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Table of Contents
September 2020
Volume 17 | Issue 5 (Supplement)
Page Nos. 1-66
Online since Wednesday, September 9, 2020
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EDITORIAL
Unraveling the COVID-19 pandemic and undertaking counteractive measures
p. 1
RN Srivastava, Raju Vaishya
DOI
:10.4103/am.am_110_20
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REVIEW ARTICLES
COVID-19 and stroke – Updated review
p. 2
Pushpendra Nath Renjen, Dinesh Mohan Chaudhari, Anjali Mishra, Immia Bukhari
DOI
:10.4103/am.am_89_20
Although the precise incidence is not known, stroke is emerging as a complication of the COVID-19 pandemic. The clinical course of COVID-19 is most severe in elderly patients, in men, and in patients with comorbidities such as hypertension, diabetes, heart disease, and obesity, all risk factors for stroke. Severe acute respiratory syndrome coronavirus infection is linked to a prothrombotic state causing venous and arterial thromboembolism and elevated D-dimer levels. The occurrence of acute ischemic stroke at the time of this pandemic poses a great challenge regarding emergency treatment (particularly administering thrombolysis and performing thrombectomy) of acute stroke patients. In this article, we will review the pathophysiology and challenges in the management of COVID-19 infection-associated stroke.
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In-patient management of hyperglycemia during COVID-19 pandemic
p. 6
W Y. Khwaja Mohammed Usman, Radhika Jindal, Danendra Sahu, Mohammad Asim Siddiqui, Subhash Kumar Wangnoo
DOI
:10.4103/am.am_72_20
The pandemic of COVID-19 has presented new challenges to endocrine physicians and diabetologists in providing care for infected patients with dysglycemia, who may already be having diabetes and who present with newly diagnosed diabetes. The additional burden of metabolic decompensation, effect of treatment on glycemia, and the presence of comorbid complications make the management challenging. The presence of diabetes as a comorbid condition has shown to be associated with poorer outcomes in patients with COVID-19 infection. In addition, the effects of treatments such as the use of medications such as glucocorticoids and hydroxychloroquine may further add to the variability in glycemic control. Appropriate glycemic management leads to improvement in clinical outcomes, which involves intensive bedside glucose monitoring, intravenous and subcutaneous insulin administration, transition from intravenous to subcutaneous insulin, as well as interventions for hypoglycemia events. A uniform treatment protocol related to insulin administration and glucose monitoring is essential for improved clinical outcomes in admitted patients. Where feasible, continuous glucose monitoring systems have been proposed as an option for reducing time spent with patients, but they are not available everywhere and not many personnel are experienced in its usage. In-patient care of diabetes is an important issue that needs to be addressed if it is used in hospitalized patients.
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Care of pediatric and adolescent endocrine disorders during COVID-19 pandemic
p. 11
Inderpal Singh Kochar, Smita Ramachandran, Gitanjali Kochar
DOI
:10.4103/am.am_60_20
Coronavirus pandemic cases are increasing worldwide, including that in India. Pediatric cases are also increasing, although children may have more of mild manifestation of the disease and are recovering fast. Children with endocrine disorders are considered at a higher risk of contracting the virus due to their immunocompromised status. Children with diabetes, adrenal insufficiency, and thyroid disorders are the usual conditions for which they are on long-term treatment and need to be monitored closely. The article gives an outline of management of children with endocrine disorders during the current pandemic.
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Obesity and COVID-19
p. 14
Arun Prasad, Abhishek Tiwari, Deeba Siddiqui, Nimo Osman
DOI
:10.4103/am.am_78_20
The coronavirus disease 2019 (COVID-19) pandemic has affected the global population. More and more studies are emerging that are showing the increased susceptibility of the obese to this infection. The adipose tissue along with the low-grade inflammation sets the background for a severe infection in most of the infected obese people. They have a longer hospital stay, increased chances of requiring ventilatory support, and also a higher mortality rate. We do a short review of some of the recent articles studying obesity and COVID-19 infection. While extra care and precautions have to be taken with the obese getting infected with this virus, there is an increased need to highlight the disease of obesity and the ways to fight it. Diet, exercise, medications, and endoscopic and bariatric surgeries would need to be seen in a new light during and after this pandemic.
