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1.
Lung India ; 39(3): 247-253, 2022.
Article in English | MEDLINE | ID: covidwho-1810866

ABSTRACT

Background: Hypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterised by the presence of hypoxia without dyspnoea. Silent hypoxia has been shown to affect the outcome in previous studies. Methods: This was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory and treatment parameters in patients with silent hypoxia and dyspnoeic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality. Results: Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2 <94% at the time of presentation. Among them, 174 (21.45%) did not have dyspnoea since the onset of COVID-19 symptoms. Further, 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspnoeic hypoxic patients (P = 0.202). The odds ratio of death was 1.1 (95% CI: 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment and in-hospital complications, which did not reach statistical significance (P = 0.851). Conclusion: Silent hypoxia may be the only presenting feature of COVID-19. As the case fatality rate is comparable between silent and dyspnoeic hypoxia, it should be recognised early and treated as aggressively. Because home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry in the home setting to identify these patients.

2.
Indian J Palliat Care ; 26(Suppl 1): S45-S47, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1792228

ABSTRACT

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) pandemic has affected all the aspects of life of mankind, posing unique challenges for health-care services. In order to contain the spread of the virus, a countrywide mass lockdown has been imposed in India. Although the lockdown has modified the epidemic trajectory, it has affected the lives of many non-COVID patients. Patients in need of care could not approach hospitals. METHODS: This retrospective observational study was conducted in the Department of Onco-Anaesthesia and Palliative Medicine at a tertiary care center in India. The yearly data of patient flow for the year 2019 was compared with that during the lockdown. RESULTS: The single-day average of out-patients, in-patients, and other department consultation requests requiring palliative care decreased drastically during the lockdown in comparison to the previous year. The single-day average of teleconsultations increased more than double during the lockdown. CONCLUSION: Although lockdown decreases the spread of the epidemic, it increases the suffering of other patients who require medical care. Various steps have to be adopted in the regular working pattern of hospitals to cater to the needs of the patients requiring care, without increasing the risk of contracting COVID-19.

3.
Indian J Palliat Care ; 26(Suppl 1): S21-S26, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1792222

ABSTRACT

CONTEXT: The coronavirus pandemic has put an unprecedented burden on the health-care workers who are the cornerstone of the work system, preparing to mitigate its effects. Due to the lack of protective equipments, guidelines for managing patients, or proper training and education regarding the same, health care professionals (HCPs) working in non-COVID areas may face even greater problems than those working in COVID areas of a hospital. Our aim was to find out the concerns of HCPs working in non-COVID areas. SUBJECTS AND METHODS: After obtaining institutional ethics approval, a descriptive cross-sectional study was planned. An online Google-based questionnaire was rolled out to all doctors through various social media platforms who were dealing with COVID-negative patients. RESULTS: We received a total of 110 responses. 84.5% of participants were concerned about the risk of infection to self and family, 67.3% were concerned by the disruption of their daily activities. 56.4% of HCPs were disturbed by the lack of any concrete protocol for patient management. Less staff availability, delay in discharging duties toward their patients, and increased workload were other concerns. More than half of the doctors received N-95 masks whenever required and were trained in donning and doffing of Personal protective equipment. Sixty-eight percemt of our respondents labeled their current quality of life as stressful. CONCLUSION: It is the need of the hour to develop a comprehensive strategy focussing on the above challenges that HCPs working in non-COVID areas are facing. This will go a long way in not only providing holistic care to the patients but also in controlling this pandemic.

