tag:blogger.com,1999:blog-83941954748492180972024-03-12T18:56:05.192+09:00Dr K K AggarwalPadma Shri and B C Roy National AwardeeDr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.comBlogger3973125tag:blogger.com,1999:blog-8394195474849218097.post-67104067757676371722020-08-30T10:33:00.001+09:002020-08-30T10:33:15.092+09:00200 CMAAO CORONA FACTS and MYTH COVID: Non COVID phase<p> </p><p class="MsoNormal">200 CMAAO CORONA FACTS and MYTH COVID:<span style="mso-spacerun: yes;"> </span>Non COVID phase<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With input from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1071: <span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Minutes of Virtual Meeting of CMAAO NMAs on “Covid-19
Update”<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">29<sup>th</sup>
August, 2020, Saturday<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">9.30am-10.30am<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Participants<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Member NMAs<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
KK Aggarwal, President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Marthanda Pillai, Member World Medical Council<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Alvin Yee-Shing Chan, Hong Kong<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Prakash Budhathoky, Nepal<o:p></o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Invitees<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Russell D’Souza, UNESCO Chair in Bioethics, Australia<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
S Sharma, Editor IJCP Group<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Key points from the
discussion<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Three acute phase reactants– CRP,
ESR and IL-6. In a resource-limited country, of the three, choose CRP. It
is indicator of intensity of inflammation. CRP cannot rise without
increase in IL-6. Raised CRP, presume that the d-dimer is high.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">We do not know how China which
has a higher population density than India has managed to control the
disease. Mortality is 3 per million; new cases are 9.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Antigens of various diseases such
as typhoid, malaria, chikungunya, and dengue are false positive in
Covid-19.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">“<i style="mso-bidi-font-style: normal;">All overseas players and support staff underwent two COVID-19
RT-PCR tests before flying in to the UAE and could fly only if the tests
are negative. If not, then the same 14-day quarantine period and two
negative tests to be able to fly to the UAE. The players and support staff
will be tested on Day 1, Day 3 and Day 6 of their quarantine in the UAE
and after clearing that, they will be tested every fifth day during the
53-day event</i>.” Instead of three tests, pooled testing of the teams can
be done daily.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Giving oxygen without
anticoagulation has no significance. You have to give
aspirin/anticoagulation. For cases under home care, rivoraxaban (10 mg prophylaxis)
can be given in place of LMWH; it is cheaper, can be taken by the patient,
onset of action is 10 hours.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">According to TOI report, 87,000
healthcare workers in India are infected with Covid; there have been 573
deaths; 74% cases and over 86% deaths</span><span style="background: white; color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">are from six states: Maharashtra, Tamil
Nadu, Delhi, West Bengal, Gujarat and Karnataka. The number projected
seems to be very high and needs to be checked.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Doctors have high viral load so
have higher chances of developing hypercoagulable state. Should
prophylactic anticoagulation be started on right on Day 1 of the illness
for doctors/HCWs?<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">There are three phases of the
illness: Covid (1-9 days, infectious phase), post-Covid (after 9 days,
non-infectious, persistent inflammation) and non-Covid (after 3 months).
After 3 months, the patient should be treated as non-Covid, instead of
post-Covid. This has medicolegal issues<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">In Hong Kong, the third wave is
partly controlled. There have been less than 20 cases per day for the last
week or more. One-third of confirmed cases have no known source of origin;
so the chain of spread of infection is not known. Universal community
testing scheme will start from 1<sup>st</sup> September to find out silent
carriers. The Hong Kong government has agreed to expand to high risk group
tracing and testing even with universal testing. With opening up of
economy, better monitoring of industries so that there will not be a
fourth wave. The third wave began with 9 cases with mutated virus strain
(d614g). At that time, sailors coming to Hong Kong had been exempted from
testing and quarantine; also restrictions of social distancing were
relaxed. This created the third wave.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Reinfection: A person from Spain
positive in March and became negative reached Hong Kong and tested
positive again in July. This raises a question whether this virus can
re-infect. It was a mutated virus with 24 gene differences. It formed
antibodies quickly, caused no symptoms and not serious and disappeared
early. We need to be vigilant about this. People in post-Covid phase
getting recurrent corona-like illness may be getting re-infection with a
different strain.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Another case of re-infection
reported in the US; a young person who had severe symptoms and required
oxygen and assisted breathing in the second infection. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">A study from Mumbai has
reconfirmed the US study that antibodies do not last for more than 3
months.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color: #00b050; font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color: black; font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color: black; font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com10tag:blogger.com,1999:blog-8394195474849218097.post-80899348015022737992020-08-26T11:07:00.001+09:002020-08-26T11:07:05.119+09:00196 CMAAO CORONA FACTS and MYTH COVID : Dentistry<p> </p><p class="MsoNormal"><b><span style="font-size: 12.0pt;">196 CMAAO CORONA FACTS and
MYTH COVID : Dentistry<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12.0pt;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12.0pt;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12.0pt;">With input from Dr Monica
Vasudev<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12.0pt;"><o:p> </o:p></span></p>
<h1 style="background: white; line-height: 18.75pt; margin-bottom: 9.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 15.0pt;"><span style="color: black; font-size: 12.0pt; mso-color-alt: windowtext;">1068: </span><span style="color: #595959; font-size: 12.0pt;">Study finds anaemia associated with severe COVID-19 illness<o:p></o:p></span></h1>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">DG alerts excerpts: Research published
in the <i>Journal of Medical Virology</i> point to anaemia being an
independent risk factor tied to severe coronavirus disease 2019 (COVID‐19) said
with Zheying Tao, Department of Critical Care Medicine, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China, and
colleagues.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The odds ratio (OR) of anaemia
related to severe manifestations of COVID‐19 in the study was 3.47and 3.77 after
adjusting for baseline data and laboratory indices, respectively.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The retrospective, observational
study involved a total of 222 patients with laboratory-confirmed severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to Wuhan Ninth
Hospital from December 1, 2019, to March 20, 2020. Among these, 202 were
non-severe COVID-19 cases and 20 had severe disease. In addition, 79 (35.6%) of
the 222 patients had anaemia, defined as haemoglobin level <120 g/L in women
and <130 g/L in men, while the other 143 patients did not.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The authors reported that in severe
COVID-19 patients, haemoglobin levels showed a significant decline when
compared to non-severe patients (128 g/L vs 111.5 g/L, P=0.002). Further,
significantly more patients in the severe group met the diagnostic criteria for
anaemia (32.2% vs 70.0%, P=0.001).<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The prevalence of severe illness in
the anaemic group was significantly higher than that in the non-anaemic group
(8.1% vs 17.7%, P=0.001). Compared to patients without anaemia, those with
anaemia were older and more likely to have chronic kidney disease (0.0% vs
3.8%), cardiovascular disease (CVD) (3.5% vs 15.2%), and chronic obstructive
pulmonary disease (COPD) (0.0% vs 10.1%) (all P<0.05).<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">COVID-19 patients with anaemia were
predisposed to more severe inflammatory responses, coagulation disorders, and
organ injuries. Specifically, more patients had elevated levels of C-reactive
protein (CRP) (8.5% vs 24.7%) and procalcitonin (PCT) (1.3% vs 15.6%) in the
anaemic group (all P<0.05). Patients with anaemia also showed significantly
higher levels of erythrocyte sedimentation rate (ESR), D-dimer, myoglobin,
T‐pro brain natriuretic peptide (T‐pro‐BNP) and urea nitrogen (BUN) (all
P<0.05).<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Forty-six patients were classified as
having mild anaemia, whereas 29 and 4 patients were classified as having
moderate and severe anaemia.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">There was no significant difference
in the proportion of severe patients or in mortality between the anaemia
subtypes. However, severity of anaemia was "positively and strongly"
associated with inflammatory responses and also positively associated with
coagulation disorders, while no significant relationship with organ injuries
was observed.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In univariate analysis, baseline data
including age ≥60 years, anaemia, any comorbidities, hypertension, CVD, COPD,
and laboratory indices containing CRP ≥10 mg/L, lactate dehydrogenase (LDH)
≥250 U/L, D-dimer ≥0.5 mg/L and creatinine ≥133 μmol/L were significantly
associated with greater disease severity in patients with COVID-19. <o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Anaemia remained significant as an
independent risk factor for patients with severe COVID-19 in the multivariable
analysis, even after adjusting for baseline data and laboratory indexes.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Three patients died in the severe
COVID-19 group (15%) compared to none in the non-severe group.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The prevalence of anaemia in
hospitalised COVID-19 patients was up to 35.5%, which was "much
higher" than a previous report that had found the frequency of anaemia in
COVID-19 patients to be 15%.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">As anaemia and low haemoglobin could
decrease oxygen delivery, it is possible that COVID-19 patients are more
susceptible to severe illness due to worse pulmonary function and poor tissue
oxygenation. <o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Those with moderate-to-severe anaemia
were more likely to present with dyspnea symptoms and lower levels of PaO2 and
SaO2 than patients with mild anaemia.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Myocardial injury and renal
dysfunction were more remarkable in patients with anaemia, possibly due to a
progressive reduction in blood oxygen content and limited tissue oxygen
delivery.<o:p></o:p></span></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Thus, it is difficult to verify
whether SARS-CoV-2 has a direct role in anaemia, as well as if patients have anemia
of chronic disease."<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12.0pt;"><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-64730006476473791852020-08-25T10:49:00.000+09:002020-08-25T10:49:43.190+09:00195 CMAAO CORONA FACTS and MYTH COVID : Dentistry<p> </p><p class="MsoNormal"><b>195 CMAAO CORONA FACTS and MYTH COVID : Dentistry<o:p></o:p></b></p>
<p class="MsoNormal"><span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With input from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1067: <b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Update on Covid-19<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">IMA-CMAAO Webinar on
“COVID-19 and Dentistry”<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">22<sup>nd</sup>
August, 2020<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">4-5pm<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Participants<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
KK Aggarwal, President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Ramesh K Datta, Hony Finance Secretary IMA<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Jayakrishnan Alapet<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
S Sharma <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Faculty<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Prof Dr Mahesh Verma<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Prosthodontist<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Vice
Chancellor, Guru Gobind Singh Indraprastha University<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Former,
Director and Principal of Maulana Azad Institute of Dental Sciences<span style="background: yellow; mso-highlight: yellow;"><o:p></o:p></span></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Key points from the
discussion<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dentistry has progressed in the
past few decades and it is now a huge group of Dental Sciences. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Nine specialties where MDS is
offered: Oral medicine & Radiology, Prosthodontics, Conservative
Dentistry & Endodontics, Orthodontics, Pediatric Dentistry and
Preventive Dentistry, Periodontology, Oral & Maxillofacial surgery,
Oral Pathology and Public Health Dentistry.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The dental profession has been
very aware and proactive in strategising how to tackle the infection.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Initially only emergent and
urgent cases such as pain, infection, bleeding, trauma, were attended to
and elective procedures were delayed or postponed.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Guidelines for dental
professionals were the first guidelines issued by the health ministry.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Every patient is a potential
source of infection, whether Covid-19 or not.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">All specialties other than oral
medicine, oral pathology and a little bit of orthodontics generate
aerosols as dentists work with a hand high speed instrument. Air and water
produces a splatter of droplets with microbes.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The risk of infection in the
dental profession is because of close proximity to the patient,
micro-organisms in the mouth (remain viable and suspended in the air for
long time as droplets) and droplets adhere to the surfaces (fomites).<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Safety not only of the
patient/doctor, but also the staff in the immediate vicinity and other
staff is important.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">For aerosol procedures, gown
(impervious), mask (N95and triple layer), face shield, goggles, shoe
cover, gloves are required. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Clinic is cleaned and sterilized
before and after every patient. This is time-consuming so fewer patients
are attended to now. One chamber works at a time, more ventilation,
exhaust, windows open, extra-oral suction system, HEPA filters, UV lights,
more air changes in AC (8-12/hour)<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Infection and biomedical waste
protocols are strictly followed now as increased risk of cross infection. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Earlier dentistry as a speciality
was studied after completing MBBS (UK Royal Colleges), including in India
(Annamalai University). As there are lot of biomechanical procedures
involved, dentistry soon grew as a separate speciality.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dentists work together with many
medical specialities like ENT, plastic surgery, oncosurgery. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Often oral manifestations of a
disease appear first and so are first incidentally diagnosed by dentists. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Oral cavity has lot of ACE2 receptors.
