Impact of COVID-19 lockdown on patients with cancer in North Bihar, India: A phone-based survey

Background: In India, the coronavirus disease-2019 (COVID-19) outbreak led to an extensive lockdown, leaving the other time-sensitive medical conditions, such as cancer unaddressed. Patients with cancer are extremely vulnerable to infections owing to their already immunocompromised status and the need for prolonged treatment. Objectives: We aimed to study the impact of the COVID-19 lockdown on the utilization of health-care services by patients with cancer in the Muzaffarpur district of North Bihar, India. Materials and Methods: This descriptive, cross-sectional study was conducted at a preventive oncology clinic in the Muzaffarpur district of North Bihar in India. All consecutive patients registered in the population-based cancer registry of Muzaffarpur were telephonically contacted between April 15, 2020, and May 7, 2020, during the first phase of the nationwide lockdown. The patients were asked questions related to their disease, treatment status, and impact of the lockdown on their treatment. Detailed responses were recorded and analyzed. Results: The study comprised 210 patients of which majority were women (62.9%) and aged more than 40 years (77.1%). A total of 162 (77%) patients were found to be affected by the lockdown, of which 137 (65.4%) missed their scheduled visits, 1 (0.5%) missed surgery, 1 (0.5%) missed chemotherapy, and 24 (11.4%) could not get the prescribed drugs. Most patients who missed their scheduled appointments were aged more than 60 years, women, inhabitants of rural areas, with multiple comorbidities, or belonged to the lower middle-income economic strata. About 70% of the patients faced transportation issues, and 55% experienced financial problems during the lockdown. Conclusion: The lockdown led to difficulties in accessing cancer care in almost 80% of the patients with cancer. This suggests the need for strategic planning of health-care services for patients with cancer during the current pandemic, by means of telemedicine consultation, home-based palliative care services, and ensuring the availibility of essential cancer drugs. © 2021 Cancer Research, Statistics, and Treatment ;Published by Wolters Kluwer - Medknow.

Natural Products-Based Drug Design against SARS-CoV-2 Mpro 3CLpro.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has received global attention due to the serious threat it poses to public health. Since the outbreak in December 2019, millions of people have been affected and its rapid global spread has led to an upsurge in the search for treatment. To discover hit compounds that can be used alone or in combination with repositioned drugs, we first analyzed the pharmacokinetic and toxicological properties of natural products from Brazil's semiarid region. After, we analyzed the site prediction and druggability of the SARS-CoV-2 main protease (Mpro), followed by docking and molecular dynamics simulation. The best SARS-CoV-2 Mpro complexes revealed that other sites were accessed, confirming that our approach could be employed as a suitable starting protocol for ligand prioritization, reinforcing the importance of catalytic cysteine-histidine residues and providing new structural data that could increase the antiviral development mainly against SARS-CoV-2. Here, we selected 10 molecules that could be in vitro assayed in response to COVID-19. Two compounds (b01 and b02) suggest a better potential for interaction with SARS-CoV-2 Mpro and could be further studied.

Mhealth based mental health support counselling service for covid-19 suspect and positive patients in isolation facilities

Introduction: Psychological issues of COVID-19 suspect and positive patients in isolation and quarantine facilities can be addressed using mHealth. Methodology: mHealth telecounselling framework for COVID-19 inpatients was established using existing manpower and standardised operating procedures. Separate WhatsApp groups were used to obtain contact data of consenting patients, allocate patients to counsellors, and clinical discussion. Telecounselling was documented in real-time in a Google form database and remotely monitored for adherence to the standard of care. Pilot anonymised scale based client satisfaction feedback was obtained from discharged patients using a Google form link shared on WhatsApp. Results: 2918 telecounselling sessions were conducted between 21 March and 25 June 2020 for 643 inpatients (280 COVID-19 positive and 363 COVID suspect but later determined negative;mean age 49.57 years ± 15.23;male: female = 404: 239). Psychological issues included anxiety (43.54%), low mood (9.79%), irritability (9.33%), insomnia (8.39%) boredom (8.24%), frustration (7.46%), fearfulness (3.57%) anger (1.24%) and Delusion of pregnancy in one non-compliant psychotic patient. Interventions provided were supportive psychotherapy (57.69%), psychoeducation (52.72%), counselling regarding testing protocol (41.21%), sleep hygiene (20.06%), relaxation techniques (14.61%), activity scheduling (6.22%). Only 9 (1.39%) patients needed pharmacotherapy. Most respondents expressed satisfaction on pilot anonymised feedback (n = 115: M: F = 73: 42) with 83% recommending the programme for other COVID-19 settings despite concerns for possible lack of privacy and confidentiality (31.1%). Conclusion: Telemental Health Counselling Programme is a low cost, feasible, culturally acceptable, and sustainable mHealth initiative which can be easily transposed in other COVID-19 settings. © 2021, Indian Academy of Clinical Medicine. All rights reserved.

COVID-19 and orthopaedic surgery in a large trauma centre in India

Background: We are in the midst of a pandemic caused by the novel SARS-Cov-2 virus. A large percentage of the patients are asymptomatic and hospitals around the world are struggling to restart routine services. We report the results of a universal testing protocol of all patients who underwent orthopaedic surgery in the month of July 2020 in a large orthopaedic speciality hospital in Bangalore, India. Methods: A retrospective study of all patients who underwent orthopaedic surgery in the month of July 2020 at a tertiary care orthopaedic speciality hospital in Bangalore, India. All patients underwent nasopharyngeal swab test before surgery. A questionnaire was used to assess the patient before the RT-PCR nasopharyngeal swab test. Data regarding imaging, investigations and follow up was recorded. Results: In the month of July 2020, 168 patients underwent routine nasopharyngeal RT-PCR swab test for COVID-19 prior to planned orthopaedic surgical procedure (Both trauma and elective cases). 16 of the RT-PCR tests were positive. However vascular cases and absolute emergencies were done without a RT-PCR test with PPE and all universal precautions. 11 patients underwent emergency surgery without a RT-PCR test. All 16 cases who were positive were asymptomatic. The asymptomatic positive rate was 9.52%. Of the 11 patients who underwent emergency surgery without a RT-PCR test, only one patient had a positive test post-operatively. Conclusions: Routine nasopharyngeal RT-PCR testing revealed a high rate of asymptomatic cases. If the RT-PCR test is positive, it is best to defer the case till the test returns negative. All precautions must be taken while performing emergency surgeries. Our algorithm in managing patients has proven to be effective and can be replicated with ease to continue operating and taking care of orthopaedic patients during this pandemic.