4.
Indian J Palliat Care ; 26(Suppl 1): S31-S35, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1792221

ABSTRACT

BACKGROUND AND AIMS: With the COVID-19 pandemic, lockdown, and fear from contagion, the advantages of telemedicine are clearly outweighing the setbacks by minimizing the need for individuals to visit health-care facilities. Our study aims to assess how palliative medicine physicians could follow up on cancer patients and barriers they faced, discuss their results, and evaluate their treatment response with the help of telemedicine. MATERIALS AND METHODS: We conducted a prospective analysis of the smartphone-based telemedicine service at our palliative care (PC) unit from March 25, 2020, to May 13, 2020. We recorded the patient's reason for call, main barriers to a hospital visit, and the assistance given to them by the physician on call. Each caller was asked to measure his/her satisfaction with the service on a 4-point scale. RESULTS: Out of 314 patients, 143 (45.54%) belonged to Delhi and 171 (54.46%) belonged to other states. 157 patients sought help for symptom management; 86 patients needed to restock their opioid medications. Seventy-one patients required information regarding their oncological treatments requiring consultation from other departments. Titration of oral opioids and medication prescription (n = 129), contact details of other PC units at their native state for opioid procurement (n = 55), and attachment to our community-based PC service (n = 22) were main modes of management. Fifty-six patients were very satisfied and 152 patients were satisfied with the service. CONCLUSION: Telemedicine is the future of health-care delivery systems. In PC, we deal with immunocompromised debilitated cancer patients and telemedicine is immensely helpful for us to provide holistic integrated care to these patients who are unable to visit hospitals regularly.

5.
Indian J Palliat Care ; 26(Suppl 1): S70-S75, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1792215

ABSTRACT

INTRODUCTION: During the current COVID-19 crisis, striking a balance between adequate pain relief in advanced malignancy patients and avoiding hospitals due to fear of contracting the infection has been the biggest challenge for patients as well as palliative care physicians. This study explored the trends in opioid dispensing for cancer pain before and during the lockdown. METHODS: The trends were calculated based on an analysis of quantity of all opioids dispensed. March 24, 2020, was considered as a cutoff for analyzing before and during lockdown period dispensing trends. No information regarding individual patients was retrieved in the current study. RESULTS: There was a decrease in total morphine, tramadol, and fentanyl patch dispensing parallel to decrease in total number of patients visiting the outpatient department. However, there was a statistically significant increase in per capita opioid dispensing during the lockdown period. There was also an increase in the proportion of cancer pain patients that were dispensed morphine during the lockdown. CONCLUSION: Despite the lockdown, the palliative care team at Institute Rotary Cancer Hospital has continued to provide adequate pain relief to patients that could manage to reach the center. Policy-makers need to be cognizant of the pain relief needs of cancer patients in times when accessing hospitals is becoming increasingly difficult. Cancer-related pain and mortality could well be the next pandemic once the current COVID-19 begins to reduce.

6.
Indian J Crit Care Med ; 24(9): 763-770, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1792080

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and has been declared as a pandemic. COVID-19 patients may require transport for diagnostic or therapeutic purposes intra- or interhospital or transport from an outside hospital to a healthcare facility. Transport of critically ill or infectious patients is always challenging and involves the integration of various tasks and manpower. The adverse events have been attributed to various factors such as a multidisciplinary team and lack of appropriate communication among team members, absence of equipment, or failure during transport, apart from physiological alteration inherent to the disease of the patient. The transport of COVID-19 patients carries an additional risk of not only the disease itself but also due to the risk of its transmission to the transport team. The human-to-human transmission of the virus can occur via respiratory droplets. So, the person involved in the transport of such patients shall be at risk and warrants appropriate steps for their safety. Appropriate planning by a well-trained transport team is an essence for the safe transport of the suspected or confirmed COVID-19 patients. The Transport Medicine Society guidelines present consensus guidelines for the safe transport of COVID-19 patients. DISCLAIMER: These consensus guidelines are applicable for the safe transport of suspected or confirmed COVID-19 adult patients. These recommendations should be used in conjunction with medical management guidelines and advisories related to COVID-19. These recommendations should be adapted to the local policies prevalent at the workplace and also per agreement among the hospitals for transport (agreement between referring and receiving facilities). With the emergence of new scientific evidence, these guidelines may require modification. HOW TO CITE THIS ARTICLE: Munjal M, Ahmed SM, Garg R, Das S, Chatterjee N, Mittal K, et al. The Transport Medicine Society Consensus Guidelines for the Transport of Suspected or Confirmed COVID-19 Patients. Indian J Crit Care Med 2020;24(9):763-770.

