CME Lecture on "COVID-19 Presentation and Diagnosis"
Presented at the Scientific Seminar of Philippine American Medical Association in Chicago on March 6th, 2021.
COVID 19- Basics beyond Basics by Dr. Brij Teli doc2rock
COVID-19: Basics Beyond Basics, is a concise presentation on Some Salient aspects and facts about Management of COVID-19 as per the Evidence based information on the day of Webinar.
Video of Webinar available at:
https://youtu.be/fjlgVzvwhM4
Can Join Telegram Group for Discussion: https://t.me/covindia
Target Audience being- Resident Doctors of Medicine, Pulmonary Medicine, Anesthesia, Pharmacology as well as Undergraduate Medical Students, Interns and HealthCare Workers from Various States of India as well as Outside India.
Covers aspects Like- Maskology, COVID-19 Antigen Detection Test, X-Ray & CT Findings of COVID-19, Cytokine Storm, Tocilizumab, Steroids & Recovery Trial, Covid Associated Coagulopathy(CAC), Hydroxychloroquine & the Controversies, Remdesivir, Convalescent Plasma, Awake Non-Intubated Prone Positioning, Thromboprophylaxis in COVID-19 including calculating SIC Score, Newer Trials and Publications, COVID-19 Vaccine Status, Favipiravir.
CME Lecture on "COVID-19 Presentation and Diagnosis"
Presented at the Scientific Seminar of Philippine American Medical Association in Chicago on March 6th, 2021.
COVID 19- Basics beyond Basics by Dr. Brij Teli doc2rock
COVID-19: Basics Beyond Basics, is a concise presentation on Some Salient aspects and facts about Management of COVID-19 as per the Evidence based information on the day of Webinar.
Video of Webinar available at:
https://youtu.be/fjlgVzvwhM4
Can Join Telegram Group for Discussion: https://t.me/covindia
Target Audience being- Resident Doctors of Medicine, Pulmonary Medicine, Anesthesia, Pharmacology as well as Undergraduate Medical Students, Interns and HealthCare Workers from Various States of India as well as Outside India.
Covers aspects Like- Maskology, COVID-19 Antigen Detection Test, X-Ray & CT Findings of COVID-19, Cytokine Storm, Tocilizumab, Steroids & Recovery Trial, Covid Associated Coagulopathy(CAC), Hydroxychloroquine & the Controversies, Remdesivir, Convalescent Plasma, Awake Non-Intubated Prone Positioning, Thromboprophylaxis in COVID-19 including calculating SIC Score, Newer Trials and Publications, COVID-19 Vaccine Status, Favipiravir.
While the world was focused on covid 19, WHO has made and issued consolidated guidelines making changes in how to prevent, diagnose and treat tuberculosis.
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help
clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale
for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
This was a lecture I gave for the Upstate Nurse Practitioners Association. This is a comprehensive overview. I would to thank all health care professionals for doing their jobs as well as they can.
Constance Benson, MD
Professor of Medicine and Director of the UC San Diego
AntiViral Research Center
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
While the world was focused on covid 19, WHO has made and issued consolidated guidelines making changes in how to prevent, diagnose and treat tuberculosis.
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help
clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale
for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
This was a lecture I gave for the Upstate Nurse Practitioners Association. This is a comprehensive overview. I would to thank all health care professionals for doing their jobs as well as they can.
Constance Benson, MD
Professor of Medicine and Director of the UC San Diego
AntiViral Research Center
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
The Cancer Association of South Africa (CANSA) launches its Colorectal Cancer Awareness Campaign in partnership with Medtronic.
Colorectal cancer is the second most common cancer in men (following prostate cancer) and the third most common cancer in women (following breast and cervical cancer). An estimated 6 927 new cases of colorectal cancer were diagnosed in South Africa in 2018 which was about 6.5% of all cancers (1). More men (7.3% of all cancers) than women (5.7% of all cancers) were diagnosed with colorectal cancer in this same year.