So, the coronavirus can cause gingivitis, periodontitis. It does not
involve tooth. But, if periodontium is affected, it can loosen the tooth.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Oral hygiene is very important as
the oral cavity has millions of different pathogens. It is important to
reduce the viral load before any procedure so fewer aerosols are formed.
Ask the patient to do pre-treatment or pre-procedural rinse with hydrogen
peroxide, povidone iodine.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Three basics for dental health:
Brushing, flossing and swish (with water).<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-16692184353195089632020-08-24T11:08:00.000+09:002020-08-24T11:08:32.519+09:00193 CMAAO CORONA FACTS and MYTH COVID : Formula of six<p> </p><p class="MsoNormal"><b>193 CMAAO CORONA FACTS and MYTH COVID : Formula of six<o:p></o:p></b></p>
<p class="MsoNormal"><span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With input from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal">1065: <b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Minutes
of Virtual Meeting of CMAAO NMAs on “Asian countries update – Formula of Six”<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">22<sup>nd</sup> August, 2020, Saturday<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">9.30am-10.30am<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Participants<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Member
NMAs<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr KK Aggarwal, President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Yeh Woei Chong, Singapore Chair CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Marthanda Pillai, Member World Medical Council<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Alvin Yee-Shing Chan, Hong Kong<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Marie Uzawa Urabe, Japan<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Md Jamaluddin Chowdhury, Bangladesh<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Prakash Budhathoky, Nepal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Subramaniam Muniandy, Malaysia<o:p></o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Invitees<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Dr S Sharma, Editor IJCP Group<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Key
points from the discussion<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Six
things to remember in COVID-19<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">If you do not have Covid-19, ask yourself <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l4 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">“Am I at risk?”</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Age, sex (males
more at risk), am I vaccinated (flu, pneumonia, MMR, BCG), do I have any
comorbid condition, am I immunocompromised, is my profession high risk
e.g. healthcare worker dealing with microdroplets.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l4 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">“Is my
environment at risk?”</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">My room, my office, travel, kitchen, drawing and
dining table, toilet – are they well ventilated or not.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l4 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">“Am I prepared” </span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Who will be my
treating doctor, which hospital if I need admission, do I have stand-by
oxygen, first aid box, notification (who should I notify), which lab for
home test<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l4 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">“What do I do if
I get it?”</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
Do I need to isolate/quarantine/inform contacts, interpretation of rapid
antigen test or RTPCR; start observing for symptoms; start treatment for
Day 1<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l4 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Observation
days:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
1-6 days (watch for hypoxia complications), Day 9 (allowed to meet
family), Day 14 (no quarantine), Day 28 (consider plasma donation), Day
40, Day 90<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l4 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">0-9 days:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> Nutrition,
6MWT, cohort isolation, blood tests, teleconsult, treatment<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l4 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">9-90 days:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> Observe (for
post-Covid symptoms), appeal, plasma donation, antibodies, antigen Ct
value, nutrition<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Six
things to do to tackle Covid-19<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">During first 6 days (6am, 6pm) 6MWT, 6 parameters, 6
feet distance (ideal)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">6 parameters:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> Shortness of
breath, cough or difficulty talking, SpO2, increase in temperature, distance
and heart rate<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">6 tests on Day
1:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
CBC with ESR, CRP, LDH, ferritin, d-dimer, IL-6<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Six instruments
at home: </span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">SpO2
monitor, PEFR, BP, thermometer, glucometer, smell and taste<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Six gene
targets:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
E, N, S, RdRp, ORF 1a, ORF 1b; gene targets may remain in the body for
about 120 days<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Reception</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> (whosoever
visits my home): Jaggery (taste), rose (smell), wash feet/hands, namaste
(greet), ask to sit a higher place (no face to face meeting)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Decontaminate</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">: 6 g bleaching
powder in 900 ml water to make 0.1% solution<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l1 level1 lfo2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">6 Treatment
options:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
Oxygen, plasma, steroids, heparin, antibiotics, antiviral<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Six
things for prevention<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Contact time in last 48 hours, contact distance (was
it less than 6 feet [ideal]), was the area cross ventilated, was the
person wearing a mask and was the person coughing/sneezing<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Appeals (ask for): Prevent, test, home (quarantine),
cohort (two covid-positive persons can stay in isolation together), day 9,
day 14 (stop quarantine, shift to monitoring)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo3;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">6 ways to clean
and sanitize:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
Soap, sanitizer, disinfectant, UV, ozone, air purifier<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo3;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">6 tastes: </span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Astringent,
bitter, pungent, sweet, sour, salt. In Covid-19, salt and bitter tastes
are retained, while the rest are lost.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo3;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Mistakes: </span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Missing first
case in your family, first cluster in your colony, first spread,
misinterpreting antigen / antibody test, missing Days 1-3 (pneumonia
develops on Day 3)<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo3;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">6 supplements: </span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Vitamin C, D,
B12, iron, zinc, thymosin alpha<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;">Six
things about the virus<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Six different
behaviors:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
Viral, bacterial, HIV-like, it causes immunoinflammation (antigen
triggered), thromboinflammation and cytokine storm <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Six strains:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> L strain
(original strain in Wuhan), strains S, V, G, GR, and GH.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">New definition:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> Acute
manageable thrombo immunoinflammatory disease with post-viral state<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The CDC has recommended maintaining a distance of 2
m (6 feet), while WHO has recommended maintaining a distance of 1 m (3
feet) as 2 m distancing may be difficult in developing countries.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The third wave in Hong Kong is coming down from 114
new cases in a day in July to 18 cases per day now. Hong Kong will launch
en masse population screening program to identify silent carriers;
screening will be voluntary. Should the rules about social gatherings be
relaxed is a dilemma because of apprehension of another wave of the
infection, which might exhaust the resources. <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The first sero survey (done between June 27 and July
10) in Delhi showed 22.8% seroprevalence; the second sero survey (done in
the first week of August) shows a seroprevalence of 28.3% (males 28.3%,
females 32.2%, <18 years 35%, 18-49 years 29%, >50 years 31%).<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Seroprevalence is 51.5% in Pune; in Mumbai, it is
57% in slums and 16% in residential societies <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">A study in Bangladesh conducted by the Institute of
Epidemiology, Disease Control and Research and the International Centre
for Diarrhoeal Disease Research, Bangladesh in Dhaka (RTPCR) has shown 9%
of population in Dhaka has the infection.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Nepal is testing for Covid-19 with Gene Xpert test
for emergency cases; it has 100% specificity, but sensitivity is around
50%. RT PCR is the gold standard.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Singapore is reaching the tail end of the outbreak
in dormitories; community cases in the last week have been 0-2 in a day.
Challenge is the next wave of infection, opening up of economy. Singapore
is looking to open up travel to selected destinations.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Malaysia has detected D614g strain of the virus
(mutation of SARS-CoV-2 virus) in a cluster of cases, which has been
termed as the “Sivaganga cluster”. The index case belongs to Sivaganga in
Tamil Nadu.<o:p></o:p></span></li>
</ul>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l0 level1 lfo5;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">In Australia, all travel within the country has been
stopped. Cases are coming under control in Victoria. <o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com1tag:blogger.com,1999:blog-8394195474849218097.post-700891641637887562020-08-24T11:07:00.000+09:002020-08-24T11:07:38.770+09:00194 CMAAO CORONA FACTS and MYTH COVID : Post-Covid 19 inflammation<p> </p><p class="MsoNormal"><b>194 CMAAO CORONA FACTS and MYTH COVID : <o:p></o:p></b><b><span style="font-family: Verdana, sans-serif; font-size: 10pt;">“Post-Covid 19 inflammation”</span></b></p>
<p class="MsoNormal"><span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With input from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1066: <b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Round Table Expert
Zoom Meeting on “Post-Covid 19 inflammation”<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">22<sup>nd</sup>
August, 2020<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">11am-12pm<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Participants<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
KK Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
AK Agarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Ashok Gupta<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
JA Jayalal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Atul Pandya<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Jayakrishnan Alapet<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Shantanu Tripathi<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Prof
Bejon Misra<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
(Major) Prachi Garg<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Ms
Ira Gupta<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
S Sharma <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Key points from the
discussion <o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Delhi has seroprevalence of 28%,
but asymptomatic persons with no increase in CRP/ESR do not develop
antibodies. We have been able to tackle the disease in Delhi, Mumbai and
Pune.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">In countries where 6 feet (2 m)
social distancing is not possible, reduce the distance to 3 feet (1 m).<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The need of the hour is one
vaccine, one movement. Polio has been almost eradicated because of global
effort for one polio vaccine, but this is not the case with Covid-19.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The government may revise its
testing strategy to testing on demand.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">We should come out with a consensus
statement regarding international travel stating under what conditions the
7-day quarantine could be exempted.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Covid-19 disease has two phases:
Viral phase and post-viral phase. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Viral phase can be divided into
aggressive phase and non-aggressive phase. About 33% of patients in
non-aggressive phase go into post-viral phase manifested as persistence of
gene target positive for 120 days, fever, recurrent diarrhea, episodes of
costochondritis, abdominal pain/nausea/vomiting, calf pain, rash,
cystitis, lower abdominal pain, loss of smell/taste etc.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Pyrexia vs thermia: pyrexia is
because of the organism (first 9 days); thermia is not due to the virus
(after 9 days), it is caused by thermodysregulation in the hypothalamus.