7.
Indian J Anaesth ; 66(3): 187-192, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1776444

ABSTRACT

Background and Aims: The risk of contracting infection while intubating a coronavirus disease 2019 (COVID-19)-positive patient can be reduced by the use of personal protective equipment (PPE), video laryngoscope (VL) and aerosol-preventing intubation box. We compared two VLs (C-MAC and King Vision laryngoscope [KVL]) for ease of intubation and time taken to intubate the manikin using an intubation box. Methods: This randomised study involved healthcare workers having experience in using both C-MAC and KVL. After explaining the study and five practice sessions, a total of 63 volunteers were included; 61 participants gave consent and were enroled. The participants were allowed to intubate initially with one VL as per random sequence. Each participant performed three tracheal intubations with each device (C-MAC VL and KVL) on a manikin using an aerosol-prevention box over the head end at the time of intubation. Results: Time taken, percentage of glottic opening (POGO) score and the number of attempts taken for successful intubation with C-MAC and KVL were comparable in any of the three attempts (P > 0.05). The participants reported more difficulty in using KVL compared to C-MAC, and insertion of laryngoscope blade into the mouth of manikin for intubation was easy in group C-MAC compared to KVL in all three intubations (P < 0.01). Conclusion: C-MAC and KVL take comparable time for successful intubation under COVID-19 simulation conditions. But C-MAC is more user-friendly.

8.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-330913

ABSTRACT

Selection of reference genes in quantitative PCR is critical to determine accurate and reliable mRNA expression. Despite this knowledge, not a single study has investigated the expression stability of housekeeping genes to determine their suitability to act as reference gene in SARS-CoV-2 or Covid19 associated mucormycosis (CAM) infections. Herein, we address these gaps by investigating the expression stability of nine most commonly used housekeeping genes including TBP, CypA, B2M, 18S, PGC-1α, GUSB, HPRT-1, β-ACTIN and GAPDH in the patients of varying severity (asymptomatic, mild, moderate and severe). We observed significant differences in the expression of candidate genes across the disease spectrum. Next, using various statistical algorithms (delta Ct, Normfinder, Bestkeeper, RefFinder and GeNorm), we observed that CypA demonstrated the most consistent expression across the patients of varying severity and emerged as the most suitable gene in Covid19, and CAM infections. Incidentally, the most commonly used reference gene GAPDH showed maximum variations and found to be the least suitable. Lastly, comparative evaluation of expression of NRF2 is performed following normalization with GAPDH and CypA to highlight the relevance of an appropriate reference gene. Our results reinforce the idea of a selection of housekeeping genes only after validation especially during infections.

9.
Indian J Crit Care Med ; 26(3): 327-330, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1742855

ABSTRACT

Introduction: Providing cardiopulmonary resuscitation (CPR) to a coronavirus disease-2019 (COVID-19) patient is challenging for the healthcare providers (HCP). COVID-19 cases have specific CPR requirements, which differ from standard resuscitation efforts. Objective: This paper aims to evaluate whether online learning can be an effective methodology for imparting information on the management of cardiopulmonary arrest in COVID-19 patients due to a novel virus unknown to HCP based on evaluation of knowledge acquisition and satisfaction of the nurses in the new area of medicine and virology. Methodology: In a single-arm, one group before and after design, from a cohort of 160 nurses trained in comprehensive cardiac life support (CCLS) formulated by the Indian Resuscitation Council (IRC), 73 nurses participated in the study. After obtaining informed consent through the email from the nurses, baseline data including demographic profile and knowledge related to CPR in COVID-19 patients were collected. An online intervention spread over 1 week was given using a validated e-learning module. The online intervention was found to be effective (pre- and post-intervention knowledge score 13.65 ± 3.01 vs 19.92 ± 1.94, p = 0.001). The majority of nurses were highly satisfied with the content and the training methodology (37.23 ± 4.70). Conclusion: A well-structured, online study material can be used in imparting knowledge and demonstrating the basic and essential skills to nurses, required for giving CPR to COVID-19 patients. How to cite this article: Joshi P, Das S, Thomas M, Mawar S, Garg R, Shariff A, et al. Dissemination of Cardiopulmonary Resuscitation Training for Nurses Treating Coronavirus Disease-2019 Patients: A Single-arm Pre-experimental Study. Indian J Crit Care Med 2022;26(3):327-330.

