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  Citation statistics : Table of Contents
   2020| April-June  | Volume 5 | Issue 2  
    Online since June 29, 2020

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Combating corona virus disease 2019 and comorbidities: The Kerala experience for the first 100 days
Kavumpurathu Raman Thankappan
April-June 2020, 5(2):36-42
Kerala, a highly vulnerable state for a virus disease like coronavirus disease 2019 (COVID-19) because of the largest proportion of elderly population in India with an extremely high prevalence of most of the noncommunicable diseases and their risk factors, reported first COVID-19 case in India. Using secondary data available from various search engines and specific websites of Kerala and Government of India, a review was done. Based on the World Health Organization's warning, Kerala anticipated cases from China where the first COVID-19 case was confirmed and was able to detect and isolate the cases as soon as they landed in Kerala. The total number of active cases in Kerala peaked at 262 in the first week of April and then decreased to 16 on May 8, flattening the epidemiological curve within 100 days. The major factors that lead to the success of Kerala in managing COVID-19 are depicted in this review.
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COVID-19 and noncommunicable diseases: Identifying research priorities to strengthen public health response
Prashant Mathur, Sukanya Rangamani
April-June 2020, 5(2):76-82
Coronavirus disease 2019 (COVID-19) pandemic is the most important global public health event of this century, and India is among the first 15 countries with affected persons. Persons with male gender, older age, and preexisting noncommunicable diseases (NCDs) are found to be associated with severe and fatal disease. Specific treatment modalities for COVID-19 are still elusive. NCDs are reported as presenting symptoms in COVID-19 patients, and preexisting NCD can worsen COVID-19 prognosis. The management of NCDs in the context of COVID-19 infection is challenging. India poses a huge burden of NCDs and their risk factors which could synergize with COVID-19 for serious illness and outcome. This article reviews and proposes a research agenda for COVID-19 and NCDs in the ambit of strategic approach: review of adequacy of existing mechanisms to tackle NCDs and their risk factors, strengthen the evidence base, enable remote access health-care service delivery, strategically revamp health systems to become more responsive, integrated, and universal, encourage all-round innovation through collaborations and partnerships, and empower community actions for home-based care. The key research domains are burden and epidemiology, health-care delivery, use of technology, sectoral approach, surveillance-monitoring-evaluation, behavioral and communication research, and governance and policy. Within each domain, key research priorities are identified which would be cross-cutting across more domains.
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COVID-19 and chronic noncommunicable diseases: Profiling a deadly relationship
Jai Prakash Narain
April-June 2020, 5(2):25-28
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Psychological dimensions of COVID-19: Perspectives for the practicing clinician
Angela Paric, Lakshmi Ravindran, Arun Ravindran
April-June 2020, 5(2):83-89
For most individuals, the coronavirus disease 2019 (COVID-19) pandemic is a novel and anxiety provoking experience. With ongoing outbreaks in many regions around the globe, it has led to worldwide social distancing measures, travel restrictions, job and financial losses, and depletion of resources. In addition, morbidity and mortality of the infection with mental health sequelae including health-related anxiety, depression, and traumatic-related conditions are common. Such adverse mental health consequences clearly have a bidirectional relationship with the infection's presence, and thus, there is a need to recognize and address such complications to optimize care. The perspectives outlined here are based on a review of literature regarding past infectious outbreaks, current experiences with the ongoing pandemic, and their effects on psychological well-being and clinical practice. They attempt to provide a framework that integrates the mental, physical, and social domains of the COVID-19 pandemic and their interrelationships. Thus, it is recommended that management includes a psychological component, and evidence supports the use of psychoeducation and social support groups to mitigate the adverse psychological effects of the pandemic. Virtual delivery of such interventions is becoming a reality, although efforts to address the COVID-19 outbreak largely remain a work in progress with global collaboration and innovation. The lessons learned from the COVID-19 pandemic may provide valuable information to overcome the psychological impact of future infectious disease outbreaks.
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Hypertension and COVID-19: A public health perspective
Alka Aggarwal Singh, Asha Shah, Jai Prakash Narain
April-June 2020, 5(2):90-95
As the count for COVID-19 infection and deaths climb around the world, it is pertinent to look at the other pandemic of cardiovascular disease (CVD) and hypertension (HT). These conditions have been found to be the most common underlying conditions around the world. Unlike CVD, HT is not considered an independent risk factor for COVID-19. However, it is a risk factor for CVD and hence needs attention. Globally, HT affects approximately 900 million people and kills an estimated 9 million annually (11% of all deaths). It causes end-organ damage to cardiac, cerebral, and renal systems as well as eyes. However, <15% of those with HT have it under control. The COVID-19 pandemic has affected the HT situation by its psychogenic effects which are known to exacerbate HT, questioned the use of certain antihypertensives, decreased access to health services, and diverted resources from already stretched health systems. Despite these challenges, some lessons from the earlier outbreaks of infectious diseases are indicative. Primary health services can still support patients of HT with some adaptation of the traditional system, as well as by the adoption of new technologies. Patients can be encouraged for self-care. HT needs attention as a serious medical condition that can be controlled with concerted efforts from the global community. In the pandemic situation, there needs to be an advocacy for the continuity of services for HT as well as for other noncommunicable diseases and other health services. The treatment protocols for HT need to be simplified keeping prolonged social isolation in mind. Serious efforts are being made to protect healthcare workers from infection. These should be complemented with attention to HT and other underlying conditions that increase morbidity and mortality among the infected. Countries should adopt a policy of data sharing to learn from each other and to keep the public informed. Finally, countries should reserve health funds for disasters and pandemic situations and build a reserve force of healthcare workers to prevent a massive disruption of regular health services.
