ABSTRACT
Context: Fatigue is the most prominent feature of long COVID. With the increasing burden of long COVID cases post-acute phase of illness after recurrent waves of the pandemic, understanding its pathophysiology is of paramount importance. Such fatigue and post-viral illness could be associated with features of neuroimmune exhaustion and thus be a part of a larger syndrome such as myalgic encephalomyelitis (ME). Identifying the proportion of patients having ME from those experiencing fatigue would bring us one step closer to understanding the pathophysiology. International consensus criteria (ICC) originally published in English (ICC-E) is a valid and reliable tool for identifying cases of ME. However, a validated Hindi version of ICC-E is not available. Aims: To develop and validate an equivalent version of ICC-E in the native Hindi language (ICC-H) to suit Indian patients and health care workers even at peripheries and to make conducting large scales surveys more feasible. Subjects and methods: Once permission from the ethics board was granted, guidelines given by MAPI Research Trust were followed and ICC-H was developed from ICC-E, in the following steps: (a) translation to Hindi, (b) back translation, (c) comparison between the translated and back-translated version performed by experts, and (d) pre-pilot test in the intended population. The ICC-H was applied to 53 bilingual individuals knowing both Hindi and English. Statistical analysis used: The distribution of Hindi and English questionnaires was analyzed using the Chi-square test and Spearman's correlation coefficient was used for correlation between answers of each question. Results: The score of individual items and its global score was highly correlated with each other (p< 0.001). The scores of individual components and global scores of ICC-H at baseline and original ICC-E after 4 weeks did not differ significantly. Conclusion: This study shows that the ICC-H is a valid and reliable instrument for the assessment of ME. ICC-H can be used for Hindi speaking population for identifying cases of ME. © The Author(s). 2022Open Access This article is distributedunder the terms ofthe Creative Commons Attribution 4.0InternationalLicense (https://creativecommons.org/licenses/by-nc/4.0/)
ABSTRACT
Background: Lymphedema is estimated to effect between 100 - 300 million people worldwide, India has a higher proportion due to tropical problems like Filariasis and Podoconiosis over and above general causes like cancer, venous disease trauma, old age, obesity etc. Not only do the patients get a disfiguring swelling but they also get repeated infections in the limb called Adeno-Dermato-Lymphangitis Attacks (ADLA). These are mostly gram positive in origin and best managed through Penicillin. CDT (Comprehensive Decongestive Therapy) is considered the worldwide gold standard for management of Lymphoedema. CDT is labor intensive requiring physical interaction with a trained therapist who are expensive as well as hard to find. This is yet to become commonplace in India. It consists of two parts, Initiation Phase done in the hospital, and Maintenance phase, at home. MLD orManual Lymphatic Drainage is a major component of Initiation phase, but lately its relevance has been discounted. We have been managing Lymphedema - largely without MLD at our clinic since 25 years, giving good outcomes. Training on self bandaging has been a major component of our processes. Recently due to COVID some patients from far, could not reach us for care initiation. So we decided to provide counselling and training totally online. A case report is presented. Method(s): We get lymphedema patients come from across India. After diagnosis, we initiate CDT on an ambulatory basis along with long term Penicillin, counselling, training and motivation to continue self care at home. The duration of initiation phase has of late reduced great from the initial 7-10 days, as patients and care givers are taught how to self bandage. Patients are encouraged to make videos for later recall. An Electronic Medical Record system which has a special module for Lymphedema is used for care documentation. Penicillin was prescribed and patient sent appropriate bandage sets. Online training provided not only of self tying of bandage but also how to take measurements. Result(s): A total of 10 Video-Conferencing (VC) sessions were held over 2 weeks with the first two devoted to patient examination and taking measurements. The volume difference from the normal side reduced from 53% to 39% initially, later she became lax and got an ADLA attack after another 2 weeks, Penicillin had not been taken. the same was started and another counselling session done. After another two months the limb was stable at 35% volume difference from original. Limb circuferenence over time Table showing results with calculated volumes marked out Conclusion(s): Totally online CDT provision saves hugely in costs of travel and stay away from home. The occurrence of ADLA showed that patients may not follow online instructions strictly.
ABSTRACT
Therapies used to tide over acute crisis of COVID-19 infection may lower the immunity, which can lead to secondary infection or a reactivation of latent infection. We report a 75-years-old male patient who had suffered from severe COVID-19 infection three weeks earlier and who had been treated with corticosteroids and convalescent plasma along with other supportive therapies. At time of discharge he had developed leukopenia which worsened at 1-week follow up visit. On 18th day post-discharge, he became very sick and was brought to our hospital with complaints of severe persistent dysphagia. During evaluation he was diagnosed to have an acute cytomegalovirus infection and severe oropharyngeal thrush. Both COVID-19 and cytomegalovirus are known to cause synergistic decrease in T cells and NK cells leading to immunosuppression. The patient made complete recovery with a course of intravenous ganciclovir and fluconazole. Persistent leukopenia in high risk and severely ill cases should give rise to a suspicion of COVID-19 and cytomegalovirus co-infection.