At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread globally, resulting in an ongoing pandemic. Coronaviruses can cause illnesses ranging from common cold to more severe respiratory diseases. This particular virus is designated SARS-CoV-2 and causes the disease COVID-19. Symptoms include fever, cough and shortness of breath. Diagnosis is made through PCR testing of respiratory samples. Treatment is supportive and includes oxygen supplementation. Several investigational agents are being studied but no proven treatments currently exist.
Coronaviruses are important human and animal pathogens. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, in the Hubei Province of China. It is rapidly spreading, resulting in an epidemic throughout china, followed by an increasing number of cases in other countries throughout the world. In February 2020, the WHO designated the disease COVID 19, which stands for corona viruses 2019. The virus that causes COVID 19 is designated severe acute respiratory syndrome coronavirus 2 SARS COV 2 previously, it was referred to as 2019 nCoV. Anushka Bharti | Dr. Gaurav Kumar Sharma | Dr. Kaushal Kishore Chandul "COVID-19" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd46439.pdf Paper URL : https://www.ijtsrd.com/pharmacy/pharmaceutics/46439/covid19/anushka-bharti
Corona viruses are a group of RNA viruses. In late December 2019, Patients with pneumonia with unknown etiology was get admitted in health care facilities in Wuhan, China, and resulted in a pandemic disease which affected more than 200 countries and responsible for 182,989 deaths world wide. The disease is officially named as Coronavirus Disease 2019 COVID 19, by WHO on February 11, 2020 . COVID 19 is a potential zoonotic disease with low to moderate estimated 2 -5 mortality rate. Currently, there is no definite treatment for COVID 19 although some trials are under investigation. Hence, appropriate use of PPE, regular hand hygiene, Respiratory and cough etiquettes, social distancing are some key elements to prevent the spread of disease. Ms. Pabalpreet Kaur | Ms. Eenu | Ms. Pooja Jaswal | Dr. (Mrs.) Jyoti Sarin "The Outbreak of COVID-19: An Overview" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30859.pdf Paper Url :https://www.ijtsrd.com/medicine/nursing/30859/the-outbreak-of-covid19-an-overview/ms-pabalpreet-kaur
This presentation showed the impact and the challenges of facing COVID-19 Pandemic and how the world becomes morbid, while the healthcare workforce tries to flatten the "curve".
Corona virus was first identified as a cause of the common cold in 1960. Until 2002, the virus was considered a relatively simple, nonfatal virus.Over the last three decades there have been three attacks of three different coronaviruses, SARS-CoV, MERS CoV and the recent one 2019 novel coronavirus (2019-nCoV).
corona is a pandemic disease in the world so many people are died because of this disease, it's not coming in a particular structure. it's having a different type of structure . how to prevent this disease maintain social distance, maintain hand hygiene, wear masks .nowady vaccines are available covishield ,covaxin, Pfizer, sputnik vaccine etc...this mainly helpful to prevent the corona
Coronaviruses are important human and animal pathogens. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, in the Hubei Province of China. It is rapidly spreading, resulting in an epidemic throughout china, followed by an increasing number of cases in other countries throughout the world. In February 2020, the WHO designated the disease COVID 19, which stands for corona viruses 2019. The virus that causes COVID 19 is designated severe acute respiratory syndrome coronavirus 2 SARS COV 2 previously, it was referred to as 2019 nCoV. Anushka Bharti | Dr. Gaurav Kumar Sharma | Dr. Kaushal Kishore Chandul "COVID-19" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd46439.pdf Paper URL : https://www.ijtsrd.com/pharmacy/pharmaceutics/46439/covid19/anushka-bharti
Corona viruses are a group of RNA viruses. In late December 2019, Patients with pneumonia with unknown etiology was get admitted in health care facilities in Wuhan, China, and resulted in a pandemic disease which affected more than 200 countries and responsible for 182,989 deaths world wide. The disease is officially named as Coronavirus Disease 2019 COVID 19, by WHO on February 11, 2020 . COVID 19 is a potential zoonotic disease with low to moderate estimated 2 -5 mortality rate. Currently, there is no definite treatment for COVID 19 although some trials are under investigation. Hence, appropriate use of PPE, regular hand hygiene, Respiratory and cough etiquettes, social distancing are some key elements to prevent the spread of disease. Ms. Pabalpreet Kaur | Ms. Eenu | Ms. Pooja Jaswal | Dr. (Mrs.) Jyoti Sarin "The Outbreak of COVID-19: An Overview" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30859.pdf Paper Url :https://www.ijtsrd.com/medicine/nursing/30859/the-outbreak-of-covid19-an-overview/ms-pabalpreet-kaur
This presentation showed the impact and the challenges of facing COVID-19 Pandemic and how the world becomes morbid, while the healthcare workforce tries to flatten the "curve".
