining, or an injury to the spinal cord.

Severe IC symptoms can have an adverse impact on your life and disrupt many everyday activities like exercise, work, and sexual intercourse. IC is diagnosed by doctors by ruling out other conditions that cause similar symptoms with urine sampling, cystoscopy, or an ultrasound/ CT scan of the pelvic area.

Symptoms of interstitial cystitis:

• The main symptom of IC is pain. The pain increases as the bladder fills, and then dissipates with passing urine. The pain usually alleviates once the bladder is emptied. Pain may also be felt in the groin, abdomen, or lower back.

• The frequency of urination can increase without passing much urine. Most people pass urine 4-7 times a day; with IC, this frequency can go up considerably.

• An urgent need to urinate before the bladder has had time to be full.

4.Bladder cancer:

Cancer can affect the bladder as well. The most common kind of bladder cancer is transitional cell carcinoma, which begins in the innermost layer of the bladder lining. Factors that increase the risk of developing bladder cancer are smoking, exposure to carcinogenic substances, and genetic predispositions such as family history and being male, older, or white.

Symptoms of bladder cancer:

• Presence of blood in the urine, also known as hematuria.

• Pain during urination.

• An increase in the frequency and urgency to urinate.

• Difficulty in passing urine.

• Pain in the lower back.

It is important that you take any symptoms or difficulties in your urinary system seriously, and seek medical attention as soon as possible. Most bladder issues share similar symptoms such as discomfort during urination, an increase in the frequency to urinate, and increased urgency. A medical professional will conduct physical examinations and run tests to identify the condition to start appropriate medication immediately. If you are suffering from any bladder-related issues or are seeking more information regarding urinary problems, book an appointment with our experts at the Department of Urology and Nephrology at Sagar Hospitals.

So, how do the kidneys work?

Healthy kidneys are capable of filtering about 180 litres of fluid every day, removing waste and toxins from the plasma to make urine. Part of the urinary system, kidneys are the major excretory organ of the human body. The bladder stores this urine until it is excreted out through the urethra.

Why are the kidneys important?

The kidneys perform critical functions that are necessary to regulate and maintain the balance of body chemicals. These vital organs perform the following functions:

• Remove waste, toxins, and excess fluid from the body, a process that involves complex steps of filtration, reabsorption, secretion, and excretion.

• Remove acids produced by body cells and maintain a steady balance of salts, water, and minerals such as sodium, potassium, calcium, and phosphorus. Without this optimum balance, tissues such as nerves and muscles may not work correctly.

• Filter medication and drugs from the body.

• Release hormones that help control blood pressure.

• Produce the hormone EPO that controls the production of red blood cells.

• Promote strong and healthy bones by producing an active form of vitamin D.

How do the kidneys filter blood?

The kidneys filter blood in the following steps:

1. Blood flows to the kidneys: Blood flows from the aorta (the main artery branching from the heart) to the kidneys through the renal arteries. The renal arteries carry a large volume of blood, nearly 25% of the cardiac output, to the kidneys for filtration.

2. The two-step process of nephrons: The main functional and filtering units of the kidneys are the nephrons (each kidney has ~1 million nephrons). A nephron in turn consists of a filtering unit of tiny blood vessels called the glomerulus that is attached to a tubule that runs along the blood vessel. The nephrons work in a two-step process: the glomerulus filters the blood and the required chemicals are returned to the filtrate in the tubules.

3. Filtration of blood by the glomerulus: The walls of the glomerulus are fenestrated—the perforated and thin walls of the glomerulus allow small molecules (mostly minerals), fluids (mostly water), and wastes to pass into the tubule. Proteins and blood cells, which are larger, remain in the blood vessel.

4. Reabsorption in the tubule: The tubule runs along the blood vessel. As the filtrate (filtered blood) flows in the tubule, most of the water and essential nutrients and minerals such as glucose, salts, and amino acids are reabsorbed into the blood vessel. The newly filtered blood is recirculated into the body through the renal vein.

5. Removal of waste and transport of urine to the bladder: The tubule also helps remove the excess acid from the blood. The remaining fluid and wastes from the tubule, high in urea, become urine and are transported to the bladder for excretion.

What are the causes of kidney problems?

