Discussion:
Since 2003, there have been a total of five pandemic outbreaks: SARS
(2003), Swine Flu (2009), Ebola (2014), ZIKA (2015), and the most
recent, COVD-191. Every new pandemic has brought with
it a high infection rate and a significant surge in death toll when
compared to the preceding pandemic. This has revolutionised the health
care delivery system and given an opportunity to adopt “telemedicine”.
Telemedicine is a rapidly evolving service that enables faster diagnosis
of health-related issues, lower costs for both healthcare services and
patients, and protection from community infection
risks1. Telemedicine can also aid in the evaluation
and monitoring of patients in remote and underserved
areas5. Telemedicine allows patients to stay in the
comfort of their own care setting, but the main limitation is
an inability to perform physical examinations6.
Nevertheless, the slow growth of this type of care has been attributed
to constrained administrative regulations, reluctance to adopt new
system and a lack of strong legislative framework3.
Our article has addressed how a rare unseparated adult conjoined twin
was first managed using telemedicine due to the existing social barrier,
which also resulted in a reduction in their medical expenses. However,
when they required rapid transfer to a tertiary care institution as a
result of a Covid-19 infection, they were sent without hesitation. There
were several challenges in their management. First, it was difficult to
intubate the patients because of not being able to attain the ideal
position. Secondly, these patients are known to have restrictive lung
disorder of extra-thoracic origin given the kyphotic disorder they had
because of their stance and posture. Hence they developed respiratory
acidosis after admission because of decreased thoracic compliance.
Thirdly, prone position which is known to be useful in improving the
ventilation perfusion mismatch and drainage of secretions could not be
achieved7. Other than these issues, it was also
difficult to place central lines in them. There were certain logistic
issues as well such as arranging ICU beds and conduction of chest x-ray.
To the best of our knowledge, this is the first case of longest
surviving adult pygopagus who died due to covid related complications.
Observations: Telemedicine has been around for a long
period of time, but modern technology have made it much more attainable
than ever before, and COVID-19 has rendered it more useful than it has
ever been. Barriers to access, on the other hand, continue to persist,
and are particularly noticeable in remote and technologically
underdeveloped populations. The governments of various countries, as
well as regulatory authorities, should promote this innovative technique
of consultation. However, never hesitate to call patient in
out-patient-department for physical examination.