Concluded Case

CLINICALLY CONFIRMED CASE OF COVID 19

61yrs/M patient with past medical history of T2DM on Glimipride + Metformin presented to emergency department for evaluation of a 7 day history of fever, cough and shortness of breath.Clinically suspected Covid 19 but his COVID RT PCR test was negative,on Bipap support.SUGGESTION PLEASE?? Chief Complaints Fever,Cough,SOB Vitals BP - 130/80,RR -32,Spo2 - 81% on room air and 94% on o2 support,Temp - 99 Physical Examination Chest - B/l Crepts present,No cyanosis and clubbing,Normal JVP Investigations TLC -12000,LFT and KFT normal,D Dimer -1200,LDH -600,S.ferritin -320,CRP -150,HbA1C -11

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Concluded answer

Definitive positive case of covid19 and treat as positive repeat RTPCR should also be done because first test can be false negative but treatment should be started immediately as positive pt adv 1, maintain oxygen saturation by NIV 2maintain hydration 3,ing remdesevir 200mg stat in 100ml bd in 30 minutes then 100 mg od for four days 4 ing enoxaparim LMWH .4 mg bd sc 5 ing dexona 8 mg tds iv 6 tab ivermectin 12 mg 1 od for three days 7 tab vit c, Becomplex ,zinc 8 ing tocilizumab 8mg per kg body wt if cytokine Strom symtoms develops

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Definitive positive case of covid19 and treat as positive repeat RTPCR should also be done because first test can be false negative but treatment should be started immediately as positive pt adv 1, maintain oxygen saturation by NIV 2maintain hydration 3,ing remdesevir 200mg stat in 100ml bd in 30 minutes then 100 mg od for four days 4 ing enoxaparim LMWH .4 mg bd sc 5 ing dexona 8 mg tds iv 6 tab ivermectin 12 mg 1 od for three days 7 tab vit c, Becomplex ,zinc 8 ing tocilizumab 8mg per kg body wt if cytokine Strom symtoms develops

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RT PCR result can be false negative.. Continuous Bipap support as soon as possible.. Poor Prognosis.. It is pure indication to start Inj.Remdesivir(200mg) Iv Stat & Inj.Remdesivir(100mg) Iv Od.. Send G6pd,if normal then give Inj.Methylene Blue(1amp)+Ns(100) iv stat.. Send IL-6 and PCT,Respective of result give Inj.Tocilizumab(600mg)+Ns(100) Iv stat..

Valuable opinion
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Classical pattern of COVID seen... RT PCR is negative ... is unusual for this patient... need to follow COVID guideline and can use Ramdesivir or Favipiravir in such cases ... Any way same case was observed by me also... recently. Twice RT PCR negative...

More than 50 % of Bilateral pulmonary parenchyma is involved with viral pneumonia with Crazy Pavement pattern typical of COVID-19 disease. As patient is already on BIPAP support Add Inj Remdesivir Inj Dexamethasone LMWH . Supportive care .

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Crazy paving pattern seen in bil lung fields. Findings sugg of covid pneumonia. Early and aggressive treatment will be required.

This x ray of chest indicates with A.c.. LVF with B/L crests with spo2 81% & go for ABG test

On which day RT PCR was done? Do RT PCR once again. May it other disease?

Diffuse Bilateral consolidations

Repeat RT PCR Treat as COVID 19

Ars alb 30 4pills tds ×3days