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Robotic surgery in ENT and head and neck during the COVID-19 pandemic
p. 18
Kalpana Nagpal, Noor Ul Din Malik, Suresh Singh Naruka, Nishant Rana
DOI
:10.4103/am.am_65_20
The COVID-19 pandemic has resulted in a deep impact on the health-care system. The increased risk of contagion is especially for anesthetists, dentists, otolaryngologists, and head-and-neck surgeons. The management of ENT and head-and-neck surgical cases represents a unique challenge in the COVID-19 times. The COVID-19 pandemic posed an immense impact on ENT and head-and-neck routine and emergency surgeries. Patients needing immediate intervention when operated using robotic assistance could prove beneficial. Console surgeon is sitting at a distance to the patient and is not directly exposed to the surgical field. Short hospital stay, less blood loss, and no direct handling of tissue are some advantages. Robotic-assisted surgery in ENT and head-and-neck surgery can effectively minimize the risk of contamination of health-care providers.
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Aesthetic practice in covid times-evolving guidelines at the cosmetic clinic
p. 21
Kuldeep Singh, Shahin Nooreyezdan, Pankaj Mehta, Amrit Shankar Shastry, Gaurav Kumar, Kriti Agarwal, Uma Krishna, Pulkit Arora
DOI
:10.4103/am.am_83_20
Background:
The coronavirus disease 19 (COVID-19) pandemic has led to an almost complete initial halt of all elective surgical and medical procedures, more so in the practice of esthetic surgery and medicine, globally. As practices are trying to open up, the when, how, and what services can be scheduled again are the questions which arise in front of all service providers. Stringent infection control measures are the need of the hour in response to the current continuing COVID-19 pandemic. In esthetic clinics, guidelines for infection control measures as well as protocols for performing procedures are of particular importance for their safe and smooth functioning.
Methods:
A Medline/PubMed search was conducted for any and all possible publications on esthetic guidelines for safe functioning during the COVID pandemic. Advisories by the governments of the day, the World Health Organization, as well as those issued by various national and international esthetic societies were also taken into consideration. A set of protocols and preferred practice guidelines were drafted to allow functioning of the esthetic clinics as well as protect the doctors, clinic staff, and patients from the SARS-CoV-2 infection.
Results:
“Standard operating procedure (SOP)” guidelines for esthetic clinics were drafted and put into place in our Aesthetic Clinic at Indraprastha Apollo Hospital after going through all possible recommendations for scheduling patients, screening at entry, declaration and esthetic consultations, and for safety precautions about the different procedures and later categorized into low risk, moderate risk, and high risk based on the possibility of the transmission of SARS-CoV-2 virus from a possible infected patient to the treating physician or therapist, and the other way around.
Conclusions:
The SOP provides sound infection control measures for esthetic practices. There are guidelines regarding safety measures and use of personal protective equipment during scheduling, distancing, and risk-wise categorization, and also what procedures are permitted. These may vary from country to country, but local and national guidelines should be incorporated and followed to prevent the COVID-19 infection in esthetic clinics.
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COVID 19 and pregnancy
p. 27
Neelam Suri, Kanika Suri
DOI
:10.4103/am.am_80_20
Pregnant women constitute a vulnerable subgroup among the general population. Various aspects of COVID-19 infection in pregnant patients' need to be studied in detail to frame management strategies for dealing with this subgroup. Since COVID-19 infection has emerged only recently, limited data restricted to small case series are available. Pregnant women form a vulnerable group which can be affected by COVID-19. Data suggest that pregnant women are as susceptible as rest of the population without any higher susceptibility for the infection. The clinical features and course of the COVID 19 illness remain similar to the nonpregnant group. The large proportion of women manifest with mild symptoms of cough, fever, anosmia, or ageusia whereas some women may develop a more serious form of disease with pneumonia and respiratory failure. A multidisciplinary approach is important to manage these patients especially when the COVID 19 infection is of a serious nature. Normal vaginal delivery is not a contraindication in women with COVID-19. The current data suggest that there is no evidence of vertical transmission of the COVID 19 virus. Breast feeding should not be prohibited in mothers with COVID-19 disease. Currently, no data are available regarding risk of congenital malformations in babies conceived to COVID 19 positive mothers.
