COVID-19 Trends of the day

The Toughest Triage — Allocating Ventilators in a Pandemic The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale. Of all the medical care that will have to be rationed, the most problematic will be mechanical ventilation. Several countries, but not the United States, have already experienced a shortage of ventilators. Although shortages of other goods and services may lead to deaths, in most cases it will be the combined effects of a variety of shortages that will result in worse outcomes. Mechanical ventilation is different. When patients’ breathing deteriorates to the point that they need a ventilator, there is typically only a limited window during which they can be saved. And when the machine is withdrawn from patients who are fully ventilator-dependent, they will usually die within minutes. Anticipating the need to allocate ventilators to the patients who are most likely to benefit, clinicians should proactively engage in discussions with patients and families regarding do-not-intubate orders for high-risk subgroups of patients before their health deteriorates. Once patients have already been placed on mechanical ventilation, decisions to withdraw it are especially fraught. In the weeks ahead, physicians in the United States may be asked to make decisions that they have never before had to face, and for which many of them will not be prepared. Though some people may denounce triage committees as “death panels,” in fact they would be just the opposite — their goal would be to save the most lives possible in a time of unprecedented crisis. To read more- https://www.nejm.org/doi/full/10.1056/NEJMp2005689?query=featured_home Source-The New England Journal Of Medicine Authors- Robert D. Truog, M.D., Christine Mitchell, R.N., and George Q. Daley, M.D., Ph.D. Do Such situation may arise in India in the Near Future? Share your views Doctors.

x-ray chest of first case of Corona virus pneumonia patient aged 61 years male who died during treatment in WUHAN city of China.

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women Background Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. Methods Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. Findings All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. Interpretation The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. To read more- https://www.sciencedirect.com/science/article/pii/S0140673620303603 Source-sciencedirect

Patient came with c/o left eye pain Civid positive 15day back *Chief Complaints* L.E.pain *History* Covid positive 15day back Treated under intensive care(steroids) Hypertensive under rx Non diabetic *Vitals* Shortness of breath Rest WNL *Physical Examination* Wheel chair assisted Left eye - Periorbital swelling Black brown discoloration of periorbital skin Mild proptosis Restricted ocular movement. Ant.seg- Chemosis Cornea-clear Iris/pupil-n/RRTL A.C.-quite Post.seg- Retina ON CDR-0.3 Vitreous-n *Investigations* BP-140/100 BSL(R)-170mg/dl. MRI(BRAIN AND ORBIT) SHOWS:- -B/L Ethmoide,frontal and maxillary sinusitis - no hemorrhage. -left preseptal orbital swelling. -suggestive of agressive fungal sinusitis with left intraorbital extension. *Diagnosis* Mucormycosis...??? *Management* Pls suggest further prognosis and manegement.

27 yr old male,covid antigen positive 2 days back C/o cough running nose Spo2 98 room air No other comorbidities Ur comment on CT thorax and case pls!!!