UNCOMMON MANIFESTATIONS OF COVID 19

30 year old male, 10 day history of diarrhoea and reduced oral intake, presented with lethargy and ongoing abdominal cramps. No respiratory symptoms, but O2 sats noted to be on the lower side, exertional O2 sats dropped to 86%. No past medical history of note, normal white cell count, not lymphopenic, urea 18.9 mmol/L, creatinine: 489 µmol/L, amylase 600 (30-118), ALT: 65, CRP: 100, Trop I 267 (0-46). Chest X-ray as shown. What do you think the patient is suffered from?

34yrs/M admitted with C/o Generalized bodyaches,3 day history of on and off fever which is temporarily relieved by paracetamol,Hypogastric pain,He also experienced nausea and vomitting with loss of appetite.NO PETECHIAE OR RASES present over body.He was tested negative for COVID 19 but positive for dengue.On day 2 admission patient developed dry cough and mild difficulty in breathing. NEED SUGGESTIONS? *Chief Complaints* Fever,bodyaches,NV, Abdomen pain *History* No relevant medical history *Vitals* BP - 120/80,HR -110,Temp -99°F,Spo2 -98% without O2 support,RR - 18 *Investigations* COVID - RT PCR - NEGATIVE DENGUE IGg - Positive Platelet counts -4000,Hb -12,TLC -12000 HRCT chest enclosed

The severity of COVID-19 illness may be influenced by what researchers call "cytokine storms." In a new study, investigators assessed 522 COVID-19 patients, aged 5 days to 97 years, who were admitted to two hospitals in Wuhan, China, in December and January. The study also included a "control group" of 40 healthy people. Compared to the control group, 76% of COVID-19 patients had significantly lower levels of T cells -- a type of white blood cell that plays a crucial role in immune response against viral infections. Patients admitted to the intensive care unit had much lower T cell counts than those who didn't require ICU care. Patients over age 60 had the lowest T cell counts, the findings showed. And the T cells that did survive in COVID-19 patients were exhausted and unable to function at full capacity, the study authors said. COVID-19 patients also had high levels of cytokines -- a protein that normally helps fight off infection. Too many cytokines can prompt an excessive inflammatory response called a "cytokine storm," which causes the proteins to attack healthy cells. That suggests the new coronavirus does not attack T cells directly. Instead, it triggers the cytokine release, which results in the loss and exhaustion of T cells, according to the authors of the study published May 1 in the journal Frontiers in Immunology. The study results provide new clues on how to treat COVID-19, the researchers said. "We should pay more attention to T cell counts and their function, rather than respiratory function of patients," study author Dr. Yongwen Chen of Third Military Medical University in Chongqing, China, said in a journal news release. Chen added that "more urgent, early intervention may be required in patients with low T lymphocyte counts." In addition, he noted, future research should focus on pinpointing subgroups of T cells that may be most important in COVID-19, along with identifying drugs that boost T cell counts and functioning. Source-https://www.drugs.com/news/blood-count-may-offer-clues-covid-19-study-89971.html

Saliva As Protective Shield Against SARS-Cov-2 Hyposalivation as a potential risk factor for a SARS‐CoV‐2 infection was discussed in an article published in Oral Diseases. Human saliva is a very complex fluid and plays a crucial role in the prevention of viral infections and protection against them, since it contains a large number of proteins and peptides with antiviral effects. Previous studies have documented the antiviral effects of some of those proteins against other coronaviruses. In addition, such proteins have been reported to inhibit the replication of other coronaviruses. According to the authors, it is therefore reasonable to assume that the protective effect of these salivary proteins against SARS-CoV-2 might be similar.   Another previous study has suggested that hyposalivation could lead to acute respiratory infection, because the reduced saliva secretion may impair the oral and airway mucosal surface and may result in a decreased secretion of antimicrobial proteins and peptides. Thus, hyposalivation may expose patients to a higher risk of contracting SARS‐CoV‐2. However, the study authors acknowledge that further studies on this topic are needed to prove this hypothesis.   Is mucosal immunity more important? Although several knowledge gaps about SARS-CoV-2 exist, it is clear that a vaccine is urgently needed to prevent infection and possible reinfection in the long term. A study published recemtly addressed the question of whether mucosal SARS-CoV-2 vaccines would be more effective than parenteral vaccines. Owing to their genetic similarity, the development of MERS-CoV and SARS-CoV-1 vaccines in recent years has provided important insights for the development of SARS-CoV-2 vaccines. In an experimental series of SARS-CoV-1/MERS-CoV vaccines, mucosal vaccination resulted in attractive protective correlates—even higher than with parenteral vaccines. Thus, the research of mucosal vaccine candidates should be encouraged for developing effective SARS-CoV-2 vaccines.

Pregnant women do not appear more likely to contract the infection than the general population. However, pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19. Transmission  With regard to vertical transmission (transmission from mother to baby antenatally or intrapartum), emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined.  At present, there are no recorded cases of vaginal secretions being tested positive for COVID-19.  At present, there are no recorded cases of breast milk being tested positive for COVID-19. Effect on Foetus  There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19.  There is no evidence currently that the virus is teratogenic. Long term data is awaited.  COVID-19 infection is currently not an indication for Medical Termination of Pregnancy. General Guidelines for Obstetric Health Care Providers  Ob-gyns and other health care practitioners should contact their local and/or state health department for guidance on testing persons under investigation and should follow the national protocol.  Health care practitioners should immediately notify infection control personnel at their health care facility and their local or state health department in the event of a PUI for COVID-19.  A registry for all women admitted to with confirmed COVID-19 infection in pregnancy should be maintained. Maternal and neonatal records including outcome should be completed in detail and preserved for analysis in future.  Health care providers should create a plan to address the possibility of a decreased health care workforce, potential shortage of personal protective equipment, limited isolation rooms, and should maximize the use of telehealth across as many aspects of prenatal care as possible.  Each facility should consider their appropriate space and staffing needs to prevent transmission of the virus that causes COVID-19.  Pregnant women should be advised to increase their social distancing to reduce the risk of infection and practice hand hygiene.  Health care practitioners should promptly notify infection control personnel at their facility of the anticipated arrival of a pregnant patient who has confirmed COVID-19 or is a PUI so that infection control measures can be kept in place.  Intrapartum services should be provided in a way that is safe, with reference to minimum staffing requirements and the ability to provide emergency obstetric, anaesthetic and neonatal care where indicated. To read complete guidelines- https://icmr.nic.in/sites/default/files/upload_documents/Guidance_for_Management_of_Pregnant_Women_in_COVID19_Pandemic_12042020.pdf