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Table of Contents
CLINICAL PRACTICE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 7-8

Facing challenges in medical practice during COVID-19 pandemic


Department of Nephrology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India

Date of Submission14-Jun-2020
Date of Acceptance14-Jun-2020
Date of Web Publication20-Jul-2020

Correspondence Address:
Dr. Georgi Abraham
Madras Medical Mission Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_13_20

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How to cite this article:
Abraham G. Facing challenges in medical practice during COVID-19 pandemic. J Renal Nutr Metab 2020;6:7-8

How to cite this URL:
Abraham G. Facing challenges in medical practice during COVID-19 pandemic. J Renal Nutr Metab [serial online] 2020 [cited 2020 Dec 3];6:7-8. Available from: http://www.jrnm.in/text.asp?2020/6/1/7/290278



As of June 1, 2020, there are 190,609 case of COVID-19 in India, with 8782 new cases being added. The doubling time of SARS-CoV2 in India is 14 days. The number of cases stands at 803/million population, with the number of deaths being 47.9/million. The total number of deaths till date had been 5408, with 223 new deaths. India is now in the top seven among all nations affected by the pandemic. A total of 91,852 patients have recovered, while 8944 patients are critical. There are 33 asymptomatic for every one symptomatic patient.

The LANCET gives simple advice to reduce COVID-19 spread. This includes use of face mask (covering mouth and nose), social distancing of minimum 1 m, and eye protection. This must be mandatory.

The challenges faced by the ordinary people for nutritional requirement during COVID-19 are enormous as shown by the millions of migrant workers unable to get even a morsel of rice [Figure 1]. Chronic kidney disease (CKD) patients who form 17% of the Indian population majority being from the lower socioeconomic status have complex issues related to food procurement and diet discipline. Many of them because of dehydration and inability to get medical advice, especially diabetics, hypertensive, and other CKD patients, may progress without their knowledge risking their lives. End-stage-renal-disease patients on dialysis have exaggerated protein degradation along with decreased protein synthesis because of which they are advised high protein diet with careful monitoring of potassium and phosphorus intake.[1],[2] These recommendations are adhered to and implemented through regular follow up by dieticians on hemodialysis sessions. The patients continue to follow the diet prescription even if they are unable to keep up to their dialysis schedule. The closure of hemodialysis facilities in many parts of the country has lead to life-threatening situations with hyperkalemia, worsening of uremia, metabolic acidosis, fluid overload situations which neither the government nor the private sector can handle [Figure 2] and [Figure 3]. The dialysis staffs are exposed to COVID-19 compromising their well-being as seen in our charity dialysis unit. The deprived dialysis patients who live in hutments cannot practice social distancing, exposing them to increased risk of COVID-19 infections, and mortality. We have no real solution for the complex issues faced by CKD patients, especially those who on hemodialysis.
Figure 1: Migrant workers walking to their native places

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Figure 2: Chronic kidney disease malnutrition data and nutritionist intervention[1]

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Figure 3: The challenges are complex and solutions are not simple. However, all healthcare workers should totally dedicate their efforts to do our best in these extraordinary circumstances

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The dialysis staffs are exposed to COVID-19 compromising their well-being as seen in our charity dialysis unit. The deprived dialysis patients who live in hutments cannot practice social distancing, exposing them to increased risk of COVID-19 infections, and mortality. We have no real solution for the complex issues faced by CKD patients, especially those who on hemodialysis.

The healthcare workers (HCWs) including those who are in the hospital and in the community face enormous challenges to protect themselves as frontline fighters. This is particularly important in those who are 65 years or above and with comorbidities, such as malignancy, diabetes, hypertension, and other chronic diseases. We have heard that hundreds of HCW succumbed to COVID-19 the course of their discharge of duties. We salute them for their bravery and commitment to save human lives risking their own personal safety.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Anupama SH, Abraham G, Alex M, Vijayan M, Subramanian KK, Fernando E. A Multicenter Study of Malnutrition Status in References: Chronic Kidney Disease Stages I–V-D from Different Socioeconomic Groups Saudi J Kidney Dis Transpl 2020;31.  Back to cited text no. 1
    
2.
Menaka Sarav and Allon N. Friedman Use of Intradialytic Parenteral Nutrition in Patients Undergoing Hemodialysis Nutrition in Clinical Practice. 2018;33:767-71.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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