Smoking habit and hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)- related pneumonia: The unsolved paradox behind the evidence.

THE COVID-19 SYMPTOMS WE DID NOT KNOW ABOUT As the pandemic spreads around the world, doctors are beginning to scope the coronavirus’s damage. Seen initially as a cause of viral pneumonia during the chaos of an explosion of cases in China, it’s now emerging as an enigmatic pathogen capable of harming the body in a myriad of unexpected, and sometimes lethal, ways. Clinical manifestations range from common cold-like symptoms and bronchitis to more severe disease such as pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. The illness may occur as a direct result of viral infection, as well as the body’s response to it. Here’s a snapshot of some of the symptoms Covid-19 causes, including some you might not have heard about. Blood Fever and inflammation may disrupt blood vessels, rendering blood cells more prone to clumping while interfering with the body’s ability to dissolve clots. That may trigger a clotting cascade that can lead to blood-vessel blockages in tissues and organs throughout the body. Life-threatening clots in the arteries of the lung, known as pulmonary emboli, may occur even after symptoms of the infection have resolved. Damaged blood vessels may become leaky and prone to bleeding. In children, inflammation of veins and arteries triggered by excessive immune activation may cause an illness similar to Kawasaki disease, an inflammatory disorder. Brain Dysfunction in the lining of blood vessels and associated bleeding and clotting disorders may cause strokes and bleeding in the brain. Patients may also experience headache, dizziness, confusion, impaired consciousness, poor motor control, delirium and hallucinations. Eyes Red, puffy eyes, sometimes referred to as pink eye, may result from infection in the conjunctiva, the tissue that lines the inside of the eyelids and covers the white part of the eye. Gastrointestinal tract Infection of cells lining the digestive tract may cause diarrhea, nausea, vomiting and abdominal pain. Blood-vessel blockages caused by abnormal clotting have been found to damage the bowel, requiring emergency surgery and resection. Hands Prickling or burning sensation in the hands and limbs may indicate Guillain-Barré syndrome, a rare nervous-system disorder that may be triggered by aberrant immune responses to viral infection. Other symptoms of the syndrome include poor coordination, muscle weakness and temporary paralysis. Heart Cardiac injury, sometimes leading to irregular heartbeat, heart failure, and cardiac arrest, may occur as a result of excess strain, inflammation of the heart muscle and coronary artery, blood clots, and overwhelming multi-organ illness. Infection, fever, and inflammation in people with existing heart-vessel blockages may cause their fatty plaques to break off, blocking or stopping blood flow in organs and tissues. Limbs Obstructions in large blood vessels may cause insufficient flow, or acute ischemia, in the limbs. Severe vascular complications can be lethal. At least one reported cases resulted in lower limb amputation. Liver Liver dysfunction may occur as a direct result of the viral infection, or more likely because of immune-mediated, systemic inflammation and circulatory blockages cutting blood flow to the organ. Lungs The virus targets the epithelial cells that line and protect the respiratory tract as well as the walls of the tiny grape-like air sacs, or alveoli, through which gas exchange occurs to oxygenate the blood. Damage to alveoli and inflammation in the lungs can cause pneumonia, characterized by chest pain and shortness of breath. In severe cases, the lack of oxygen can trigger acute respiratory distress syndrome, leading to multi-organ-system failure. Kidneys Acute kidney injury may result from clots and impaired blood supply, or as a direct result of infection. Nose and tongue While the virus can cause the sneezing and runny nose typical of a common cold, it can also disrupt the olfactory system, causing an abrupt full or partial loss of the sense of smell known as anosmia. Taste may also become distorted in a condition known as dyguesia. Skin Hive-like rashes, small red dots and purplish discolorations on the legs and abdomen are part of a complex category of so-called paraviral dermatoses that may result from the body’s immune response to the virus or from benign, superficial blood-vessel damage beneath the skin. Toes Purple rashes that resemble chickenpox, measles or chilblains may appear on the feet, especially of children and younger adults.

