WORLD COPD DAY - 18 TH NOVEMBER 2020

A 46-year-old female, was admitted for wheezing and dyspnea. She had been diagnosed with asthma 10 years previously and was well controlled using budesonide at 160 μg + formoterol at 4.5 μg b.i.d. combination therapy until 5 months before when she had a severe asthma attack at that time, during which her wheezing was not well correlated with physical exercise and had persisted for several months. She was treated unsuccessfully with budesonide at 320 μg + formoterol at 9 μg b.i.d. combination, montelukast at 10 mg/day, and oral steroids. Her medical history was significant for appendectomy and hemorrhoidectomy. She was taking thyroid hormone for Hashimoto's thyroiditis and calcium tablets for osteoporosis. What is your opinion on the case?

Patient in early 40 s with a week of fever and dry cough, the normal image on the left is one acquired a year earlier. Image 2 patient in mid 50s with similar history but unlike the former, has oxygen requirement. First patient discharged, second admitted for O2 therapy. Your opinion.

Geriatric female with PMHx DM, HTN, A fib on Xarelto, chronic facial asymmetry present to ED following fall at home, change in mental status and febrile. Suggestions? Should I sent for COVID-19 test.

Doctors report that, placing the patients on their stomachs improved their oxygen saturation levels. This technique had also proved to improve the oxygen supply to the lungs. By placing in such way the parts of lungs are opened up which are not so before. A study conducted in the year 2013, also proved the same: Prone positioning is not a new technique it has been used for many years in improving the oxygen saturation in acute respiratory distress syndrome (ARDS) patients those requiring mechanical ventilation. Controlled trials have confirmed that oxygenation is significantly better when patients are in the prone position than when they are in the supine position. Several evidences had shown that prone positioning could prevent ventilator-induced lung injury. The studies have also confirmed that there was significant improved with prone positioning as compared with supine positioning among patients with severely hypoxemic ARDS at the time of randomization. “Lying face down was in some cases more helpful than applying positive pressure in the lungs using ventilators in COVID-19 patients.” Another recent study claims this. It indicates that some patients do not respond well to high positive pressure and respond better to prone positioning in bed. Researchers in the US are now looking at the effects of turning patients who need extra oxygen — but not necessarily a ventilator — on their stomachs, as part of clinical trials. NOTE: Hence, flipping COVID-19 patients onto their stomachs, or “prone positioning,” is an effective way to keep them alive in intensive care.

UNCOMMON MANIFESTATIONS of COVID-19 Recent findings suggest that a significant number of people with COVID-19 may experience digestive symptoms. New research data says that out of all the patients who approached for medical care half of them have come up with the symptoms of the digestive system, such as loss of appetite and diarrhea. As the world races to find the best ways to cope with the new coronavirus, researchers continue to contribute to our understanding of COVID-19, the disease that the virus causes. The exact symptoms are the main point of interest. As with many other viral infections, SARS-CoV-2 infections cause different symptoms in different people. But WHICH SYMPTOMS ARE THE MOST COMMON? According to information from the World Health Organization (WHO), three of the most common symptoms are fever, coughing, and some difficulty breathing. However, people with COVID-19 have reported many other symptoms, including digestive ones. While the WHO still consider digestive symptoms to be uncommon, a new study from the Wuhan Medical Treatment Expert Group for COVID-19 suggests that such symptoms may be more widespread than specialists had thought. Digestive symptoms in 50.5% of patients were observed. The expert group behind this new study — the findings of which appear in The American Journal of Gastroenterology — analyzed data from 204 people who received medical care for COVID-19 between January 18 and February 28, 2020. The patients had an average age of 52.9 years, and of the total, 107 were male and 97 female. When they presented to a hospital, 103 of the 204 people — or 50.5% — were experiencing digestive symptoms. The main symptom reported was diarrhea, and other symptoms included vomiting, in four individuals, and abdominal pain, in two. Moreover, the digestive symptoms among the larger group grew more severe as the severity of COVID-19 increased the researchers' report.