The fever is low grade, appears after exertion, all inflammatory marker
are normal.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Phytoestrogens reduce IL-6;
hence, soya, rich source of phytoestrogens can help. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Some patients have post-Covid
persistent inflammatory state – rising inflammatory markers or reducing
but not rapidly.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Do CRP as follow up test. If
normal, then IL-6 is normal; if high, then IL-6 is high. This means that
the person can still go into delayed cytokine storm.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">After 9 days, even if no fever
but raised CRP/ESR with/without increased IL-6: Curcumin (TNF like
activity), soya protein (reduces IL-6), NSAIDs (nimesulide, mefenamic
acid, naproxen, indomethacin), hydroxychloroquine (discarded but remerging
in post-covid illness).<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">If the patient develops symptoms
again e.g. diarrhea with raised ESR/CRP, is it re-infection? We do not
know.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">If first diagnosed as post-Covid
illness after having missed earlier diagnosis, the prognosis may be
unfavorable.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">In high prevalence area, both antigen
and antibody tests should be done together. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">According to the CDC, the virus
particle may be detected in the body for up to 120 days. This is
persistent inflammation or the persistent virus particle, which is causing
the inflammation. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Do baseline CBC with ESR, CRP,
IL-6, LDH, ferritin, d-dimer. A rapid rise in any of these is important.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">If CT scan is positive on Day 3
(pneumonitis) with more than 2-fold rise in CRP/ESR or rapid rise
(>2-fold) in IL-6, this is the time to give remdesivir. If available
give it on Day 1, but definitely on Day 3 along with LMWH (to reduce
thrombosis) and steroid (to reduce IL-6). Give heparin for 9 days, then
shift to dabigatran/rivoraxaban x 40 days or even more, depending on the
hypercoagulable state of the patient.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Patients with GI symptoms
(diarrhea) may have more severe disease and higher mortality. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Off-label use is anecdotal
evidence. Off-label use does not require trial; it is a shared decision
made by the patient and all legal heirs and the doctor after informed
consent. Consent may be routed through Ethics Committee if it is a
hospital policy.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">If post-Covid patient needs
oxygen, this means either resolving pneumonia or that the patient has
developed lung fibrosis.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-83628863746580762242020-08-22T11:02:00.001+09:002020-08-22T11:02:19.384+09:00192 CMAAO CORONA FACTS and MYTH COVID : Autopsy reports of COVID 19 patients<p> </p><p class="MsoNormal"><b>192 CMAAO CORONA FACTS and MYTH COVID : Autopsy reports
of COVID 19 patients<o:p></o:p></b></p>
<p class="MsoNormal"><span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With input from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal">1064: Medscape excerpts<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1.<span style="mso-tab-count: 1;"> </span>Every
organ in the body is pretty much affected.<o:p></o:p></p>
<p class="MsoNormal">2.<span style="mso-tab-count: 1;"> </span>Conducting
COVID autopsies has been like going to a police line up where one might not be
able to definitively pick out the perpetrator but unlikely suspects can be
eliminated<o:p></o:p></p>
<p class="MsoNormal">3.<span style="mso-tab-count: 1;"> </span>We've
learned through autopsy that there's no direct tissue pathology to account for
the acute symptoms that are seen" in the heart, the kidney, and the brain<o:p></o:p></p>
<p class="MsoNormal">4.<span style="mso-tab-count: 1;"> </span>
Pathologists have postulated a handful of hypotheses about the causes of
extensive organ damage in COVID-19, including that hypoxia resulting from
compromised lung function may be causing secondary injuries<o:p></o:p></p>
<p class="MsoNormal">5.<span style="mso-tab-count: 1;"> </span> obesity
pre-disposes the infected to worse morbidity and mortality. Obesity in and of
itself is a pathologic state, that it leads to atherosclerosis, increased
clotting, fatty liver disease, and often, enlarged hearts.<o:p></o:p></p>
<p class="MsoNormal">6.<span style="mso-tab-count: 1;"> </span>SARS-CoV-2
is exhibiting a selectivity for the lungs. In one decedent, bone marrow
response was observed with many myeloid precursors in the peripheral blood
vessels typical in an overwhelming infection.<o:p></o:p></p>
<p class="MsoNormal">7.<span style="mso-tab-count: 1;"> </span> The cells
that SARS-CoV-2 may be targeting are the type II pneumocytes<o:p></o:p></p>
<p class="MsoNormal">8.<span style="mso-tab-count: 1;"> </span>Those lung
surface cells secrete a fatty substance to keep the lobes pliable. And that,
precipitates the diffuse alveolar damage and acute respiratory failure that we
are observin<o:p></o:p></p>
<p class="MsoNormal">9.<span style="mso-tab-count: 1;"> </span>Immunohistochemistry
testing and electron microscopy "confirmed viral tropism for pulmonary II
pneumocytes.<o:p></o:p></p>
<p class="MsoNormal">10.<span style="mso-tab-count: 1;"> </span>Viral
antigen in lung tissue was higher than with SARS or MERS.<o:p></o:p></p>
<p class="MsoNormal">11.<span style="mso-tab-count: 1;"> </span>Extensive
detection in epithelial cells of the upper respiratory tract is unique among
these highly pathogenic coronaviruses<o:p></o:p></p>
<p class="MsoNormal">12.<span style="mso-tab-count: 1;"> </span> COVID-19
autopsies have confirmed clinicians' reports of increased clotting. The virus
may very well be infiltrating the endothelium and causing injury to the blood
vessel.<o:p></o:p></p>
<p class="MsoNormal">13.<span style="mso-tab-count: 1;"> </span>
Myocarditis is typical of viral diseases, but it has been frustratingly
inconsistent in COVID-19 autopsies. Most have reported very little inflammation
of the heart muscle. At least one death has been directly attributed to
COVID-19–induced lymphohistiocytic and eosinophilic myocarditis.<span style="mso-spacerun: yes;"> </span>And German researchers report in JAMA
Cardiology that 60 of 100 patients who had recovered from COVID-19 had ongoing
myocardial inflammation, as measured by cardiovascular magnetic resonance
imaging (MRI). Many collegiate football programs, reporting evidence of
myocarditis in athletes who have recovered from COVID-19, said they would
postpone their seasons.<o:p></o:p></p>
<p class="MsoNormal">14.<span style="mso-tab-count: 1;"> </span> But, looks
like, what they are seeing by [MRI] is not true myocarditis but something else
as per Richard S. Vander Heide, MD, PhD, MBA, a professor of pathology at
Louisiana State University Health Sciences Center in New Orleans<o:p></o:p></p>
<p class="MsoNormal">15.<span style="mso-tab-count: 1;"> </span> So far,
autopsy studies have found no typical myocarditis in nearly every case.<o:p></o:p></p>
<p class="MsoNormal">16.<span style="mso-tab-count: 1;"> </span> Vander
Heide and colleagues published cardiopulmonary findings from 10 autopsies
conducted on African Americans who died from COVID-19 in The Lancet in May and
updated it with an additional 12 cases in Circulation in July. Six of the 22
had a history of heart disease. All had diffuse alveolar damage — a
histopathologic marker of Acute Respiratory Distress Syndrome (ARDS) — in
addition to pulmonary thrombi and microangiopathy. In all the cases, the virus
was not found in the heart muscle cells and there was no evidence of what the
authors called "typical lymphocytic myocarditis. In the newer study,
Vander Heide and colleagues used electron microscopy to find what appeared to
be viral particles in the vascular cells in the heart, lungs, and kidneys.
