CME Lecture on "COVID-19 Presentation and Diagnosis"
Presented at the Scientific Seminar of Philippine American Medical Association in Chicago on March 6th, 2021.
Rekha Dehariya (M.Sc nursing 1st year) Bhopal Nursing College, Bhopal
Covid -19 has effected broud number of people all over the world. the health education is necessary to aware people about it.
Bedside to Bench: How Clinical Imaging of Patients with COVID-19 is Informing...Scintica Instrumentation
In this webinar presented by Scintica Instrumentation, we took a look at both clinical and preclinical imaging of COVID-19. Starting with a review of current literature surrounding clinical imaging and post-mortem histological autopsy studies of patients with COVID-19, this webinar examined how these studies can inform prospective preclinical investigations using novel imaging tools to better understand COVID-19 pathophysiology
Rekha Dehariya (M.Sc nursing 1st year) Bhopal Nursing College, Bhopal
Covid -19 has effected broud number of people all over the world. the health education is necessary to aware people about it.
Bedside to Bench: How Clinical Imaging of Patients with COVID-19 is Informing...Scintica Instrumentation
In this webinar presented by Scintica Instrumentation, we took a look at both clinical and preclinical imaging of COVID-19. Starting with a review of current literature surrounding clinical imaging and post-mortem histological autopsy studies of patients with COVID-19, this webinar examined how these studies can inform prospective preclinical investigations using novel imaging tools to better understand COVID-19 pathophysiology
In COVID-19 any antiviral is more effective when used early in first week of illness.
What should not be used in covid-19 is also discussed in presentation.
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.
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.
In COVID-19 any antiviral is more effective when used early in first week of illness.
What should not be used in covid-19 is also discussed in presentation.
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.
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.
Brief presentation about COVID19 diagnosis ,management and discharge criteria from isolation. Short Discussion about guideline given by Nepal medical council and TUTH for management.
Covid19 and pregnancy: There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous.
As per ICMR Guidelines Pregnant women do not appear more likely to contract the infection than the general population. However, pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19. Reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery.Pregnant women with heart disease are at highest risk (congenital or acquired). In other types of coronavirus infection (SARS, MERS), the risks to the mother appear to increase in particular during the last trimester of pregnancy. There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous.The coronavirus epidemic increases the risk of perinatal anxiety and depression, as well as domestic violence. It is critically important that support for women and families is strengthened as far as possible; that women are asked about mental health at every contact. A small study of nine pregnant women in Wuhan, China, with confirmed COVID-19 found no evidence of the virus in their breast milk, cord blood or amniotic fluid. According to WHO, pregnant women
do not appear to be at higher risk of severe disease.
Furthermore, WHO reports that currently there is no known difference between the clinical manifestations of COVID-19 in pregnant and non-pregnant women of reproductive age
ACOG is advising caution based on the impact of other respiratory illnesses (including influenza/ SARS outbreak of 2002–2003), stating that “pregnant women should be considered an at-risk population for COVID-19
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
How to Give Better Lectures: Some Tips for Doctors
Covid 19 - Presentation & Diagnosis
1. Tahseen J. Siddiqui, M.D, MRCP
Infectious Disease Specialist & Infection Control Chair
Holy Cross Hospital, Humboldt Park Health, St. Bernard Hospital &
Roseland Community Hospitals
Asst. Professor of Medicine, St. George's University Medical School
President, Chicago Infectious Disease Physicians
COVID-19
Presentation and
Diagnosis
2. 1. PRE-TEST
QUESTIONS
1. COVID-19 “Reinfection” is defined as clinical recurrence of symptoms compatible
with COVID-19, accompanied by positive PCR test, more than 90 days after the
onset of the primary infection, while COVID-19 “Relapse” (recurrence or
reactivation) refers to clinical recurrence of symptoms compatible with COVID-19,
accompanied by positive/persisting RT-PCR test within 90 days of primary infection.
TRUE / FALSE
1. Diagnostic testing to identify persons previously infected with SARS-CoV-2
usually involves the detection of SARS-CoV-2 nucleic acid by means of PCR
assay/Antigen Tests while Antibody tests are authorized by the FDA to detect a
current infection with SARS-CoV-2.