Corona virus was first identified as a cause of the common cold in 1960. Until 2002, the virus was considered a relatively simple, nonfatal virus.Over the last three decades there have been three attacks of three different coronaviruses, SARS-CoV, MERS CoV and the recent one 2019 novel coronavirus (2019-nCoV).
corona is a pandemic disease in the world so many people are died because of this disease, it's not coming in a particular structure. it's having a different type of structure . how to prevent this disease maintain social distance, maintain hand hygiene, wear masks .nowady vaccines are available covishield ,covaxin, Pfizer, sputnik vaccine etc...this mainly helpful to prevent the corona
The whole world is under the threatens of respiratory disease caused by infections of coronavirus. The latest threat to global health is the ongoing outbreak of the respiratory disease that was recently given the name Coronavirus Disease This article trying to focus on the current outbreak of and explores the epidemiology, causes, clinical manifestation and diagnosis, and prevention and control of the novel coronavirus. The aim of this article to provide valid and reliable information and increasing awareness about the COVID 19. Sameer Pawar | Sayali Budhwant | Ketan Shinde | Ashwini Sable "COVID-19: A Scoping Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-3 , April 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30567.pdf Paper Url :https://www.ijtsrd.com/pharmacy/other/30567/covid19-a-scoping-review/sameer-pawar
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health ...semualkaira
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
a quick review of the articles issued by WHO, CDC and other medical experts...
>>>
on its epidemiology, etiology, clinical manifestations, diagnosis, management and prevention.
Coronavirus Disease-19 and Reinfections: A Review of Casesasclepiuspdfs
Since first surfacing in Wuhan, China, in December 2019, the novel coronavirus disease-2019 (COVID-19) has led to a global pandemic with confirmed cases and death bells tolling in the millions with new cases still emerging daily. Despite sharing genetic similarities to the severe acute respiratory syndrome (SARS) virus, the specific viral proteins found on the novel SARS coronavirus 2 and its structure seems to make this strain much more elusive and destructive. Based on peer-reviewed cases, there seems to be an increase in patient reinfection, but due to current testing and treatment limitations, it is yet to be determined if the new trend of reinfection is due to a persistent COVID-19 infection that involves a latent period, a recurrent infection due to the same strain of COVID-19, or a mutated strain of COVID-19. The purpose of this study is to discuss the recent reports of the development of reinfection in previously confirmed COVID-19 cases in an attempt to gain a further understanding of the mechanisms of virulence, the effects on the human immune system, and how current testing and treatment modalities are faring. While the virus seems to have a penchant for patients with existing comorbidities, newer data indicate that everyone may be susceptible to possible infection and that not all patients will present with typical respiratory symptoms, making it imperative to examine established cases of reinfection in an attempt to further help with developing drugs for treatment, vaccines, and protocols for prevention.
The whole world is under the threatens of respiratory disease caused by infections of coronavirus. The latest threat to global health is the ongoing outbreak of the respiratory disease that was recently given the name Coronavirus Disease This article trying to focus on the current outbreak of and explores the epidemiology, causes, clinical manifestation and diagnosis, and prevention and control of the novel coronavirus. The aim of this article to provide valid and reliable information and increasing awareness about the COVID 19. Sameer Pawar | Sayali Budhwant | Ketan Shinde | Ashwini Sable "COVID-19: A Scoping Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-3 , April 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30567.pdf Paper Url :https://www.ijtsrd.com/pharmacy/other/30567/covid19-a-scoping-review/sameer-pawar
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health ...semualkaira
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
a quick review of the articles issued by WHO, CDC and other medical experts...