A 60-year-old male presented with cough and dyspnea. He is a known Sarcoidosis patient. He is on cortisol treatment for 6 months. New Chest CT shows multiple mediastinal lymph nodes, interstitial sarcoidosis findings, and Pleural thickening. Newly presented Chest CT is almost same. Additionally bilateral ground-glass densities. The question: Is it alveolar Sarcoidosis or COVID 19?

People with asthma and other lung diseases are at increased risk for serious complications from COVID-19, caution experts from the American Lung Association. "Everyone's health is at risk from COVID-19, and those living with a lung disease or who are immunocompromised may be more vulnerable to the impacts of the virus," said Dr. Albert Rizzo, the association's chief medical officer. COVID-19 can cause a pneumonia-like lung infection, with a range of symptoms from mild or absent in some to life-threatening in others, he said. It's crucial for people with chronic lung diseases such as asthma or chronic obstructive pulmonary disease (COPD) to keep taking their maintenance medications and tell their health care provider about any symptoms or changes in their health, Rizzo said. All lung disease patients -- including those with lung cancer who may have a weakened immune system -- need to take steps avoid contact with the coronavirus. Besides social distancing, measures include thorough hand-washing; not touching face, nose, mouth and eyes; and avoiding contact with people who may have been infected. "The healthcare system and hospitals are already stressed with admissions as a result of the pandemic," Rizzo said. "It's important for those with lung disease to use their best practices in managing their disease." People who smoke or vape are also at increased risk of serious COVID-19 complications. "Cigarette smoking and vaping are linked to lung inflammation and lowered immune function in the lung's airways, both of which can increase likelihood of complications if exposed to COVID-19," he said. "Therefore, long-term smokers and e-cigarette users may have a higher risk of developing chronic lung conditions associated with severe cases." Source- https://www.drugs.com/news/asthma-copd-raise-odds-severe-covid-19-lung-experts-warn-89379.html

On March 11th, 2020 the World Health Organization declared COVID-19 a global pandemic. The infection, transmitted by 2019 novel coronavirus (2019-nCov), was first discovered in December 2019, in Wuhan, Hubei Province, and then rapidly spread worldwide. Italy was early and severely involved, with a critical spread of the infection and a very high number of victims. Person-to-person spread mainly occurs via respiratory droplets and contact. The median incubation period is 5 days. The spectrum of respiratory symptoms may range from mild to severe, strictly depending on the age of the patient and the underlying comorbidities. In children COVID-19 related disease is less frequent and less aggressive. In Italy 1% of positive cases are under 18 years of age, and no deaths have been recorded before 29 years of age. For patients affected by rheumatic disease, despite the concerns related to the imbalance of their immune response and the effect of immunosuppressive treatments, there are still few data to understand the real consequences of this infection. Major scientific societies have issued recommendations to help rheumatologists in caring their patients. Interestingly, some of the drugs mostly used by rheumatologists appear to be promising in critical COVID-19 infected patients, where the hyperinflammation and cytokine storm seem to drive to the multiorgan failure. Pediatric rheumatologists are expected to play a supporting role in this new front of COVID-19 pandemic, both as general pediatricians treating infected children, and as rheumatologists taking care of their rheumatic patients, as well as offering their experience in the possible alternative use of immunomodulatory drugs. The COVID-19 epidemic is now a pandemic and may affect millions of people worldwide. For the time being, children seem to be spared, at least from the more severe consequences of this infection. All physicians dealing with patients with chronic diseases, in particular immunosuppressed subjects, should be aware of the possible risks linked to the drugs used to treat rheumatologic disorders. However, there now hints that some of these drugs might be beneficial to fight COVID-19 infection. Use of social isolation and hygienic measure are fundamental in order to decrease viral spread. To read more- https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-020-00422-z

This is an x-ray chest PA view from a 26-year-old boy who presented with a left scrotal swelling for 6 months and low grade fever for 2 months. On examination, built and nourishment is below average, afebrile. No lymphadenopathy, clubbing. Mild pallor present. A swelling of size 2 X 3 cm is found in left scrotum arising from left spermatic cord, non tender with no local rise of temperature. Rest of the systems WNL. The case is open for discussion.