×
Choose Speciality

EXPLORE!

LOGIN

CMAAO Coronavirus Facts and Myth Buster 56

  478 Views

Dr KK Aggarwal    16 April 2020

How many healthcare workers have been affected in USA

At least 9,282 healthcare workers have contracted the coronavirus in the United States in a two-month period that has resulted in 27 deaths, according to a report released Tuesday by the Centers for Disease Control and Prevention.

How to detect myocardial involvement in COVID-19 patient

Cardiac troponins by high-sensitivity assays (hs-cTn) must be regarded as a crucial diagnostic and prognostic aid during the COVID-19 pandemic.

The tests can help inform the triage of patients to critical care, guide the use of supportive treatments, and facilitate targeted cardiac investigations in those who are most likely to benefit, states Nicholas Mills, MD, PhD, University of Edinburgh, United Kingdom, senior author on the viewpoint published online April 6 in the journal Circulation.

A report on hospitalized patients with COVID-19 in Wuhan, China stated that cardiac injury (hs-cTn above the 99th-percentile upper reference limit) was evident in 1 in 5 patients and independently predicted dying in the hospital. Mortality was 10-fold higher in those with cardiac injury on presentation.

Elevated cardiac troponin in the setting of COVID-19 may suggest illness severity with myocardial injury occurring as a result of myocardial oxygen supply-demand imbalance. Or it could be due to direct cardiac involvement through viral myocarditis or stress cardiomyopathy, or where the prothrombotic and proinflammatory state leads to acute coronary syndromes.

Will Antibody Tests Help Us Leave Quarantine

One thing that might help us get back to normal is a rapid blood test to see if someone has developed immunity to COVID-19.

Theres a chance that a significant number of us have developed antibodies already. Only a subset, called neutralizing antibodies, can block the virus. We are yet to understand which antibody response neutralizes the virus.

What are the current treatment protocols

The evidence is insufficient to recommend any particular treatment for COVID-19, says an expert panel from the Society for Infectious Diseases of America (IDSA). However, an interim evidence-based guideline has been developed to help clinicians make decisions about the treatment of patients with COVID-19.

The panel has put forward some recommendations; however, they used the phrase "knowledge gap" to accentuate their statements on the seven recommendations.

  1. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends hydroxychloroquine/chloroquine in the context of a clinical trial. (Knowledge gap)
  2. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends hydroxychloroquine/chloroquine plus azithromycin only in the context of a clinical trial. (Knowledge gap)
  3. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends the combination of lopinavir/ritonavir only in the context of a clinical trial. (Knowledge gap)
  4. Among patients who have been admitted to the hospital with COVID-19 pneumonia, the IDSA guideline panel suggests not using corticosteroids. (Knowledge gap)
  5. Among patients who have been admitted to the hospital with acute respiratory distress syndrome associated with COVID-19, the IDSA guideline panel recommends the use of corticosteroids in the context of a clinical trial. (Knowledge gap)
  6. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends tocilizumab only in the context of a clinical trial. (Knowledge gap)

[Medscape]

Atypical findings in COVID-19

Bruising and lesions on the feet could be a sign of coronavirus, suspect Spanish doctors.

Patients with either purple chickenpox or chilblain-like marks on their toes tested positive for the infection. Several cases have been reported in Spain as well as Italy and France.

SARS-CoV-2 virus causes persistent cough and fever. However, recent studies have suggested that diarrhea, skin marks, testicular pain and a loss of taste and smell are atypical signs.  

A large number of people who contract COVID-19 also experience headaches and dizziness, reported a study from China. 

How to use an ultrasound machine

A long sheath cover should be used with the ultrasound unit and cable to limit the chances of contamination of the equipment. Nonessential parts of the ultrasound cart may be covered with drapes to minimize droplet exposure.

Disposable covers such as plastic sheets for surfaces, long ultrasound probe sheath covers, etc. should be considered to reduce droplet and contact contamination of equipment and other environmental surfaces.

What are the engineering controls

Installing high-efficiency air filters

Increasing ventilation rates in the work environment

Installing physical barriers, for instance clear plastic sneeze guards

Installing a drive-through window for customer service

Specialized negative-pressure ventilation in some settings, such as for aerosol-generating

procedures (eg, airborne infection isolation rooms in healthcare settings and specialized autopsy suites in mortuary settings)

NEJM Remdesivir Article

A report published in the New England Journal of Medicine about the investigational antiviral drug remdesivir suggests that the drug may help in fighting the novel coronavirus; however, experts stress that the results have been obtained from compassionate use in a limited number of patients, with no control group.

COVID-19 and surgery

The underlying assumption is that every patient is potentially infected with COVID-19 until proven otherwise [Journal of the American College of Surgeons.]

How to do emergency surgeries

For emergency procedures (or when SARS-CoV-2 testing is not possible before surgery), it is important that the personnel use full PPE, including gown, gloves, eye protection and a fitted N-95 mask.

What if the surgery cannot be postponed

Urgent procedures on symptomatic patients should be delayed if possible. If the procedure cannot be delayed, patients should undergo SARS-CoV-2 testing.

Any urgent procedure where testing is positive should be first approved by the anesthesia and surgical chair, and if approved, personnel should use full PPE and follow the hospitals protocol for COVID-19 patients.

Asymptomatic patients scheduled for high-risk procedures who test negative for SARS-CoV-2 and asymptomatic patients scheduled for low-risk procedures can undergo surgery where OR members use standard surgical attire.

