ABSTRACT
Background: The COVID-19 pandemic severely impacted patients with acute lymphoblastic leukemia(ALL) in maintenance phase of chemotherapy. Teleconsultation was introduced to ensure continuity of care for these patients during the lock-down phase of the pandemic and was continued well after its end. Hence, we decided to analyze the impact of teleconsultation in a cohort of ALL patients. Method(s): Our study was a single-centre retrospective analysis of patients with ALL on maintenance chemotherapy. Thirty-five patients records were analyzed, comparison was made between absolute neutrophil counts (ANC) and frequency of consultations before and after the start of teleconsultation, which included 2-weekly phone calls, necessitating visit only once in 3 months as opposed to a monthly visit as required before. Hemograms were done twice a month and sent on WhatsApp. Consultations were done via phone calls and prescriptions sent via WhatsApp. Result(s): The median [IQR] age of our cohort was 7.5 [4.2;9.3] years and age at diagnosis was 5.4 [2.3;7.5] years;23/35 (66%) were male and 30/35 (88%) were phenotypically B-ALL;rest T-ALL/Lymphoma. All patients received chemotherapy as per the ICiCLE (Indian Collaborative Childhood Leukaemia group) protocol. A total of 437 teleconsultations were done (73/month). Before teleconsultation, the mean (SD) ANC was 2272 (644)//microL, and after teleconsultation it was 1754 (461)/microL (p value=0.0001). Teleconsultation improved target ANC (<2000/microL) attainment in our cohort of patients (31% vs 80%, p value=0.0002). Prior to teleconsultation, majority (27/35, 77%) visited the hospital once a month which reduced to once in 3 months, after teleconsultation. Conclusion(s): Teleconsultation is time saving, economical and reduces the gap in schooling in a child with ALL. It also helps optimize compliance during this maintenance phase of chemotherapy, a key in management of leukemia patients, contributing to the continuum of care and improvement in overall survival of these patients. Copyright © 2022
ABSTRACT
Summary: Cytokine storm is believed as a major root cause for multi-organ failure and death in severely infected diabetic patients with COVID-19. This condition is treated with anti-inflammatory drugs, mainly steroids, to recover people from critical conditions. However, steroid therapy causes immune suppression and uncontrolled hyper-glycaemia in post-COVID. This altered immune-metabolism provides a fertile environment for the infection of a black fungus, Rhizopus arrhizus which causes mucormycosis in diabetic patients. It is a life-Threatening infection causing death in different countries. It is treated either with anti-fungal drugs, surgical debridement, or adjunctive therapies. The available therapies for mucormycosis have been associated with several drawbacks. Thus, the present review has explored and suggested herbs-spices based adjunctive therapy for possible realignment of the impaired immune system in the post-COVID diabetic subjects. The consumption of herbal therapeutics after COVID-19 could realign the impaired immune-metabolism in the post-COVID and thereby exert prophylactic effects against mucormycosis. Furthermore, the suggested herbal sources could help in the discovery of novel therapeutics against the COVID-19 associated mucormycosis. © 2022 Rajasekar Panchamoorthy et al., published by Sciendo.
ABSTRACT
COVID-19 is a multisystem sickness caused by the complex interaction of inflammatory, immunological, and coagulative cascade. Risk assessment, choice of appropriate treatments, monitoring, and timely discharge are important aspects of COVID patient management. Along with the proper clinical evaluation, laboratory markers can offer extra information that can have a substantial influence on these aspects of patient management. To identify potential markers of COVID-19-related mortality, a meta-analysis of papers concerning C-Reactive Protein (CRP), D-Dimer, Ferritin, Interleukin-6 (IL-6), Neutrophil-to-Lymphocyte ratio (N/L ratio), Procalcitonin and mortality was conducted. D-Dimer and N/L ratios were found to be significantly different between the non-survivor and survivor groups. Overall meta-risk of death associatedwith the laboratory values was as follows;CRP HR 2.39 (1.05- 3.74), D-Dimer HR 1.25 (1.03-2.48), Ferritin HR 3.37 (0.86-5.88),IL-6 HR 3.07 (-1.35-7.49), N/L ratio HR 1.20 (1.14-1.63),Procalcitonin OR 3.60 (1.60-8.10). More study is needed to determine whether these laboratory biomarkers can be employed inthe development of a clinical scoring system to help in patient triage. © The Electrochemical Society