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
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.
This is a kind of seminar presentation that covers the basic information about COVID 19 including virus origin, the molecular structure of the virus. It also presents adequate information on the outbreak happened all over the world and the mathematical model for prediction of what will happen later. The other part of the presentation contains a cellular mechanism of how the virus invades our body. Finally, treatment strategies are clarified.
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.
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.
Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment.
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.
COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The first cases were seen in Wuhan, China in December 2019 before spreading globally. The current outbreak was recognized as a pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or organizing pneumonia, often with a bilateral, peripheral, and basal predominant distribution. No effective treatment or vaccine exists currently (March 2020).
TheNeuroSurgeons sponsored the presentation to the Zimbabwe Association of Neurological Surgeons.
we are learning more about the neurological manifestations of the novel coronavirus as we are frantically looking for solution to this formidable pandemic.
KEY TAKEAWAYS:
1. ABOUT COVID-19
Biology of the COVID-19, virulence,
diagnosis and treatment
2. PREVENTION MEASURES
How can one stay unaffected from
the current and future outbreaks
3. STATS ABOUT COVID-19
Patterns of this infection
worldwide
The global Corona virus pandemic has brought in a lot of issues, concerns and challenges to humanity and the ecosystem. There is a medical emergency to take up strict measures to slow or stop the spread of this virulent pathogen SARS-CoV-2, the virus that causes COVID-19 which is a new variant indicating its origin to the Wuhan city of China. People across nations have been experiencing all the economic and psychological consequences due to this outbreak, and the whole world has joined hands in eradicating this deadly disease. A lot of awareness schemes are being undertaken by many countries and organizations, to not only control the infection but also to revive normalcy. This article provides valuable information about the cause, symptoms, diagnosis, treatment protocols, counseling support systems, innovation strategies, etc., all to ensure that we overcome this crisis and spring back to our healthy routines.
This is a kind of seminar presentation that covers the basic information about COVID 19 including virus origin, the molecular structure of the virus. It also presents adequate information on the outbreak happened all over the world and the mathematical model for prediction of what will happen later. The other part of the presentation contains a cellular mechanism of how the virus invades our body. Finally, treatment strategies are clarified.
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.
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.
Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment.
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.
COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The first cases were seen in Wuhan, China in December 2019 before spreading globally. The current outbreak was recognized as a pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or organizing pneumonia, often with a bilateral, peripheral, and basal predominant distribution. No effective treatment or vaccine exists currently (March 2020).
TheNeuroSurgeons sponsored the presentation to the Zimbabwe Association of Neurological Surgeons.
we are learning more about the neurological manifestations of the novel coronavirus as we are frantically looking for solution to this formidable pandemic.
KEY TAKEAWAYS:
1. ABOUT COVID-19
Biology of the COVID-19, virulence,
diagnosis and treatment
2. PREVENTION MEASURES
How can one stay unaffected from
the current and future outbreaks
3. STATS ABOUT COVID-19
Patterns of this infection
worldwide
The global Corona virus pandemic has brought in a lot of issues, concerns and challenges to humanity and the ecosystem. There is a medical emergency to take up strict measures to slow or stop the spread of this virulent pathogen SARS-CoV-2, the virus that causes COVID-19 which is a new variant indicating its origin to the Wuhan city of China. People across nations have been experiencing all the economic and psychological consequences due to this outbreak, and the whole world has joined hands in eradicating this deadly disease. A lot of awareness schemes are being undertaken by many countries and organizations, to not only control the infection but also to revive normalcy. This article provides valuable information about the cause, symptoms, diagnosis, treatment protocols, counseling support systems, innovation strategies, etc., all to ensure that we overcome this crisis and spring back to our healthy routines.
Clinical Research Centre (CRC) Hospital Kuala Lumpur (HKL) just released their new e-newsletter. This edition focused on COVID-19 experiences by health care providers.
