Data Loading...
The Indian Practitioner- April Issue 2020 Flipbook PDF
TIP April 2020
162 Views
105 Downloads
FLIP PDF 13.11MB
The Indian Practitioner A Monthly Journal Devoted to Medicine, Surgery and Public Health
COVID-19 Indian Perspectives and Challenges: The TIP Approach A Study of Probiotic Bacillus subtilis HU58 for the Management of Antibiotic-Associated Diarrhoea in Adults Relevance of Nutrition Intervention in Diabetes Management: A Perspective from Indian Clinical Experts The 2019 Novel CoronaVirus / COVID-19 – An Update From Illness to Wellness through Nutritional Science “We must Anticipate that COVID-19 will also Become Pan-Endemic” COVID-19 in India: Current and Future Insights from Different Specialties COVID-19 – Our Emotions & Disorders Need to Brace Ourselves for Major Mental Health Issues Post COVID-19 Pandemic
>>> Plus regular features & much more
Vol.73 No.4 April 2020 Mumbai Pages 70 `100/ISSN 0019-6169 E-ISSN 2394-3017
Commentary
The Indian Practitioner d Vol.73 No.4 April 2020
The Indian Practitioner Editorial m COVID-19 Indian Perspectives and Challenges: The TIP Approach - Dr Varsha Narayanan Orignal Article m A Study of Probiotic Bacillus subtilis HU58 for the Management of Antibiotic-Associated Diarrhoea in Adults - Mehta DS, de Souza A, Jadhav SS, Devale M
April 2020
...7
...22
Review Article m Relevance of Nutrition Intervention in Diabetes Management: A Perspective from Indian Clinical Experts ...29 - Dr. Arun Vadavi , Dr. Vinod Kumar Bhargava , Dr. Ashok Jhingan , Dr. CR Anand Moses, Dr. Partha Sarathi Mandal, Dr. Gunjan Lath, Dr. Anand V, Dr. Sameer Rao Commentary m From Illness to Wellness through Nutritional Science - Dr. Gautam Banerjee
m COVID-19 – Our Emotions & Disorders - Dr. M S Reddy
...36 ...51
m Need to Brace Ourselves for Major Mental Health Issues Post COVID-19 Pandemic - Dr. Ashoka Jahnavi Prasad
...53
Special Articles m The 2019 Novel CoronaVirus / COVID-19 – An Update - Dr Tanu Singhal
...38
Expert Speaks m COVID-19 in India: Current and Future Insights from Different Specialties Interview m “We must Anticipate that COVID-19 will also Become Pan-Endemic” - Dr. T Jacob John
...48 ...46
Medi Matters
...11
Nutraceuticals
...59
Alternative Medicine
...63
Events
...65
The Indian Practitioner qVol.73. No.4. April 2020
C O N T E N T S 5
MD , DM, FACG
6
The Indian Practitioner qVol.73. No.4. April 2020
Editorial
COVID-19 Indian Perspectives and Challenges: The TIP Approach Dr Varsha Narayanan
Overview
C
OVID-19 (Coronavirus Disease), caused by the novel Coronavirus designated 2019-nCoV (and thereafter called SARS-CoV-2), first seen in Wuhan, China in December 2019, has now swept across most countries and surfaced as one of the major pandemics the world has seen.1 India too has been impacted with the first few cases emerging in end January-early February 2020 and the disease gaining a foothold across the country by March 2020. COVID has a Reproductive number (R0) of around 2.3, and is transmitted by droplets emitted from infected individuals through direct contact or close proximity (about 1 meter) and infected surfaces (on which virus can remain for around up to 12 hours or longer).2,3 From the time of getting infected, COVID symptoms can take from 2 days to 2 weeks to manifest. Symptoms include sore throat, cough and fever which may be sometimes accompanied by nasal congestion, running nose, loss of smell, sneezing, headache, fatigue, body pain and rarely vomiting or diarrhea. The virus can spread to the lower respiratory tract and lungs in about 4-5 days causing breathlessness due to bronchitis and pneumonia. Death occurs from ARDS (Acute Respiratory Distress Syndrome) or sepsis and multi-organ failure.4 Almost 80% of people have mild symptoms. The overall global mortality rate from COVID-19 is around 2-3% as has been seen in India as well. Risk of serious disease, complications, and death is higher in patients >60 years and those suffering from other underlying medical illnesses like Diabetes, Hypertension, Cancers, and diseases of the Airway, Heart, Kidney, Liver or Immune system.5 Currently there are no specific drugs validated by large randomized clinical trials for COVID-19, but based on small studies, case reports and anecdotal evidence, Hydroxychloroquine and its combination with Azithromycin, and antiretrovirals Lopinavir-Ritonavir are being selectively used with ADR monitoring, along with symptomatic therapy in India.6,7 The global SOLIDARITY trial may shed more light and conviction on
these therapies in the near future.8 COVID RNA vaccine trials are underway with the hope of its availability by early 2021.9
Tackling COVID-19 in India India represents one of the most unique countries in terms of diversity and disparity. While instituting uniform COVID-19 measures and policies, an array of occupational, cultural, educational and economic issues presents themselves. There are also challenges related to types of housing and living, as well as distribution and availability of health care facilities. The approach befitting a country like India would be TIP – Testing and Tracing contacts, Isolation of confirmed and suspected cases as well as high risk contacts, and Precautions and Preventive measures for the population.