Vander Heide, whose primary research interest is myocardial cell injury and
adaptation, believes the infection of these endothelial cells is leading to
clotting abnormalities in the heart's small vessels, causing inflammation. The
heart cells are dying, but not from myocarditis. Instead, he thinks it's likely
that the clotting is causing cell death from ischemia.<o:p></o:p></p>
<p class="MsoNormal">17.<span style="mso-tab-count: 1;"> </span> Some pathologists
are looking at vascular changes, which are "among the distinctive features
of COVID-19," write Maximilian Ackermann, MD, and colleagues in an article
published in May in the New England Journal of Medicine.<o:p></o:p></p>
<p class="MsoNormal">18.<span style="mso-tab-count: 1;"> </span> They
compared lungs of seven patients who died from COVID-19 with seven who died
from ARDS secondary to influenza, as well as those from 10 age-matched,
uninfected patients. The COVID-19 lungs exhibited severe endothelial injury,
which appeared to be associated with intracellular SARS-CoV-2 virus.<o:p></o:p></p>
<p class="MsoNormal">19.<span style="mso-tab-count: 1;"> </span> There also
was widespread vascular thrombosis with microangiopathy and occlusion of
alveolar capillaries and significant new vessel growth from an unusual form of
angiogenesis called intussusceptive angiogenesis — a reactive formation of new
vessels where one splits into two, said co-author William W. Li, MD, president
and medical director of the Angiogenesis Foundation.<o:p></o:p></p>
<p class="MsoNormal">20.<span style="mso-tab-count: 1;"> </span>Venous
thromboembolism has also been observed in patients, including in a study at the
University Medical Center Hamburg-Eppendorf in Germany that was published in
May in the Annals of Internal Medicine.<o:p></o:p></p>
<p class="MsoNormal">21.<span style="mso-tab-count: 1;"> </span>
Coronavirus infections may be a trigger for venous thromboembolism<o:p></o:p></p>
<p class="MsoNormal">22.<span style="mso-tab-count: 1;"> </span>Several
potential mechanisms include endothelial dysfunction, systemic inflammation,
and a pro-coagulatory state.<o:p></o:p></p>
<p class="MsoNormal">23.<span style="mso-tab-count: 1;"> </span>
Researchers at Hospital Graz II in Graz, Austria, also homed in on thrombosis,
with evidence of it in all 11 autopsies they conducted, according to an article
published in Annals of Internal Medicine.<o:p></o:p></p>
<p class="MsoNormal">24.<span style="mso-tab-count: 1;"> </span>
Pathologists were initially reluctant to take on COVID-19 autopsies, especially
any that would involve aerosol-generating procedures. The College of American
Pathologists attempted to allay fears with guidelines that recommend techniques
that minimize those procedures, including using hand shears or other
alternatives to an oscillating bone saw (also recommended by the CDC) or using
a vacuum shroud with the bone saw.<o:p></o:p></p>
<p class="MsoNormal">25.<span style="mso-tab-count: 1;"> </span> Williamson
pointed out that there have been no reported cases of SARS-CoV-2 transmission
from a corpse to any pathologist, morgue technician, or assistant. Still, his
informal survey in March of pathologists on a LISTSERV he manages found that
only six out of 50 respondents were conducting autopsies. A month later, that
number had risen to 30.<o:p></o:p></p>
<p class="MsoNormal">26.<span style="mso-tab-count: 1;"> </span> The CDC
recommends autopsies be done in a negative pressure suite, which are more
common at academic centers.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com2tag:blogger.com,1999:blog-8394195474849218097.post-78955264627603624552020-08-21T11:05:00.001+09:002020-08-21T11:05:27.929+09:00191 CMAAO CORONA FACTS and MYTH COVID CDC Immunity Three Months<p> </p><p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">191 CMAAO CORONA FACTS and MYTH COVID CDC
Immunity Three Months<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="tab-stops: 432.35pt;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">With input from Dr Monica Vasudev<o:p></o:p></span></b></p>
<h2 style="line-height: 27.0pt; margin-bottom: 3.75pt; margin-left: 0cm; margin-right: 0cm; margin-top: 4.5pt;"><span style="font-size: 14.0pt; font-weight: normal;">1063:<span style="color: #333132;"> <span style="mso-spacerun: yes;"> </span>ERS: </span><span style="color: #313131;">Study of nose and throat reveals why people with COVID-19
may lose their sense of smell<o:p></o:p></span></span></h2>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Researchers studying tissue removed from patients noses during surgery
believe they may have discovered the reason why so many people with COVID-19
lose their sense of smell, even when they have no other symptoms.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">They found extremely high levels of angiotensin converting enzyme II
(ACE-2) only in the area of the nose responsible for smelling. This Enzyme is
thought to be the 'entry point' that allows coronavirus to get into the cells
of the body and cause an infection.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Findings, </span><u><span style="color: #4680e4; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">published in the </span></u><i><span style="color: #4680e4; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">European Respiratory Journal</span></i><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">, offer clues as to
why COVID-19 is so infectious and suggest that targeting this part of the body
could potentially offer more effective treatments.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">While other respiratory viruses generally cause loss of the sense of
smell through obstruction of airflow due to swelling of the nasal passages,
this virus sometimes causes loss of smell in the absence of other nasal
symptoms.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The team used tissue samples from the back of the nose of 23 patients,
removed during endoscopic surgical procedures for conditions such as tumours or
chronic rhinosinusitis, an inflammatory disease of the nose and sinus. They
also studied biopsies from the trachea (windpipe) of seven patients. None of
the patients had been diagnosed with coronavirus.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In the lab, the researchers used fluorescent dyes on the tissue samples
to detect and visualise the presence of ACE2 under a microscope and compare
levels of ACE2 in different cell types and parts of the nose and upper airway.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">They found by far the most ACE2 on the lining cells of the olfactory
epithelium, the area at the back of the nose where the body detects smells. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The levels of ACE2 in these cells was between 200 and 700 times higher
than other tissue in the nose and trachea, and they found similarly high levels
in all the samples of olfactory epithelium, regardless of whether the patient
had been treated for chronic rhinosinusitis or another condition. ACE2 was not
detected on olfactory neurons, the nerve cells that pass information about
smells to the brain.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The levels of ACE2 - the COVID-19 'entry point' protein were highest in
the part of the nose that enables us to smell. These results suggest that this
area of the nose could be where the coronavirus is gaining entry to the body.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The olfactory epithelium is quite an easy part of the body for a virus
to reach, it's not buried away deep in our body, and the very high levels of
ACE2 there might explain why it's so easy to catch COVID-19.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 15.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="background: #F9F9F9; color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">[Professor Andrew P.
Lane, director of the division of rhinology and skull base surgery, and Dr
Mengfei Chen, research associate, and colleagues from Johns Hopkins University
School of Medicine, Baltimore, USA.</span>]<span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p></o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com1tag:blogger.com,1999:blog-8394195474849218097.post-27987609716267266122020-08-21T11:03:00.000+09:002020-08-21T11:03:03.842+09:00190 CMAAO CORONA FACTS and MYTH COVID CDC Immunity Three Months<p> </p><p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">190 CMAAO CORONA FACTS and MYTH COVID CDC
Immunity Three Months<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="tab-stops: 432.35pt;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<h1 style="margin-bottom: 16.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="font-size: 14.0pt; font-weight: normal;">1056:<span style="color: #333132;"> <span style="mso-spacerun: yes;"> </span></span></span><span style="color: black; font-size: 14.0pt;">Second Sero-survey suggests 28% in city
have antibodies<o:p></o:p></span></h1>
<p align="center" class="MsoNormal" style="line-height: 14.25pt; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center; vertical-align: baseline;"><span style="background: black; border: none windowtext 1.0pt; color: white; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-border-alt: none windowtext 0cm; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; padding: 0cm;">X</span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="border: none windowtext 1.0pt; color: #747474; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-border-alt: none windowtext 0cm; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; padding: 0cm;">The previous
serological survey carried out by the National Centre for Disease Control on a
sample size of 21,387 showed that 22.86% of the people surveyed had been
exposed to the virus.</span><span style="color: black; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: 21.0pt; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="border: none windowtext 1.0pt; color: #747474; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-border-alt: none windowtext 0cm; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; padding: 0cm;"><span style="mso-spacerun: yes;"> </span></span><span style="color: #3e3e3e; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The second round of serological
survey, conducted in the first week of August across the national capital, has
suggested that 28.35% of the people tested have developed antibodies.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: 21.0pt; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #3e3e3e; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><span style="mso-spacerun: yes;"> </span>More than 15,000 samples were
lifted across 11 districts in Delhi to assess the spread of the virus. The
samples were processed in 18 labs authorised by the state government for the
rigorous exercise.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: 21.0pt; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #3e3e3e; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><span style="mso-spacerun: yes;"> </span>The data collated by researchers
at Maulana Azad Medical College has been submitted to Principal Health
Secretary Vikram Dev Dutt.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: 21.0pt; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #3e3e3e; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><span style="mso-spacerun: yes;"> </span>The highest prevalence has been
reported from the central district<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #3e3e3e; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span style="background: white; color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Sampling taken: 25 %
less than 18 years, 18-49 years 50% and 25% over 50 years of age</span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Antibodies in males 28.3%</span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Antibodies in females 32,2%</span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Less than 18 years antibodies in 34.7%</span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">18-49
years 28.5%</span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span style="color: #747474; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-bidi-font-size: 14.0pt; mso-fareast-font-family: Arial; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="background: white; color: #333333; font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Over
50 years 31.2%</span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; vertical-align: baseline;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">1057: </span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">A top ICMR official told a parliamentary panel on
Wednesday that phase-two clinical trial of two indigenously developed Covid-19
vaccine candidates have almost been completed and emergency authorisation of a
vaccine could be considered if the Centre decides so.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p></o:p></span></p>
<p class="1l6ov" style="line-height: 18.75pt; margin-bottom: .0001pt; margin: 0cm;"><b><span style="color: #1f1f1f; font-size: 14.0pt;">1058: <a href="https://timesofindia.indiatimes.com/india/coronavirus-what-is-vaccine-nationalism/articleshow/77638162.cms">What
is vaccine nationalism</a>: </span></b><span style="color: #1f1f1f; font-size: 14.0pt;">The countries with more money are striking pre-purchase deals