>>>
on its epidemiology, etiology, clinical manifestations, diagnosis, management and prevention.
Coronavirus Disease-19 and Reinfections: A Review of Casesasclepiuspdfs
Since first surfacing in Wuhan, China, in December 2019, the novel coronavirus disease-2019 (COVID-19) has led to a global pandemic with confirmed cases and death bells tolling in the millions with new cases still emerging daily. Despite sharing genetic similarities to the severe acute respiratory syndrome (SARS) virus, the specific viral proteins found on the novel SARS coronavirus 2 and its structure seems to make this strain much more elusive and destructive. Based on peer-reviewed cases, there seems to be an increase in patient reinfection, but due to current testing and treatment limitations, it is yet to be determined if the new trend of reinfection is due to a persistent COVID-19 infection that involves a latent period, a recurrent infection due to the same strain of COVID-19, or a mutated strain of COVID-19. The purpose of this study is to discuss the recent reports of the development of reinfection in previously confirmed COVID-19 cases in an attempt to gain a further understanding of the mechanisms of virulence, the effects on the human immune system, and how current testing and treatment modalities are faring. While the virus seems to have a penchant for patients with existing comorbidities, newer data indicate that everyone may be susceptible to possible infection and that not all patients will present with typical respiratory symptoms, making it imperative to examine established cases of reinfection in an attempt to further help with developing drugs for treatment, vaccines, and protocols for prevention.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
- 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
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Coronaviruses are important human and animal pathogens that can cause
diseases ranging from the common cold to more severe and even fetal
respiratory infections.
At the end of 2019, a novel coronavirus was identified as the cause of a
cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China.
It rapidly spread, resulting in an epidemic throughout China, followed by an
increasing number of cases in other countries throughout the world.
3. Evidence indicates that substantial similarities exits between severe acute
respiratory syndrome and covid-19.A recent study reported a 79.5%
genome sequence identity between SARS-cov-2 and SARS COV-1.
6. In February 2020, the World Health Organization designated the disease
COVID-19, which stands for coronavirus disease 2019 . The virus that
causes COVID-19 is designated severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2); previously, it was referred to as 2019-nCoV.
7. EPIDEMIOLOGY
Geographic distribution — Since the first reports of cases from Wuhan, a
city in the Hubei Province of China, at the end of 2019, more than 80,000
COVID-19 cases have been reported in China.
Increasing numbers of cases have also been reported in other countries
across all continents except Antarctica, and the rate of new cases outside
of China has outpaced the rate in China.
These cases initially occurred mainly among travelers from China and
those who have had contact with travelers from China . However,
ongoing local transmission has driven smaller outbreaks in some
locations outside of China, including South Korea, Italy, Iran, and Japan,
and infections elsewhere have been identified in travelers from those
countries .
8. Transmission
Person-to-person spread of severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) is thought to occur mainly via respiratory
droplets, resembling the spread of influenza.
9. With droplet transmission, virus released in the respiratory secretions when
a person with infection coughs, sneezes, or talks can infect another person
if it makes direct contact with the mucous membranes; infection can also
occur if a person touches an infected surface and then touches his or her
eyes, nose, or mouth.
Droplets typically do not travel more than six feet (about two meters) and
do not linger in the air
10. Viral RNA levels appear to be higher soon after symptom onset compared
with later in the illness [15]; this raises the possibility that transmission
might be more likely in the earlier stage of infection, but additional data
are needed to confirm this hypothesis.
11. VIROLOGY
Full-genome sequencing and phylogenic analysis indicated that the
coronavirus that causes COVID-19 is a betacoronavirus in the same
subgenus as the severe acute respiratory syndrome (SARS) virus (as well as
several bat coronaviruses).
