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Mumbai: When the world is fighting against Covid-19 during this time delivery of a child has become very challenging for the frontline health workers and Pregnant woman. A team of doctors in Mumbai hospital headed by Dr Pritam Moon (consultant physician), Dr Bipin Jibhkate (Consultant and Head Critical Care Medicine), Dr Mangala Patil (Consultant Obstetrician), Dr Samir Shaikh (Consultant Neonatologist), helped a 35 years old woman who was Covid-19 positive and delivered a second baby at 31st week, after performing the emergency labour in ICU. The mother and baby both are doing well and have been discharged after spending 21 days in ICU, 14 days on the ventilator, and a total of 25 days of Hospital stay.

A 35-year-old Hethal Gandhi is a housewife and resident of Mira Road was tested positive for Covid-19 during her pregnancy. She was referred to Wockhardt Hospital but having no symptoms of Covid-19 that means she was an asymptomatic patient. But she was having mild fever and after 5days she started complaining about breathlessness. and couldn’t maintain saturation with a high flow of oxygen.

According to Dr. Bipin Jibhkate who is Consultant and Head Critical Care Medicine, Wockhardt Hospital, Mira Road said, “RT PCR test was performed on admission to confirm COVID. On admission the patient was having a low Oxygen level, so was admitted to ICU and started on HFNC (high flow nasal cannula). There were multiple challenges in managing this patient in ICU as her immunity was low; her physiological needs were different from normal women. Pregnant females have a higher tendency for clotting, their abdominal pressures are high, their carbon dioxide levels are low, they have a higher tendency to vomit, and they are carrying a baby in their tummy. So in such a situation, if their oxygen level is not maintaining the options are very limited. Considering all these things initially HFNC was tried but she could not maintain her oxygenation even with the highest settings of HFNC. So, we decided to put a tube through her mouth to her chest and put the patient on a ventilator. On ventilator initially, she was requiring very high oxygen and pressure support, even with that patient’s oxygen level was low. In such a situation, generally normal patients are managed in prone position ventilation, but due to pregnancy that was not possible with this patient, so we decided to put her in right lateral position. Along with this, she was started on standard treatment of COVID, like anti-viral, antibiotics, steroids, and anticoagulation. She also had decreased urine, alternate hypotension and hypertension, very high heart rate of around 150/minute. Slowly she responded to the treatment and her ventilator requirement went down. But even after 7 days of ventilation she was requiring a significant level of the ventilator and hence it was decided that we will have to remove her tube from the mouth and put it through the throat, a procedure called as a tracheostomy. “

“ICU team performed a procedure called a percutaneous tracheostomy. In this procedure, a hole is made in the front of the neck into the patient’s windpipe that is the trachea.  We at this stage also repeated her COVID test, which turned out to be negative and patient was free from COVID. So, this patient was shifted to non-COVID ICU and slowly was taken out of ventilator after 14 days of ventilation.” he added

The patient went into the labour pain due to stress after which delivery has to be performed in ICU itself where she deliver a child.

 “Considering that patient was having tracheostomy, still requiring a small amount of Oxygen, had higher chances of clot-forming which may go into lungs during operation and cause the life-threatening condition to the patient, as well anesthesia-related complication, it was decided that labour should be conducted in ICU in the supervision of Intensivists and neonatologists. This was very risky and unusual as labour is normally conducted in labour rooms.” said Dr. Mangala Patil, Consultant Obstetrician, Wockhardt Hospital Mira Road

Ultimately labour was conducted successfully and both mother and baby were fine after that.

Finance Minister Nirmala Sitharaman has announced Rs 900 crore grants to the Department of Biotechnology for COVID-19 vaccine.

Central government to spend Rs 900 crore for research and development of Covid-19 vaccine under Suraksha Mission “We are providing Rs 900 crore for research and development of COVID-19 vaccine. This is being provided for COVID-19 Suraksha Mission, purely for R&D but this money goes to the Department of Biotechnology for research purposes,” she said.

Moderna vaccine results to come soon their first analysis is likely to include more than 53 cases in next week, it’s also considered to be higly effective.US drugmaker comoany Moderna Inc has recently in  a relase has sadid that preliminary data of its Phase 3 Mrna-1273 vaccine trials would realsed soon.

However interim data released by Pfizer and BioNTech indicated that its vaccine candidate was more than 90% effective.

According to the recent reports by media, a volunteer who is a US student and volunteered for the Moderna vaccine trails has reported pain and fever after taking a shot of the coronavirus (COVID-19) vaccine. On the other hand, the biggest challenge for Pfizer vaccine is the requirement of ultracold vaccine freezers because the vaccine is based on a novel technology that uses synthetic mRNA to activate the immune system against virus needs to be kept at minus 70 degrees Celsius(-94F) or less but most of the developing countries doesn’t have such cold storage facilities.