Oral Lefamulin vs Moxifloxacin for Early Clinical Response Among Adults With ...farah al souheil
criticism of the article "Oral Lefamulin vs Moxifloxacin for Early Clinical Response Among Adults With Community-Acquired Bacterial Pneumonia The LEAP 2 Randomized Clinical Trial"
knowledge, attitude and practice of Lebanese adult population towards topical...farah al souheil
This dissertation is submitted in partial fulfilment of the requirements for the Degree of PharmD
assesses the KAP of patients towards their meds: use, abuse and misuse and aims to spread awareness about the topic
Remdesivir in the Management of COVID-19: Evidence Based Approachfarah al souheil
the presentation starts with a quick overview of COVID-19 followed by Remdesivir focused clinical trials assessment and evaluation for the treatment of Corona virus
Ulcerative Colitis: Case Presentation & Disease Overviewfarah al souheil
patient presenting with bloody stools and systemic signs with no previous medical complaints was diagnosed with amoebiasis on top ulcerative colitis (sigmoid-proctitis)
pelvic inflammatory disease: case presentation & disease overview farah al souheil
pelvic inflammatory disease is a very common type of Sexually transmitted disease among young sexually active females. in this presentation we discuss a case suffering from PID and then we evaluate the plan of discharge based on disease and treatment overview
COPD exacerbation case presentation and disease overview farah al souheil
management of a simulated case scenario: patient presenting with COPD exacerbation: what's the best next step? summary of the guideline is then described
Endometrial cancer: Disease & Treatment Overview & Journal club farah al souheil
general overview of endometrial (uterine) cancer followed by treatment options followed by journal club about the possible effects of metformin on Ki-67 one of the approved prognostic factors for EC
eczema is a widespread disease that's gone uncontrolled sometimes due to lack of knowledge. here's a presentation prepared for awareness campaigns to increase the knowledge of patients and help them control their symptoms
obesity is a disastrous phenomenon that's quite on the rise due to different factors.due to it's deleterious effects, it's highly recommended to highlight such topic and address it especially in the pediatrics where the complications double. such topic is still in its infancy and needs to be workedon
infantile hemangioma, also known as birthmarks, is a disease of the pediatrics. most birthmarks fade away by the 12th year of life. however, others necessitate treatment and care.
anemia is a very common marker of underlying diseases. it's sometimes gone under diagnosed due to lack of knowledge. here's an overview of the different types and causes of anemia and the pharmacists approach in addressing such problem.
this ppt presentation handles the topic of acne vulgaris which has proven to be a wide epic disease necessitating pharmacologic and non pharmacologic care for best outcomes
this presentation is for children care providers whether in school or in any other facility where children are in close proximity making them more prone to infection.
general microbiology chapter that introduces the ways by which the bacteria invade our bodies and cause diseases. This course is taken by pharmacy , nutrition, and biomedical students at the lebanese international university.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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2. Lebanese International University
School of Pharmacy
Advanced Pharmacy Practice Experience
Intensive Care Unit
Management of COVID-19 in ICU &
Promising New Treatment
April 7, 2020
3. Outline
i. Definition
ii. Epidemiology
iii. Pathophysiology
iv. Prevention
v. Diagnosis
i. Risk factors
ii. Differentials
vi. Treatment
i. Treatment approach
ii. Emerging
vii. Follow-up
i. Complications
ii. Prognosis
viii. Abbreviations
ix. References
3
4. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Identified as the cause of an outbreak of pneumonia of unknown cause
Labs ruled out SARS-CoV, (MERS)-CoV, influenza, avian influenza
Named as SARS-CoV-2 owing to the virus's genetic similarity to the SARS-CoV
Also known as Novel coronavirus (2019-nCoV)
Disease named by WHO as COVID-19 ( Coronavirus disease 2019)
Definition
Ren LL, Wang YM, Wu ZQ, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020 Jan 30
[Epub ahead of print].
