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 Table of Contents  
CORRESPONDENCE
Year : 2020  |  Volume : 22  |  Issue : 3  |  Page : 139-140

Practice of pediatric nephrology during the COVID-19 pandemic: Readapting the wheel in unprecedented times


Department of Pediatrics, Army Hospital (R&R), New Delhi, India

Date of Submission01-Sep-2020
Date of Decision02-Sep-2020
Date of Acceptance01-Oct-2020
Date of Web Publication02-Nov-2020

Correspondence Address:
Lt Col Suprita Kalra
Army Hospital (R&R), New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_127_20

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How to cite this article:
Kalra S. Practice of pediatric nephrology during the COVID-19 pandemic: Readapting the wheel in unprecedented times. J Mar Med Soc 2020;22, Suppl S1:139-40

How to cite this URL:
Kalra S. Practice of pediatric nephrology during the COVID-19 pandemic: Readapting the wheel in unprecedented times. J Mar Med Soc [serial online] 2020 [cited 2020 Nov 28];22, Suppl S1:139-40. Available from: https://www.marinemedicalsociety.in/text.asp?2020/22/3/139/299799



This year witnessed the rapid spread of coronavirus disease 2019 (COVID 19) across the world which was declared a pandemic by the WHO in March 2020. This was the first time since the Spanish Flu pandemic close to a century ago that the inhabitants of this planet have had to face a pandemic. This pandemic by one of the most contagious organisms known to humankind, brought in its wake travel restrictions and lockdowns of varying severity across the world to contain its spread. Our country faced possibly the longest nationwide lockdown from March 25, 2020, to June 31, 2020, followed by gradual relaxation of the lockdown, with restrictions varying at state governments' discretion.

What did this mean to children with chronic diseases, specifically those with renal disorders which are chronic and yet require careful and close monitoring at regular intervals to keep the disease well controlled and prevent complications. An example in point would be children with nephrotic syndrome, the most common glomerular disease in the pediatric age group. On an average, 70% of them have one or more relapses per year wherein early diagnosis and appropriate management is imperative to prevent life-threatening complications such as peritonitis and other serious systemic infections, acute kidney injury, and thromboembolism.[1],[2] The safety of our little patients while providing optimal care was the chief concern.

In recent years, mobile technology and its application in various fields has grown tremendously and its use in health care has gradually gaining popularity.[3] A systematic review examining the role of mobile phones in various aspects of doctor–patient communication showed that the use of mobile phone-based apps had some benefit in doctor–patient communication and health outcomes.[4]

Rather than developing a new mobile application which would have taken time and would have required additional resources, we adapted our existent system of review and referral to include a combination of virtual consultation online or telephonically with a real-time review at the nearest Armed Forces Medical Services (AFMS) Hospital. We searched the outpatient department records for telephone numbers of all our patients and shared the mobile number of the treating pediatric nephrologist. We also messaged them to call at their scheduled appointment or when their review was due and earlier than that if the child had one or more danger signs/symptoms explained to them. All children who presented with any symptoms were advised to be reviewed by a pediatrician at the nearest Military Hospital or by a medical specialist/medical officer if pediatrician was not available/posted there. The pediatric nephrologist then spoke to the reviewing physician to explain the concerns and discuss and formulate the plan of management of the child there itself and transfer only critically ill children, whose management entailed the use of resources not available locally, to a tertiary care center after initial stabilization. This simple system of virtual consultation meets real-time review and management at the nearest AFMS Hospital utilizing the existing facilities and expertise of the service hospitals, and a bit of easily available technology helped us to reach out to our patients and determine if they were well, tailor their treatment plans to keep them disease free, and prevent complications inevitable in patients with chronic diseases in the absence of close monitoring. We also postponed the investigations planned during the review if they were not immediately vital to further management in these children. All these saved the patients and their attendants from having to travel for review/further management during the peak infectivity period of the COVID-19 pandemic while at the same time ensuring continuity of care. This was especially important as a large proportion of children with chronic renal disorders are on long-term immunosuppressive medications or immunosuppressed due to the nature of their disease.

As months of the lockdown extended, this system evolved itself to be the part of a “new normal” and it proved to be an eye-opener for us that we could manage most of the patients by this combination of virtual and real-time consultation.

The pandemic came into our lives as a storm threatening to disrupt everything normal, but the strength lies in reinventing or adapting what we have and utilize it with best intentions and sincere perseverance.

Acknowledgment

We sincerely acknowledge and express our gratitude to all pediatricians and doctors whose tireless efforts and expertise helped us to reach out to our patients who trust us and motivate us to go on.



 
  References Top

1.
Kayali F, Najjar R, Aswad F, Matta F, Stein PD. Venous thromboembolism in patients hospitalized with nephrotic syndrome. Am J Med 2008;121:226-30.  Back to cited text no. 1
    
2.
Wei CC, Yu IW, Lin HW, Tsai AC. Occurrence of infection among children with nephrotic syndrome during hospitalizations. Nephrology (Carlton) 2012;17:681-8.  Back to cited text no. 2
    
3.
Agarwal N, Biswas B. Doctor consultation through mobile applications in India: An overview, challenges and the way forward. Healthc Inform Res 2020;26:153-8.  Back to cited text no. 3
    
4.
Kashgary A, Alsolaimani R, Mosli M, Faraj S. The role of mobile devices in doctor-patient communication: A systematic review and meta-analysis. J Telemed Telecare 2017;23:693-700.  Back to cited text no. 4
    




 

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