India has 77 million people with diabetes and in Delhi alone, the prevalence of diabetes in those over 18 years of age is almost 20%. Diabetes can be fatal if we don’t keep a tab on our blood sugar levels, hence we need to be very careful in keeping a check on it.

Max Healthcare in its endeavour to reiterate its commitment to diabetes on this World Diabetes Day (November 14, 2020) lit up its Saket complex in blue. We, at Max Healthcare, believe that people with diabetes can be managed well by empowering them with the knowledge to manage the disease and close clinical monitoring. 
On this World Diabetes Day, Max Healthcare would like to send out a solemn message – let us all pledge to fight this disease together!

According to the data released by the Government of Delhi in 24 hours, Delhi reports more than 7,000 i.e 7340 new Coronavirus (COVID-19) cases. The total number of COVID-19 cases reported in Delhi after the outbreak of COVID-19 is 4,82,170 which is almost 5 lakh. The total number of deaths is 96 in the last 24 hours and recoveries are 4,30,195 that counts total number of active case stands are 44,456.

The total of 54,28,472 tests have been done so far that includes less RTPCR/CBNAAT/TRUENAT and more Rapid antigen testing.

There’s no denying that the air we inhale is laden with a layer of poisonous pollutants and obnoxious gases. In fact, some studies on air pollution have revealed that the air quality in NCR is as bad as smoking 40-50 cigarettes in a day. This extreme level of air pollution, in the form of ‘smog’ not only affects our respiratory and cardiovascular systems, but it causes damage to our eyes too.

Drink at least 2 litres of water every day. Safety Comes First and wear UV protected sunglasses when you step outdoors. Eat a healthy diet that’s rich in omega 3.

Dr. Shantanu Mukherji, Senior Consultant, Sharp Sight Eye Hospitals, says, “This is just the tip of the iceberg, Diwali comes and the air quality is only gets deteriorate further. Smoke from firecrackers adding to the activities like stubble fires by farmers, burning of leaves and heaps of garbage are autumn fall along with non-stop toxic vehicular pollution will only worsen Delhi’s already hazardous air quality. Though the health impact of these pollutants can range from asthma to cancer, strokes and Alzheimer’s disease, it can have severe effects on our eyes too.”

“Children are always the worst sufferers of these effects, leading to a multiple of health problems such as various eye allergies and infections like watering and red eyes, burning, itchy eyes and dry eyes, etc.,” added Dr.Shantanu.

The sign and symptoms of eye infection may include:

Persistent redness or swelling

Burning sensation

Watery eyes

Itching

Dryness

Precautions

In case of irritation or redness in eyes, do not rub them. Wash your eyes with cold water to prevent any further infection.

Drink at least 2 litres of water every day.

Use lubricating eye drops as prescribed by your eye doctor.

Wear UV protected sunglasses when you step outdoors.

Avoid contact lens and eye makeup of there is itching or redness in eyes.

Eat a healthy diet that’s rich in omega 3.

Ensure adequate period of rest from digital devices to avoid eye fatigue, dry eyes and computer vision syndrome.

The winter in India gives us respite from hot and sweaty days but it also brings along a plethora of health problems, especially to our eyes. More so, because the calm and cool weather makes pollution hang heavy in the air. And what’s worrying is the fact that every year the severity of the smog is only on the rise in the capital city and surrounding areas. Unsurprisingly, many even complained of inability to sight the moon this Karwa-chauth, as it was hidden under a blanket of misty smog.

There’s no denying that the air we inhale is laden with a layer of poisonous pollutants and obnoxious gases. In fact, some studies on air pollution have revealed that the air quality in NCR is as bad as smoking 40-50 cigarettes in a day. This extreme level of air pollution, in the form of ‘smog’ not only affects our respiratory and cardiovascular systems, but it causes damage to our eyes too.

Drink at least 2 litres of water every day. Safety Comes First and wear UV protected sunglasses when you step outdoors. Eat a healthy diet that’s rich in omega 3.

Dr. Shantanu Mukherji, Senior Consultant, Sharp Sight Eye Hospitals, says, “This is just the tip of the iceberg, Diwali comes and the air quality is only gets deteriorate further. Smoke from firecrackers adding to the activities like stubble fires by farmers, burning of leaves and heaps of garbage are autumn fall along with non-stop toxic vehicular pollution will only worsen Delhi’s already hazardous air quality. Though the health impact of these pollutants can range from asthma to cancer, strokes and Alzheimer’s disease, it can have severe effects on our eyes too.”

“Children are always the worst sufferers of these effects, leading to a multiple of health problems such as various eye allergies and infections like watering and red eyes, burning, itchy eyes and dry eyes, etc.,” added Dr.Shantanu.