10.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-317240

ABSTRACT

Introduction: Till date, no drug has shown definite benefit in non-severe COVID-19. Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing coronavirus-2 (SARS-CoV-2) load in severe disease. Objectives: To determine if a single oral administration of Ivermectin to patients with mild and moderate COVID-19 is effective in converting SARS-CoV-2 RT-PCR to negative result and in reducing viral load. Methods: : In this double-blind trial, patients were randomized to elixir formulation of Ivermectin in 24 mg, 12 mg or placebo in 1:1:1 ratio. The co-primary outcomes were conversion of RT-PCR to negative result and the decline of viral load at day 5 of enrolment and were assessed in patients with positive RT-PCR at enrolment (modified intention-to-treat population). Safety outcomes included total and serious adverse events and were assessed in all patients who received the trial drug (intention-to-treat population). Results: : Among 157 patients randomized, 125 patients were included in mITT analysis. Forty patients each were assigned to Ivermectin 24 mg and 12 mg, and 45 patients to placebo. The RT-PCR negativity at day 5 was higher in the two Ivermectin arms but failed to attain statistical significance (Ivermectin 24 mg, 47.5%;12 mg, 35.0%;and placebo, 31.1%;p= 0.30). The decline of viral load at day 5 was similar in the three arms. No serious adverse events were encountered. Conclusion: In patients with mild and moderate COVID-19, a single administration of Ivermectin elixir (either 24 mg or 12 mg) demonstrated a trend towards higher proportion of RT-PCR negativity at day 5 of enrolment. The protocol was registered in the Clinical Trial Registry – India (CTRI) vide ref No CTRI/2020/06/026001.

11.
Lung India ; 39(1): 16-26, 2022.
Article in English | MEDLINE | ID: covidwho-1604705

ABSTRACT

BACKGROUND: The "second wave" of the COVID-19 pandemic hit India from early April 2021 to June 2021. We describe the clinical features, treatment trends, and baseline laboratory parameters of a cohort of patients with SARS-CoV-2 infection and their association with the outcome. METHODS: This was a retrospective cohort study. Multivariate logistic regression models were fitted to identify clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay, and death. RESULTS: A total of 2080 patients were included. The case fatality rate was 19.5%. Among the survivors, the median duration of hospital stay was 8 (5-11) days. Out of 853 (42.3%%) of patients who had COVID-19 acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged >45 years had higher odds of death as compared to the 18-44 years age group. Vaccination reduced the odds of death by 40% (odds ratio [OR] [95% confidence interval [CI]]: 0.6 [0.4-0.9], P = 0.032). Patients with hyper inflammation at baseline as suggested by leukocytosis (OR [95% CI]: 2.1 [1.5-3.1], P < 0.001), raised d-dimer >500 mg/dL (OR [95% CI]: 3.2 [2.2-4.7], P < 0.001), and raised C-reactive peptide >0.5 mg/L (OR [95% CI]: 3.7 [2.2-13], P = 0.037) had higher odds of death. Patients who were admitted in the 2nd week had lower odds and those admitted in the 3rd week had higher odds of death. CONCLUSION: This study shows that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Improving vaccination rates and early admission of patients with moderate and severe COVID-19 can improve the outcomes.

12.
Indian J Surg Oncol ; 12(Suppl 2): 294-300, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1568402

ABSTRACT

COVID pandemic has impacted cancer care delivery and cancer surgical services globally. There is an urgent need to study the extent of the impact of COVID on cancer surgery and individual institutional response and strategies adopted to counter the adverse impact. A review of administrative and clinical policy changes adopted at the tertiary cancer center to combat COVID pandemic and resume cancer surgical services were performed. A retrospective comparative analysis of cancer out-patient census during COVID pandemic affected year and the preceding normal year along with cancer surgery data audit for the same periods was performed to assess the impact of the pandemic on cancer surgery. In addition, COVID infection rates among cancer surgery patients and healthcare workers were evaluated. There was approximately a 50% reduction in cancer outpatient registrations during COVID pandemic affected year. A trend of increasing footfalls was noted with decreasing COVID intensity and opening of lockdowns. There was a 33% reduction in major elective surgery and a 41% reduction in emergency surgery performed during the COVID period. As far as cancer surgeries are concerned, there was a 12-50% reduction in volumes involving different subsites. Overall COVID positivity rates among cancer surgery patients was low (8.17%), and approximately 30% of healthcare workers involved in cancer surgery were tested positive for COVID during the study period. Results of the current study indicate a significant impact of COVID pandemic on cancer surgical services. There was a significant impact on outpatient visits and cancer surgery volumes. However, a multidisciplinary-coordinated team approach, effective administrative and policy implementation, adoption of revised surgical safety and anesthesia protocols, COVID screening, and testing protocols facilitated resumption of cancer surgical services without adverse impact on surgical outcomes.