Testing for COVID-19 and Tracing Contacts Testing criteria in India include symptomatic patients (fever with cough or breathlessness) with travel history (in past 14-21 days), or contact history with symptomatic travelers or high suspicion/confirmed COVID cases. Asymptomatic persons in these categories undergo minimum 14-day quarantine to observe for symptoms. In addition, testing asymptomatic people living in the same household as a COVID positive case (high risk contacts) is also an important part of the criteria, as these people carry high risk of contracting and transmitting infection.10 Testing this last group is challenging in urban slums and clustered residential areas with several sharing a room, common balconies, toilets and water filling sources. In such areas more robust testing of possible COVID contacts becomes very important to limit the rapid spread and spike in cases which can make these areas hotspots. In addition, meticulously tracing and quarantining of contacts though of high importance to prevent and contain outbreaks, can prove to be a major task due to close proximity of living, mixing and working in these areas, thereby necessitating sealing and cordoning off huge population clusters. Other groups to be tested include hospitalized patients with severe acute respiratory symptoms or influenza like illness and pneumonia, symptomatic Health
Health and Pharmaceutical Consultant, Dr Varsha’s Health Solutions, Andheri West, Mumbai. Email: [email protected] The Indian Practitioner qVol.73. No.4. April 2020
7
Editorial Care Workers (HCWs) handling COVID positive patients and asymptomatic HCWs if they have handled a COVID positive case without adequate protection. Contact tracing for positive HCWs can be a daunting task considering patient volumes in India, resulting in decisions to temporarily close many OPDs and non-emergency consulting clinics. However, this can establish and propagate E-consulting and Tele-medicine, that can play a very positive role in the future of health care in the 2020 decade.11
risk of exposure and being infected with COVID-19, like people recently returned from travel, those exposed to symptomatic people with recent travel history, and those possibly exposed to known positive COVID cases. Such people are either isolated in their home/home room (with intimation of the housing society administration) or in assigned approved quarantining facilities. These group of people are under observation for a minimum period of 14 days (extendable in specific situations) and swab tested when symptomatic.
More and more testing and tracing contacts is central to tackling and containing COVID-19 in India. Currently testing in suspected cases is done with nasopharyngeal and/or oropharyngeal swab samples for presence of the nCoV-2019 RNA by RTPCR (Real-time Polymerase Chain Reaction).12 Domestic production and approval of testing kits which can reduce testing time to under 2.5-3 hours has been a major step. (Rapid 5-minute tests launched globally will be on their way in the near future). Expanding testing centers to involve both government and private hospitals and laboratories has been an encouraging move. Currently there are more than 125 government testing centers spread across India with at least one in most states, and more in pipeline. Over 50 private hospitals and labs have stepped in with more than 15,000 country wide collection centers, with introduction testing kiosks and even drive-through testing recently. However, shortage of testing kits and handling gear, hurdles in home sample collection, high test cost and differential directives have been some of the challenges faced by private labs in contributing to greatly scaling up testing, which is the need of the hour.
The second type of isolation is of those who have tested positive for COVID-19. All such patients were being hospitalized in India in isolation wards. There are now many government hospitals and apex institutes, along with private hospitals also being commissioned recently, which have established COVID Isolation wards and ICUs. To prevent overwhelming and overloading of healthcare workers and facilities, a triple level of isolation will be seen coming into play, with patients having mild symptoms and no risk factors or pre-existing medical illness, isolated in COVID-Care Centers, (self-care/ basic care repurposed stay centers like hostels, lodges, stadia, guest houses, etc.) until their symptoms resolve and laboratory tests for COVID-19 virus are negative.10
The rapid blood serological testing for antibodies to 2019-nCoV in blood has been now developed and approved in India, which can give results within 15-30 minutes.13 This can aid as a quick screening test (to be followed by confirmatory swab test) in hotspots, or in dense clusters or interiors (where migrant population from cities has returned) when there are suspected/ known positive cases. In combination with the RTPCR swab test, the rapid antibody test can help detect active symptomatic cases, asymptomatic carriers, and those with immunity developed to the virus.
Moderate and Severe cases having breathlessness (increased RR with SpO2