The sign and symptoms of eye infection may include:

Persistent redness or swelling

Burning sensation

Watery eyes

Itching

Dryness

Precautions

In case of irritation or redness in eyes, do not rub them. Wash your eyes with cold water to prevent any further infection.

Drink at least 2 litres of water every day.

Use lubricating eye drops as prescribed by your eye doctor.

Wear UV protected sunglasses when you step outdoors.

Avoid contact lens and eye makeup of there is itching or redness in eyes.

Eat a healthy diet that’s rich in omega 3.

Ensure an adequate period of rest from digital devices to avoid eye fatigue, dry eyes, and computer vision syndrome.

According to the Union Ministry of Health and Family Welfare in last 24 hours India has reported new 44,684 infection cases and total cases rise to 87,73,479 .

The total number of deaths reported is 520 in 24 hours and the total Coronavirus (COVID-19) cases mounts to 1,29,188. Active cases in India are less than 5 lakh i.e 4,80,719.

The maximum cases are from 10 States/UTs that counts total 76.38% of the new cases. and 520 case deaths that have been reported in the past 24 hours.

By Prof Sujata Sharma Department of Biophysics, AIIMS, New Delhi

The recent pandemic of Covid-19 has led to loss of many lives and crippling of economies of several countries. However, beyond the most obvious fallouts of this deadly disease caused by an insidious virus, the shadow of upsurge of antibiotic resistance is looming over the entire mankind which will be realized in the time to come. A medical revolution of colossal proportions happened on September 28, 1928, when the first antibiotic was discovered by Sir Alexander Fleming, a Scottish bacteriologist. This discovery was heralded as a path breaking moment in the history of medicine as it seemed that the human race had finally found a new direction to combat deadly bacterial infections. What followed that event was the discovery, mass production, and prescriptions of several antibiotics over the next few years. A mass optimism swept the world towards the dawn of a new period termed as the Antibiotic era. A race to produce new antibiotics led to hundreds of antibiotics being churned out and consumed by the masses for bacterial infections. Even in his acceptance speech of Nobel Prize conferred to him, Sir Fleming had warned mankind against indiscriminate use of antibiotics, since that would lead to the bacteria developing resistance against the antibiotics which had been designed to kill them. Unmindful of this warning, overuse of antibiotics all over the world finally led to a global phenomenon, known as Antibiotic Resistance. This was a blanket term to describe the emergence of novel bacterial strains which are resistant to several antibiotics, known as multi-drug resistant bacteria (MDR) and all antibiotics, 2 known as all drug resistant bacteria (ADR).

The battle between the humans and these bacteria, also known as ‘Super bugs’ has set the ball rolling once again, for the sharp descent into the ‘Pre-antibiotic’ era in the future.

The new drug pipeline for drug-resistant bacteria is drying out, causing alarm and concern about the impending doom of mankind. While sometimes resistance occurs naturally, in most cases, it happens due to clinical misuse and self-medication. The other causes for antibiotic resistance are irresponsible disposal of untreated chemicals from manufacturing units and healthcare systems in the environment, indiscriminate feeding of antibiotics to livestock, and overuse of pesticides on crops, which are consumed unknowingly by humans. The multipronged solution to the worldwide predicament of antibiotic resistance includes creating awareness among the common man about the phenomenon of antibiotic resistance in order to prevent self-medication, careful monitoring of specific bacterial responses to various antibiotics, limiting the prescriptions of antibiotics by clinicians, and prevention of environmental pollution.

There is also a need to discover and design new drug molecules which could be used in lieu of the commonly prescribed antibiotics. In the recent times, the outbreak of the pandemic of Covid-19 has only led to escalate the imminent threat of antibiotic resistance. Though Covid-19 is caused by a coronavirus, its health complications are often compounded by serious secondary bacterial infections. In the ensuing chaos of this pandemic, two diverse phenomena are occurring which are causing overuse of antibiotics. One, several patients are not being able to access the healthcare workers due to lockdowns, and are indulging in self 3 medication. Second, since Covid-19 has caught the world at the wrong foot unexpectedly, many antibiotics are being widely used to combat bacterial infections in the Covid-19 patients in hospitals all over the world. The sudden emergence of this deadly virus has not given enough time to the healthcare workers to prudently balance the treatment of the patients against the future danger of the antibiotics resistance, which will be felt for centuries to come. The bright side of the problem is that the emergence of this pandemic has brought the spotlight on the infectious diseases caused by superbugs, which is making the governments and policy makers of all the countries in the world take these phenomena seriously. This event has indicated that despite the cutting edge technologies and sophisticated medical care, pandemics of gigantic magnitudes caused by super bugs may happen in future as well. Despite the doomsday prophecies, it is hoped that this global crisis will help the world to educate itself better about the constant and impending threat of superbugs and antibiotic resistance, and recognize the critical tip of the iceberg that we are collectively sitting on. The mankind has valiantly fought and emerged victorious after the onslaught of past pandemics. Hence, careful monitoring of antibiotic use and aggressive repurposing of drugs to enhance the drug pipeline for new antibiotics while limiting environmental pollution will give a new direction for the mankind to overcome the global threat of antibiotic resistance.