Positive sense,single strandard RNA virus
12. The structure of the receptor-binding gene region is very similar to that of
the SARS coronavirus, and the virus has been shown to use the same
receptor, the angiotensin-converting enzyme 2 (ACE2), for cell entry .
The Coronavirus Study Group of the International Committee on
Taxonomy of Viruses has proposed that this virus be designated severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
13. Spectrum of illness severity
In a study describing 138 patients with COVID-19 pneumonia in Wuhan
Mild (no or mild pneumonia) was reported in 81 percent.
Severe disease (eg, with dyspnea, hypoxia, or >50 percent lung
involvement on imaging within 24 to 48 hours) was reported in 14
percent.
Critical disease (eg, with respiratory failure, shock, or multiorgan
dysfunction) was reported in 5 percent.
The overall case fatality rate was 2.3 percent; no deaths were reported
among noncritical cases.
14. Impact of Age
In several cohorts of hospitalized patients with confirmed COVID-19, the
median age ranged from 49 to 56 years .
In a report from the Chinese Center for Disease Control and Prevention
that included approximately 44,500 confirmed infections, 87 percent of
patients were between 30 and 79 years old .
Older age was also associated with increased mortality, with a case fatality
rate of 8 and 15 percent among those aged 70 to 79 years and 80 years or
older, respectively.
15. Clinical manifestations
Initial presentation — Pneumonia appears to be the most frequent
serious manifestation of infection, characterized primarily by fever, cough,
dyspnea, and bilateral infiltrates on chest imaging . There are no specific
clinical features that can yet reliably distinguish COVID-19 from other viral
respiratory infections.
16. In a study describing 138 patients with COVID-19 pneumonia in Wuhan, the
most common clinical features at the onset of illness were
Fever in 99 percent
Fatigue in 70 percent
Dry cough in 59 percent
Anorexia in 40 percent
Myalgias in 35 percent
Dyspnea in 31 percent
17. Other, less common symptoms have included headache, sore throat,
anosmia and rhinorrhea. In addition to respiratory symptoms,
gastrointestinal symptoms (eg, nausea and diarrhea) have also been
reported in some patients, but these are relatively uncommon.
18.
19. Acute respiratory distress syndrome (ARDS) is a major complication in
patients with severe disease.
In the study of 138 patients described above, ARDS developed in 20
percent after a median of eight days, and mechanical ventilation was
implemented in 12.3 percent .
In another study of 201 hospitalized patients with COVID-19 in Wuhan, 41
percent developed ARDS; age greater than 65 years, diabetes mellitus, and
hypertension were each associated with ARDS .
Other complications have included arrhythmias, acute cardiac injury, and
shock. In one study, these were reported in 17, 7, and 9 percent,
respectively .
20. Laboratory findings
In patients with COVID-19, the white blood cell count can vary.
Leukopenia, leukocytosis, and lymphopenia have been reported,
although lymphopenia appears most common .
Elevated lactate dehydrogenase and ferritin levels are common, and
elevated aminotransferase levels have also been described.
High D-dimer levels and more severe lymphopenia have been associated
with mortality
21. Imaging findings
Chest CT in patients with COVID-19 most commonly demonstrates
ground-glass opacification with or without consolidative abnormalities,
consistent with viral pneumonia .
Case series have suggested that chest CT abnormalities are more likely
to be bilateral, have a peripheral distribution, and involve the lower lobes.
Less common findings include pleural thickening, pleural effusion, and
lymphadenopathy
22. 79-year-old woman who presented with fever, dry cough, and chest pain for 3 days. Her husband and daughter-in-law
had been recently diagnosed with coronavirus disease 2019 (COVID-19). Patient expired 11 days after admission
(Courtesy of Song F, Shanghai Public Health Clinical Center, Shanghai, China)
A, Axial (A) and coronal (B) CT images show multiple patchy, peripheral, bilateral areas of ground-glass opacity.
