The emergent COVID-19 pandemic dictates an urgent switch to teleconsultation. India has high patient to rheumatologist ratio, and patients have limited concepts about telemedicine. Thus, we attempted to find the feasibility and acceptance of patients in switching to teleconsultation. The CARE rheumatology clinic at Kerala, India, caters to average 170 (range: 140-240) patients per day. Patients with prefixed appointments had two-level screening for eligibility for teleconsultation. Those eligible were given the option for teleconsultation on the widely available WhatsApp app. Of those who completed teleconsultations, 100 were chosen at random to provide feedback. In the first 7 days, out of 1469 appointments, 975 were found eligible for teleconsultation. Of these, 723 (74%) opted for it. The average footfall in the clinic was reduced to 67 (range 29-117). The proportion of patients accepting teleconsultations increased with time. Amongst the 100 respondents, median satisfaction was 9 (IQR 8-10) and recommendation for continuing was 9.5 (IQR 8-10) on a 0-10 scale. Multivariate analysis showed the recommendation score was dependent on beliefs about social distancing, perceptions about clinical examination, and the satisfaction score of the first teleconsultation. Age, sex, availability of personal video conferencing app or of vehicles did not independently influence this score. Without teleconsultation facilities, three-fourths of the respondents would have stopped drugs or self-medicated. The switch was feasible and accepted by patients. It enabled quick reduction in the number of persons travelling to the centre. Not making the switch could have deprived approximately three-quarters of these patients of proper medical care. Key Points • Patient to rheumatologist ratios in India is heavily skewed and awareness about telemedicine is limited. • Switch to telemedicine was feasible and allowed a decrease in the number of people attending the clinic. • Not switching could have lead to disruption of care or self-medication in a majority of patients.
Coronavirus disease 2019 (COVID-19) was declared an epidemic and a global health emergency by the World Health Organization (WHO), prompting various countries to implement early and stringent social distancing protocols through lockdown, to flatten the epidemic curve. The objective of our present study was to assess the impacts and effectiveness of the lockdown protocol in Karnataka and Punjab, compared with the implementation of this method in Australia and the United Kingdom (UK). This study involved the collection of data from different authorized databases, in two phases. The first phase included the time starting with the first-reported index case through the 14th day after the declaration of lockdown, for each country. The second phase involved the data collected between the 15th day through the 28th day of the lockdown. The highest doubling rate for cases was observed in Australia, followed by Karnataka and Punjab, whereas the lowest was observed in the UK. Comparisons of the numbers of the samples tested, the mortality rate, and the recovery rate between Karnataka and Punjab, after the implementation of lockdown, revealed a better recovery rate and lower mortality rate in Karnataka than in Punjab. Our study revealed that the implementation of social distancing and lockdown reduced the transmission of the coronavirus and the number of cases reported. However, the effectiveness of lockdown varied among locations, due to demographic and physiological differences.
Objective: To compare the impact of lockdown in Maharashtra, Kerala and United States. Methodology: We conducted a prospective observational study in order to assess and compare the impact of lockdown between Kerala, Maharashtra and United States (US). The study involved the collection of data from two phases. The first phase is the time from the index case reported in each country till the 14 th day after the declaration of lockdown in that country. The second phase involved the data collected from the 15 th day to the 28 th day of lockdown. Data storage and analysis were performed using Microsoft excel and SPSS version 24. Result: As per 21 st April, 426 cases were reported in Kerala among which 307 (70.07%) recovered, active cases were 117 and 2 deaths (0.4694%). Whereas in Maharashtra 7628 cases were reported and among which 1076 had recovered and there was 323 deaths. The total number of cases reported before lockdown in Maharashtra was 97 and in Kerala was 95. After the 29 days of lockdown the increase in the number of cases in Maharashtra was significantly higher when compared with Kerala. Also, the recovery rate before and after lockdown in Kerala was 4.10% and 72.53% respectively. In Maharashtra recovery rate before and after was 70.93% and 14.00% respectively. Conclusion: The implementation of lockdown had a great impact on reducing the transmission of infection across the country. The number of cases also reduced due to this lockdown, but its effectiveness varied from place to place.
Background: The role of ascorbic acid in cancer therapy is mainly due to its structural similarity with glucose. When supplemented intravenously in high dose, ascorbic acid can get into the cancer cells and induce apoptosis by causing mitochondrial damage. Aim: The aim was to study the efficacy of high-dose intravenous (IV) ascorbic acid as monotherapy in cancer patients following ketogenic diet and its role in improving the quality of life. Results: C-reactive protein (CRP) and erythrocyte sedimentation rates (ESRs) were considered as parameters to determine the efficacy of the treatment, and substantial decrease in both the levels was observed within 1-week treatment. CRP levels declined from 3.1946 ± 3.2508 mg/L to 1.0606 ± 0.6706 mg/L (P = 2.27E-10), whereas ESR levels declined from 64.1333 ± 38.8253 mm/h to 31.6 ± 16.5520 mm/h (P = 0.0041). A decline in these parameters shows the association of ascorbic acid in reducing the inflammatory response in cancer. The renal effect of ascorbic acid was also studied by analyzing the creatinine level pre- and postascorbic acid treatment sessions, and it raised from 0.8526 ± 0.22904 to 1.1666 ± 0.2894 mg/dL (P = 1.18E-14). This showed the renal impact of ascorbic acid. Conclusion: The study highlighted the clinical benefit of IV ascorbic acid in the reduction of inflammatory response in cancer patients. The renal adverse events associated with ascorbic acid alarm the use with caution and therapeutic drug monitoring for ascorbic acid.
BackgroundThe novel corona virus disease (COVID-19) was declared as pandemic by World health organisation (WHO) on the 11th of March 2020. India was one among the countries in the world to declare the longest lock down across the nation in order to resist the spread of COVID-19. It was a challenge to assess the medical care of chronic disease patients during these lock down days.MethodologyWe adopted a cross sectional survey design to assess the health conditions and perceptions of patients with cardiovascular metabolic co-morbidities and those with autoimmune rheumatic diseases during the COVID-19 lock down daysResults and DiscussionA total of 310 patients completed the survey during this time period. Among these 310 responders, 299 completed the survey. We had 157(52.50%) patients with cardiovascular metabolic co-morbidities and 142(47.49%) with autoimmune rheumatic diseases. The mean age of patients in cardiovascular metabolic co-morbidities group was found to be 59.19±16.34 and those in autoimmune rheumatic diseases was 47.05±13.30. The predominant distribution of female gender for cardiovascular metabolic co-morbidities (57.32%) group and autoimmune rheumatic diseases (72.53%) is in accordance all the previous studies in this field.. The women are found to react more negatively in terms of to the same traumatic stress when compared with menConclusionIn conclusion there is strong need for health policy reformations in the field of the chronic diseases health care management to equip the preparedness in order respond adequately to such medical emergencies including natural disaster
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