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AIIMS issues COVID-19 document for health care workers

It also advised for the doctors not to go to public places and to report to the hospital authority if any of their friends, hostel staff develop fever or othe respiratory symptoms.

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Randeep Guleria AIIMS

New Delhi, March 29 : The All India Institute of Medical Science (AIIMS), Delhi has issued a preparedness document to address the cases of novel Coronavirus in the country.

The document called COVID-19 Preparedness Document’, which was issued on March 27, is meant for circulation within the hospital. The document, however is dynamic and may be modified as per the progression of the disease in India and when more data was available regarding epidemiology, transmission, and treatment.

The preparedness document is a comprehensive compilation of guidelines to provide the health workers information of various aspects of the disease and its Clinical management.

It deals with issues like Case definition, Clinical features, Laboratory diagnosis, Infection control measures, Clinical management and other matters like isolation, quarantine, etc.

According to the document, all symptomatic individuals, who have undertaken international travel in the last 14 days, all symptomatic contacts of laboratory confirmed cases, all symptomatic healthcare personnel, asymptomatic direct and high risk contacts of a confirmed case fall in the category of suspected novel coronavirus case and should be tested once between day 5 and day 14 after contact. While a person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms is considered as confirmed COVID-19 case.

The document showed clinical features of the disease that has been adopted from Report of the WHO-China Joint Mission on Coronavirus Disease 2019 based on 55,924 cases and a study on 1,099 cases by Guan in which symptoms like fever, dry cough, fatigue, sore throat, headache, shortness of breath, nausea or vomiting, nasal congestion, diarrhea and many others have been considered.

The document stressed upon proper doffing of PPE material by the health care personnel. Doffing to be performed only in the designated area, check for any leak or soiling in PPE before doffing. If any, disinfect the area before doffing. Doffing room should have two chairs, one labelled ‘dirty’ and the other ‘clean’. All PPE must be discarded in the yellow bin. Hand hygiene must be performed after every step,” said the document.

According to the document the disinfection of high touch surfaces like doorknobs, telephone, call bells, bed rails, stair rails, light switches, wall areas around the toilet should be done every 3-4 hours while at low-touch surfaces such as walls, mirrors, etc. mopping should be done at least once daily.

“In case of onset of danger signs like shortness of breath, hemoptysis, altered mental status, patient should immediately inform the nearest health centre or call 011-23978046,” said the document.

The document also advised precautions to be taken by the hostel residents at the AIIMS, according to which, the residents are to stay alone in separate rooms till 14 days after their duties in corona unit are over, not to travel outside or within country unless absolutely indicated, food should be ordered from canteen to their room, daily clothes used by the residents to be washed themselves and not to be given to laundry and proper hygiene of the toilets.

It also advised for the doctors not to go to public places and to report to the hospital authority if any of their friends, hostel staff develop fever or othe respiratory symptoms.

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Harsh Vardhan bats for total ban on tobacco, its products

This year’s World No Tobacco Day campaign focuses on protecting children and young people from exploitation by the tobacco and related industry.

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Harsh Vardhan

New Delhi, May 31 : Union Health Minister Harsh Vardhan on the World Tobacco Day on Sunday said the battle against tobacco was a personal fight for him and he wanted total ban on it and its products.

“The battle against tobacco is a personal fight for me. As an ENT surgeon, I’ve been first-hand witness to how it destroys not just the user, but the entire family. I am a votary for a complete ban on tobacco and its products on the World No Tobacco Day to nip the evil in the bud,” he tweeted.

According to the World Health Organisation, every year the tobacco industry spends over $9 billion to advertise its products. Increasingly, it’s targeting youth with nicotine and tobacco products to replace the 8 million people that its products kill every year.

This year’s World No Tobacco Day campaign focuses on protecting children and young people from exploitation by the tobacco and related industry.

The WHO said even during the global pandemic, the tobacco and nicotine industry persisted by pushing products that limited people’s ability to fight coronavirus and recover from the disease.

The industry offered free branded masks and doorstep delivery during quarantine and lobbied for their products to be listed as ‘essential’. Over 40 million young people, aged 13-15 years, had started to use tobacco, it added.

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COVID-19 patients who undergo surgery at high death risk: Lancet

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Coronavirus Symtoms

London, May 31 : Researchers, including one of Indian-origin, have found that patients undergoing surgery after contracting COVID-19 are at greatly increased risk of postoperative death, according to a new global study published in The Lancet journal.

Published in ‘The Lancet’ journal, the global study found that amongst SARS-CoV-2 infected patients who underwent surgery, mortality rates approach those of the sickest patients admitted to intensive care after contracting the virus in the community. In the study, the research team led by the University of Birmingham in the UK examined data for 1,128 patients from 235 hospitals and a total of 24 countries participated, predominantly in Europe, although hospitals in Africa, Asia, and North America also contributed.

The researchers noted that SARS-CoV-2 infected patients who undergo surgery, experience substantially worse postoperative outcomes than would be expected for similar patients who do not have the infection. “We would normally expect mortality for patients having minor or elective surgery to be under one per cent but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3 per cent) and elective surgery (18.9 per cent),” said study co-author Aneel Bhangu from the University of Birmingham.

