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Managing co-morbid conditions just as important as Covid treatment, say experts

The workshop largely captured the four aspects of acute respiratory distress syndrome in Covid patients, diabetes and hypertension, the need for counselling in psychiatric cases and challenges in paediatric cases.

Written by Anuradha Mascarenhas | Pune |
February 11, 2021 12:50:41 am
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From a 90-year-old female Covid-19 patient with comorbidities, who weighed less than forty kilos, to a severely malnourished child with tuberculosis who had also contracted coronavirus, a day-long workshop at the Pune district collectorate on Wednesday had experts from BJ Medical College and Sassoon General Hospital, Maharashtra Institute of Medical Education and Research (MIMER) Medical College and Yashwantrao Chavan Memorial Hospital (YCMH), Pimpri, presenting complicated cases of coronavirus and the challenges healthcare workers faced in treating such patients.

The workshop was attended by over 100 doctors even as 170 doctors participated virtually.

Dr DB Kadam, who chairs the district’s Covid task force of experts, was among the doctors on the panel that moderated the case presentations. He said that there is a need to consistently be on alert and ensure aggressive management of the disease. “It is now time for people to manage their comorbidities, as results are not very satisfactory when they get infected with coronavirus. For instance, blood sugar monitoring is an important part of coronavirus management. People need to realise that their management of co-morbid conditions is equally important (as treatment for Covid),” Dr Kadam said.

CEO of Pune Zilla Parishad Ayush Prasad, who organised the workshop along with the district health society, said that the aim of the medical training workshop on case presentations was to provide a platform for doctors to have discussions. “We had over 50 entries for case presentations, but the team identified complicated cases that were mainly handed by government medical colleges,” Prasad said.

He pointed out that while several Standard Operating Procedures (SOPs) are listed for the management of Covid patients, doctors often face challenges when a patient presents with a combination of conditions and has self-medicated. “For instance, the patient may have taken medicine for treating inflammation due to a urinary tract infection and then presents with Covid-like symptoms,” he said. Several case presentations were made so that doctors, especially those at rural primary health centres (PHCs), can understand the management of the disease through clinical practical experiences, he added.

The workshop largely captured the four aspects of acute respiratory distress syndrome in Covid patients, diabetes and hypertension, the need for counselling in psychiatric cases and challenges in paediatric cases.

Prasad further said that the larger aim was to stop blindly referring asymptomatic patients, or persons suspected to have Covid, to more established centres reserved for serious cases. “There is a need to understand the NEWS (National Early Warning Score) — a system that is used to identify and respond to patients at the risk of deteriorating — and ensure effective screening at the PHC-level itself,” he said.

In her presentation, Dr Deepali Ambike from YCMH, Pimpri, presented a case where a malnourished girl had fever for ten days and was closely monitored in the high dependency unit. “There were several challenges as the immunity levels of the child were compromised, as she also had TB along with Covid,”’ she said.

Dr Anjali Kamat from the medicine department at BJ Medical College presented the case of a 56-year-old woman from Ganj Peth, who had cough and fever for two days and throat pain for a day, but did not have any comorbidities. “Her pulse rate was weak and the patient was febrile — this was a suspected case of Covid 19. We isolated her and monitored her NEWS score, respiratory rate, oxygen saturation, apart from testing her for Covid 19,” she said, adding that at least 90-95 per cent of the cases require treatment only at the PHC level.

However, Dr Subhash Salunkhe, Covid-19 advisor to the state, pointed out that doctors have to remain on alert as delayed referrals have been among the major reasons for Covid fatalities. Meanwhile, experts also said that X-Ray is an important diagnostic tool, while physiotherapy plays a crucial role in recovery of Covid patients.

Across Pune district, 21.62 lakh tests for Covid have been conducted till date and a total of 3.9 lakh persons have tested positive for the viral infection. In Pune Municipal Corporation (PMC) area, a total of 1.93 lakh persons have tested positive, while Pimpri-Chinchwad Municipal Corporation (PCMC) limits has also registered 1.01 lakh cases of Covid-19. The remaining cases in the district were recorded in Pune rural and Cantonment areas.

According to district health authorities, a total of 1,757 persons across Pune have Covid-19 and are isolated at hospitals, while 2,706 patients are in home isolation. Overall, Pune district has reported a total of 9,123 deaths due to Covid so far, with the highest numbers in the PMC area at 4,959.

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