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   Table of Contents - Current issue
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May 2020
Volume 7 | Issue 7 (Supplement)
Page Nos. 1-75

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EDITORIAL  

COVID-19: The war against the invisible enemy p. 1
Vinayak Patki, Arun Bansal, GV Basavraja
DOI:10.4103/JPCC.JPCC_76_20  
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COVID-19: Epidemiology and virology p. 3
Antariksh Deep, Aparna Yadav, Madhu Sharma, Kundan Mittal, Anupama Mittal
DOI:10.4103/JPCC.JPCC_60_20  
The novel coronavirus (CoV), termed Severe Acute Respiratory Syndrome related CoV-2 (SARS CoV-2), responsible for an outbreak of unusual viral pneumonia in Wuhan city, Hubei province, China is a testimony to the risk the CoVs pose to the public health. In this review, a brief introduction of the human CoVs (hCoV), along with the epidemiology and pathogenesis of the infection caused by the hCoVs, especially the SARS-CoV-2, shall help in the understanding of the COVID-19.
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Clinical manifestations, laboratory findings, and imaging in COVID-19 p. 10
Goutam Goswami, Nikhil Vinayak, Maneesh Kumar, Pradeep Kumar Sharma
DOI:10.4103/JPCC.JPCC_56_20  
Coronavirus disease 2019 (COVID 19) caused by severe acute corona virus 2 (SARS-CoV2) strain is an ongoing pandemic affecting more than 200 countries worldwide. On April 15, 2020 total 2,000,995 persons are affected with 126,783 deaths worldwide. It is mainly an adult disease, but it can affect any age group. Children are less likely to be affected and severity and mortality is less compared to adults. Infants however are more prone to develop severe disease. The disease has human to human transmission with an incubation period of 2–14 days. It spread through respiratory droplets which enter the body through respiratory tract or conjunctiva. Children usually present with fever, cough, and breathing difficulty. Diarrhea and abdominal pain can also be seen. Pulmonary and extrapulmonary complications can occur, but these are less frequent in children except infants. Critical illness and mortality increase significantly with age and associated comorbidities. In children, no typical laboratory findings are seen. Radiological investigations are not specific and hence their routine use is not recommended especially in milder cases. Subpleural lesion with ground glass opacification is the most common radiological finding. Confirmation is done by real-time reverse transcriptase polymerase chain reaction. The management is mainly supportive. Drugs and vaccines are under trial. Prevention is done by breaking the chain of transmission.
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COVID-19: Evaluation and diagnosis p. 16
Govind Benkatti, Vinayak Patki
DOI:10.4103/JPCC.JPCC_74_20  
Rapid and accurate COVID-19 diagnostic testing is essential for controling the ongoing COVID-19 pandemic. Evaluation and diagnosis of COVID-19 infection is done on the basis of the clinical suspicion and appropriate laboratory tests. The current gold standard for COVID-19 diagnosis is real-time reverse transcription–polymerase chain reaction detection of SARS-CoV-2 from nasopharyngeal swabs. The World Health Organization, Centre for Disease control and Indian Council of Medical Research has published various guidelines about the scientific use and interpretation of results. Recently rapid antibody testing has also been recommended for clusters with influenza-like illness. These laboratory tests have their own limitations about their sensitivity and specificity; clinician has to interpret the results in the light of clinical condition of patient with suspected COVID-19 infection. Health-care provider should take due precautions while collecting, packaging, and transport of these samples. One has to adhere strictly to the guidelines published by the Government authorities in the diagnosis of these patients.
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Personal protective equipment during COVID-19 epidemic p. 22
Dhiren Gupta, Ashish Kumar Simalti, Neeraj Gupta, Anil Sachdev, Arun Bansal, Ashwani Kumar Sood, Tripti Sharan, Vinayak Patki
DOI:10.4103/JPCC.JPCC_75_20  
Personal Protective Equipments (PPEs) are used to safeguard the health of workers. Airborne aerosol with size below 5 micron can enter lower respiratory system directly whereas bigger size particles either settles on surrounding equipment and become fomites. COVID 19 can stay in air after 3 hours with airborne spread in health care with fomites especially plastic showing infection up to 72 hours. Examples of PPE include items as mask, gloves, shield, goggles, gowns and full body suits. All health care workers need to be taught the correct sequence of wearing and taking off the PPE in order to avoid contamination.
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Management of COVID-19-positive asymptomatic and mildly symptomatic children p. 31
GV Basavaraja, KS Sanjay, ML Keshavamurthy, GR Rajashekar Murthy, Pooja Gujjal Chebbi
DOI:10.4103/JPCC.JPCC_70_20  
Coronavirus disease (COVID) in children is milder in comparison to adults with a better prognosis and minimal mortality. The most common clinical presentation of COVID-19 in children includes fever and cough, but a significant number of infected children may be asymptomatic contributing to transmission of the disease. Several hypotheses have been put forth to explain the less severe disease in children including lower expression of angiotensin converting enzyme 2 (ACE2) receptors in the lungs of pediatric patients which is the main receptor through which the virus enters the cells in the lung and mediates its effects, lower exposure to virions, higher likelihood of viral co-infection in children which may be responsible for limited replication of the severe acute respiratory syndrome coronavirus 2 by direct virus-to-virus interaction and competition and the protective role of Bacillus Calmette-Guerin vaccine. Reverse transcriptase-polymerase chain reaction testing of upper or lower respiratory tract secretions is the recommended confirmatory test and management is guided by the severity of illness in the child. In this review, we will discuss the management of asymptomatic and mildly symptomatic children.