with pharma companies to buy coronavirus vaccine once the trials prove
successful. Since, several companies across the world are researching on a
Covid-19 vaccine, the wealthier nations have already placed orders worth
millions to get their citizens the first shots.<o:p></o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><b><u><span style="color: #232323; font-size: 14.0pt;"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><b><u><span style="color: #232323; font-size: 14.0pt;">1059: Cohort isolation: </span></u></b><span style="color: #232323; font-size: 14.0pt;">Patients should be placed in a well-ventilated
single-occupancy room with a closed door and dedicated bathroom. When this is
not possible, patients with confirmed COVID-19 can be housed together. Patients
with confirmed COVID-19 should <strong>not</strong> be in a
positive-pressure room. An airborne infection isolation room (AII; ie, a
single-patient, negative-pressure room) should be prioritized for patients
undergoing aerosol-generating procedures. <o:p></o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><span style="color: #232323; font-size: 14.0pt;"><o:p> </o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><b><span style="color: #333132; font-size: 14.0pt;">1060: Kidney a 'Bystander' in COVID-19: </span></b><span style="color: #222222; font-size: 14.0pt;">A new Canadian study has found increased
expression of angiotensin-converting enzyme 2 (ACE2) receptors in the kidneys
of patients with <a href="https://emedicine.medscape.com/article/238946-overview"><span style="color: #5757a6; text-decoration: none; text-underline: none;">diabetic nephropathy</span></a>,
which may help explain why such patients are at higher risk of COVID-19 and
have severe outcomes. However, that SARS-CoV-2 virus directly infects the
kidneys has not been proven so far. Kidney damage may be the by-product of the
novel coronavirus wreaking havoc elsewhere in the body. The new study has been
published as a <a href="https://www.canadianjournalofdiabetes.com/article/S1499-2671(20)30215-X/fulltext"><span style="color: #5757a6; text-decoration: none; text-underline: none;">journal preproof</span></a> in
the <i>Canadian Journal of Diabetes </i>by Richard Gilbert, MD, Canada
Research Chair in Diabetes Complications, St Michael's Hospital, Toronto,
Ontario, and colleagues.<o:p></o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><span style="color: #222222; font-size: 14.0pt;"><o:p> </o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><span style="color: #222222; font-size: 14.0pt;">1061: More data from observational studies, this time in
hospitalized patients, indicated that famotidine (Pepcid AC), which is used to
treat heartburn, was associated with improved clinical outcomes in COVID-19
patients. Use of famotidine in a small group of 83 patients was associated with
a lower risk of in-hospital mortality and a combined outcome of death and
intubation, reported Jeffrey Mather, MS, of Hartford Hospital in Connecticut,
and colleagues.<o:p></o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><span style="color: #222222; font-size: 14.0pt;"><o:p> </o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><span style="color: #222222; font-size: 14.0pt;">1062: </span><b><span style="color: #595959; font-size: 14.0pt;">Study
shows SARS-CoV-2 causes a specific dysfunction of the kidney proximal tubule: </span></b><span style="color: #757475; font-size: 14.0pt;">Findings from a study published in <em>Kidney
International</em> show that SARS-CoV-2 causes an early and specific
dysfunction of the kidney proximal tubule (PT), characterized by low molecular
weight (LMW) proteinuria, neutral aminoaciduria, and defective handling of uric
acid and phosphate. ACE2 receptor for SARS-CoV-2 is highly expressed in the PT
cells.<o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">67% <span style="mso-spacerun: yes;"> </span>had elevated urinary
levels of β2-microglobulin, 85% had a urinary protein to creatinine ratio
(UPCR) >0.2 g/g, and 98% had a urinary albumin to protein ratio (UAPR)
<0.5. <o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">Electrophoresis of urine samples from these patients evidenced
multiple protein bands below 70 kDa (LMW proteinuria), which included the
vitamin D-binding protein (DBP) and Clara cell secretory protein (CC16). <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">47% and 56% of the patients were reported to have hypouricemia
and/or hypophosphatemia, respectively. <o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">Defective tubular handling of uric acid (hypouricemia with
inappropriate uricosuria; FE<sub>UA</sub> >10%) was found in 46% of the
cohort. Meanwhile, hypophosphatemia with inappropriate phosphaturia (FE<sub>P</sub> >20%)
was observed in 19%. <o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">Aminoaciduria was detected in 46% of patients and was restricted
to neutral amino acids.<o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">Further, the authors noted that PT dysfunction was independent
of pre-existing comorbidities, glomerular proteinuria, nephrotoxic medications
or viral load among the cohort. <o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">During a median follow-up of 44 days 39% of patients required
invasive mechanical ventilation, 29% died, 22% developed AKI and 4% required
kidney replacement therapy. Hypouricemia with inappropriate uricosuria was
found to be independently associated with disease severity and with a
significant increase in the risk of respiratory failure requiring invasive
mechanical ventilation<o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">PT dysfunction develops in a subset of patients with COVID-19
and is characterized by LMW proteinuria, hypophosphatemia and hypouricemia due
to inappropriate urinary loss of phosphate and uric acid, and neutral
aminoaciduria<o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">Hypouricemia was common and associated with poor outcome in
patients with SARS. <o:p></o:p></span></p>
<p style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #757475; font-size: 14.0pt;">Potential mechanisms linking PT dysfunction and respiratory
failure may include the loss of important solutes, including uric acid, which
may affect defense against oxidative stress and respiratory function<o:p></o:p></span></p>
<p class="headinganchor" style="background: white; margin-bottom: 10.8pt; margin-left: 0cm; margin-right: 0cm; margin-top: 10.8pt;"><span style="color: #232323; font-size: 14.0pt;"><o:p> </o:p></span></p>
<p class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; vertical-align: baseline;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-62447355090061599492020-08-19T10:56:00.001+09:002020-08-19T10:56:36.315+09:00189 CMAAO CORONA FACTS and MYTH COVID CDC Immunity Three Months<p> </p><p class="MsoNormal"><b><span lang="EN-US" style="font-size: 14.0pt;">189 CMAAO
CORONA FACTS and MYTH COVID CDC Immunity Three Months<o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 14.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="tab-stops: 432.35pt;"><span lang="EN-US" style="font-size: 14.0pt;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 14.0pt;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size: 14.0pt;"><o:p> </o:p></span></b></p>
<h1 style="margin-bottom: 16.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="font-size: 14.0pt; font-weight: normal;">1055:<span style="color: #333132;"> <o:p></o:p></span></span></h1>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">People infected with COVID-19 do not necessarily
have immunity to reinfection for three months said CDC.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">While people can continue to test positive for
SARS-CoV-2 for up to three months after diagnosis and not be infectious to
others, that does not imply that infection confers immunity for that period.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Earlier the confusion stemmed from an August
3 </span><u><span style="color: #0271c1; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">update to
CDC's isolation guidance</span></u><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><b><i><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Who needs to quarantine?</span></i></b><b><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></b></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><i><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">People who have been in close contact with someone
who has COVID-19 -- excluding people who have had COVID-19 within the past 3
months.</span></i><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><i><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">People who have tested positive for COVID-19 do not
need to quarantine or get tested again for up to 3 months as long as they do
not develop symptoms again. <b>People who develop symptoms again within 3
months of their first bout of COVID-19 may need to be tested again if there is
no other cause identified for their symptoms.</b></span></i><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">These statements could be read as suggesting that those
recovering from COVID-19 will likely be safe from reinfection for three months
even with close exposure to infected people. Media reports took this as a </span><u><span style="color: #0271c1; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">tacit acknowledgment of
immunity</span></u><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> from
the agency.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Friday's CDC statement chided the media for
misinterpreting its guidance, which was <b>about retesting, not immunity</b>.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The latest data simply suggests that retesting
someone in the 3 months following initial infection is not necessary unless
that person is exhibiting the symptoms of COVID-19 and the symptoms cannot be
associated with another illness.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In fact, the CDC went so far as to update,
which now says explicitly, "<b>We do not know if someone can be
re-infected with COVID-19." <o:p></o:p></b></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><b><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The agency added that people who were previously
infected may continue to have "low levels of virus in their body for up to
3 months," which could explain positive test results even if they
recovered from the virus.<o:p></o:p></span></b></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The agency concluded the duration of infection in
most people is no longer than 10 days following symptom onset, and no more than
20 days in people with severe illness or those who are "severely
immunocompromised," <o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><b><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The CDC added there are no confirmed reports of
reinfection within 3 months of initial infection. <o:p></o:p></span></b></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><b><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The guidance still recommends that if those
recovering from the virus come into contact with a positive case and have new
symptoms, they should isolate themselves, contact their healthcare provider and
possibly be retested.<o:p></o:p></span></b></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Everyone, including those recovering from COVID-19,
should continue to follow the recommended non-pharmaceutical interventions,
including social distancing, wearing a face mask in public, and washing their
hands.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom: 9.0pt;"><span style="color: #222222; font-size: 14.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In the statement, the CDC reiterated that people
who test positive for COVID-19 should isolate for at least 10 days after
symptom onset and until 24 hours after their fever subsides without the use of
fever-reducing medications.<o:p></o:p></span></p>
<h1 style="margin-bottom: 16.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #333132; font-size: 14.0pt; font-weight: normal;"><o:p> </o:p></span></h1>
<h1 style="background: white;"><span style="color: black; font-size: 14.0pt; font-weight: normal;">Updated Isolation Guidance Does Not Imply Immunity to
COVID-19<o:p></o:p></span></h1>
<p class="MsoNormal" style="background: white;"><strong style="box-sizing: border-box;"><span lang="EN-US" style="color: black; font-size: 14.0pt;">Media Statement</span></strong><span lang="EN-US" style="color: black; font-size: 14.0pt;"><o:p></o:p></span></p>
<p style="background: white; box-sizing: border-box; margin-bottom: .0001pt; margin: 0cm;"><span style="color: black; font-size: 14.0pt;">For Immediate Release: Friday, August 14,
2020<br style="box-sizing: border-box;" />
<strong style="box-sizing: border-box;">Contact:</strong> Media Relations<br style="box-sizing: border-box;" />
(404) 639-3286<o:p></o:p></span></p>
<p style="background: white; box-sizing: border-box; margin-bottom: 1rem; margin-top: 0cm;"><span style="color: black; font-size: 14.0pt;"><o:p> </o:p></span></p>
<p style="background: white; margin-top: 0cm;"><span style="color: black; font-size: 14.0pt;">On August 3, 2020, CDC updated its isolation guidance based on the
latest science about COVID-19 showing that people can continue to test positive
for up to 3 months after diagnosis and not be infectious to others.