4
5. Facts & Numbers
Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases
(COVID-19) in China [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 17;41(2):145-51
There are two
major types (or
strains) of the
virus (L and S)
The L type was
more prevalent
during the early
stages of the
outbreak (More
aggressive)
Transmission
occurs via
respiratory
droplets
Detected in
blood, saliva,
tears, and
conjunctival
secretions, and
feces)
87% were
aged 30-79
1% were
aged ≤ 9
1% were
aged 10-19
3% were
aged ≥80
Reported cases’ age
in years
Globally, 123420
cases have been
reported as of 5
April, 2020
Spread from asymptomatic
contacts can occur
5
6. Pathophysiology
Incubation period range
from 1 to 14 days (Median =
5 days)
Virus binds to the ACE2
receptor in humans (Similar
pathogenesis to SARS)
Both symptomatic &
asymptomatic patients have
a similar viral load
World Health Organization. Novel coronavirus (2019-nCoV) situation report - 6. January 2020 [internet publication]
2-14 D
6
7. Primary Prevention
Washing hands often
Maintaining a distance of at least 1 meter from people
Seeking medical care in case of fever, cough, and dyspnea
Avoiding direct unprotected contact with live animals
Avoiding raw or undercooked animal products
Individuals with fever and/or respiratory symptoms are
advised to wear a mask
An mRNA vaccine (mRNA-1273) in phase 1 clinical trials
World Health Organization. Novel coronavirus (2019-nCoV) situation report - 6. January 2020 [internet publication]
7
8. Clinical Presentation
Most common symptoms:
• Fever (Children may be afebrile)
• Dry cough (59-82%)
• Dyspnea ( 18-55%)
• Myalgia (38-69%)
• Fatigue
Less common symptoms include:
• Anorexia
• Sputum production
• Sore throat
• Confusion, Dizziness, Headache
• Rhinorrhea
• Chest pain
• Diarrhea, N/V, Abdominal pain
• Conjunctival congestion
Symptoms range from a mild common cold like illness, to a severe viral
pneumonia leading to ARDS
15% of patients present with
fever, cough, and dyspnea
90% of patients have ≥ 1 Symptom
Signs of pneumonia present on chest imaging despite having minimal or no Sx
Patients with ARDS may have tachycardia, tachypnea, or cyanosis with hypoxia
8
9. Lab Workup
ABG (to detect
hypercarbia or
acidosis)
FBC
Coagulation screen
(D-dimer; PT) Procalcitonin &
CRP
Serum troponin Serum LDH Serum CK
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA.
2020 Feb 7 [Epub ahead of print].
Expected labs: Leukopenia/leukocytosis, lymphopenia and elevated liver transaminases
Other: neutrophilia, thrombocytopenia, decreased hgb & albumin, & renal impairment
Perform (RT-PCR), for SARS-CoV-2 in all patients with suspected infection
CXR: bilateral lung infiltrates are found in 75% of patients
9
10. Diagnosis
A confirmed case is based on
Epidemiological history (including cluster transmission)
Clinical manifestations (fever and respiratory symptoms)
Lung imaging
Results of SARS-CoV-2 nucleic acid detection
Serum-specific antibodies
10
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
11. Clinical Classification
Mild
Cases
Symptoms
are mild and
pneumonia
is absent on
imaging
Moderate
Cases
Fever and
respiratory
tract
symptoms
Pneumonia
present on
imaging
Severe
Cases
RR ≥ 30
breaths/min
Spo2 ≤ 93% at
rest
(PaO2)/(FiO2)
≤ 300 mmHg
> 50% lesions
progression within
24 to 48 hours in
lung imaging
Critical
Cases
11
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
12. Critical Cases Classification
No organ failure
other than the lungs
Great chance of
recovery by:
Early stage
May be
complicated by
other mild or
moderate
dysfunction of
other organs
Middle stage
Diffuse
consolidation
of both lungs
(ECMO)
Failure of other
vital organs
High mortality
risk
Late stage
Stage Oxygenation Index
(mmHg)
Compliance of Respiratory
System (mL/cmH2O)
Early 100-150 ≥30
Middle 60-100 15-30
Late ≤60 ≤15
Anti-viral
Anti-cytokine
Supportive care
12
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
13. ICU Management
Patients with respiratory
failure should be
admitted to ICU
Between 23% to 32% of
hospitalized patients
require ICU
13
Coronavirus disease 2019 (COVID-19). (2020, April 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
15. Oxygen
• Target SpO₂
≥90%
• Rate of 5
L/min
• Patients with
severe
ARDS,
hypoxemia,
or shock
Fluids
• Aggressive
fluid
resuscitation
may worsen
oxygenation
Symptom
relief