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Noncommunicable diseases and maternal health in face of the coronavirus disease 2019 response
Jennifer Prince Kingsley, Nalini Sathiakumar, Bolanle Bolaji, Jacob Kumaresan
April-June 2020, 5(2):96-98
Maternal health and Non-communicable Disease (NCD) are closely linked. NCDs in pregnancy lead to serious complications during pregnancy and delivery and in newborns. The management and treatment of pregnant women with NCDs have been compromised by the coronavirus disease 2019 (COVID-19) pandemic, which has brought to the forefront the deficiencies in the healthcare systems globally. Measures such as lockdowns, social distancing, and transportation restrictions impact maternal healthcare by disrupting access and continuity of care for NCDs and to preventive and health promotion services. In parallel, it negatively impacts the global progress made in decreasing the maternal and neonatal mortality rates (MMR and NMR) in the lower and middle-income countries. There is an urgent need to incorporate maternal health with a focus on high-risk pregnancies into the response measures for COVID-19 and in the planning of preparedness of future pandemics if the Sustainable Development Goals targets for MMR and NMR are to achieve by 2030.
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Is the COVID-19 pandemic an opportunity to advance the global noncommunicable disease agenda?
Jacob Kumaresan, Bolanle Bolaji, Jennifer Prince Kingsley, Nalini Sathiakumar
April-June 2020, 5(2):43-49
More than 70% of the annual global deaths are due to noncommunicable diseases (NCDs), and 80% of these deaths occur in low- and middle-income countries. Most of these deaths are in people <70 years of age and can be prevented and controlled by addressing a set of modifiable risk factors, namely tobacco use, alcohol misuse, unhealthy diets, physical inactivity, and obesity. Recognizing the global burden of NCDs, the world's leaders adopted several policy instruments such as the NCD Global Action Plan, the Framework Convention on Tobacco Control, and the global monitoring framework on NCDs. In 2015, the UN General Assembly included reduction of premature mortality from NCDs by one-third by 2030 as target 3.4 of the Sustainable Development Goals (SDGs). Assessment of this target in 2018 found some progress with tobacco control, but the overall progress was inadequate. The global pandemic of coronavirus disease 2019 (COVID-19) has brought NCDs to the forefront. Preliminary data indicate that persons with NCDs are extremely susceptible to COVID-19 and its complications including death. Focus on controlling the pandemic has led to delays in the diagnosis, treatment, and management of NCDs. This pandemic has exposed the weaknesses of the health-care systems, exacerbated the inequalities within societies, and disproportionately affected the vulnerable groups. In the process of recovery and in future planning, governments and leaders need to take proactive actions toward the prevention and control of all avoidable deaths from NCDs if the SDG target 3.4 is to be achieved by 2030.
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Cardiovascular disease in the context of the COVID-19 pandemic
Shanthi Mendis
April-June 2020, 5(2):50-57
Emerging evidence indicate a close relationship between coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs). Age is a potent shared risk factor which links the two conditions. Although severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) principally affects the lungs, a sizeable number of patients develop new-onset cardiac dysfunction during the course of the illness. As outlined in this review, cardiovascular manifestations of COVID-19 are complex with patients presenting with one or more of the following: myocarditis, acute myocardial infarction, stroke, cardiomyopathy, heart failure, arrhythmias, acute pericarditis, and venous thromboembolism. Preexisting CVDs make people more vulnerable to SARS-CoV-2 infection and adversely impact clinical outcomes. The World Cardiology Associations have issued consensus-based guidance to ensure that cardiac and stroke care needs of people, are met effectively within the context of the COVID-19 burden. Clinicians caring for COVID-19 patients need to be aware of the potential cardiovascular side effects of various therapies used for treating SARS-CoV-2 infection, including chloroquine/hydroxychloroquine and azithromycin. Research is essential to better understand the mechanisms that shape the close interplay between SARS-CoV-2 infection and CVDs.