TRUE / FALSE
3. RISK FACTORS OF COVID-19
• It is unclear whether other conditions (e.g., uncontrolled HIV infection or use of immunosuppressive medications)
confer an increased risk of complications,
4. Relative Risks of Severe Illness in COVID-19
Blood type A: a higher risk for COVID-19 respiratory failure in people with the A blood type. Blood group A antigen is present on
respiratory epithelial cells as well as red blood cells possibly explaining the increased risk for respiratory failure in these patients.
5. CLINICAL MANIFESTATIONS OF COVID-19
• The clinical spectrum of f SARS-CoV-2 infection ranges from asymptomatic infection to critical illness.
• Incubation period — generally within 14 days following exposure, with most cases occurring approximately
4-5 days after exposure
• Among patients who are symptomatic, the median incubation period is approximately 4 to 5 days, and 97.5%
have symptoms within 11.5 days after infection
• It is estimated that 33 percent of people with SARS-CoV-2 infection never develop symptoms
• Patients with asymptomatic infection may have objective clinical abnormalities:
• In a study of 24 patients with asymptomatic infection who all underwent chest computed tomography (CT),
50 % had typical ground-glass opacities or patchy shadowing, and another 20 % had atypical imaging
abnormalities
• Presymptomatic- some individuals who are asymptomatic at the time of diagnosis go on to develop symptoms
6. DESEASE SEVERITY/MORTALITY OF COVID-19
• Mild to moderate (81%)
Hallmarks of moderate disease are the presence of clinical or radiographic evidence of lower respiratory tract disease but with a
blood oxygen saturation of 94% or higher while the patient is breathing ambient air.
• Severe (14%)
Indicators of severe disease are marked dyspnea/tachypnea (respiratory rate, ≥30 breaths per minute), hypoxemia (oxygen
saturation, ≤93%; ratio of partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (Fi02), <300), and lung
infiltrates (>50% of the lung field involved on imaging within 24 to 48 hours)
• Critical (5%) (Respiratory failure, shock, or multiorgan system dysfunction)
• Overall case fatality ratio (CFR) 2.3%.
• CFR among patients with critical disease was 49%
• CFR in people aged 85 years or older (10%–27%), aged 65–84 years (3%–11%), aged 55–64 years (1%–3%), and in people
younger than 55 years (<1%). (U.S. epidemiologic data through March 16, 2020)
• Among U.S. COVID-19 cases reported January 22–May 30, 2020:
• Overall, the proportion of people who were hospitalized was 14%, including 2% admitted to the intensive care unit (ICU).
Overall, 5% of patients died.
7.
8. INITIAL PRESENTATION OF COVID-19
• Cough (50 %)
• Fever (43%) (subjective or >100.4°F/38°C)
(Patients hospitalized with COVID-19 in New York, only 31% had a temperature >100.4°F/38°C at presentation)
• Myalgia (36 %)
• Headache (34 %)
• Dyspnea (29 %)- (approximately one week after the onset of initial symptoms)- suggestive of worsening
disease.
• Sore throat (20 %)
• GI Sx- (18%)- (with diarrhea, nausea/vomiting, or abdominal pain reported in 13, 10, and 9 percent,
respectively)
• Loss of smell or taste (Anosmia and Dysgeusia)- (>10%) - in a meta-analysis the pooled prevalence estimates
were 52 and 44 percent respectively,- usually improves in 4 weeks - more common in women than in men.
• Rhinorrhea in fewer than 10 %
• Conjunctivitis- rare
9. INITIAL PRESENTATION OF COVID-19
• Dermatologic Manifestations :
• Maculopapular rash (22%),
• Discolored, reddish-purple lesions of the fingers and toes, like pernio (chilblains), mainly in
children and young adults (18%),
• Hives (16%) and transient livedo reticularis
• Vesicular (varicella-like) eruptions - appeared 4 to 30 days after the onset of COVID symptoms
and resolved in a median of 10 days
• Less frequently -Papulosquamous eruptions, erythema multiforme-like lesions, dengue-like
rashes, petechiae, and gangrene.
• Multisystem inflammatory syndrome in children (MIS-C)
• An erythematous, polymorphic rash, erythema and/or firm induration of hands and feet, oral
mucositis, and conjunctivitis, along with systemic, laboratory, and imaging findings of atypical,
severe Kawasaki disease
11. Clinical Spectrum of COVID-19 in Children
Key distinctions between MIS-C and KD include:
●MIS-C commonly affects older children and adolescents, whereas classic KD typically affects infants and young children.