• Antipyretic/
analgesic
• For the relief of
fever and pain
Antiviral
Treatment
• Shock
• Respiratory
failure
• Other organ
failure that
requires
monitoring in
the ICU
Empirical
Antimicrobial
s
• Antibiotics for
secondary
bacterial
infection
• Neuraminidase
inhibitor until
influenza is
R/O
• Given within 1
hour if sepsis is
suspected
• De-escalate
empirical
therapy based
on test results
Supportive Care
15
Coronavirus disease 2019 (COVID-19). (2020, April 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
16. Monitoring
Monitor
for
Signs of
clinical
deterioration
and sepsis
Intervene when indicated
Hemo-
dialysis
Vasopressor
therapy
Fluid
resuscita-
tion
Ventilation
Anti-
microbials
16
Coronavirus disease 2019 (COVID-19). (2020, April 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
17. Mechanical Ventilation
High fraction of inspired oxygen for severe hypoxic respiratory failure
High air flow rates to match inspiratory flow demand
Positive pressure breathing assistance for increased work of breathing
Lung protection through low TV /low inspiratory pressure ventilation strategy
Some patients may require extracorporeal membrane oxygenation (ECMO)
High-flow nasal oxygen and non-invasive ventilation are recommended in select patients
17
In patients who cannot maintain an
SpO₂ ≥90% with oxygen therapy
Coronavirus disease 2019 (COVID-19). (2020, April 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
18. Artificial Liver Support System (ALSS) & Blood Purification
• Can conduct plasma exchange, adsorption,
perfusion, and filtration of inflammatory mediators
such as endotoxins and harmful metabolic
substances
Diminish inflammatory
mediators and cytokine
cascade
• Can provide serum albumin, coagulation
factors, balance fluid volume, electrolytes
and acid-base ratio
Prevent the incidence of
shock, hypoxemia and
ARDS
Hypoxemia
Cytokine
cascade
Severe
infections
Shock
Tissue
perfusion
disorders
Multiple
organ
failure
18
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
19. ALSS Indications
IL6 level rises to ≥ 5 ULN or rising rate is ≥1x/ day
≥10% progression per day of involved area on pulmonary CT
19
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
20. Corticosteroids
For patients with
severe COVID-19
pneumonia
Not routinely
recommend for the
treatment of viral
pneumonia or
ARDS
High dose of
glucocorticoids
should be avoided
Inhibits cytokine
cascade & prevents
disease progression
20
Short-term use
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
21. Corticosteroids Indications
Severe and critically
ill stages
Persistent high fever
(above 39°c)
Patchy ground-glass
attenuation or ≥
30% of the lungs are
involved on CT scan
≥ 50% area involved
in pulmonary CT
images in 48 hours
IL-6 is above ≥ 5
ULN
(80 pg/mL)
21
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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22. Corticosteroids Dosing
Methylprednisolone
0.75-1.5 mg/kg IV
once daily
40 mg q12h for
patients with
•Falling body temperature
•Increasing cytokines
40-80 mg q12h can
be considered for
critical cases
Taper down
Decrease dose by
50% every 3 to 5
days
When body
temperature
normalizes
When involved
lesions on CT are
absorbed
Switch to oral
methylprednisolone
When the IV dose is
reduced to 20
mg/day
22
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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23. Special Considerations
Screening of TB,
HBV and HCV by
antibody assay should
be performed
PPI could be
considered
Blood glucose should
be monitored
Hypokalemia should
be corrected
Liver function should
be monitored closely
Sedative-hypnotics
can be administered
temporarily for
patients with sleep
disorder
23
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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24. Antivirals
Simultaneous use of three or more antiviral drugs is not
recommended
Treatment course is around 2 weeks
Antiviral drugs should be stopped if nucleic acid test results
remain negative for more than 3x
Oseltamivir
Lopinavir/ritonavir
Ganciclovir
Favipiravir (used in china)
Baloxavir marboxil
Umifenovir
Interferon alfa
Remdesivir
24
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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25. Basic regimen
Lopinavir/ Ritonavir
Lopinavir/ ritonavir (2 capsules, po q12h) combined with