The following are the common causes of kidney damage:

• Diabetes: The leading cause of kidney disease is diabetes. Insulin is required to maintain proper sugar levels in the body. Diabetes is a condition where the body’s ability to produce or use insulin is impaired. When the sugar level in the blood is high, kidney function can get severely affected.

• High blood pressure (hypertension): Sustained high blood pressure can cause damage to the blood vessels and filters (glomeruli) in the kidneys and in advanced stages, renal failure.

• Kidney stones: Kidney stones are formed by the concentration of crystals in the urine. Stones can be formed due to many reasons, such as habits, diet, or an inherited tendency. They can cause severe pain in the sides and lower back when they pass.

• Urinary tract infections (UTI): Urinary tract infections (UTI) usually occur in the lower urinary tract—the bladder or the urethra. However, sometimes a UTI can spread to the upper urinary tract and infect the kidneys. This can prove to be dangerous as the infection can spread from the kidneys into the blood.

• Drugs and toxins: Sustained and frequent use of over-the-counter pain medication like NSAIDs (nonsteroidal anti-inflammatory drugs) can be harmful to kidneys. Toxins, pesticides, certain medications, and illegal drugs like heroin can also cause kidney damage.

• Inherited and congenital kidney disorders: Congenial conditions that develop in the womb that may result in defects that can cause improper kidney function, such as reflux or backing up of urine to the kidneys. Inherited kidney diseases such as polycystic kidney disease can cause serious kidney damage or even kidney failure.

What are the warning signs of kidney problems?

Kidney disease usually manifests in both kidneys. If the kidneys’ ability to filter blood is compromised, there may be a buildup of wastes, excess liquid, and toxins in the body, leading to serious complications. The warning signs of kidney disease are:

• Blood in the urine, or foamy urine.

• Hypertension, or high blood pressure.

• Cramping muscles.

• Swelling in hands and feet.

• Puffiness around the eyes.

• Difficulty or pain during urination.

• An increased frequency in urination, especially at night.

• A glomerular filtration rate lower than 60.

• Excess of Blood Urea Nitrogen (BUN) and creatinine in the blood.

Kidneys perform a vital role in maintaining the overall health of the body. Kidneys act as the blood filtration unit of the body and help maintain the right balance of body minerals. Knowing the importance of the renal system and understanding how kidneys function can help you keep your kidneys healthy and prevent future issues. This knowledge can be especially useful for understanding a treatment process when under the supervision of a urologist. For further information on kidney health, or to seek guidance regarding any kidney-related issues that you think you might have, reach out to the experts at the Department of Urology and Nephrology at Sagar Hospitals.

Dietary guidelines for kidney stone formers

The chances of a person developing a kidney stone during the course of their lifetime are 1 out of 10. So if you have developed kidney stones, do not be alarmed. The condition is manageable and stones can be passed out of your body with medication and the right diet. Further, your doctor will run blood and urine tests to determine any risk factors and then prescribe you medical treatment and a specific diet plan to prevent the recurrence of stone formation.

What is a kidney stone?

A kidney stone is formed by the concentration of crystals in your urine. Usually, the natural chemicals in the urine prevent stone formation, but chemical imbalance and other factors can lead to substances getting concentrated into kidney stones.

What kinds of kidney stones are there?

The most common kind of kidney stones is calcium oxalate stones. Calcium in the urine can combine with chemicals like oxalate or phosphorus and solidify into crystals. With increasing concentration of these crystal substances over time, calcium oxalate kidney stones can be formed.

Another common kind of stones is uric acid stones, formed by the buildup of uric acid. This buildup is caused by the metabolism of proteins. Organ meats, red meat, and fish have large amounts of a natural compound called purines. A high intake of purine leads to high uric acid production, which in turn creates a higher acid load to be excreted by the kidneys. This high acid concentration in the urine makes the kidneys susceptible to uric acid stone formation.

What is the most important aspect of managing kidney stones?

The most thoroughly proven intervention to prevent stone formation from recurring is good hydration. Drinking enough water to keep calcium crystals in solution or keep uric acid concentrations low in the urine is one of the most reliable methods to prevent kidney stones.

