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.