ABSTRACT
Introduction Children with cancer are immunocompromised due to the disease per se or anticancer therapy. Children are believed to be at a lower risk of severe coronavirus disease 2019 (COVID-19) disease.Objective This study analyzed the outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with cancer.Materials and Methods A retrospective analysis was performed on patients (<= 14 years) with cancer attending the pediatric oncology services of our institute who tested positive for the SARS-CoV-2 infection and those who had COVID-19 disease between August 2020 and May 2021. Real-time reverse transcriptase-polymerase chain reaction performed on the nasopharyngeal swab identified the SARS-CoV-2 infection. The primary endpoints were clinical recovery, interruption of cancer treatment, and associated morbidity and mortality.Results Sixty-six (5.7%) of 1,146 tests were positive for the SARS-CoV-2 infection. Fifty-two (79%) and 14 (21%) patients had hematolymphoid and solid malignancies. Thirty-two (48.5%) patients were asymptomatic. A mild-moderate, severe, or critical disease was observed in 75% (18/24), 12.5% (3/24), and 12.5% (3/24) of the symptomatic patients. The "all-cause" mortality was 7.6% (5/66), with only one (1.5%) death attributable to COVID-19. Two (3%) patients required ventilation. Two (3%) patients had a delay in cancer diagnosis secondary to COVID-19 infection. Thirty-eight (57.6%) had a disruption in anticancer treatment.Conclusion Children with cancer do not appear to be at an increased risk of severe illness due to SARS-CoV-2 infection. Our findings substantiate continuing the delivery of nonintensive anticancer treatment unless sick. However, SARS-CoV-2 infection interrupted anticancer therapy in a considerable proportion of children.
ABSTRACT
Objective: Continuity of care has demonstrated positive outcomes from the advanced countries with insurance care model. There is limited evidence for the benefits from developing countries, in limited resource setting where the patients directly pay from the pocket for the diabetes care. Methods: We retrospectively analysed the relationship between the continuity of care and the glycemic control in patients who atleast had a biannual visit to our comprehensive care centre from 2016 to 2020 (n=1160). Results: The mean number of visits in the year 2016, 2017, 2018, 2019 and 2020 were 3.6 (±1.6, max 11, 95% CI 3.38 to 3.98), 5 (±2.5, max 16, 95% CI 4.5 to 5.5), 4.8 (±2.1, max 12, 95% CI 4.4 to 5.2), 4.7 (±2.2, max 14, 95% CI 4.3 to 5.1), 3.4 (±1.6, max 12, 95% CI 3 to 3.7) (p< 0.0001), respectively. The mean number of visits cumulatively for the continuous five years for each patient was 22 (±7.9, min 11, max 56, 95% CI 20 to 23). The mean number of HbA1c readings done cumulatively for the continuous five years for each patient was 22 (±3.8, min 1, max 17, 95% CI 3.3 to 4.4). The mean interval (days) between the two consecutive visits was 85 (±26, min 33, max 155, 95% CI 81 to 90). The mean number of HbA1c tests were 3.8 (±2.8, min 1, max 17, 95% CI 3.3 to 4.4). The mean number of visits were 4.3 (±1.6, min 2.2, max 11, 95% CI 4 to 4.6). There was a non-significant positive correlation between the mean number of visits and the mean HbA1c readings (Pearson r 0.113, p= 0.22). The baseline value of HbA1c (%) was 8.0 (±1.5, min 5.3, max 13.3, 95% CI 7.7 to 8.3), which reduced by 0.7 when compared for the minimum value of HbA1c achieved at any point of time as mean 7.2 (±7.2, min 4.8, max 10.9, 95% CI 7 to 7.5), (p< 0.0001). There were 360 patients who had atleast one visit in 3 months and achieved HbA1c < 7, as compared to 250 patients with more than 3 months interval for consecutive visits and with HbA1c ≥ 7 (p=0.0404, OR 1.2 95% CI 1.01 to 1.62). COVID-19 induced lockdown led to the decrease in the patient visits in the year 2020. There were 55 all cause hospitalizations. Discussion/Conclusion: The results of our study demonstrate that comprehensive diabetes care have a potential positive implication, even in out-of-pocket ecosystem, which can drive the demand for a continuous follow up visits. We attribute long continuity of care for the smaller number of hospitalizations.
ABSTRACT
Objective: Uncontrolled hyperglycaemia is associated with poor clinical outcomes in patients with COVID-19. Basal-bolus (BB) insulin regimen is recommended for intensification and is safe and effective. However, this is complex in COVID era, especially for initiation with challenges in deployment of healthcare personnel with gaps in required expertise. Hence, implementation of an effective insulin therapy is challenging. Methods: We evaluated the impact of initiating premix analog insulin regimen (PA) in T2D patients diagnosed with COVID-19 during the second wave of the pandemic (n=434), who consulted virtually. Insulin initiation was based on random blood sugar (RBS) as reported through SMBG by the patients who were already under regular care, across two dedicated diabetes management centres. Patients were advised to contact over Whatsapp in case self-reported RBS was above 300 mg/dL Results: The mean age of the patients was 59 years (SD±13, 95% CI 58 to 60). 256 were male. 48 patients (11%) were started with basal insulin (43 glargine, 5 degludec) and were optimally managed by dose uptitration. There were 92 patients (21.1%) who were initiated on PA twice daily to achieve glycemic control. Of these, 56 patients (12.9%) were diagnosed as moderate COVID-19 and required corticosteroids. Among these, 42 patients (75%), on PA regimen reported post lunch and dinner glycemic spikes which necessitated additional pre-lunch dose of premix analogue. 36 patients with mild COVID-19, were continued on PA twice daily and doses were uptitrated based on the SMBG reports. The rest 378 (87%) mild COVID-19 cases, were managed by standard care approach for diabetes care, including oral drugs. The mean RBS at the first consultation at insulin initiation was 211 mg/dL (SD±98, 95% CI 192 to 230). On first follow up teleconsultation;mean RBS in mild COVID-19 was 178 mg/dL (SD±50, 95% CI 138 to 195), while those who progressed to moderate COVID-19, RBS was 267 mg/dL (SD±101, 95% CI 210 to 298). On second follow up;mean RBS in mild COVID-19 was 168 mg/dL (SD±54, 95% CI 148 to 183) and in moderate COVID-19 was 203 mg/dL (SD±88, 95% CI 174 to 258). 138 patients (31.7%) needed uptitration of insulin regimen Discussion/Conclusion: Simplified insulin regimen based on premix analog insulin has the potential for timely initiation of insulin, titration and intensification to third dose of PA to optimise the management of T2D in COVID-19. Our study did not account for the compliance to beyond the second teleconsultation and the pandemic prevented the estimation of A1C and did not account for patients who transformed as severe COVID-19 patients who needed hospitalisation