How much is enough water for low urine concentration? A water intake that produces a volume of 2.5 litres per day of urine is recommended. Fluid intake from non-sugary and non-alcoholic beverages such as lemonade, freshly-pressed juices, and water with the exception of grapefruit juice is proven to have a beneficial effect.

It is also important to be mindful of the other ways in which your body loses water. If you sweat a lot due to exercise or because of your environment, you must increase your water intake. Loss of water due to excessive sweating can reduce urine production and cause stone-causing crystals to deposit in your kidneys, increasing the chances of stone formation.

Dietary recommendations to manage kidney stones

For calcium-oxalate stones:

1.Increase citrus intake: Citrate reduces the formation of calcium stones by binding with urinary calcium to reduce saturation and by binding with calcium oxalate crystals to reduce crystal growth. Citrus fruits such as oranges, grapes, lemons, and their juices are a rich source of naturally occurring citrates.

2.Limit foods with high oxalate and phosphate content: Oxalate is found naturally in many kinds of food including vegetables, fruits, legumes, nuts and seeds, and grains. A few examples of these oxalate-rich foods are peanuts, spinach, sweet potatoes, beets, chocolate, Swiss chard, and rhubarb. Limiting the intake of these foods can prevent exacerbating current stone formation and also prevent new stones from forming. Avoid colas. Colas contain a high amount of phosphates and increase the risk of stone formation.

3.Include adequate calcium in your diet: Though the name “calcium-oxalate stone” may suggest that calcium leads to stone formation, on the contrary, a lack of dietary calcium actually increases the chances of developing kidney stones. It is advised that calcium and oxalate-rich foods are eaten together in a meal so that they bind in the stomach and intestines before entering the kidneys. The daily recommended intake of dietary calcium to reduce the occurrence of calcium stones is 1000-1200mg per day.

4.Reduce sodium intake/ avoid a high salt diet: High sodium levels in your diet and body can increase calcium buildup. Sodium and calcium share the same transport in the kidneys, so a high sodium intake increases the leakage of calcium into the urine. A high sodium diet thus increases your chances of developing a new kidney stone. Hidden sources of sodium are canned and processed foods, restaurant and fast foods, and even some vegetable juices.

5. Avoid fasting: Fasting, in general, dehydrates the body and concentrates urine. Such conditions are ripe for crystal deposits to concentrate in the urine. Once triggered, this usually leads to stone formation. It has been noted that individuals who keep religious fasts are prone to recurrent stone formation.

For uric acid stones:

1. Reduce animal-based protein in your diet: Animal proteins like red meat, chicken, poultry, fish, organ meats, and gravies containing these foods have high purine content. Reducing purine-rich food in your diet reduces the risk of recurrence of uric acid stones.

2. Eat a plant-based diet: A diet comprising vegetables, fruits, whole grains, and low-fat dairy items is recommended to manage and reduce the recurrence of uric acid stones.

3. Avoid added sugars, sugary and alcoholic drinks: Avoid drinking beverages that dehydrate you, such as alcohol. Alcohol also increases uric acid levels in the blood and urine and the risk of uric acid stones. Sweetened drinks, especially those that contain fructose corn syrup should be avoided. Added sugars increase the risk of kidney stones. Processed foods such as cakes, corn syrup, white sugar, commercially produced desserts are high in added sugars.

Kidney stones can be a painful ailment to live with. However, it is a condition that can be managed effectively with diet and medication. Staying hydrated is a key factor in managing and preventing new kidney stones. Increasing your citrate intake, pairing calcium with oxalates and phosphates, and maintaining regular eating habits can be beneficial as well. Avoiding certain foods such as those containing high sugar and salt, alcohol, and sticking to a plant-based diet are important aspects of an effective diet for stone formers. For more information regarding kidney stones and how to manage them, book an appointment with our urology experts at the Department of Urology and Nephrology at Sagar Hospitals.

6 Superfoods to Improve Your Heart Health

Contrary to what the name might suggest, superfoods are neither exotic nor expensive. They are usually common, affordable, and fairly easy to incorporate into your diet for healthy eating.

Superfoods are nutrient-dense foods that include vegetables, fruits, whole grains, and plant-based and animal proteins. They are recommended by nutrition experts as healthy food choices because of their numerous health benefits. Superfoods can be beneficial to prevent a wide variety of conditions including heart disease.