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Long-term health consequences of COVID-19 disease
p. 32
Karthikeyan P Iyengar, Raju Vaishya
DOI
:10.4103/am.am_109_20
The effects of novel coronavirus Severe Acute Respiratory Syndrome-CoV-2 outbreak until now have been dramatic on public health with widespread disruption of daily life and health care systems across the world. As we understand the new COVID-19 better, it is becoming apparent that the disease is far more complex. The extent and severity of the long-term health consequences remain uncertain, but emerging data suggest persistent, substantial morbidity of the population is likely. Long-term consequences are expected to have lasting physical, mental, and social health impact along with global economic effects.
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Mental health in India in times of COVID-19
p. 36
Achal Bhagat
DOI
:10.4103/am.am_92_20
The number of people who have been affected by COVID-19 is rising and is a public health emergency. The experience of COVID-19 is showing a universal mental health impact and an increase in number of people experiencing mental ill-health in India. The current mental health morbidity in India is significant, and its impact is compounded by a large treatment gap for mental health. In the face of COVID-19, depression, anxiety, and posttraumatic stress disorder are likely to rise. Health-care workers are likely to be at risk for mental health problems. An increase in social risks of domestic violence, unemployment, unsafe migration, decreased access to education, and challenged safety nets for those who are more vulnerable is becoming evident. This will further contribute to magnifying the mental health problems in India. The mental health impacts are likely to be significant and sustained. There is a need to emphasize on preparedness for an emerging secondary public health crisis of mental health in India.
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Multi-agent system applications to fight COVID-19 pandemic
p. 41
Abhishek Sharma, Shashi Bahl, Ashok Kumar Bagha, Mohd Javaid, Dinesh Kumar Shukla, Abid Haleem
DOI
:10.4103/am.am_54_20
A multi-agent system (MAS) uses multiple interacting intelligent agents with the support of the computerized system. During this COVID-19 pandemic, there is a requirement to improve service for patients to fulfill the ongoing challenges. This technology provides a digital service continuously for the patients. An MAS-based platform is helpful for different scenarios during this pandemic. This article discusses significant components, as used for developing an MAS to handle COVID-19 situations. Finally, it discusses various significance applications of an MAS for COVID-19 pandemic patients. The knowledge and data required to solve the COVID-19 pandemic are distributed spatially in different locations, which add constraints, toward proper planning of the treatment of patients to combat this pandemic. Governments accept that their systems cannot stop the widespread transmission of this virus. However, by flattening the curve, the mortality rate can be reduced. MAS consist of autonomous entities, also known as agents, who work collaboratively. By using MAS, lots of real-world data of the emerging situation such as an outbreak can be processed gainfully. It will allow doctors and organizations to create flexible models of potential scenarios.
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ORIGINAL ARTICLE
COVID-19 pandemic-related lockdown: Effects on persons with disabilities in India
p. 44
Rajendra Prasad, Anandita Lidhoo, Tarun Lala, Prateek Sharma, Anjali Lodwal, Manish Jaiswal, Shagufta Nayar, Charu Khatri, Surbhi Vyas, Umaid Singh Deora, Shikha Vaswani
DOI
:10.4103/am.am_81_20
Introduction:
To study the impact the COVID-19-related lockdown on persons with disabilities (PWDs), we conducted a telephonic survey of (
n
= 120) participants in four major cities of India (Delhi, Hyderabad, Jodhpur, and Patna). The survey was conducted twice-once in Phase 2 (April 15, 2020–May 3, 2020) and again in Phase 5 (June 1, 2020–June 30, 2020) of the lockdown.
Methods:
A questionnaire was prepared for this survey of PWDs to understand the following: participants' understanding of the prevention of COVID-19 handwashing technique, use of facemasks, social distancing and sanitization directives, their type of disability, and extent of dependence on caregivers, along with their financial situation and food and medicine availability.
Results:
From the PWDs surveyed, the main impact of the prolonged lockdown was on mental health, limited ability to work from home, lack of access to rehab professionals or rehabilitation units, and external caregivers, along with difficulty in repair of assistive technology devices. They relied largely on family for finances, activities of daily living, and food and medicine supply. On the positive side, most had access to information on COVID-19 and an understanding of the health and safety guidelines.
Discussion:
The authors recommend the development of an updated national database of PWDs and the elderly and to establish tele-medicine and tele-rehabilitation services for this group of people to ensure uninterrupted physiotherapy, mental health counseling, and treatment for their comorbid conditions. They advocate for an increase in government support to PWDs in these times and provision of medicines, masks, gloves, and sanitizing products at subsidized rates.