Contrary to media reporting today, this science does not imply a person is
immune to reinfection with SARS-CoV-2, the virus that causes COVID-19, in the 3
months following infection. The latest data simply suggests that
retesting someone in the 3 months following initial infection is not necessary
unless that person is exhibiting the symptoms of COVID-19 and the symptoms
cannot be associated with another illness.<o:p></o:p></span></p>
<p style="background: white; box-sizing: border-box; margin-bottom: 1rem; margin-top: 0cm;"><span style="color: black; font-size: 14.0pt;">People with COVID-19 should be
isolated for at least 10 days after symptom onset and until 24 hours after
their fever subsides without the use of fever-reducing medications.<o:p></o:p></span></p>
<p style="background: white; box-sizing: border-box; margin-bottom: 1rem; margin-top: 0cm;"><span style="color: black; font-size: 14.0pt;">There have been more than 15
international and U.S.-based studies recently published looking at length of
infection, duration of viral shed, asymptomatic spread and risk of spread among
various patient groups. Researchers have found that the amount of live
virus in the nose and throat drops significantly soon after COVID-19 symptoms
develop. Additionally, the duration of infectiousness in most people with
COVID-19 is no longer than 10 days after symptoms begin and no longer than 20
days in people with severe illness or those who are severely immunocompromised.<o:p></o:p></span></p>
<p style="background: white; box-sizing: border-box; margin-bottom: .0001pt; margin: 0cm;"><span style="color: black; font-size: 14.0pt;">CDC will continue to closely monitor the
evolving science for information that would warrant reconsideration of these
recommendations.<o:p></o:p></span></p>
<p style="margin-bottom: 9.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #222222; font-size: 14.0pt;"><o:p> </o:p></span></p>
<p style="margin-bottom: 9.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="font-size: 14.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 14.0pt;"><o:p> </o:p></span></p>
<h1 style="margin-bottom: 16.5pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="color: #333132; font-size: 14.0pt; font-weight: normal;"><o:p> </o:p></span></h1>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-34372914751923957332020-08-18T11:13:00.001+09:002020-08-18T11:13:52.434+09:00188 CMAAO CORONA FACTS and MYTH COVID Preexisting Heart Disease<p> </p><p class="MsoNormal"><b><span lang="EN-US" style="font-size: 16.0pt;">188 CMAAO
CORONA FACTS and MYTH COVID Preexisting Heart Disease<o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 16.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="tab-stops: 432.35pt;"><span lang="EN-US" style="font-size: 16.0pt;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 16.0pt;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size: 16.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="background: white;"><b><span lang="EN-US" style="color: black; font-size: 16.0pt; mso-color-alt: windowtext;">1054: <span style="mso-spacerun: yes;"> </span></span></b><b><span style="color: #595959; font-family: "Helvetica",sans-serif; font-size: 13.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; mso-font-kerning: 18.0pt;">Meta-analysis evaluates impact of cardiovascular risk profile on
COVID-19 outcome<o:p></o:p></span></b></p>
<p class="MsoNormal" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt;"><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p> </o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Patients with coronavirus disease 2019 (COVID-19) with cardiovascular
comorbidities or risk factors are more likely to develop cardiovascular
complications while hospitalised for COVID-19 and have a higher mortality risk,
according to a study published in <i>PLOS One</i>.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><span style="mso-spacerun: yes;"> </span>Jolanda Sabatino, MD, "Magna
Graecia" University, Catanzaro, Italy, and colleagues analysed data from
21 published observational studies on a total of 77,317 patients hospitalised
for COVID-19 in Asia, Europe, and the United States. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><span style="mso-spacerun: yes;"> </span>Mean age was 48.4±18.5 and 40.41%
of the hospitalised patients were females. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">12.89% had cardiovascular comorbidities, 36.08% had hypertension, and
19.45% had diabetes. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">10.74% of patients were smokers while obesity was present in 33.78%. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Coronary artery disease and heart failure were reported in 11.67%, 9.35%
of patients, respectively, at presentation. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">5.30% had a history of chronic obstructive pulmonary disease. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Cardiovascular complications were registered during the hospital stay of
14.09% of patients. The most common of these complications were arrhythmias
(18.40%) and myocardial injury (10.34%).<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Pre-existing cardiovascular comorbidities or risk factors were
significant predictors of cardiovascular complications (P = .019)<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-bidi-font-family: Helvetica; mso-fareast-font-family: Helvetica; mso-fareast-language: EN-IN;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #757475; font-family: "Helvetica",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Age (P < .001), pre-existing cardiovascular comorbidities or risk
factors (P < .001) and the development of cardiovascular complications
during COVID-19 period (P = .038) were significant predictors of death. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="background: white; line-height: 18.0pt; margin-bottom: 12.0pt; mso-add-space: auto;"><span lang="EN-US"><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-21583520822224148192020-08-17T10:31:00.001+09:002020-08-17T10:31:23.109+09:00 186 CMAAO CORONA FACTS and MYTH COVID Differently<p> </p><p class="MsoNormal"><b><span lang="EN-US" style="font-size: 16.0pt;">186 CMAAO
CORONA FACTS and MYTH COVID Differently<o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 16.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="tab-stops: 432.35pt;"><span lang="EN-US" style="font-size: 16.0pt;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 16.0pt;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size: 16.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="background: white;"><b><span lang="EN-US" style="color: black; font-size: 16.0pt; mso-color-alt: windowtext;">1052: <span style="mso-spacerun: yes;"> </span></span></b><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Update on
Covid-19</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">IMA-CMAAO
Webinar on “Understanding Coronavirus differently”</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">15<sup>th</sup> August,
2020</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">4-4.30pm</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Participants</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr KK
Aggarwal, President CMAAO</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr RV Asokan,
Hony Secretary General IMA</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr Ramesh K
Datta, Hony Finance Secretary IMA</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr S Sharma</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Faculty</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr KK
Aggarwal</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Padma Shri
Awardee</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">President,
CMAAO & HCFI</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Key points
from the discussion</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The new coronavirus behaves in six
different ways: Viral, bacterial, HIV-like, it causes immunoinflammation,
thromboinflammation and cytokine storm.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">This virus causes immune (antigen)
triggered inflammation wherever ACE2 receptors are present. If
pre-existing inflammation, it will flare up.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">This is a disease of the inflammation of
the digestive and metabolic fires of the body. </span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">There are two types of fire or agni in
the body: microbiome fire and<span style="background: yellow;"> my agni
fire.</span> The balance or imbalance between the two causes health
and disease. This virus triggers and increases agni in the body leading
to disruption of the body’s thermostat resulting in low grade fever.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">If baseline CRP is less than 1, then no
impact; if 1-3, then exacerbation of fire and if more than 3, then there
is high hyperinflammation leading to vasculitis, thrombus formation,
neoangiogenesis and hypoxia.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The route of entry is GI or respiratory.
The virus may be present in GI system much before it is seen in the
respiratory system and even if not seen in the respiratory tract.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Skin biopsy may also be positive for the
virus (Lancet).</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">If fragments of the antigen persist, the
person may be a carrier; they may also cause recurrence of symptoms,
reactivation of illness and trigger inflammation.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">There are six antigens in Covid-19
virus: E, S, N, ORF 1a, ORF 1b and RDRP antigen. The RT PCR test assesses
the antigens and not the virus.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">E antigen is must; it is common for all
corona viruses. If negative, no corona.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">We do not know yet which antigen
persists for more than 9 days or longer. We must find out which of these
antigens is infectious.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">When we say RT PCR is positive, it is
important to know which antigen is positive.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">True Nat tests RDRP; Singapore at
airports are testing N, ORF and S;</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">If we find out which part of the virus
(antigen) is causing which inflammation, this could be a game changer.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In patients with insulin resistance,
where there is already low grade inflammation, the trigger is faster and
more significant.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size: 16.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-42351983147289969062020-08-17T10:29:00.001+09:002020-08-17T10:29:18.692+09:00187 CMAAO CORONA FACTS and MYTH COVI Update<p> </p><p class="MsoNormal"><b><span lang="EN-US" style="font-size: 16.0pt;">187 CMAAO
CORONA FACTS and MYTH COVI Update<o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 16.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="tab-stops: 432.35pt;"><span lang="EN-US" style="font-size: 16.0pt;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size: 16.0pt;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size: 16.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="background: white;"><b><span lang="EN-US" style="color: black; font-size: 16.0pt; mso-color-alt: windowtext;">1053: <span style="mso-spacerun: yes;"> </span></span></b><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Update on
Covid-19</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Minutes of
Virtual Meeting of CMAAO NMAs on “Asian countries update – part 2”</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">15<sup>th</sup> August,
2020, Saturday</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">9.30am-10.30am</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Participants</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Member NMAs</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr KK
Aggarwal, President CMAAO</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr Yeh Woei
Chong, Singapore Chair CMAAO</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr Alvin
Yee-Shing Chan, Hong Kong</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr Marie
Uzawa Urabe, Japan</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr Sajjad
Qaisar, Pakistan</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr Prakash
Budhathoky, Nepal</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Invitees</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr Russell
D’Souza, UNESCO Chair in Bioethics, Australia</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Dr S Sharma,
Editor IJCP Group</span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><b><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Key points
from the discussion</span></b><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<p class="MsoNormal" style="background: white;"><span style="color: #222222; font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span><span style="color: #222222; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The Covid-19 virus has six antigens: E,
S, N, ORF 1a, ORF 1b and RDRP antigen. E antigen is common to corona
viruses; if negative, no corona. The rest five are specific to Covid-19.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">RT PCR antigen has been reported for up
to 40 days. But, there is no data available as to how long any of these
antigens last in the body.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The RT PCR tests the antigen; it does
not detect the virus. If only one antigen is tested, the sensitivity is
low. Testing for 2 or more antigens incurs higher cost.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In cold, frozen foods, the virus can
survive for much longer.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The virus becomes non-replicable inside
the body after 9 days.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">We need to have studies to find out how
long these antigens remain inside the body.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The virus is present in skin. The Lancet
has published a case report where RT PCR was negative, but the skin biopsy
samples from rash, were positive for the virus.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Covid-19 causes immune hyperreaction in
the body. It is a multisystem disorder, especially in children and also
now in adults. Skin could also be involved.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">It is the duty of the treating doctor to
decide after Day 14, whether his patient is infectious or not.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The certificate stating simply
positive/negative status has no value. The doctor should mention if the
patient is infectious or not.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">For instance, a doctor should be able to
give a certificate that the patient is non-infectious under following
conditions: the patient demonstrates the presence of IgG antibodies with
or without presence of antigens, the patient is asymptomatic after 10 days
without doing antigen test, the patient is positive for 2 weeks, his ESR
and CRP are normal.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">We should know which antigens are being
tested. A person detected negative in one country may test positive in
another country. This depends on the antigen/s being tested.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">It was suggested that a survey could be
conducted in the member countries to find out which country is testing
which antigen.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In Singapore, chip machines check for N,
ORF and S antigens at the airports.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">In Japan, the quarantine period has been
reduced from 14 days to 10 days. It is a recommendation and not a law.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Regarding the strike in South Korea, it
is risky to issue a statement without knowing all facts as had been
discussed in the last meeting.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Melbourne has reached the peak; the
cases are now coming down in the last 3-4 days.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
<li class="MsoNormal" style="background: white; color: #222222; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt; mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Masking and social distancing will only
prevent the infection. So, prevent as long as you can and as much as you
can.</span><span style="mso-ansi-language: EN-IN; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-28573158690195083772020-08-15T10:41:00.003+09:002020-08-16T10:39:15.603+09:00185 CMAAO CORONA FACTS and MYTH COVID Surge<p> </p><p class="MsoNormal"><b><span lang="" style="font-size: 16pt;">185 CMAAO
CORONA FACTS and MYTH COVID Surge<o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="" style="font-size: 16pt;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="tab-stops: 432.35pt;"><span lang="" style="font-size: 16pt;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="" style="font-size: 16pt;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><b><span lang="" style="font-size: 16pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span lang="" style="font-size: 16pt;">1051: <span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Round
Table Expert Zoom Meeting on “Will Covid 19 surge come back again?”<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">8<sup>th</sup>
August, 2020<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">11am-12pm<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Participants<o:p></o:p></span></b></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
KK Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Prof
Mahesh Verma<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
Suneela Garg<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
Narottam Puri<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
Alex Thomas<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
Atul Kochhar<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
Ashok Gupta<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
JA Jayalal<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
Jayakrishnan Alapet<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
Anil Kumar<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Mrs
Upasana Arora<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
KK Kalra<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Ms
Ira Gupta<o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Dr
S Sharma <o:p></o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Key points from the
discussion <o:p></o:p></span></b></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">With unlock 3.0,
the people have relaxed, winter is approaching when a new wave is
expected. We have seen that summer had no effect on the number of cases.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">There are six
strains of the coronavirus: L strain (original strain in Wuhan), strains
S, V, G, GR, and GH. Strain G and its related strains GR and GH are the
most common. In North America, the most widespread strain is GH, while in
South America we find the GR strain more frequently. In Asia, where the
Wuhan L strain initially appeared, the spread of strains G, GH and GR is
increasing. Globally, strains G, GH and GR are constantly increasing.