The following are 6 superfoods that can improve your heart health:

1. Leafy green vegetables: Some studies have found a direct link between increasing the intake of green leafy vegetables and a lower risk of heart disease to an extent of 16%. Common dark leafy greens found at the grocery store are kale, broccoli, spinach, mustard, and salad greens.

Green leafy vegetables are rich in minerals, vitamins, and antioxidants. In particular, they are rich in Vitamin K, which promotes proper blood clotting and protects your arteries. They also contain folate—a very important vitamin B that prevents heart disease. These vegetables are also rich in dietary nitrates which are shown to decrease blood pressure, protect blood vessels, and decrease arterial stiffness.

Leafy greens can be sautéed, stir-fried, roasted, and added to salads to make a delicious meal easily.

2. Berries: Researchers recommend eating berries such as strawberries, blueberries, and blackberries three times a week to reduce several risk factors for heart disease. Berries are rich in antioxidants like anthocyanins that protect against inflammation and age-induced oxidative stress and prevent cardiovascular disorders.

An analysis of 22 studies has shown that the consumption of berries is associated with a reduction of bad LDL cholesterol, blood pressure, inflammation, and body mass index. Berries are jam-packed with nutrients that can play a central role in maintaining the health of your heart.

3. Beans: Beans are a rich source of protein and fiber and have almost no saturated fats that increase cholesterol and risk of heart disease. Fiber not only helps in digestion but also prevents heart disease. Beans are a good substitute to animal proteins, which though contain high quantities of protein and iron, tend to contain saturated fat.

Beans contain resistant starch which is shown to improve heart health by reducing levels of cholesterol and triglycerides in the blood. In addition, the inclusion of beans to the diet has shown a reduction in inflammation and blood pressure, both of which are major contributors to heart disease.

4. Whole grains: Whole grains such as oats, whole wheat, brown rice, rye, barley, and quinoa are grains that include all three nutrient-rich parts of the grain—bran, endosperm, and germ. Whole grains like oats contain a fiber called beta-glucan. Fibers are known to reduce bad LDL cholesterol and reduce the risk of heart disease and stroke. Eating whole grains is also shown to reduce systolic blood pressure.

Multiple studies have found a link between including whole grains in your diet and improved heart health. An analysis of 45 studies concluded that eating three more servings of whole grains daily was associated with a 22% reduction in the risk of heart disease.

5. Foods with good fats: fatty fish, seeds, and nuts: Fats like omega-3 fatty acids and mono- and polyunsaturated fats can reduce cholesterol and prevent cardiovascular disorders. Fatty fish such as salmon, mackerel, sardines, and tuna are particularly rich in omega-3 fatty acids. Nutritionists at the American Heart Association recommend eating at least two portions of fatty fish a week. Omega-3 fatty acid is a nutrient that can lower blood pressure, lower total cholesterol and triglycerides, decrease the risk of abnormal heart rhythms or arrythmia, reduce plaque from arteries to prevent coronary artery disease, reduce the probability of a < href="https://sagarhospitals.in/healthlibrary/heart-attack-every-second-counts/" target="_blank">heart attack, and improve arterial function.

Nuts and seeds such as walnuts, chia seeds, and flaxseeds are rich in mono- and polyunsaturated fats. They are also excellent plant-based sources of omega-3 fatty acids such as alpha-linolenic acid.

6. Tomatoes: Tomatoes are rich in lycopene, a natural plant pigment with antioxidant properties. Antioxidants help neutralise harmful free radicals, preventing inflammation and oxidative damage that can cause heart disease. Lycopene has been linked to a reduced risk of heart disease and stroke.

Tomatoes are also rich in nutrients such as folate, vitamin C, potassium, and choline, all of which promote heart health. Scientists have argued that increasing potassium intake while reducing sodium intake is the most important dietary change while trying to prevent cardiac disease.

Healthy eating can not only improve your overall health, but certain foods can significantly improve the health of your heart and help keep heart disorders at bay. However, eating superfoods alone is no guarantee of good heart health. You must eat a balanced diet with the right portions of fiber, vitamins, protein, and fat to main a healthy body weight. For more information regarding your heart health and risks of cardiac disorders, book an appointment with our specialists at the Sagar Heart and Vascular Institute.