Concluded Case

COVID-19- VIRAL Pneumonia- A casual attitude by People?

46 years old female with history of fever since 7 days S.O.B - 5 days - Being treated at home by on - line consultation- but not thinking the seriousness of the condition- continues,to get treated at home Investigations were startling with X - ray chest and HRCT indicative of COVID-19 viral pneumonia with CORADS- score 5 Now - I have asked her to get immediately shifted to hospital- otherwise patient may not be lost

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Concluded answer

I say that this patient is at high risk because of few parameters 1. Absolute neutrophils to lymphocyte ratio is 15 , which is very high.. So she got effected severely. Moreover there might be secondary bacterial infection burden. So she needs REMEDISVIR 5days course Day1 200mg , day2-4 :100mg. And definitely needs broad-spectrum antibiotics to prevent going into sepsis. 2. Raised LFT: this might be a hindrance for remedisvir , but the values are not raised more than 5times the normal . Therefore no active intervention needed for LFT. So weighing risk and benefit, we can give antiviral as creatinine is in normal range. 3.crp is good. Check out d-dimer also. So as to plan for anticoagulant therapy 4.give t.ivermectin 12mg od for 5days Add zinc , vitamin C , vitamin D 5. Monitor saturations . 6.give importance to pulse rate also. If saturation is normal but heart rate is increasing , it may indicate hypoxemia at earliest stage. So that we can be more alert.

All Answers

I say that this patient is at high risk because of few parameters 1. Absolute neutrophils to lymphocyte ratio is 15 , which is very high.. So she got effected severely. Moreover there might be secondary bacterial infection burden. So she needs REMEDISVIR 5days course Day1 200mg , day2-4 :100mg. And definitely needs broad-spectrum antibiotics to prevent going into sepsis. 2. Raised LFT: this might be a hindrance for remedisvir , but the values are not raised more than 5times the normal . Therefore no active intervention needed for LFT. So weighing risk and benefit, we can give antiviral as creatinine is in normal range. 3.crp is good. Check out d-dimer also. So as to plan for anticoagulant therapy 4.give t.ivermectin 12mg od for 5days Add zinc , vitamin C , vitamin D 5. Monitor saturations . 6.give importance to pulse rate also. If saturation is normal but heart rate is increasing , it may indicate hypoxemia at earliest stage. So that we can be more alert.

Valuable opinion
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Rt PCR clia cp score less then 24 will spread disease 5 minutes walking test spo2 drop by 5 then usal reading is candidate for additional Corads score5 poor Admit Oxygen Antibiotics doxy azithro Antiviral ivermectol ranivir Steriod 6 mg dexa Lmwh bd If il6 ddimer high cytomic strom Cytolizubab injection 3 days

Valuable opinion
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The patient may be positive covid19, however her sob level is improving to 95%,she should get monitored and do the covid19 test

Thank you Dr Ashok Leel sir
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Bryonia alb