What modifications we can bring in our clinical setup to prevent our staff & patients from COVID 19?

 PATHOPHYSIOLOGY OF AKI IN COVID- 19 PATIENTS. AKI appears to involve a complex process driven by virus-mediated injury, cytokine storm, AngII pathway activation, dysregulation of complement, hypercoagulation, and microangiopathy interacting with common and known risk factors for AKI . There is paucity of data regarding clinical and laboratory characteristics of AKI in patients with COVID-19. We urge that further studies describing and analyzing the clinical course of patients with COVID-19 include appropriate indices of kidney function and diagnosis of AKI in their analyses, including kidney injury markers, urine microscopy, quantified urine protein, urine output, and urine electrolytes. Markers of macrophage activation, coagulation, microangiopathy, and complement activation, as well as kidney imaging and need for KRT (with relevant details), are important data needed to further our understanding of AKI pathophysiology associated with COVID-19. Rates of reversibility of, or partial improvement in, kidney function and any kidney biopsy results (including immunofluorescence and electron microscopy) should be reported. In the rush to report medical complications of COVID-19, we are missing valuable clinical information. Speculation about specific interventions would not be appropriate until we obtain appropriate information. We advocate for a complete and standardized appraisal of the clinical and laboratory picture so that preventative and therapeutic strategies for AKI can be appropriately designed and implemented.

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

Doctors and other healthcare workers are paying a heavy price for doing their jobs on the frontline. Despite taking all the precautions, it is still getting difficult for them to treat the patients and keeping themself and their families safe. Apart from the risk of infection, they are also dealing with anxiety, being separated from their families, harassment and even assault. What are your thoughts on this? How can doctors protect themselves and how others can contribute to that?

Know a patient who is a COVID survivor. He was in the ICU for a month, requiring mechanical ventilation for almost four weeks. That’s much longer than a typical patient with bacterial pneumonia. This patient required a lengthy infusion of the neuromuscular blockade which, along with shock, contributed to the profound weakness. This complication is also called critical illness polyneuropathy. *What can we do during these 4 weeks when the patient is paralyzed to minimize the myopathy and neuropathy that may develop? *Are there treatments or therapies? *Are you familiar with the concept of Disease tolerance and Adaptogens? I’d love to hear others’ reflections on this and if you have any tips for preparation

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.