Impact of post-COVID-19 lung damage on Respiratory function and HRQOL in Indians

Background: In people recovering from COVID-19, there is concern regarding potential long-term pulmonary sequelae and associated impairment of functional capacity. This study was designed to assess this. Method(s): 207 subjects with mean age of 48.7 years were assessed after 63 days(mean), from symptom onset. Clinical symptoms, St George's Respiratory questionnaire(SGRQ), pulmonary function testing, 6-minute walk test(6MWT) and chest radiography were evaluated. Details pertaining to the COVID-19 illness and hospitalisation, WHO disease severity categories(asymptomatic, mild, moderate, severe and critical) and baseline laboratory biomarkers were retrieved from the hospital records. 'Mild COVID'(WHO mild category) was compared with 'COVID pneumonia'(WHO moderate, severe & critical) and further, moderate was compared with the severe/critical. Result(s): In all,35% had restrictive defect(TLC< 80%), 8.3% had obstructive defect(FEV1/FVC<70%) and 44.4% had impaired diffusing capacity(DLCO<80%). The 'COVID pneumonia'group, compared to 'mild COVID' had lower FVC(2.4vs2.9;P=0.0002), FVC%(77.85vs88.18;P=0.001), FEV1(2.0vs2.36;P=0.0014), TLC% (79.48vs87.91;P=0.0002), DLCO(6.80vs8.30;P=0.0004), DLCO%(75.30vs89.20;P<0.0001), DLCO/VA(2.0vs2.2;P=0.004) and DLCO/VA%(105.6vs111.8;P=0.032), lower minimum oxygen saturation(94.89vs97.73;P<0.0001) and drop in saturation >=4% in more subjects(21.69%vs4.84%;P=0.001) during 6MWT, higher mean total SGRQ score(29.2vs11.0;P<0.0001) and domain scores: Symptom(37.2vs12.9;P<0.0001), Activity(49.1vs13.2;P<0.0001) and Impact(12.7vs2.0;P<0.0001). Conclusion(s): In an Indian cohort, post-COVID-19 lung damage results in significant impairment of lung function, effort tolerance and quality of life.

A SYSTEMATIC REVIEW ON TELE DENTISTRY IN PUBLIC ORAL HEALTH DURING COVID-19

Providing medical care over long distances using communication systems and advanced technologies is called "telemedicine." In recent years, dentistry has witnessed a substantial amount of technological advancement. The utilization of computers, telecommunication technology, digital diagnostic imaging services, equipment, and software for analysis and follow-up have all seen significant advancements in recent years because of developments in information technology. The field of dentistry has progressed to a point where it can now cover far greater distances than it was previously capable of. In 1997, "TD" was coined to describe "the practice of employing video conferencing technologies to diagnose and provide advice regarding treatment across a distance." It provides consultations over long distances using electronic medical records, the internet, information, and communication technology. TD has four potential applications. These are teleconsultation, Tele-education, telemonitoring, and telesurgery. TD can also be used to monitor patients remotely. A general dentist in a rural region can communicate with a specialist for advice through teleconsultation by sending either live patient data or patient medical records to the specialist. This allows the dentist to provide better care for their patients. Remote rural practitioners can acquire continuous medical education using interactive video conferencing and web-based self-instruction. In telemonitoring, patients record and send data to doctors via phone, fax, or the internet. Continuous data collection and automated transmission of that data to another physician involved in the care of the patients is another method that may be used to assess the condition of the patients. Telesurgery allows experts in metropolitan regions to assist surgeons located in rural or distant places through the use of video and audio links made possible by the internet. This ensures that patients receive the best possible surgical care. This technology makes it possible for multiple dental practitioners to work together to arrive at an accurate diagnosis and a suitable treatment plan for patients who are seen in locations with a shortage of dentists or dental specialists or where dental specialists are not readily available. As a result, the objective of this study is to explore the development of tele dentistry and how it might be used in practice to address the disparities in oral health care between rural and urban areas.

Changes in ICU Practices for Mechanically Ventilated Patients Before and During the Covid-19 Pandemic

RATIONALE The COVID-19 pandemic led to rapid changes in care-delivery for intensive care unit (ICU) patients, due to factors including high ICU strain, shifting team member roles, and changes in care locations. As these changes may have not only impacted patients with COVID-19 but also critically ill patients without COVID-19, we assessed changes in common ICU practices for mechanically ventilated patients without COVID before and after the start of the COVID-19 pandemic. METHODS We used the Premier Healthcare Database to identify mechanical ventilated ICU patients in the US from January 1, 2016 - December 31, 2020. Patients were excluded if they had an ICD-10 diagnosis of COVID-19 (U07.1) or if they were admitted to a hospital that did not contribute data for all five years. We assessed annual rates of common ICU imaging studies (chest CT scan, chest x-ray, lower extremity doppler ultrasound), bedside diagnostics (electrocardiogram, electroencephalogram), and bedside procedures (arterial line, central venous catheterization, bronchoscopy) and annual mortality rates. We used interrupted time series analysis, adjusted for seasonality and autocorrelation where present, to evaluate trends in ICU practices prior to the pandemic (March 2016 - February 2020), at the onset of the pandemic (April 2020) and as the pandemic progressed (April 2020 - December 2020). March 2020, as the US transitioned into the pandemic, was excluded from the analysis. RESULTS We identified 584,393 mechanically ventilated patients without COVID- 19 at 509 hospitals. Trends in ICU procedures and mortality are illustrated in Figure 1. At the onset of the pandemic, use of chest x-ray (-35.6% [-53.5 to -17.8%, p<0.001]), electrocardiogram (-14.8% [-21.9 to -7.6%, p<0.001]), and bronchoscopy (-1.2% [-1.8 to -0.6%, p<0.001]) decreased;rates of lower extremity doppler (-1.8% [-4.1 to -0.5%, p=0.12]), electroencephalogram (-0.8% [- 1.7 to 0.1%, p=0.09]), arterial lines (-0.09 [-1.0 to 0.9%, p=0.85]) and central venous catheters (+0.2 [-1.3 to 1.7%, p=0.77]) did not significantly change;use of chest CT increased 2.6% (0.9 to 4.3%, p=0.001). With the exception of chest CT, arterial lines, and central venous catheters, trends in all other measured procedures increased as the pandemic progressed, compared with pre-pandemic trends. There was no significant trend change in mortality at the onset of the pandemic or during the pandemic. CONCLUSIONS Multiple practice patterns changed among patients without COVID-19 early during the pandemic. However, no change in mortality was seen during this time. These findings warrant further investigation to determine their impact on patientcentered outcomes.

Redefining 'Safe bodies': queering the shifting body politics during the COVID-19 pandemic

Bodily safety during the post-covid 'new normal' is a fraught, but phantasmal notion, subject to manipulation by both institutional and non-institutional power structures. Looking at the Indian context, a queerer understanding of the pandemic is required at a time when bodily relations have been queered by numerous instances where new forms of non-economic social stratification are discernible. Bodies are getting targeted, otherized, and discriminated against in unpredictable ways while imagining and negotiating the modalities of the new norm. Medicalization of the everyday at this massive scale does not follow the biomedical logic but seeks to normalize heterogenous responses based on irrational fears perpetuating ableist myths about the normal body. Queer activism and praxis need to play an interventionist role in shaping policies cognizant of the new threats and challenges that are being faced by queer individuals in such a scenario. Queer identities need to be reconfigured for continued sustenance, support, and political relevance. The case of the Hijrah community in India is studied as an example where a new political language is needed for revamping their mode of protest in response to the shift in the current body politics.