Immune boosters

AYUSH Ministry

Modern Medicine

Drink warm water

Ginger lukewarm water is detoxifying. The consumption of soft drinks and other sweetened beverages (fruit drinks, sports drinks, and energy drinks) is a major source of added refined sugar and calories in the diet and should be discouraged.

Daily practice Yoga asana, Pranayama and meditation for at least 30 minutes

Learn progressive muscular relaxation and mindfulness meditation.

Avoid sympathetic and deep nasal and chest exhalation exercises during the COVID era.

Most breathing techniques are designed to prolong exhalation and decrease minute ventilation.

Pranayama, or yoga breathing exercise, emphasizes deep respiration with slow exhalation.

Do Yoga. It is a practice of breathing, mindfulness, spirituality, body, and the connection among these factors. Through its three main components (postures, breathing, and meditation), as well as nonspecific events, yoga appears to be safe and to improve multiple parameters of health and quality of life.

Mindfulness is defined as "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally"

Basic elements include self-regulation of attention and taking a non-judgmental stance towards one’s experience

Lockdown is the best time to stop smoking, tobacco consumption and stop or limit alcohol intake.

Spices like Haldi (Turmeric), Jeera (Cumin), Dhaniya (Coriander) and Lahsun (Garlic) in cooking.

Take

1.      2000 units of vitamin D daily

2.       Vegetarians take B12

3.      Patients with allergies take Vitamin C

4.      High-risk individuals take pneumonia, flu vaccines.

5.      Consume five or more servings of fruits and/or vegetables daily. They are a rich source of fiber, and fruit/vegetable consumption is inversely associated with risk of coronary heart disease, stroke, and mortality.

6.      Replace refined grains (white bread, white rice, refined and sweetened cereals) with whole grains (eg, whole-wheat bread, brown rice, whole-grain cereals or oatmeal), which have a higher content of fiber and other nutrients

7.   Trans fatty acid consumption should be kept as low as possible by limiting foods such as partially hydrogenated oils, which are found in stick margarine and in many store-bought, processed, and fast foods.

8.      Moderate intake of red and processed meats and to eat a variety of healthy protein-rich foods, including seafood, lean meat (such as poultry), eggs, beans, peas, soy products, and unsalted nuts and seeds. Consumption of red and processed meats is associated with a moderate increase in mortality compared with consumption of white meat.

9.      Low-fat diet, vegetarian diets, Dietary Approaches to Stop Hypertension (DASH) diet, and the Mediterranean diet are among the most commonly used diets to maintain good health, where weight loss is not necessarily the primary goal. These diets are associated with health benefits. However, it is not known which type of diet is optimal for the general population. The decision to choose one of these diets is generally based on individual risk factors, personal preference, and the ability to adhere to a given diet.

Chyavanprash 10gm daily. Diabetics should take sugar-free Chyavanprash.

Take a mix of all seven colors and six tastes in the diet. All six tastes are present in kitchen spices.

Recommended dietary sodium intake for the general population is less than 6 g of sodium chloride. Low sodium intake is associated with decreased risk of cardiovascular events, including death.

Drink herbal tea/decoction (Kadha) made from Tulsi (Basil), Dalchini (Cinnamon), Kalimirch (Black pepper), Shunthi (Dry Ginger) and Munakka (Raisin) - once or twice a day. Add jaggery (natural sugar) and/or fresh lemon juice to your taste, if needed

Herbal teas, black coffee, green tea, black tea are antioxidants. Limit white sugar and instead add jaggery, honey or stevia.

Golden Milk- Half tea spoon Haldi (turmeric) powder in 150 ml hot milk - once or twice a day.

Turmeric has TNF blocker like anti-inflammatory action [ Br J Pharmacol. 2013 Aug;169(8):1672-92]

Apply sesame oil/coconut oil or Ghee in both the nostrils (Pratimarsh Nasya) in morning and evening.

Keep nose, eyes, and mouth moist with saline water to avoid any irritation. Use tear eye drops for dry eyes due to computer use. After every 20 minutes of computer use, do eye exercise for 20 seconds.

Oil pulling therapy- Take 1 tablespoon sesame or coconut oil in mouth. Do not drink, Swish in the mouth for 2 to 3 minutes and spit it off followed by warm water rinse. This can be done once or twice a day.

Povidone-iodine or warm saline or turmeric hot saline gargles

For dry cough: Dry cough/sore throat: Steam inhalation with fresh Pudina (Mint) leaves or Ajwain (Caraway seeds) can be practiced once in a day.

Lavang (Clove) powder mixed with natural sugar/honey can be taken 2-3 times a day in case of cough or throat irritation.

Suppression of cough is important. Stop smoking. Anti-allergic and non-opioid dextromethorphan.

Benzonatate can be added if the cough persists despite dextromethorphan.

For patients who have a cough due to an unrelenting cause or a persistent cough despite both specific therapy and nonspecific therapy with non-opioid agents, give a trial of opioid antitussive Codeine.

Gabapentin and pregabalin are alternative, symptomatic treatments for patients whose cough is refractory to the above measures.

In cough of more than 3-8 weeks, further evaluation needs to be done for postnasal discharge, TB, acid reflux, asthma, anti-BP drugs like ACE inhibitors etc.

Acute cough exists for less than three weeks and is most commonly due to an acute respiratory tract infection. Other considerations include acute exacerbation of underlying chronic pulmonary disease, pneumonia, and pulmonary embolism.

Cough that has been present longer than three weeks is either subacute (three to eight weeks) or chronic (more than eight weeks).

Among patients with chronic cough, women tend to cough more often and to have heightened cough reflex sensitivity compared to men.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.