23. 79-year-old woman who presented with fever, dry cough, and chest pain for 3
days. Her husband and daughter-in-law had been recently diagnosed with
coronavirus disease 2019 (COVID-19). Patient expired 11 days after admission
(Courtesy of Song F, Shanghai Public Health Clinical Center, Shanghai, China)
B, Axial (A) and coronal (B) CT images show multiple patchy, peripheral, bilateral
24. 47-year-old Chinese man with 2-day history of fever, chills, productive cough, sneezing, and fatigue who presented to
emergency department. (Courtesy of Liu M, China-Japan Friendship Hospital, Beijing, China)
A, Initial CT images obtained show small round areas of mixed ground-glass opacity and consolidation (rectangles) at
at level of aortic arch (A) and ventricles (B) in right and left lower lobe posterior zones.
25.
26. EVALUATION AND DIAGNOSIS
At present, the possibility of COVID-19 should be considered primarily in
patients with fever and/or respiratory tract symptoms (eg, cough,
dyspnea) who have had any of the following in the prior 14 days:
27. Close contact with a confirmed or suspected case of COVID-19, including
through work in health care settings. Close contact includes being within
approximately six feet (about two meters) of a patient for a prolonged
period of time while not wearing personal protective equipment or having
direct contact with infectious secretions while not wearing personal
protective equipment.
28. Residence in or travel to areas where widespread community transmission
has been reported (eg, China, South Korea, most of Europe [including
Italy], Iran, Japan).
●Potential exposure through attendance at events or spending time in
specific settings where COVID-19 cases have been reported
29. In the United States, the CDC recommends collection of a nasopharyngeal
swab specimen to test for SARS-CoV-2 [64]. An oropharyngeal swab can
be collected but is not essential; if collected, it should be placed in the
same container as the nasopharyngeal specimen. Sputum should only be
collected from patients with productive cough; induction of sputum is not
indicated.
30. SARS-CoV-2 RNA is detected by reverse-transcription polymerase chain
reaction (RT-PCR).
A positive test for SARS-CoV-2 confirms the diagnosis of COVID-19. If
initial testing is negative but the suspicion for COVID-19 remains, the WHO
recommends resampling and testing from multiple respiratory tract sites .
The accuracy and predictive values of SARS-CoV-2 testing have not been
systematically evaluated. Negative RT-PCR tests on oropharyngeal swabs
despite CT findings suggestive of viral pneumonia have been reported in
some patients who ultimately tested positive for SARS-CoV-2
33. MANAGEMENT
Site of care
Home care — Home management is appropriate for patients with mild
infection who can be adequately isolated in the outpatient setting .
Management of such patients should focus on prevention of
transmission to others and monitoring for clinical deterioration, which
should prompt hospitalization.
34. Hospital care — Some patients with suspected or documented COVID-19
have severe disease that warrants hospital care. Patients with severe
disease often need oxygenation support. High-flow oxygen and
noninvasive positive pressure ventilation have been used, but the safety
these measures is uncertain, and they should be considered aerosol-
generating procedures that warrant specific isolation precautions.
Some patients may develop acute respiratory distress syndrome and
warrant intubation with mechanical ventilation; extracorporeal membrane
oxygenation may be indicated in patients with refractory hypoxia
35. Supportive therapy
Vitals signs and oxygen saturation should be monited regularly,supportive
treatment strengthened , sufficient calories provided, and the stability of
the internal environment,such as water ,electrolyte and acid-base balance
maintained.The intake and output volumes should be strictly balanced.
36. Limited role of glucocorticoids
The WHO and CDC recommend glucocorticoids not be used in patients
with COVID-19 pneumonia unless there are other indications (eg,
exacerbation of chronic obstructive pulmonary disease) .
Glucocorticoids have been associated with an increased risk for mortality
in patients with influenza and delayed viral clearance in patients with
Middle East respiratory syndrome coronavirus (MERS-CoV) infection.
Although they were widely used in management of severe acute
respiratory syndrome (SARS), there was no good evidence for benefit,
and there was persuasive evidence of adverse short- and long-term harm
38. Remdesivir – Several randomized trials are underway to evaluate the
efficacy of remdesivir for moderate or severe COVID-19 .