13.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-295883

ABSTRACT

Background Due to the unprecedented speed of SARS-CoV-2 vaccine development, their efficacy trials and issuance of emergency use approvals and marketing authorizations, additional scientific questions remain that need to be answered regarding vaccine effectiveness, vaccination regimens and the need for booster doses. While long-term studies on the correlates of protection, vaccine effectiveness, and enhanced surveillance are awaited, studies on breakthrough infections help us understand the nature and course of this illness among vaccinated individuals and guide in public health preparedness. Methods This observational cohort study aimed at comparing the differences in clinical, biochemical parameters and the hospitalization outcomes of 53 fully vaccinated individuals with those of unvaccinated (1,464) and partially vaccinated (231) individuals, among a cohort of 2,080 individuals hospitalized with SARS-CoV-2 infection. Results Completing the course of vaccination protected individuals from developing severe COVID-19 as evidence by lower proportions of those with hypoxia, abnormal levels of inflammatory markers, requiring ventilatory support and death compared to unvaccinated and partially vaccinated individuals. There were no differences in these outcomes among patients who received either vaccine type approved in India. Conclusion With a current rate of only 9.5% of the Indian population being fully vaccinated, efforts should be made to improve the vaccination rates as a timely measure to prepare for the upcoming waves of this highly transmissible pandemic. Vaccination rates of the communities may also guide in the planning of the health needs and appropriate use of medical resources. Research in context Evidence before this study The Government of India started vaccinating its citizens from the 16 th of January 2021, after emergency use authorization had been received for the use of two vaccines, BBV152, a COVID-19 vaccine based on the whole-virion SARS-CoV-2 vaccine strain NIV-2020-770, (Covaxin) and the recombinant replication-deficient chimpanzee adenovirus vector encoding the spike protein ChAdOx1 nCoV-19 Corona Virus Vaccine (Covishield). These have been approved by the Indian regulatory authority based on randomized controlled studies. In these studies, was found that the vaccines led to more than 90% reduction in symptomatic COVID-19 disease. However, there is scarce evidence of the efficacy of these vaccines in real-world scenarios. A few studies have looked at vaccinated cohorts such as health care workers in whom the vaccines had an efficacy similar to the RCTs. In a study of patients with SARS-CoV-2 infection admitted to a tertiary care hospital in New Delhi, it was found that mortality in fully vaccinated patients was 12.5% as compared to 31.5% in the unvaccinated cohort. Added-value of this study This cohort of hospitalized patients with SARS-CoV-2 infection was studied during the peak of the second wave of COVID-19 in India during which the delta variant of concern was the predominant infecting strain and had 26% patients who were partially vaccinated and 71.4% who were unvaccinated. Only 3% of the patients were fully vaccinated and developed a breakthrough infection. At the time of presentation, 13% of the individuals with breakthrough infection and 48·5% in the non-vaccinated group were hypoxic. Inflammatory markers were significantly lower in the completely vaccinated patients with breakthrough infection. The need for use of steroids and anti-viral agents such as remdesivir was also significantly low in the breakthrough infection group. A significantly less proportion of the individuals with breakthrough infection required oxygen supplementation or ventilatory support. Very few deteriorated or progressed to critical illness during their hospital stay. Only 3 individuals (5.7%) out of the 53 who developed breakthrough infection succumbed to illness while case fatality rates were significantly higher in the unvaccinated (22.8%) and pa tially vaccinated (19.5%) groups. Propensity score weighted multivariate logistic regression analysis revealed lower odds of developing hypoxia, critical illness or death in those who were completely vaccinated. Implications of all the available evidence The real-world effectiveness of the vaccines against SARS-CoV-2 seems to be similar to the randomized controlled trials. The vaccines are very effective in reducing the incidence of severe COVID-19, hypoxia, critical illness and death. The reduced need for oxygen supplementation, mechanical ventilation and the requirement of corticosteroids or other expensive medications such as anti-viral drugs could go a long way in redistributing scarce health care resources. All nations must move forward and vaccinate the citizens, as the current evidence suggests that ‘prevention is better than cure’.