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NOVEL THERAPEUTIC APPROACH
COVID19 infection and vascular rearrangement/ controlled angiogenesis – A new supportive therapeutic approach in patients with pre-existing ischemic and high-shear vascular conditions
p. 50
Debatosh Datta, Gautam Kumar Saha, Nirmal Kumar Ganguly
DOI
:10.4103/am.am_93_20
This is an indicative mini-review on possible new therapeutics for COVID-19 with preexisting ischemic morbidities. The review highlights a new supportive therapeutic approach where lysine-induced controlled vascular organization (angiogenesis) has been demonstrated in reversal of cerebrovascular ischemic stroke which appears to be one of the few final fatal clinical outcomes of current COVID-19 infections. Further, a parallel supportive time-bound induction of fresh exchange beds, by way of rapid collateral formation, is proposed in all comorbid ischemic patients with the low-molecular-weight angiogen(s), with an objective of mitigation of tissue/organ ischemia.
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TECHNOLOGY
Role of internet of things for health-care monitoring during COVID-19 pandemic
p. 55
Abid Haleem, Mohd Javaid, Raju Vaishya, Abhishek Vaish
DOI
:10.4103/am.am_66_20
Internet of Things (IoT) is already being implemented in the medical field to improve the treatment outcome. This technology also plays a significant role during the COVID-19 pandemic for the betterment of the infected patient. With such high levels of infection of the SARS-CoV-2 virus, organisations want to automate hospital facilities, so there is a need for this technology for improving hospital management and patient care system. A proper application & implementation of these technologies may reduce the chances of mistakes and provides effective control during the entire treatment process of COVID-19 patients. This short review identifies and discusses significant roles of IoT in taking up major healthcare challenges during the COVID-19 pandemic. IoT helps identify the symptoms and provides a rapid treatment process with the help of internet-connected devices and networks. It automatically helps to manage the medical staff to maintain quality supervision. There are an adequate flow and better safety of the patient in the internet-connected hospital. It helps provides real-time information to create transparency in the treatment. In the future, this technology can predict the upcoming situation and make appropriate forecasting regarding this virus.
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Automated COVID-19 emergency response using modern technologies
p. 58
Ibrahim Haleem Khan, Mohd Javaid
DOI
:10.4103/am.am_68_20
Almost all countries are struggling with a pandemic created by infection of the severe acute respiratory syndrome coronavirus-2 virus. Health professionals are overstretched and are estimating to treat millions of peoples infected by this virus. However, we see the gainful employment of new technologies to provide fewer human interaction benefits to prevent the transmission of this virus. Here, in this paper, the capabilities of new technologies such as unmanned aerial vehicles, data analysis, three-dimensional (3D) printing, machine learning, and artificial intelligence are used to develop a model to the limit of their autonomous functionalities. We have proposed an automated COVID-19 pandemic emergency response system using the above modern technologies. These technologies are used efficiently to supply essential items in the required location and minimize the need for transportation. Advanced digital technologies are used to observe the crowd in different cities. It can identify people who are not wearing masks in public places. Further, 3D printing technology is used to manufacture personal protective equipment for COVID-19, and drones are used to deliver these items in the required places. The integrated deployment of new technologies can help us to fight this virus in a better way. This model can help through intelligent population screening, improved medical help, timely notification, and suggestions about infection control. It uses an innovative platform supported through different software and machine learning techniques. Furthermore, doctors, analysts, governments, and researcher can take its advantage to analyze the level of infection by the virus.
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CASE REPORT
An interesting case of life-threatening COVID-19 pneumonia
p. 62
Sudha Kansal, Aakanksha Chawla Jain, MS Kanwar, Avdhesh Bansal, Nikhil Modi, Athar Parvez Ansari, Roseleen Kaur Bali, Viny Kantroo, Rajesh Chawla
DOI
:10.4103/am.am_87_20
COVID-19 pneumonia requires intensive care unit admission in approximately 5% of patients. The treatment options are all experimental. We report a case of life-threatening COVID-19 pneumonia with cytokine release syndrome who had successful outcome with tocilizumab.
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LETTER TO EDITOR
Does moderate-intensity aerobic exercise reduce risk and severity of respiratory viral infection in older people? A correlation with COVID-19
p. 65
Chidiebere Emmanuel Okechukwu
DOI
:10.4103/am.am_64_20
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