ABSTRACT
A disclaimer to start with: in a federal union of 1.3 billion persons comprising 17 per cent of humankind, 36 states and territories, multiple languages and ethnic groups, few if any observations are valid across the whole country. Democracies find it hard to make tough decisions and to adapt when they need to improvise without precedents;pre-emption to tackle a problem before it becomes a crisis is never a democratic strength, especially in a federation. India took relatively early steps against Covid-19: visas were rescinded on March 18;international flights stopped on March 22;and domestic flights were terminated on March 24. Prime Minister Narendra Modi called for a 12-h nation-wide voluntary curfew on 22 March, marked with high observance, which was a dress rehearsal for a full lock-down from 24 March for 21 days with relaxations for medicines, media, banks and groceries. The national closure was the most comprehensive in history. At that stage, India had registered 500 cases and 10 deaths. The trade-off was to lose lives to Covid-19, or gain time to prepare health services and risk the economic consequences. Modi acted quickly although it caused hardship to millions. By and large, the lockdown was observed, justifying the theory that Indians react best in emergency mode.
ABSTRACT
This is a case report of a 63-year-old African American female with a past medical history most significant for metastatic cholangiocarcinoma that presented for evaluation of persistent shortness of breath. Initial workup was remarkable for refractory anemia, moderate schistocytes on peripheral smear and lab work suggestive of a hemolytic anemia. Due to concern for thrombotic thrombocytopenic purpura (TTP), she subsequently underwent several rounds of plasma exchange without significant improvement. Secondary to progressive renal failure, patient eventually had a renal biopsy with findings remarkable for thrombotic microangiopathy (TMA). Simultaneously, patient was also diagnosed with coronavirus disease 2019 (COVID-19) infection. After a few weeks of supportive care, she was stable for discharge. Unfortunately, she did become dialysis dependent. Prior to hospital admission, she was being treated for metastatic cholangiocarcinoma and had received chemotherapy with gemcitabine. Her last chemotherapy session was approximately 3 weeks prior to her first hospitalization. Furthermore, although her hemolytic work did suggest TMA, it was not consistent with the diagnosis of TTP. She was transferred to a tertiary care center where hemolytic labs were trended, and supportive care was maximized. In light of the current COVID-19 pandemic, it is crucial to further investigate the pathophysiology of TMA in patients with active malignancies and COVID-19 infections. To our knowledge, this is the first case of TMA in a patient with both metastatic cholangiocarcinoma and COVID-19 infection.
ABSTRACT
Background. Coronavirus Disease 2019 (COVID-19, also known as 2019-nCoV), a cluster of acute respiratory illness with unknown causes, has occurred in India since January 2020. Over the past several months, the entire world is struggling to cope with and contain the virus spread. Several studies showed that mental health problems could occur in both healthcare workers and SARS survivors during the SARS epidemic. Considering the geographical variation, dense population, multistrata health care structure, and rising COVID cases in South India, we have a reason to speculate that the burden on the frontline doctors is high and their psychological condition may also be affected during COVID-19 outbreak. Aims. The aim of the study is to estimate the anxiety and depression among front line doctors during COVID 19 duty in south India and also the impact of the various strata of health care on the depression and anxiety scores. Methods. An online form was created which included personal details of COVID 19 duty, Beck's anxiety and depression questionnaire. Results. Severity of anxiety and depression scores was significantly higher among front line doctors working in primary health centers when compared to medical college and private hospital doctors (P<0.002). Conclusion. Our study verified the results from previous reports that anxiety and depression are high among doctors posted in COVID duties, but also that they remain largely unaddressed. We provide new findings regarding the nature of work place and the mental health issues.