Cancer care continuum at a tertiary care centre in India during the Covid-19 pandemic and nationwide lockdown: Healthcare delivery through telemedicine.

Background The Covid-19 pandemic and subsequent lockdown in India caused disruptions in cancer treatment due to the restriction on movement of patients. We aimed to maintain continuity in cancer treatment during the lockdown through teleconsultations. We tried to reach out to our patients using telephonic consultations by establishing a Teleconsult Centre facility run by a team of doctors and patient navigators. Methods We telephonically contacted all patients who had outpatient appointments from 23 March to 30 April 2020 at our centre through the Teleconsult Centre to understand their current circumstances, feasibility of follow-up, local resources and offered best possible alternatives to continue cancer treatment, if required. Results Of the 2686 patients scheduled for follow-up during this period, we could contact 1783 patients in 9 working days. Through teleconsultations, we could defer follow-ups of 1034 patients (57.99%, 95% confidence interval [CI] 55.6%-60.3%), thus reducing the need for patients to travel to the hospital. Change in systemic therapy was made in 75 patients (4.2%, 95% CI 3.3%-5.2%) as per the requirements and available resources. Symptoms suggestive of disease progression were picked up in 12 patients (0.67%, 95% CI 0.35%-1.17%), who were advised to meet local physicians. Conclusion Our study suggests that the majority of patients on follow-up can be managed with teleconsultation in times of crisis. Teleconsultation has the potential of being one of the standard methods of patient follow-up even during periods of normalcy.

Can Perinephric Fat Stranding be used as a Predictor of Renal Dysfunction in COVID-19 Patients? A Retrospective Study

Introduction: High Resolution Computed Tomography (HRCT) of the chest is often performed in patients with Coronavirus Disease 2019 (COVID-19) to assess the severity of lung involvement. Multiorgan dysfunction is a well-known complication of COVID-19 infection. Bilateral Perinephric Fat Stranding (PFS) is often observed in cases of COVID-19 infection while reporting the chest Computed Tomography (CT) scans, which might represent associated acute kidney injury. It is still not known whether a correlation exists between the severity of COVID-19 infection and presence of PFS or renal dysfunction. Aim(s): To determine the association between PFS, Computed Tomography Severity Index (CTSI) and serum creatinine levels in patients with COVID-19 infection. Material(s) and Method(s): This retrospective cohort study was conducted in Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India, from April 2021 to June 2021. A total of 90 COVID-19 positive patients of all ages and gender, who underwent HRCT of chest were included in the study. The chest scans were retrospectively reviewed for severity of lung involvement using a CTSI. The cases were divided equally into two groups A (n=45) and B (n=45). Group A included cases showing PFS on CT and group B included cases with no evidence of PFS. Serum creatinine levels (obtained within 24 hrs of the scan) of all patients were noted and analysed to determine any possible association between the PFS, CTSI and serum creatinine levels. Analysis was done using Mann-Whitney U test, for continuous variables and Chi-square test was used for categorical data. Result(s): The mean age of patients (p-value=0.047) and the male to female ratio (p-value<0.001) was significantly higher in group A than in group B. Statistically significant association was found between PFS and serum creatinine (W=1375.500, p-value=0.003) PFS as an indicator of renal dysfunction had a sensitivity of 73.3%, specificity of 54.7%, Positive Predictive Value (PPV) of 24.4%, Negative Predictive Value (NPV) of 91.1% and a diagnostic accuracy of 57.8%. with an odds ratio of 3.32. Conclusion(s): Presence of PFS at imaging can serve as a useful screening tool for detecting underlying renal dysfunction in patients with COVID-19 infection. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

Digital diabetes care: How well equipped are patients and what do they think about it