14.
Indian J Palliat Care ; 27(2): 306-312, 2021.
Article in English | MEDLINE | ID: covidwho-1498298

ABSTRACT

OBJECTIVES: The availability of routine care for patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic has become challenging, and the use of telemedicine can be promising in this area. The objective of the study is to evaluate the feasibility of telemedicine-based palliative interventions in cancer patients. MATERIALS AND METHODS: This retrospective study was conducted in a tertiary care centre with 547 follow-up patients who used palliative medicine teleconsultation services. The following data were retrieved from the records: Patient's reason for the call, the main barriers to a hospital visit, the assistance given to them by the physician on the call and the patients' satisfaction with the service on a 4-point scale. The data were analysed using percentages for categorical variables and mean/standard deviation for quantitative variables. RESULTS: Out of the 547 patients, 462 (84.46%) utilised voice calling service, and the major reason for not visiting the hospital were cited to be fear of contracting COVID-19 (37.3%), inability to attend due to health constraints (7.13%) and issues with transportation (48.8%). The majority of the calls (63.62%) calls were regarding uncontrolled symptoms of the primary diseases. A total of 402 (73.49%) patients were very satisfied, and a total of 399 (72.94%) decided to continue to use this medium in the future as well. CONCLUSION: Telemedicine is a good modality for the assessment of chronic pain and providing symptomatic supportive care in patients with cancer in the COIVD-19 pandemic.

15.
Support Care Cancer ; 30(2): 1547-1555, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1427273

ABSTRACT

PURPOSE: Cancer patients and their caregivers are overwhelmed with features of uncertainty, fear, shock, worry, anxiety, sadness, and grief. To add on to their misery, the COVID-19 pandemic has severely afflicted the cancer care delivery. The study was conducted to observe the challenges faced by cancer patients and their caregivers and to formulate strategies for oncological setups to overcome those challenges. METHODS: After obtaining institutional ethical clearance, a descriptive cross-sectional study was conducted to observe the challenges faced by patients and their caregivers at the level of various domains (physical, logistic, psychological, socioeconomic, and spiritual) who visited the outpatient and inpatient department of cancer pain and palliative care unit. The results were expressed in absolute numbers. RESULTS: Major challenges encountered were suffering from physical symptoms like pain, nausea, vomiting, dyspnea (90%), postponement of cancer treatment (80%), fear of contracting COVID infection due to hospital visit (93.5%), lack of accommodation (70%), and lack of spiritual clarity and hope (50%). CONCLUSIONS: Major challenges faced by patients were in physical and psychological domains, and those by caregivers were in socioeconomic domains and handling physical symptoms of their patients. It is imperative to recognize and be cognizant of the challenges faced by cancer patients and their caregivers. Health care setups should formulate strategies to alleviate these challenges and provide holistic care to cancer patients. These strategies will hold in good stead for future pandemics also.


Subject(s)
COVID-19 , Neoplasms , Caregivers , Cross-Sectional Studies , Humans , Neoplasms/epidemiology , Neoplasms/therapy , Pandemics , SARS-CoV-2
16.
Indian J Palliat Care ; 27(2): 319-329, 2021.
Article in English | MEDLINE | ID: covidwho-1372199

ABSTRACT

OBJECTIVES: Novel coronavirus (COVID-19) pandemic has brought to the fore various challenges faced by pain and palliative care physicians working in oncology setup all over the country. Cancer care has been afflicted a lot during the pandemic, with challenges faced by patients and their caregivers as well as the healthcare workers. The questionnaire based online survey was conducted to explore the personal challenges faced, strategies adopted and to compare the challenges between different oncology setups. MATERIALS AND METHODS: After obtaining institutional ethical clearance the online questionnaire prepared through Google forms was rolled out to pain and palliative care physicians working all over the country with the help of social media platforms. The results were expressed in absolute number, percentage and comparisons were made with the help of Fisher's exact test. RESULTS: Maximum challenges faced were the fear of carrying infection back home (91%), the possibility of attending to a COVID positive case in day to day clinical practice because of inadequate space and screening (62%) and limited services provided by NGO's during pandemic (71%). Strategies commonly adopted were the provision of necessary personal protective equipment (83%), the conduct of educational sessions for the task force members (67%), maximum utilization of available space in the hospital (85%) and stockpiling of necessary medications and equipment (75%). CONCLUSION: It is the need of the hour to formulate strong and effective strategies to overcome the challenges encountered by pain and palliative care physicians so that we are equipped in the future to deal with any kind of pandemics.