●In MIS-C, black and Hispanic children appear to be disproportionally affected and Asian children account for only a small number of cases. By
contrast, classic KD has a higher incidence in East Asia and in children of Asian descent
●Gastrointestinal symptoms (particularly abdominal pain) are very common in MIS-C, whereas these symptoms are less prominent in classic KD.
●Myocardial dysfunction and shock occur more commonly in MIS-C compared with classic KD
●Inflammatory markers (especially CRP, ferritin, and D-dimer) tend to be more elevated in MIS-C compared with classic KD and KDSS
In addition, absolute lymphocyte and platelet counts tend to be lower in MIS-C compared with KD
12. Multisystem
Inflammatory
Syndrome in Children
(MIS-C)
• Thought to result from an abnormal
immune response to the virus, with some
clinical similarities to KD, macrophage
activation syndrome (MAS), and cytokine
release syndrome.
• Related to immune dysregulation
occurring after acute infection has passed.
(Mostly COVID-19 seropositive and PCR neg)
16. CLINICAL COURSE OF COVID-19
• Some patients who have mild symptoms initially can subsequently progress with a rapid clinical
deterioration that occurs approximately 1 week after symptom onset
• Median time from their onset of illness to the time they experienced dyspnea (5–8 days)
• Median time from onset of illness to acute respiratory distress syndrome (ARDS) (8–12 days)
• Hospital admission after a median of 7 days of symptoms onset
• ICU admission after a median time from onset of illness (9.5–12 days)
• Among all hospitalized patients, 26%–32% of patients were admitted to the ICU
• The median length of hospitalization among survivors (10–13 days)
• Mortality among patients admitted to the ICU ranged from 39% to 72% depending on the study
and characteristics of patient population
17. COVID-19 ‘REINFECTION’
• Defined as clinical recurrence of symptoms compatible with COVID-19, accompanied by
positive PCR test, more than 90 days after the onset of the primary infection, supported by
close-contact exposure or outbreak settings, and no evidence of another cause of infection.
• Patients recovered from the primary infection are less likely to be re-infected for up to 90 days
• Limited data exist about reinfection with SARS-CoV-2 after recovery from COVID-19
• Serology does not play a factor in the reinfection definition and could be either positive or
negative after the first infection.
• Unclear how long people who have recovered from COVID-19 are protected against, what
concentration of antibodies is needed to confer protection, and how often reinfection may occur
• Reinfection with a SARS-CoV-2 variant virus has been reported in Brazil, U.K., and South
Africa.
18. COVID-19 ‘RELAPSE’
• COVID-19 relapse (recurrence or reactivation) defined as clinical recurrence of symptoms compatible with
COVID-19 infection and accompanied by positive/persisting RT-PCR within 90 days of primary infection
and supported by the absence of epidemiological exposure or another cause of the illness.
• Demonstration of same strain by whole-genome sequencing could definitively differentiate this entity from
reinfection
• An inflammatory syndrome, as a result of inappropriate immune response, has been suggested as an
alternative explanation
• Further research is needed to decide whether these cases should be considered for isolation?
• SARS-CoV-2 PCR ‘Re-Positivity’
• Positive RT-PCR following negative tests in an asymptomatic patient up to 90 days from the
first episode.
• Do not represent replicative virus and do not require isolation
19. Prolonged Detection of SARS-CoV-2
• The average duration of detectable virus ~ 0-4 days to 10 -14 days from symptoms onset
• Some people who have recovered may have detectable SARS-CoV-2 RNA in upper respiratory
specimens for up to 90 days after illness onset
• Detection of viral RNA during convalescence does not necessarily indicate replication-
competent virus (infectiousness) or the presence of new infectious viral strain
• Some people with severe illness might produce replication-competent virus beyond 10 days that
may warrant extending duration of isolation precautions for up to 20 days after symptom onset.
• Some severely immunocompromised patients (lymphoma, hypogammaglobulinemia,
hemopoietic stem cell transplant recipients, AIDS, those receiving immunosuppression with
chemotherapy, systemic corticosteroids and biologics) might produce replication-competent
virus beyond 20 days and require additional testing and isolation.