The aim of the Medtronic and CANSA partnership aim is to provide Colorectal Cancer Awareness and education so patients can get treated at early stages and offered patient support through CANSA's patient care and support programmes.
https://www.cansa.org.za/adopt-a-balanced-lifestyle/
Demonstrate the essential risk factors for developing cancer, and the predisposing factors for cancer.
Demonstrate a map of the prevalence of cancer throughout the world
Demonstrate how can we prevent the occurrence of cancer, by avoiding the predisposing risk factors.
Demonstrate the practical recommendation to avoid cancer
Cancer• What is cancer• Cancer statistics• Risk Fac.docxbartholomeocoombs
Cancer
• What is cancer?
• Cancer statistics
• Risk Factors
• Reducing burden and preventing cancer
• Cancer Treatment
• WHO/International Response
What is cancer?
• Large group of diseases where abnormal cells divide without control and are able to
spread to other tissues and organs
• The latter process is called metastasis
• More than 100 types of cancer
• No two cancers are the same.
• Globally, 18.1 million cases of cancer were diagnosed in 2020
• Nearly 10 million deaths
• Each year approximately 400,000 children are diagnosed
What Causes Cancer?
• Changes result from interaction of a person's genetic factors and external agents,
including:
• Physical carcinogens, such as ultraviolet and ionizing radiation;
• Chemical carcinogens, such as asbestos, components of tobacco smoke, alcohol, aflatoxin (a
food contaminant), and arsenic (a drinking water contaminant); and
• Biological carcinogens, such as infections from certain viruses, bacteria, or parasites
• Cancer incidence rises dramatically with age
• Likely due to a build-up of risks for specific cancers that increase with age
• Combined with the tendency for cellular repair mechanisms to be less effective as a person
ages
Risk Factors
• Tobacco use, alcohol consumption, unhealthy diet, physical inactivity and air pollution
• Some chronic infections
• In particular, low- and middle-income countries
• Approximately 13% of cancers diagnosed in 2018 globally were attributed to carcinogenic infections,
including Helicobacter pylori, human papillomavirus (HPV), hepatitis B virus, hepatitis C virus, and
Epstein-Barr virus.
• Hepatitis and some types of HPV increase the risk for liver and cervical cancer,
respectively
• Infection with HIV increases the risk of developing cervical cancer six-fold and
substantially increases the risk of developing select other rare cancers such as Kaposi
sarcoma
Cancer Global Statistics
Worldwide Cancer Diagnoses in 2020
2.26 2.21
1.93
1.41
1.2
1.09
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0.5
1
1.5
2
2.5
Breast Lung Colon Rectum Prostate Skin Stomach
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Cancer Type
Worldwide Cancer Deaths in 2020
1.8
0.92
0.83 0.77
0.69
0
0.2
0.4
0.6
0.8
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1.2
1.4
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Lung Colon and Rectum Liver Stomach Breast
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Cancer Type
Cancer Prevalence
• Who has cancer at a specific moment in time out of everyone in the population
• Includes people who are living with cancer
• Incidence and survival impact specific cancer prevalence
• Increasing incidence increases prevalence
• Increased survival time increases prevalence
• More people are living with the disease
Cancer Prevalence
• Globally 43.8 million persons were living with cancer at the end of 2018
• Asia - 17.4M (39.7%)
• Europe - 11.87M (27.7%)
• The Americas – 11.43M (26.1%)
Prevalence of Cancer by Type
• Breast cancer globally the
most prevalent form
• 2nd & 3rd most co.
Cancer is a group of diseases involving
abnormal cell growth with the potential to
invade or spread to other parts of the body. Cancer is a group of diseases involving
abnormal cell growth with the potential to
invade or spread to other parts of the body.
Cancer is one of the leading causes of morbidity and
mortality worldwide, with approximately 14 million new
cases in 2012.
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How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
1. Colon Cancer Awareness Month –
March every year
(WHO earmarked)
Dr. Gurbilas P. Singh, FRCP (London)
Gastro Physician in Chandigarh
Endoscopist in Chandigarh
Endoscopy services in Chandigarh
2. Indian population
• Largely remains rather non-aggressive in their attitudes towards
health related issues
• Lack of awareness despite improving diagnostic and healthcare
facilities
• The main reason for this seems to be the cost services are placed at.