17.
J Infect Chemother ; 27(12): 1743-1749, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1370593

ABSTRACT

INTRODUCTION: Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load. Hence, Ivermectin is under investigation as a repurposed agent for treating COVID-19. METHODS: In this pilot, double blind, randomized controlled trial, hospitalized patients with mild-to-moderate COVID-19 were assigned to a single oral administration of an elixir formulation of Ivermectin at either 24 mg or 12 mg dose, or placebo in a 1:1:1 ratio. The co-primary outcomes were conversion of RT-PCR to negative result and the decline of viral load at day 5 of enrolment. Safety outcomes included total and serious adverse events. The primary outcomes were assessed in patients who had positive RT-PCR at enrolment (modified intention-to-treat population). Safety outcomes were assessed in all patients who received the intervention (intention-to-treat population). RESULTS: Among the 157 patients randomized, 125 were included in modified intention-to-treat analysis. 40 patients each were assigned to Ivermectin 24 mg and 12 mg, and 45 patients to placebo. The RT-PCR negativity at day 5 was higher in the two Ivermectin arms but failed to attain statistical significance (Ivermectin 24 mg, 47.5%; 12 mg arm, 35.0%; and placebo arm, 31.1%; p-value = 0.30). The decline of viral load at day 5 was similar in each arm. No serious adverse events occurred. CONCLUSIONS: In patients with mild and moderate COVID-19, a single oral administration of Ivermectin did not significantly increase either the negativity of RT-PCR or decline in viral load at day 5 of enrolment compared with placebo.


Subject(s)
COVID-19 , Ivermectin , Humans , SARS-CoV-2 , Treatment Outcome , Viral Load
18.
J Anaesthesiol Clin Pharmacol ; 37(2): 171-178, 2021.
Article in English | MEDLINE | ID: covidwho-1335303

ABSTRACT

The coronavirus disease 2019 (COVID-19) has emerged as a pandemic and shall prevail for some time around the globe. The disease can manifest from asymptomatic to severe respiratory compromise requiring airway intervention. Transmission of COVID-19 has been reported to be by droplets, fomites, and aerosols, and airway management is an aerosol-generating procedure. The high viral load in the patient's airway puts the clinician performing intubation at a very high risk of viral load exposure. So, the need for barrier devices was considered and led to reporting of various such devices. All these devices have been reported individually and have not been compared. We present a review of all the information on these devices based on the reported literature.

19.
J Anaesthesiol Clin Pharmacol ; 37(1): 35-36, 2021.
Article in English | MEDLINE | ID: covidwho-1302646
20.
Diabetes Metab Syndr ; 15(3): 1001-1006, 2021.
Article in English | MEDLINE | ID: covidwho-1228014

ABSTRACT

BACKGROUND AND AIMS: Reinfection is gradually being recognised after symptomatic or asymptomatic COVID-19 infection. We try to elucidate various explanations behind COVID-19 reinfection and suggest possible strategies to counteract this threat. METHODS: We carried out a comprehensive review of the literature using suitable keywords such as 'COVID-19', 'Pandemics', 'Reinfection', 'Vaccines' and 'India' on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in March 2021 and first half of April 2021 during the current COVID-19 pandemic. Epidemiology, risk factors and trends of reinfection were assessed. RESULTS: A multitude of factors have been associated with rising incidence of COVID-19 reinfection in India and across the world. Emergence of 'Variants of Concern (VOC)', pandemic fatigue and disregard of infection prevention strategies appear to be the most obvious reasons. CONCLUSIONS: COVID-19 reinfection is an emerging concern amongst the worldwide population with newer mutant strains demonstrating increasing transmissibility and responsible for continuing waves of the pandemic. COVID Appropriate Behaviour (CAB), improvised vaccines and enhanced vaccination drives are necessary to mitigate global threat.


Subject(s)
COVID-19/epidemiology , COVID-19/etiology , Reinfection , COVID-19/therapy , COVID-19 Vaccines/therapeutic use , Humans , Incidence , India/epidemiology , Pandemics , Reinfection/epidemiology , Reinfection/etiology , Reinfection/therapy , Risk Factors , SARS-CoV-2/immunology , SARS-CoV-2/physiology
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