arbidol (200 mg po q12h)
Abnormal liver function (51.9% ), diarrhea, N/V
,jaundice, dyslipidemia, lactic acidosis, Fat
redistribution, prolong the QT/PR interval, AV
block,Pancreatitis, hyperglycemia
Amiodarone (fatal arrhythmia), quetiapine (severe
coma), simvastatin (rhabdomyolysis) , hypokalemia,
QT/PR prolonging medications
Side effects:
• Increase of serum aminotransferase
• Bradycardia (avoid combination with beta blockers
• Stop taking the drugs when the HR drops below 60/min
25
Effective in 13.5
days
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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26. Moderate-Severe Covid19
Remdisivir
200 mg as a single dose on day 1
100 mg qd for a total duration of 5-10 days
Nausea, vomiting, and transaminase
elevations
Prepared in a cyclodextrin vehicle, so there is
concern for potentially toxic accumulation of
the vehicle in renal impairment
Avoid in pregnancy
26
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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Nucleotide Analogue
RNA Synthesis Inhibitor
27. Chloroquine and Hydroxychloroquine
Hydroxychloroquine: 800 mg on day 1 then 400 mg daily
Chloroquine 1 g on day 1 then 500 mg daily
Each for 4-7 days
The most severe : cardiac arrest
The main: ocular toxicity
Other: Dizziness, headache, N/V, diarrhea, skin rash
Pregnancy, Arrhythmia (e.g., conduction block), retinal
disease, or hearing loss, drugs that cause Q-T prolongation
(moxifloxacin, azithromycin, amiodarone)
In patients with severe illness, rapid viral RNA clearance
wasn’t seen when combined with azithromycin
27If the basic regimen is not effective
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28. If intolerant to basic regimin
Favipiravir
1600 mg followed by 600 mg tid
1,600 mg bid on day 1, followed by 600 mg bid for 7-14
days
• Increases uric acid, diarrhea, neutropenia, shock, fulminant hepatitis, AKI
• In elderly patients or patients with cytokine storm
• Theophyllinum increases the bioavailability of favipiravir
• It increases the bioavailability of acetaminophen & repaglinide
• Its combination with pyrazinamide increases uric acid
Contraindicated in pregnancy
28
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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RNA Polymerase
Inhibitor
29. Darunavir/Cobicistat
Initially used for HIV Mild adverse events
For patients who are
intolerant to
lopinavir/ritonavir
1 tablet daily
N/V, diarrhea, liver
abnormalities
jaundice,
dyslipidemia, lactic
acidosis
29
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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30. Tociluzumab
Rheumatoid arthritis, Cytokine release syndrome, Giant
cell arteritis, Juvenile arthritis
Secondary opportunistic infections, GI perforation,
neutropenia and thrombocytopenia (discontinue
treatment for ANC <500/mm3 or platelet count
<50,000/mm3), hepatic injury
4 to 8 mg/kg (400-800 mg/dose) as a single dose
Repeat dose in ≥12 hours in patients who remain febrile
in 24 hours
ANC is <2,000/mm3
Platelets are <100,000/mm3
ALT or AST are >1.5 times ULN
30
UpToDate. (n.d.). Retrieved from https://www.uptodate.com/contents/tocilizumab-drug-
information?search=tocilizumab&source=panel_search_result&selectedTitle=1~109&usage_type=panel&kp_tab=drug_general&display_rank=1#F9773961
Severe & Critical Cases
IL6 inhibitor
31. Convalescent Plasma
Function:
• Neutralize the pathogens
• Reduce the damage of the target organs
• Block the subsequent immune-pathological damages
Donors:
• At least 2 weeks after recovery and being discharged
• 18 ≤ Age ≤ 55
• The body weight>50 kg (for male) or >45 kg (for female)
• At least 1 week since last glucocorticoid usage
• >2 weeks since last blood donation
Indications:
• Severe or critically ill patients
• Immune suppressed
• Rapid disease progression in the lungs
31
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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Passive Immune Antibodies
32. Interferon Nebulization
Recommended in Protocols for Diagnosis and Treatment of
COVID-19
It should be performed in negative-pressure wards rather than
general wards due to the possibility of aerosol transmission
32
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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33. IVIG