3. Rectal bleeding and its management – Indian
scenario
• Hide this symptom from all
• Finally when it stops there is a sigh of relief and it is never mentioned
until it recurs.
• Speaks to a General Physician or a Gastro Physician.
• The number of episodes will decide how many physicians or
surgeons see this patient (without doing a physical examination
including a digital rectal examination) in their busy clinics.
• Some practitioners will point towards a colonoscopy
• The person sees an Endoscopist who offers a colonoscopy. The
patient either never returns or dilly dallies.
4. Rectal bleeding – UK scenario
• A person with rectal bleeding goes to his General Physician usually
promptly.
• Assessed with blood tests as well as a digital rectal examination or
even a rigid sigmoidoscopy.
• Referred to an endoscopy clinic to be seen asap (generally within 2
weeks) for a flexible sigmoidoscopy or a colonoscopy.
• A diagnosis is hence generally made and acted upon promptly if
something needs doing.
5. Colon Cancer
• Affecting men and women almost equally.
• Third most common cancer in the world and fourth most common
cause of death.
• Worldwide, it accounts for 9% of all cancers.
• High incidence areas are North America (particularly USA and
Canada) and Australasia.
• Low incidence areas include China, India, Africa and South America.
6. Colon Cancer declining !?
• Incidence of colon cancer is declining steadily at the rate of over 2% per year since
1998 because of screening programmes offering colonoscopy (lower gastrointestinal
endoscopy) which in turn improves the detection of precancerous polyps.
• The overall burden of disease remains high and there is a change noted in
demographics with Afro-Caribbean population now having a higher rate of incidence as
compared to the white population. Interestingly the trend is opposite to what it was
before 1980s.
The developed world accounts for well over 60% of the cases but these rates are probably
susceptible to ascertainment bias given the under reporting in developing countries.
7. Non modifiable factors
• Age
• Personal history of Adenomatous polyp
• Tubular and villous adenomata
• Personal history of Inflammatory Bowel Disease (upto 20 fold increased risk of
colorectal cancer)
• Family history of Colorectal Cancer or Adenomatous Polyps
(Two or more first degree relatives or one under the age of 60 years with history of cancer or polyps increase the risk strongly)
• Inherited Genetic Risk
(Familial Adenomatous Polyposis and Hereditary Non Polyposis Colorectal Cancer have been linked to the genes and mutations.)
8. Modifiable factors
• Enviromental risk factors :
These include a wide range of vague cultural, social or lifestyle factors and
interestingly it has been found that a migrant from low risk area would
automatically pick up the risk of local population where one resides. These
environmental factors become important as they are modifiable and theoretically
should help in prevention. The incidence is higher in urban population,
particularly in males and for colon rather than rectal cancer.
9. Modifiable factors
• Dietary factors - A diet high in fats and meats/animal products is known to
increase the risk of colon cancer. Also a diet low in fruits and vegetables is also
linked to it. This may signify that a high fibre diet which dilutes farcal content,
increases bulk and reduces transit time is protective.
Cigarette smoking - Whereas it is bad for health generally it is known to form
and increase the size of the polyps (larger polyps are found in smokers). An
earlier average age of having colon cancer is noted in smokers.
Heavy alcohol consumption:Acetaldehyde, a metabolite of alcohol, can be
carcinogenic. Also such individuals may have poor diet.
10. Volume of problem
• Oesophageal Cancers – 26,( M =13, F = 13), Average age = 58 years
• Stomach cancer – 9 (M =5, F = 4), Average age = 58.55 years
• Colon cancer – 20 (M =9 , F =11 ), Average age = 54.55 years
11. Colon Cancer Awareness – duty of all Gastro
Physicians, Endoscopists and other healthcare
workers
This clearly depicts that colon cancer is not a rare entity and it is very
important to highlight this point to catch the disease early to save lives.
It is our duty to highlight this with the month of March, which is
earmarked as the Colon Cancer Month by WHO, approaching.