Strain S can be found in some restricted areas in the US and Spain. The L
and V strains are gradually disappearing (Science Daily).<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Up to 30% of
additions/substitution can occur in the same strain. If the virus
undergoes 70% mutation, it becomes a new virus.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">When we define a
surge, we should consider few points: Is it a new mutation? Is it a new
strain? How does a virus behave? Is it a superspreader?<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">The surge can be
due to a new virus, same virus but mutated and same virus but local spread
(superspreader, Dharavi). <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">If surge is due
to a new strain, the mortality may be different and higher initially. If
it is a surge in existing strain, then spread will be high, but mortality
will be low.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Pandemics are
won by communities. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">In Delhi and
Mumbai, the surge was in downtown, as social distancing and/or face masks
were not adhered to.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">RT PCR detects
viral antigens (E, S, M, ORF, NS, RDRP); if e antigen is negative, no
corona. All labs do not test for all antigens. If the kits test for
multiple antigens, the sensitivity of the test is higher. This will reduce
the chances of false negative result.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Cohort pooled Ct
value high, this means that the virus is getting attenuated. Ct value
cannot be the only basis of the report (ICMR), it has to be combined with
clinical interpretation; Ct value can change according to the kit used; it
may be operator dependent. The cut-off value must also be mentioned. It is
important for clinicians to know the viral load.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Family cluster
may have varied symptoms. But, people are not coming forward.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Prevention is
very important, but it is not 100% preventable; our concern is to also
reduce the mortality. All efforts today are towards reducing the infection
and less effort in reducing the mortality.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">Western models
will not work in India. We should learn from each other about things that
are unique to India.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;">It is important
to identify Day 1. CT scan can become positive on Day 3. If RT PCR report
is not available or it may be false positive, then CT becomes important.
Don’t wait for day 5, as complications may set in by this time. One must
act on day 3.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span face="" lang="" style="font-family: verdana, sans-serif; font-size: 10pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang=""><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-23600837589458537922020-08-14T10:35:00.001+09:002020-08-14T10:35:11.976+09:00184 CMAAO CORONA FACTS and MYTH Endocrinology<p> </p><p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">184 CMAAO CORONA FACTS and MYTH
Endocrinology<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">With inputs from Dr Monica Vasudev<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">1050: <span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">Update
on Covid-19 IMA-CMAAO Webinar on “COVID-19 and endocrinology”<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">25<sup>th</sup> July, 2020, 4-5pm<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">Participants<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">Dr KK Aggarwal, President CMAAO; Dr RV Asokan, Hony
Secretary General IMA; Dr Ramesh K Datta, Hony Finance Secretary IMA; Dr Avtar
Krishna, Dr S Sharma <o:p></o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">Faculty<o:p></o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">Dr
Ambrish Mithal, </span></b><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;">Chairman & Head, Endocrinology and Diabetes,
Max Healthcare<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 16.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Postpone
elective endocrine clinic visits; encourage alternative communication means
such as telehealth.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Mail
prescriptions, wherever feasible, rather than in-person pickup<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Advise
patients to stay updated with recommended vaccinations.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Advise
patients to avoid smoking.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">SARS
CoV-1 causes long term hypopituitarism, not yet seen in SARS CoV-2.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">SARS
CoV-2 enters the brain via ACE2 receptor in the olfactory bulb. It cause
anosmia and ageusia and the likely etiology is inflamed sensory epithelium,
although this is not yet proven. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Dehydration
(electrolyte and water imbalance) is a key feature of patients with known
pituitary conditions and Covid-19. Reasons for this include high fever and
tachypnea, diarrhea/vomiting, inability to take adequate fluids (seriously ill
patients). Some amount of hypokalemia is also seen due to upregulation of RAAS
by degradation of ACE2 receptor by the virus.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">In
patients with diabetes insipidus (DI), hyponatremia must be avoided. Allow
excessive urination to start and then give the next dose of desmopressin (in
older patients). Change route of administration (oral pills rather than nasal
desmopressin). In severe Covid, use parenteral desmopressin.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">There
is greater tendency towards hypernatremia and thrombosis in adipsic DI. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">In
patients with hypovolemic shock, restore blood volume with 0.9% saline even if
hypernatremia. If there is no hypovolemic shock, treat with hypotonic fluids.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Compromise
and accept mild hypernatremia to prevent pulmonary edema.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">In
patients with pre-existing hyperprolactinemia and severe Covid-19, consider
temporary discontinuation of dopamine receptor agonists to prevent additive
vasospasm. Continue DRAs during mild to moderate Covid-19.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">If
initiating treatment in growth hormone deficient patient, who is Covid
positive, call the patient and explain. Do not start on video consultation.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">SARS-CoV-1
has been demonstrated in adrenal glands, although this has not yet been
reported with SARS-CoV-2.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">In
patients with Covid-19 and pre-existing adrenal insufficiency, doubling of
steroid dose, as suggested by standard guidelines, might be inadequate due to
high levels of acute inflammation. Monitor hospitalised patients for acute
adrenal insufficiency and start on IV/IM hydrocortisone.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Evidence
has shown association between high serum total cortisol and mortality from
Covid-19.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Diabetes
and hypertension in Cushing syndrome have been identified as established poor
prognostic factors in Covid-19. Increased fibrinogen, factor VIII and vWF
together with impaired fibrinolysis in these patients results in prothrombotic
state.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Low
testosterone levels predict adverse outcomes in Covid-19 pneumonia patients. In
a study, total testosterone levels were best in Internal Medicine, while lower
levels were seen in RICU, ICU and deceased patients.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Testicular
involvement is common in SARS-CoV-2 “orchitis-like syndrome”.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Androgens
may have a role in Covid-19 severity. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Continue
the same regimen of hormone replacement for men and women with hypogonadism until
they can visit the doctor. Temporary discontinuation has no major hazards.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Low
TSH and total T3 is seen in Covid-19. After recovery, there are no differences
in TSH, TT3, TT4, FT3 and FT4. Degree of decrease in TSH and TT3 has a positive
correlation with disease severity. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Thyroid
histopathological study has shown lymphocytic infiltration in the interstitium
in SARS-CoV-2, whereas no inflammatory infiltrate and features of cellular
necrosis in SARS-CoV-1.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Subacute
thyroiditis has been reported after SARS-CoV-2 infection from Italy.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">TSH
receptor antibody can obviate the need for a radioiodine or technetium study.