Remdesivir is a novel nucleotide analogue that has activity against severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and
related coronaviruses (including SARS and MERS-CoV) both in vitro and in
animal studies
Any clinical impact of remdesivir on COVID-19 remains unknown.
39. Compassionate Use of Remdesivir for
Patients with Severe Covid-19
In this cohort of 61 patients hospitalized for severe Covid-19 who were
treated with compassionate-use remdesivir, clinical improvement was
observed in 36 of 53 patients (68%). Measurement of efficacy will require
ongoing randomized, placebo-controlled trials of remdesivir therapy.
(Funded by Gilead Sciences.)
40. Chloroquine/hydroxychloroquine – Both chloroquine and
hydroxychloroquine inhibit SARS-CoV-2 in vitro, although
hydroxychloroquine appears to have more potent antiviral activity [78]. A
number of clinical trials are underway in China to evaluate the use of
chloroquine or hydroxychloroquine for COVID-19
41. Lopinavir-ritonavir – This combined protease inhibitor, which has primarily
been used for HIV infection, has in vitro activity against the SARS-CoV and
appears to have some activity against MERS-CoV in animal studies . The
use of this agent for treatment of COVID-19 has been described in case
reports , but its efficacy is unclear. In one report of five patients who were
treated with lopinavir-ritonavir, three improved and two had clinical
deterioration; four had gastrointestinal side effects. It is being evaluated in
larger randomized trials.
42. A Trial of Lopinavir–Ritonavir in Adults
Hospitalized with Severe Covid-19
In hospitalized adult patients with severe Covid-19, no benefit was
observed with lopinavir–ritonavir treatment beyond standard care. Future
trials in patients with severe illness may help to confirm or exclude the
possibility of a treatment benefit
43. Tocilizumab – Treatment guidelines from China's National Health
Commission include the IL-6 inhibitor tocilizumab for patients with severe
COVID-19 and elevated IL-6 levels; the agent is being evaluated in a
clinical trial
46. Coronavirus in Singapore,Hong kong and Japan Lessons
from highly functioning health system
Rapid adaptation of surveillance system; rapid test
Selective use of travel restriction
Early effective inter-governmentalcordination
Shifted costs of treatment to government
Develped lans for sustaining health care system
Actively managed supply chain
Emphasized infection prevention and protection HCW.
47. Preventing exposure in the
community —
The following general measures are recommended to reduce
transmission of infection:
Diligent hand washing, particularly after touching surfaces in public. Use
of hand sanitizer that contains at least 60 percent alcohol is a reasonable
alternative if the hands are not visibly dirty.
Respiratory hygiene (eg, covering the cough or sneeze).
48. ●Avoiding touching the face (in particular eyes, nose, and mouth).
●Avoiding crowds (particularly in poorly ventilated spaces) if possible and
avoiding close contact with ill individuals.
●Cleaning and disinfecting objects and surfaces that are frequently
touched.
49. REFERENCES
Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, Chi
. Information for Healthcare Professionals. https://www.cdc.gov/coronavirus/2019
nCoV/hcp/index.html (Accessed on February 14, 2020).
World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance.
tps://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guida
nce (Accessed on February 14, 2020).
Gorbalenya AE, Baker SC, Baric RS, et al. Severe acute respiratory syndrome-relat
coronavirus: The species and its viruses – a statement of the Coronavirus Study G
oup. bioRxiv 2020. https://www.biorxiv.org/content/10.1101/2020.02.07.937862v1 (
Accessed on February 12, 2020).
Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with
Pneumonia in China, 2019. N Engl J Med 2020; 382:727.
Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019
coronavirus: implications for virus origins and receptor binding. Lancet 2020;
395:565.
ACE Inhibitors and ARBs During the COVID-19 Pandemic
Convalescent plasma as a potential therapy for COVID-19
Long Chen,Jing Xiong,Lei Bao,Yuan Shi