The writer of the article is Prof Sujata Sharma, Department of Biophysics, AIIMS, New Delhi

By Dr.Nikhil Tandon
Department of Endocrinology and Metabolism
All India Institute of Medical Sciences, New Delhi

In a year when the pandemic of a communicable disease has pervaded human consciousness and health systems alike, it appears a bit incongruent to talk about chronic non-communicable diseases such as diabetes. However, NCDs have cast their shadow on even COVID-19, and there is unequivocal evidence that people with diabetes and heart disease demonstrate a significantly higher risk of adverse clinical outcomes, including death.
Such observations serve as a reminder that despite contemporaneous discussion and debate seemingly exclusively focused on how best to tackle the onslaught wreaked by SARS CoV-2, we cannot afford to take our foot off the pedal, which is prevention and control of NCDs. This year, World Diabetes Day will be observed on November 14, 2020, with the theme as “The Nurse and Diabetes” signifying and recognizing the role of the nurse in providing essential care to patients with chronic conditions.
Diabetes and hypertension together are among the most common and deadly chronic conditions affecting over 275 million Indians and their families. In India, most adults with these conditions remain undiagnosed, untreated, or poorly treated and uncontrolled.
Recognizing the gravity and magnitude of this problem, the Ministry of Health & Family Welfare, Government of India, has implemented a strategy to integrate screening and management of these conditions into primary care under its National Health Mission (NHM) and the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS). A major component of the government strategy is to encourage universal screening for hypertension and diabetes of adults aged ≥30 years in the community and subsequent referral of potential cases to higher-level facilities. This effort starts at the grassroots, with frontline workers – ASHA – identifying individuals at high risk, referring them for screening at rural sub-centers, from where individuals are then sent up the pyramid of health care institutions, for confirmation of diagnosis and appropriate management. The establishment of Health and Wellness Centres has strengthened this effort. A further fillip has been provided by creating an information technology backbone in the form of a digitized health record which is then accessible to health care professionals as the patient traverses up and down the health system.
Building on this platform, an innovative new initiative – the Integrated Tracking, Referral, Electronic decision support, and Care coordination (I-TREC) program – has been implemented as a pilot effort in District Shaheed Bhagat Singh Nagar in Punjab. This program, resulting from a technical collaboration between the All India Institute of Medical Sciences, New Delhi (AIIMS), Centre for Chronic Disease Control (CCDC), and EmoryUniversity has been embedded within the existing infrastructural and administrative scaffolding provided by the Government of Punjab. This first of its kind hybrid model has two core components – Technology and Task shifting.

The technology component is an integration of two entities – an Electronic Case Record Form (eCRF) – superimposed on which is a Clinical Decision Support System (CDSS) that generates customized evidence-based treatment advisories for patients with diabetes and hypertension. The CDSS algorithms provide the clinician with an instantaneous advisory regarding medication titration based on patient history and current clinical examination as inputted into the eCRF.
To enable the efficient implementation of this process, the fulcrum of care has been shifted from the physician to a nurse provider. The clinic workflow is now modified such that it is the nurse who first interacts with the patient, adds information to the electronic case record form, following which the CDSS working at the backend generates guideline-based recommendations for the physician. Physicians thereby receive a suitably triaged patient with a draft management plan based on evidence-based guidelines, which ensures efficient utilization of their time and enables objectivity in decision making. Since everything is digitized, the patient record can be seen at any level of the government health facility
enabling seamless care delivery of routine care, and facilitating clinically-mandated referral to an appropriate facility.
This nurse-facilitated, technology-assisted model of care, which has now successfully been implemented in rural Punjab stands at the threshold of wider dissemination – and is a significant endorsement of the theme of World Diabetes Day 2020 – “The Nurse and Diabetes”.

The writers are Dr.Nikhil Tandon & Dr.Hanspria Sharma , Department of Endocrinology and Metabolism , All India Institute of Medical Sciences(AIIMS) New Delhi

According to the Union Ministry of Health and Family Welfare active caseload drops below 4.85 Lakhs. The total Positive Cases stands at 5.55% and sustains below the 5 lakh mark.

A total of 76.25% Coronavirus (COVID-19) of the new cases are from 10 states and UTs and Delhi is reporting maximum cases.

The total recovery rate is almost 93%.