Aims: Covid-19 precipitated an abrupt shift to non-face- to- face (digital) consultation. Some believe that this was overdue and that digital is better for many patients. Our aim was to establish the extent to which people with diabetes were equipped to manage digital consultation and what they felt about it. Methods: We surveyed 1,000 people with diabetes (500 type 1, 500 type 2) from our local, largely deprived community with a user-approved questionnaire, tested for face validity and readability. Results: Response rate was 376/1000 (38%);132 (35%) type 1 diabetes, 218 (58%) type 2 diabetes, 1% other and 6% blank. Age of respondents was: ≤30, 0%;31-40, 4%;41-50, 7%;51-60, 12%;61-70, 17%;71-80, 52%;81-90, 3%;and blank, 5%. Treatment was: diet alone, 11%;diet and tablets, 39%;diet and insulin injections, 24%;diet, tablets and glucagon-like peptide-1 receptor agonist, 2%;insulin pump, 9%;and blank, 6%. Some 22% were attending the hospital clinic;74% not and 4% blank. Only 40% patients had access to a video calling device and only 35% had ever used it. Separate Likert scales showed: 79% strongly preferred or preferred face-to- face consultation, 17% strongly preferred or preferred telephone;and only 6% strongly preferred or preferred video consultation;66% recognised limitations in examination, weight and blood pressure checks with digital. Summary: Our survey, representative of type 1 and type 2 diabetes and of all treatment modalities but with underrepresentation of very young respondents, reveals that most patients did not have equipment for digital consultation and 79% preferred face-to- face consultation.

Covid-19 pandemic associated with three-fold increase in demand for diabetes specialist advice

Aims: The covid-19 pandemic was associated with legally restricted public movement (lockdowns) and reduced access to face-to- face consultation for diabetes in primary and specialist care. The aim of this study was to assess the impact of the pandemic on requests for specialist telephone support. Methods: Retrospective analysis of calls for telephone support before and during the covid-19 pandemic via three separate extensions tailored to specific needs: (1) diabetes emergency advice line (direct diabetes specialist emergency advice 08.00-20.00, Monday to Friday and 08.00-16.00 Saturday and Sunday);(2) diabetes general advice line (a 24/7 telephone answer machine, typically used by patients and carers, answered repeatedly Monday to Friday 08.00-18.00);and (3) a diabetes community line, typically used by healthcare professionals in the community. We arbitrarily defined 'pre-covid' as calls up to 31/3/20 and 'during covid' as calls thereafter to 1/5/21. Results: Mean ( ± SD) calls per calendar month (pcm) increased highly significantly: 81 ( ± 80) pcm pre-covid to 248 ( ± 72) pcm during covid, p < 0.001. Emergency advice line calls did not increase: 15 ( ± 5) pcm pre-covid to 18 ( ± 11) during covid, p = 0.9, general advice line calls increased non-significantly: 161 ( ± 19) to 194 ( ± 68), p = 0.1, but community calls increased highly significantly: 16 ( ± 6) to 36 ( ± 12), p < 0.001. Although calls rose during lockdowns, the monthly picture was more of a sustained increase after the first lockdown. Summary: The covid-19 pandemic has been associated with a sustained increase in requests for non-emergency diabetes specialist team advice, particularly from primary care professionals in the community.

COVID-19 and its relationship to particulate matter pollution - Case study from part of greater Chennai, India.

It is well known that atmospheric contamination, especially the particulate matter (PM), causes severe human diseases. Yet, presently air pollution levels have dropped primarily attributable across the nation lockdown forced in the wake of the novel Coronavirus outbreak. In this study, we have attempted to establish a conceivable relationship between Covid 19 and PM10-2.5, obtained from eleven airquality monitoring stations in Chennai city, India for both Pre and during Covid situations and its influence over Covid positive cases. The observations of the materials (+ve cases, PM 10, PM 2.5) collected proved that during precovid regime less polluted areas are indicated with less than 5 infection cases reflecting the healthy people and they are less vulnerable to covid except the few occurrence of foreign source indicating no community spread whereus most polluted spots of precovid regimes are indicated with more than 90% cases and indicated that people in pollution zones are succumbed to get infected quickly. However, during Covid the lockdown has considerably reduced the particulate suspension and the results revealed that the +ve cases are of the nature of community spreading through primary and secondary contacts as reported from the media. If Covid is a visible, brutally virulent, incredibly contagious pandemic that kills rapidly and mercilessly, air pollution is its unseen evil twin. Under the radar, but even ruthlessly, if Covid and PM paired together lead to murder without delay. This is a non-communicable disease (NCD) slow-motion pandemic, equivalent-if not exceeding-the catastrophic wrath of SARS-CoV-2.