According to the study, the 30-day mortality among these patients was 23.8 per cent. Mortality was disproportionately high across all subgroups, including elective surgery (18.9 per cent), emergency surgery (25.6 per cent), minor surgery such as appendectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or colon cancer surgery (26.9 per cent).

The study identified that mortality rates were higher in men (28.4 per cent) versus women (18.2 per cent), and in patients aged 70 years or over (33.7 per cent) versus those aged under 70 years (13.9 per cent). In addition to age and sex, risk factors for postoperative death included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

According to the researchers, patients undergoing surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital. They may be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation. The study found that overall in the 30 days following surgery 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation.

This may explain the high mortality, as most (81.7 per cent) patients who died had experienced pulmonary complications. “Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital,” said study co-author Dmitri Nepogodiev.

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World No Tobacco Day: Ways to use this lockdown as a catalyst to quit smoking

The global observance of World No Tobacco Day on May 31 presents an opportunity to raise awareness around smoking risks, and to work with smokers to find effective strategies for quitting.

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World No Tobacco Day

New Delhi, May 31 : Tobacco kills more than 1 million people each year in India, according to the World Health Organisation. While no organ is immune to the destructive effects of cigarette smoke, it has one of the worst impacts on lungs.

With the COVID-19 pandemic, the risk of respiratory problems for vulnerable populations has increased significantly, leaving smokers more exposed to negative health outcomes. The Foundation for a Smoke-Free World’s recent Covid-19 State of Smoking Poll surveyed tobacco and nicotine users in countries that quickly imposed strong policies or guidance urging residents to remain at home. The poll evaluated the mental and physical toll of social distancing on smokers globally, many of whom have increased their tobacco intake as a way to cope with pandemic stress.

The survey found that 48 percent of combustible tobacco smokers in India believe that smoking increases the risk of either contracting COVID-19 or becoming seriously ill from it. It also revealed significant concerns about the safety of families, job security, and economic opportunity. These mental and physical stresses are particularly harmful for smokers, who often use tobacco to relieve anxiety.

On the other hand, it is possible that the global crisis will awaken a new commitment to healthy living among those who are motivated to change. 66 percent of Indian smokers surveyed reported that they had considered quitting for health concerns amid the COVID-19 crisis, and 63 percent responded they had actually made a quit attempt. Yet, there still exist many smokers who intend to quit but are uncertain about the best way to do so.

The global observance of World No Tobacco Day on May 31 presents an opportunity to raise awareness around smoking risks, and to work with smokers to find effective strategies for quitting.

Dr. Sree T. Sucharitha, MD Fellow in HIV Medicine and Professor in a private medical college in Chennai, and Medical Director of Association for Harm Reduction Education and Research (AHRER), outlines four practices smokers should adopt during COVID-19 to manage their stress and anxiety in a healthy way.

Fitness and Exercise

We all know that exercise is important in our daily lives, but under the current circumstances, this habit may require extra motivation, as activity is often restricted to the home. During the COVID-19 crisis, tobacco and nicotine users in India have proven more likely than those in other countries to increase their use of healthy coping mechanisms (physical exercise, 64 percent; breathing exercises, 58 percent; meditation, 58 percent; yoga, 55 percent), as per The Foundation’s poll. Practicing mindfulness exercises such as yoga, meditation and deep breathing exercises with guided instructions from experts as in digital apps and videos will help in building core emotional resilience and also may strengthen immunity.

Healthy Diet

A healthy balanced diet, which gives the body the essential vitamins and dietary fibers for better metabolism, is crucial during the pandemic. Proper food habits must be maintained by following a diet plan that includes not only recommended consumption of calories, but also: fruits, vegetables, proteins and dairy products. A healthy diet will ensure that our tissues and cells get proper nutrition to function smoothly. Without proper nutrition, the body is more prone to infectious diseases due to poor immunity.

Take a break, get sleep, and rest

We want to control every aspect of our lives and stay updated on the latest developments, but in situations like these we must learn to accept some lack of control. People should take scheduled breaks and mentally disconnect from the overwhelming news and social media updates about the pandemic. Activities such as playing board games, solving puzzles, or playing with children and pet animals will help you to revitalize for the days ahead. Adequate rest and sleep for 6-8 hours will help minimize the effect of the pandemic on mental wellness.

Connect with people

Humans are indeed social animals. During trying times of uncertainty and fear, it is therefore very important to stay connected with others. Isolation and fear can negatively affect mental health, which can lead to severe anxiety or depression. As per the Foundation’s poll, close to 36 percent of Indian tobacco and nicotine users stated that social distancing has had an adverse effect on their mental health. While a majority of respondents normally turned to tobacco or nicotine products to manage stress (58 percent), 46 percent of respondents have decreased their use during social distancing. Mental health experts have suggested that reducing stress about the lockdowns, spending quality time with family, and indulging in creative activities can help you overcome feelings of depression and vulnerability during this crisis.

(Puja Gupta can be contacted at [email protected])

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