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Pediatric intensive care management in coronavirus infection-19 p. 36
Namita Ravikumar, Manu Sundaram, Utpal Bhalala, Dhiren Gupta, Arun Bansal
DOI:10.4103/JPCC.JPCC_77_20  
Coronovirus-19 disease (CVOID-19) caused by severe acute respiratory syndrome-CoV2 has more than affected 3 million people worldwide, accounting for one of the largest pandemics known to humankind. Originating in China and traveling all across the globe, it spreads by droplets and fomites. Cohort intensive care units have been set up to manage critically ill CVOID-19 patients requiring organ support. Respiratory support, including low and high-flow oxygen devices, noninvasive and invasive ventilatory support have been used in the management of patients with severe acute respiratory illness. Aerosol generating procedures pose a high risk of transmission to health-care workers and need strict infection control practices and the use of personal protective equipment. Various anti-viral drugs have been tried, but there is inadequate evidence to recommend their routine use.
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Pharmacological management of COVID-19 p. 42
Veena Raghunathan, Maninder Singh Dhaliwal
DOI:10.4103/JPCC.JPCC_66_20  
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic has brought the world to a standstill and is the largest public health crisis in the world in the present generation. As the cases continue to increase globally, and more patients are developing severe disease, large volumes of clinical data collection and aggressive research is being carried out to find effective medical therapies for this disease. No definitive proven treatment option exists till date. Various immunomodulatory and anti-viral drugs have shown potential, and are being studied extensively through randomized trials. The most available literature is based on the adult study population, with few/no children being included. This review attempts to summarize the pharmacotherapeutic options presently in consideration in children in the treatment of SARS-CoV2.
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Cardiopulmonary resuscitation in coronavirus disease 2019 patients p. 49
Mohammed Salameh, Pratik Parikh, Cody Henderson, Maria Pierce, Christopher Tolentino, Arun Bansal, Utpal Bhalala
DOI:10.4103/JPCC.JPCC_69_20  
We are faced with a novel human severe acute respiratory syndrome coronavirus-2 (CoV-2) that has been pronounced a pandemic by the World Health Organization in March 2020. This virus is highly contagious and can result in a disease that has been named CoV disease 2019 (COVID-19). It is characterized by severe pneumonia followed by a cytokine storm that can result in death. In such situations, performing cardiopulmonary resuscitation (CPR) can be a huge challenge because the virus can infect healthcare workers (HCW). For this reason, The American Heart Association and The Resuscitation Council (UK) have modified their guidance on performing CPR in COVID-19 patients to give them the best chance of survival while protecting the HCW. In this review, we aim to summarize the literature and share our experience in resuscitating COVID-19 patients or persons under investigations.
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Prevention and disinfection in COVID-19 p. 56
Farhan Shaikh
DOI:10.4103/JPCC.JPCC_64_20  
The global pandemic involving severe acute respiratory syndrome – coronavirus-2 has tested the capacities of the best of the health-care system worldwide. We are in the middle of the pandemic and the knowledge and science regarding the prevention and treatment of this disease is evolving every minute. This review is an attempt to summarize and simplify the knowledge about preventive and personal protective aspects of management of covid-19 infection. It encompasses the approach to infection prevention and personal protection from the admission of patient to the management in the intensive care units.
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Published guidelines on COVID-19: Which to follow? p. 65
Manu Sundaram, Rohit Saxena, Marti Pons Odena, Giovanna Chidini, Mohammed Salameh, RN Ashwath Ram, Utpal Bhalala
DOI:10.4103/JPCC.JPCC_73_20  
The novel coronavirus 19 (COVID-19) pandemic has brought the world to a halt and humans at existential risk from an unknown enemy. In view of a high reproductive number, the number of deaths and people affected by COVID-19 has been unprecedented. At the same time, the knowledge sharing by the medical community from social media, networking, and the large number of publications has brought new challenges. To review the literature and bring out the best practice summary, we have involved physicians from the COVID-19 hotspots and societies to share their knowledge, experience, and transferable skills learned from helping their adult intensive care unit colleagues and managing pediatric COVID-19 patients. This has been particularly challenging as the goal post has been shifting very quickly and will continue to evolve while high-quality evidence is obtained.
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Role of simulation in COVID-19 management p. 72
R Deepak, Rakshay Shetty
DOI:10.4103/JPCC.JPCC_65_20  
Simulation is a method of teaching which uses simple and/or sophisticated technology to educate the target audience through guided experience and interactions that evoke real-world scenarios, which is being increasingly used in the field of medicine. Specifically, in situ simulation that is designed using specific scenarios within environments that replicate real-world clinical issues, to train multidisciplinary teams to test systems, and improve outcomes. Although it is routinely used for supplementing medical education, the current COVID-19 pandemic gives us a perfect opportunity to use simulation to test the preparedness of health-care facilities for managing COVID-19 patients and also to train health-care workers (HCWs) in the skills necessary to protect themselves from the infection while taking care of the infected patients. The HCWs can be trained in various aspects of personal safety, as well as modifications to their existing protocols needed to take care of COVID-19 patients. Here, we present how the health facilities can adopt simulation to prepare for the current pandemic and identify gaps in the systems and processes that can be corrected. We also share our experience of using this methodology for COVID-19 preparedness in a tertiary care pediatric facility.
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