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Managing diabetes and COVID-19: A national strategic framework
Viswanathan Mohan, Jagannathan Ramesh
April-June 2020, 5(2):58-62
The coronavirus disease (COVID-19) pandemic has been one of the greatest health challenges that humanity has witnessed in recent times. Diabetes mellitus is one of the most common noncommunicable diseases and its prevalence is very high in evlderly people. COVID-19 also has a worse prognosis in elderly people. Hence, most of the data, both nationally and internationally, have shown that people with uncontrolled diabetes have worse outcomes compared to people without diabetes. This article reviews the connection between diabetes and COVID-19 and suggests various precautions to be taken for people with diabetes, the management strategies for diabetes and lays down a strategic framework for managing people with diabetes and COVID-19.
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Problems of management of non-corona respiratory diseases in the era of COVID-19
Surinder K Jindal, Aditya Jindal, Subhabrata Moitra
April-June 2020, 5(2):63-69
This pandemic, COVID-19 caused by the novel coronavirus SARS-CoV-2, has not only devastated the public health, but also posed an immense impact on the societal, economical, and geopolitical conditions. The severe stress on essential health services has also adversely affected the prevalence, recognition, and management of non-COVID diseases. In particular, the management of respiratory diseases has suffered the most because of the clinical similarities between COVID-19 and non-COVID flu, respiratory allergies, pneumonias, and respiratory failure. Because of these similarities, some of the patients tend to avoid seeking treatment lest they be diagnosed as COVID-19 infection. Diagnostic tests such as spirometry and invasive investigations (bronchoscopies and thoracoscopies) are avoided by physicians for the fear of spread of the infection. Patients with acute worsening of asthma and chronic obstructive pulmonary disease requiring nebulization therapy are thus not even entertained by medical facilities. Many patients themselves are often afraid of inhalation therapy. In this article, we have summarized the problems faced by the patients suffering from respiratory disorders and their physicians as well as some of the important issues related to their therapy during this pandemic.
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Role of tobacco in SARS-CoV-2 infection and COVID-19: A scoping review
Bratati Banerjee, Rupsa Banerjee
April-June 2020, 5(2):70-75
The role of tobacco smoking in COVID-19 has been studied by several researchers, but conclusive evidence has not yet been established. This calls for assimilation of the findings reported in available published studies. The present review attempts to understand the observation and opinion of various researchers on this aspect. A scoping review was conducted to study the role of tobacco smoking in the occurrence of SARS-CoV-2 infection and severity of COVID-19. The review included 14 studies, of which 7 studies discussed the pathophysiological effects of nicotine in detail, while seven other studies analyzed the risk of tobacco use or otherwise, on occurrence and severity of COVID-19. Based on the existing evidence, it may be concluded that tobacco smoking evokes adverse pathophysiological changes in smokers and is associated with worse progression of COVID-19 to its severe form, with the patients requiring admission in the intensive care unit and placed on ventilator support or may even succumb to the disease. Although one researcher, through several studies, has reported a beneficial effect of nicotine, there is not enough evidence to support this claim. Research is probably in the pipeline to test medicinal nicotine to prevent and treat COVID-19 in providers and patients with moderate and severe illness. Until the results of the proposed research or further longitudinal analytical studies proving beneficial association are published, it will be in the best interest to advise patients and the entire population to refrain from smoking tobacco to prevent an impending upsurge of noncommunicable diseases that might otherwise happen in the near future.
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COVID-19 and noncommunicable diseases: Impact and the strategic approaches
JS Thakur, Ronika Paika, Sukriti Singh, Jai Prakash Narain
April-June 2020, 5(2):29-35
The coronavirus disease (COVID-19) has critically impacted global health systems and economies both in developed and developing world, but especially in developing countries, already struggling to address the preexisting burden of diseases with limited resources, the situation has become even more challenging. The COVID-19 pandemic is the most serious public health challenge today and is responsible for two concurrent global crises: the health crisis and an economic crisis. Only an appropriate policy response will determine the impact of pandemic on human health and economic well-being. It is clear that the pandemic will seriously undermine global efforts to attain the sustainable development goals. Among the major challenges are increased indoor time leading to increased exposure of other behavioral risk factors for noncommunicable diseases (NCDs) such as unhealthy diet, alcohol use, stress, inadequate access to essential medicines. Further travel or transport restrictions leading to inaccessibility to health care centres, early detection and laboratory testing for NCD patients and increased susceptibility in health care settings for chronic disease patients. Thus, the strategies are required to address this comorbidity which may include integration and convergence of the existing communicable and NCD programs, strengthening primary health care for universal health coverage, updating guidelines, enhancing surge capacity, and multisectoral participation. It is essential to assess the prevalent gaps, mobilization of resources, evidence-based policymaking, strengthen health systems financing and leadership and effective partnerships for addressing health disparities and inequities which are further accentuated by the COVID-19 pandemic.
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