Intravenous immunoglobulin is being trialed in some patients
with COVID-19
No data to support their use
33
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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34. Traditional Chinese Medicine
It is being trialled in some patients with COVID-19
Xue-Bi-Jing
ShuangHuang-Lian
Xin-Guan-2)
No data to support their use
34
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
35. Stem Cell Therapy
Stem cell therapy is being investigated to treat patients with
COVID-19 in clinical trials
It is thought that mesenchymal stem cells
Reduce the pathological changes that occur in the lungs
Inhibit the cell mediated immune inflammatory response
35
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
covid-19-preventionand-treatment%EF%BC%9Apart-two-diagnosis-and-treatment/
36. Angiotensin-II Receptor Antagonists
Angiotensin-converting enzyme-2 (ACE2) receptor is the main
binding site for the virus
Patients on ACE inhibitors or ARB have upregulated ACE2
receptors
No supported association of increased risk to Covid19
Stopping these agents exacerbates comorbid cardiovascular or
kidney disease and lead to increased mortality
36
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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37. Short Term Complications
ARDS
15% to 29% of patients
Acute cardiac injury
7% to 12% of patients
Arrhythmias
16% of patients
Secondary infection
10% of patients
Acute respiratory failure
8% of patients
Acute kidney injury
3% to 7% of patients
Septic shock
4% to 8% of patients
DIC
71% of non-survivors
Fetal distress
Premature labour
ARDS
Thrombo- cytopenia
Abnormall liver function
37
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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38. Antibiotics
Indications:
• Extensive lung lesions
• Excess bronchial secretions
• Chronic airway diseases
(copd,asthma)
• Glucocorticoids ≥ 20 mg × 7d
(in terms of prednisone)
• Critically severe patients,
especially those with invasive
mechanical ventilation
• Carbapenems, β-lactamase
inhibitor, linezolid and
vancomycin
Options:
• Quinolones
• Second or third generation
cephalosporin
• β-lactamase inhibitor
38
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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39. Secondary Bacterial Infection
More expectoration, darker sputum
color, especially yellow pus sputum
Rise of body temperature
Marked increase of WBC and/or
neutrophils
Procalcitonin ≥ 0.5 ng/mL
Exacerbation of oxygenation index or
circulatory disturbance
39
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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40. Pulmonary Asperigillosis
Causal Factors
• Viral infections
• Glucocorticoid
• Broad-spectrum
antibiotics
Tests
• D-Glucose (G-
test) and
galactomannan
(GM-test) of
blood or
bronchoalveolar
fluid
Fluconazole/
Echinocandin in
patients on
• Broad-spectrum
antibiotics for
>7days
• Parenteral
nutrition
• Invasive
examination or
treatment
• Positive candida
culture from two
body parts
• Positive G-test
Voriconazole/Posacona
zole/ Echinocandin in
patients
• Given
glucocorticoid for
>7 days
• With
agranulocytosis
• With COPD and
aspergillus
culture are tested
positive
• Patients with
positive GM-test
40
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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41. Anti-Coagulation and Bleeding Prevention
• In case of HIT, use
argatroban
• Monitor the activity of
antithrombin III
• If reduced activity, give
FFP to restore
sensitivity
• Bleeding
• Platelet count <
50×109/L
• No active
bleeding
• No visceral
bleeding
• Platelet >
50×109/L
Heparin
50 U/kg
Heparin
25 U/kg
The target
APTT is
40—60 sec
Heparin
resistance
41
Handbook of COVID-19 Preventionand Treatment:Part two diagnosis and treatment. (2020, March 30). Retrieved from https://events.mybiogate.com/covid-19/handbook-of-
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42. The covid-19 overall
case fatality rate
(CFR) is 2.3%
CFR of SARS is 10%
and MERS is 37%
COVID-19 has so far
resulted in more
deaths than both
SARS and MERS
combined
Conclusion
42
G D. (2020, March 20). New antibodies study may lead to a solution to the coronavirus outbreak. Retrieved from https://nationalinterest.org/blog/buzz/new-
antibodies-study-may-lead-solution-coronavirus-outbreak-134687