20. COMPLICATIONS OF COVID-19
• Acute Respiratory Failure:
• ARDS- can manifest shortly after the onset of dyspnea
• (median of 8 days in 20%, mechanical ventilation in 12% -24% )
• Cardiac/Cardiovascular complications:
• Cardiac arrhythmias, conduction system disease (prolonged QTc), acute myocardial injury, and cardiogenic
shock
• Directly and indirectly from hemodynamic derangement or hypoxemia, inflammatory myocarditis, stress
cardiomyopathy, microvascular dysfunction or thrombosis due to hypercoagulability, or systemic
inflammation (cytokine storm)
• Neurologic Complications:
• (Cerebral ischemia, acute stroke, hypoxic brain damage)
• (Histopathological examination of brain specimens obtained from patients who died 0 to 32 days after the onset of symptoms of Covid-19
showed only hypoxic changes and did not show encephalitis or other specific brain changes referable to the virus. There was no cytoplasmic
viral staining on immunohistochemical analysis)
https://www.nejm.org/doi/full/10.1056/NEJMc2019373
21. COVID-19 ASSOCIATED COAGULOPATHY
• Hypercoagulable state and increased risk for venous and arterial thrombosis of large and small vessels.
• Laboratory findings:
• Mild thrombocytopenia
• Increased D-dimer levels
• Increased fibrin degradation products
• Prolonged prothrombin time
• Clinical manifestations:
• Arterial thromboembolism: (with minimal or no symptoms of COVID-19)
• Acute ischemic stroke, acute limb ischemia, Acute myocardial injury
• Lower extremity – 71 percent /Upper extremity – 14 percent
• Cerebral ischemia – 10 percent/ Bowel ischemia – 4 percent
Multiple locations occurred – 12 percent/ Concomitant deep vein thrombosis – 16 percent
• Microvascular thrombosis of the toes (COVID toes)
• Clotting of intra-vascular catheters
• VTE – (Venous thromboembolism), including extensive deep vein thrombosis (DVT) and pulmonary embolism (PE) up to 1/3
of patients in the ICU, even when prophylactic anticoagulation.
Autopsy studies showed combination of hypercoagulability and associated inflammation in patients who died from COVID-19:
(thrombotic microangiopathy with fibrin thrombi in alveolar and glomerular capillaries)
22. Post COVID-19 Syndrome - "The Long Haulers” (PASC)
• PASC- Post-Acute Sequelae of SARS-CoV-2 infection (new name)
• Roughly 10% of coronavirus patients with COVID-19 may experience long term lingering symptoms:
• Chronic fatigue syndrome
• Body aches/Joint pain
• Shortness of breath/Cough
• Chest pain
• Loss of taste and smell — even if this didn’t occur during the height of illness
• Headaches
• Brain fog (Memory, concentration or sleep problems)
• Rash or hair loss
• Organs that may be affected by COVID-19 include:
• Heart- cardiomyopathy/CHF
• Lungs- Chronic scarring/fibrosis
• Brain- Even in young people, COVID-19 can cause strokes, seizures and Guillain-Barre syndrome and increase the risk of
developing Parkinson's disease and Alzheimer's disease.
"One common theory about patients with long-term COVID-19 symptoms is that the virus possibly remains in their bodies in some
small form. Another theory is their immune systems continue to overreact even though the infection has passed," UC Davis Health
23. DIAGNOSTIC TESTING OF COVID-19
• Diagnostic testing to identify persons currently infected with SARS-CoV-2 usually involves the detection of
SARS-CoV-2 nucleic acid by means of PCR assay/Antigen Tests.
1) SARS-CoV-2 PCR: Specificity of most assays is nearly 100%
• Just before and soon after symptom onset, the sensitivity of PCR testing of nasopharyngeal swabs is high.
• If testing is negative in a person who is suspected to have Covid-19, then repeat testing is recommended.
• RT-PCR commercial assays with multiple specimen types, including nasopharyngeal, oropharyngeal, and
mid-turbinate and anterior nares (nasal) swabs, as well as the most recently validated specimen type, saliva.
• The CDC Influenza SARS-CoV-2 (Flu SC2) Multiplex Assay is (RT-PCR) test that detects and differentiates
RNA from SARS-CoV-2, influenza A virus, and influenza B virus in upper or lower respiratory specimens
2) Rapid Antigen tests: Identify SARS-CoV-2 in a nasopharyngeal or nasal swab in 15 min
• Rapid Point-Of-Care Testing for COVID-19 in Community Settings and Schools
• Should ideally be performed within 7 days of symptoms onset.
• Antigen tests are generally less sensitive than PCR tests but less expensive ($5)
• It may be necessary to confirm a rapid POC antigen or rapid POC molecular test result with a RT-PCR test,
especially if the result of the rapid POC test is inconsistent with the clinical picture, i.e., a negative antigen
test on a symptomatic individual or on a person who is a close contact to a confirmed or probable case
26. DIAGNOSTIC TESTING OF COVID-19
Serologic tests for SARS-CoV-2
• Antibody tests: Detect a past infection with SARS-CoV-2.
• Anti–SARS-CoV-2 antibodies are detectable in the majority of patients 14 days or more after the
development of symptoms.
• The CDC does not currently recommend using antibody testing as the sole basis for diagnosing current
infection or disproving a positive result by viral testing.
• These tests measure different immunoglobulins (IgA/M/G) and detect antibodies against various viral
antigens (spike protein/nucleocapsid) with the use of different analytic methods, so direct comparison of the
tests is challenging.
• Generally reserved for people who are suspected to have Covid-19 but have negative PCR testing and in
whom symptoms began at least 14 days earlier.
• Antibody testing after 2 weeks also may be considered when there is a clinical or epidemiologic reason for
detecting past infection, such as serosurveillance.
• Because antibody levels may decrease over time and the correlates of immunity are not yet known, serologic
test results cannot currently inform whether a person is protected against reinfection
27. Laboratory Testing of COVID-19
• Laboratory testing in hospitalized patients should include a complete blood count, a comprehensive metabolic
panel, CK, troponin, coagulation studies, (D Dimer/Fibrinogen) and inflammatory markers.
(CRP/LDH/Ferritin/IL-6)
• Lymphopenia, neutrophilia, elevated ALT/AST levels, elevated lactate dehydrogenase, high C-reactive
protein (CRP), interleukin-6, high ferritin levels, may be associated with greater illness severity.
• Elevated D-dimer and lymphopenia have been associated with mortality.
• Procalcitonin is typically normal on admission but may increase among those patients admitted to an ICU.
• In addition, testing for other pathogens (e.g., influenza virus, depending on the season, and other respiratory
viruses) should be performed, if available, and chest imaging should be done.
• Baseline EKG should be obtained, especially if a medication that affects the corrected QT (QTc) interval is
considered, (Levaquin/azithromycin), and to evaluate for acute myocardial injury
28. Radiographic Testing of COVID-19
• CXR of patients with COVID-19 typically demonstrate bilateral air-space consolidation
• Chest CT images from patients with COVID-19 typically demonstrate bilateral, peripheral ground glass
opacities.
• Because this chest CT imaging pattern is non-specific and can be found in pneumonias caused by other
infections, the diagnostic value of chest CT imaging for COVID-19 may be low and dependent upon
radiographic interpretation.
• One study found that 56% of patients who presented within two days of diagnosis had a normal CT.
• Conversely, other studies have identified chest CT abnormalities in patients prior to the detection of SARS-
CoV-2 RNA in RT-PCR testing of nasopharyngeal samples.
• Given the variability in chest imaging findings, chest radiograph or CT alone is not recommended for the
diagnosis of COVID- The American College of Radiology also does not recommend CT for screening, or as a
first-line test for diagnosis of COVID-19.
• Echocardiogram- (at the baseline or when clinically indicated)
• VTE/PE – (CTA/V-Q scan/Venous/arterial dopplers)- when clinically indicated.
30. 1. POST-TEST
QUESTIONS
1. COVID-19 “Reinfection” is defined as clinical recurrence of symptoms compatible
with COVID-19, accompanied by positive PCR test, more than 90 days after the
onset of the primary infection, while COVID-19 “Relapse” (recurrence or
reactivation) refers to clinical recurrence of symptoms compatible with COVID-19,
accompanied by positive/persisting RT-PCR test within 90 days of primary infection.
TRUE / FALSE
1. Diagnostic testing to identify persons previously infected with SARS-CoV-2
usually involves the detection of SARS-CoV-2 nucleic acid by means of PCR
assay/Antigen Tests while Antibody tests are authorized by the FDA to detect a
current infection with SARS-CoV-2.
TRUE / FALSE