If positive, Graves’s disease; if negative, thyroiditis.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Patients
with chronic renal dysfunction and parathyroid dysfunction may be at risk of Covid-19
due to underlying renal disease.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Hypocalcemia
may have an association with Covid-19 severity.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">In
pre-existing parathyroid disorders, elective surgery like parathyroidectomy can
be deferred. Check calcium levels, as HCQ and azithromycin can cause QT
prolongation.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">Correct
vitamin D deficiency as such patients are more to develop viral acute
respiratory infection. Low dose (1500-2000 units/day), so that patients are at
least not below 10ng.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">There
is no evidence of increased risk of Covid-19 in patients with bone-mineral
metabolism disorders.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">In
patients on IV denosumab, the dose cannot be delayed by more than a couple of
weeks. Switch to oral bisphosphonate (alendronate), if cannot get injection. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 16.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 16.0pt;">It
is recommended that these drugs should not be started among newly diagnosed
patients during this pandemic.<o:p></o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-30244670297752658382020-08-13T11:04:00.001+09:002020-08-13T11:04:11.232+09:00183 CMAAO CORONA FACTS and MYTH: CMAAO meeting consensus and resolutions<p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">183 CMAAO CORONA FACTS and MYTH: <o:p></o:p></span></b><span style="border: 0px; font-size: 24px; margin: 0px; padding: 0px;"><b>CMAAO meeting consensus and resolutions</b></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"><br /></span></b></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr K Aggarwal<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">President CMAAO<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><br /></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></b></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">1049: </span></b><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Minutes of Virtual Meeting of CMAAO NMAs on “Asian countries update – part 2”<o:p></o:p></span></b></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">8<sup style="border: 0px; margin: 0px; padding: 0px;">th</sup> August 2020, Saturday, 9.30am-10.30am<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Participants Member NMAs<o:p></o:p></span></b></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr KK Aggarwal, President CMAAO<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Yeh Woei Chong, Singapore Chair CMAAO<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Prof Ashraf Nizami, Pakistan, First Vice President CMAAO<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr N Gnanabaskaran, President Malaysian Medical Association<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Marthanda Pillai, Member World Medical Council<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Alvin Yee-Shing Chan, Hong Kong<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Marie Uzawa Urabe, Japan<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Ashraf Nizami, Pakistan<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Sajjad Qaisar, Pakistan<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Md Jamaluddin Chowdhury, Bangladesh<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Prakash Budhathoky, Nepal<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Lochan Karki, Nepal<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></b></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Invitees: </span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia; Dr Zion Hagay, Israel Medical Association; Dr S Sharma, Editor IJCP Group<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">Key points from the discussion<o:p></o:p></span></b></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">The correct interpretation of RT PCR test, done with 2 antigen, same reagent, same lab results is important.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Rising Ct (cycle threshold) value means that the viral load is reducing.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">After nine days the virus is detectable but does not replicate and is non-culturable.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Covid-19 is an “acute immunoinflammatory manageable viral illness with post viral phase”.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Singapore is reaching the tail end of the epidemic. Swabbing of all migrant workers (330,000) has been completed and large numbers of them have returned to work. Community cases remain 1-2 per day.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Malaysia is concerned about the issue of illegal immigrants<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">In Indonesia, testing is inadequate; they are using luminosity to find out the situation i.e. they send a satellite at night and measure the light pattern all over the country and compare with base data from previous years and estimate the amount of Covid cases from satellite images.<o:p></o:p></span></b></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">In Bangladesh, tests are limited (12-13,000/day), 4-25% are positive, mostly the young have the infection, people are losing interest<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">In Pakistan, people are not following SOPs to prevent the infection; they don’t use mask or observe social distancing.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">In Nepal, when the infection first came in, the cases were asymptomatic; after lockdown relaxed, the cases have again started to increase. Most cases now are symptomatic. This may be due to a new mutation of the virus.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Prevent the infection as much as you can, if you can’t then manage it. If positivity rate is >10%, then strict precautions need to be taken; if it is less than 5%, then let the infection happen. If 25% of population is infection, then the first wave is likely to be over. This is herd immunity for the first wave.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">There are six strains of the coronavirus: L strain (original strain in Wuhan), strains S, V, G, GR, and GH.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Multiflanged approach to reduce the infection: state, society and the individual<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">RT PCR detects viral antigens (E, S, M, ORF 1a, 1b, NS, RdRp); if e antigen is negative, no corona. If the kits test for multiple antigens, the sensitivity of the test is higher. For doctors, a policy recommendation can be made that minimum 2-3 antigen tests must be done; this will reduce the chances of false negative result.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">After 10 days, the virus is nonreplicable, so test is not required after 10 days. The person can move out and after 14 days, can resume work.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">The government of Bangladesh is considering a new order regarding duty hours of doctors. Earlier, 7 days’ work and 14 days quarantine (7 days at home) and then resume work. Now the Bangladesh government has changed this to 14 days work and 14 days quarantine (no home stay).<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">The participating NMAs were of the opinion that working for 14 days straight is not a very sensible recommendation as fatigue sets in. Not allowing doctors to go home to their families may result in mental health problems. Working hours should also be reduced to reduce viral load. However, this could lead to shortage of manpower. <o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">A resolution was passed to be sent to Dr Md Jamaluddin Chowdhury, representing the Bangladesh Medical Association for discussion with the government.<b><span style="border: 0px; color: red; margin: 0px; padding: 0px;"> </span></b><i>“In a CMAAO meeting today, 8th of August 2020, it was resolved unanimously that Covid-19 duties for medical staff should not exceed more than 7 days at a stretch and the daily shift should not exceed 8 hours.”</i><o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Dr Alvin raised the issue of resident doctors’ strike in South Korea, who are protesting the government’s decision to increase the number of medical students in the country to meet the shortage. CMAAO would try to reach out to South Korea to see if they need any kind of assistance.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; color: red; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></b></p><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="background-color: white; border-collapse: collapse; border-spacing: 0px; border: none; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><tbody style="border: 0px; margin: 0px; padding: 0px;"><tr style="border: 0px; margin: 0px; padding: 0px;"><td style="border: 1pt solid black; margin: 0px; padding: 0cm 5.4pt; width: 478.8pt;" valign="top" width="638"><p class="MsoNormal" style="border: 0px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;">CMAAO Formula<o:p></o:p></span></b></p><p class="MsoNormal" style="border: 0px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Death in symptomatic cases</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">: less than 1% (with best of care). Therefore, deaths x100 = expected number of symptomatic cases<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Cases after 7 days</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">: Cases today x 2 (based on doubling time 7; this will vary from country to country)<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Cases expected in the community</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">: Get the number of deaths occurring in a 5-day period; estimate the number of infections required to generate these deaths based on the country or area case fatality rate; compare that to the number of new cases actually detected in the 5-day period. This can give an estimate of the total number of cases (confirmed or unconfirmed)<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Lockdown effect</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> = Reduction in number of cases after average incubation period (5 days)<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Lockdown effect in reduction in deaths:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> Reduction in number of deaths on day 14 (average time to death of that country)<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Requirement of ventilators on day 9:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> 1-3% of number of new cases detected<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Requirement of future oxygen on day 7:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> 10% of total cases detected today<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Requirement of ventilators:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> 1-3% of number of cases admitted 7-9 days back<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Requirement of oxygen beds today:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> 10% of total cases admitted 7 days back<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Case fatality rate:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> Number of total deaths as on date/number of total RT PCR positive cases as on today<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Infection fatality rate:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> Number of total deaths as on date/number of total calculated cases as on today<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Number of people which can be managed at home care:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> 90% of number of cases today<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Number of reported deaths:</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> Number of confirmed deaths x 2<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Number of asymptomatic cases</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">: For 6 symptomatic cases, 200 asymptomatic cases<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; line-height: normal; margin: 0cm 0cm 0.0001pt 36pt; padding: 0px; text-indent: -18pt;"><span style="border: 0px; font-family: Symbol; font-size: 18pt; margin: 0px; padding: 0px;">·<span style="border: 0px; font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; padding: 0px;"> </span></span><b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;">Number of unreported or untested cases</span></b><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; margin: 0px; padding: 0px;"> = Number of reported cases x (10-30 depending on the country<o:p></o:p></span></p><p class="MsoNormal" style="border: 0px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p></td></tr></tbody></table><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: Verdana, sans-serif; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><b><span style="border: 0px; font-size: 18pt; line-height: 25.68px; margin: 0px; padding: 0px;"> </span></b></p><p><span style="background-color: white; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 18pt;"> </span> </p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-8683917280002824762020-08-12T10:33:00.001+09:002020-08-12T10:33:33.360+09:00182 CMAAO CORONA FACTS and MYTH Human Challenge<p> </p><p class="MsoNormal"><b><span style="font-size: 14.0pt; line-height: 107%;">182 CMAAO
CORONA FACTS and MYTH Human Challenge<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Dr K
Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">President
CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">With inputs
from Dr Monica Vasudev<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size: 14.0pt; line-height: 107%;">1048: </span></b><span style="font-size: 14.0pt; line-height: 107%;">New guidance from the UK National
Diabetes COVID-19 Response Group: August 2 in Diabetic Medicine<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">Triple insult of
dexamethasone-induced impaired glucose metabolism, COVID-19-induced insulin
resistance, and COVID-19 impaired insulin production.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"> </span>Randomised Evaluation of COVID-19 Therapy
(RECOVERY) trial showed that dexamethasone reduced deaths in patients with
COVID-19 on ventilators or receiving oxygen therapy. The dose used in RECOVERY
— 6 mg daily for 10 days — is five- to six-fold greater than the therapeutic
glucocorticoid replacement dose.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"> </span>High glucocorticoid doses can exacerbate hyperglycaemia
in people with established diabetes, unmask undiagnosed diabetes, precipitate hyperglycaemia
or new-onset diabetes, and can also cause hyperglycaemic hyperosmolar state
(HHS).<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"> </span><b>The guidance recommends a target glucose of
108-180 mg/dL and up to 216 mg/dL is "acceptable."<o:p></o:p></b></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"> </span></span></b><span style="font-size: 14.0pt; line-height: 107%;">Use of once- or twice-daily NPH insulin is recommended for
patients whose glucose has risen above 216 in some cases with the addition of a
long-acting analog. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"> </span>The guidance says that patients already taking
premixed insulin formulations can continue using them while increasing the dose
by 20% to 40%.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"> </span>Given the risk of hypoglycaemia associated
with those formulations, many experts say they would switch those patients to
NPH during the time that they're on dexamethasone.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoListParagraphCxSpMiddle"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoListParagraphCxSpMiddle"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 14.0pt; line-height: 107%;">Comments<o:p></o:p></span></u></b></p>
<p class="MsoListParagraphCxSpMiddle"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">Steroid induced high sugar is often
post meals.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">Give repaglinide 1 mg or 2 mg
sublingual before meals<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">Add 0.3 units insulin per kg in
divided doses<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">In high risk cases steroids may have
to be started on day 1 itself so adjust dose accordingly<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 107%;">In post Covid illness steroids may
have to continue for weeks together like in any immunological illness<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-19484110439818346662020-08-11T11:14:00.001+09:002020-08-11T11:14:20.783+09:00181 CMAAO CORONA FACTS and MYTH Human Challenge<p> </p><p class="MsoNormal"><b><span style="font-size: 14.0pt; line-height: 107%;">181 CMAAO
CORONA FACTS and MYTH Human Challenge<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Dr K
Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">President
CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">With inputs
from Dr Monica Vasudev<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size: 14.0pt; line-height: 107%;">1047:<span style="mso-spacerun: yes;"> </span>Human Challenge Trials for COVID-19 Vaccine and
the Risk?<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Human
challenge trials for the COVID-19 vaccine —volunteering to be given an unproven
vaccine, then being exposed to the virus on purpose instead of waiting to be
exposed and for infection to occur naturally in the community. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">The goal is
to speed vaccine development. More than 32,000 people from the United States
and 139 other countries have already signed up with an online registry, 1Day
Sooner. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">The trials
could effectively deliver a vaccine and end the pandemic more quickly, but the
unknowns about this novel coronavirus, the lack of an effective treatment for
COVID-19, and the accelerated pace of the research give pause, because the
extra risk could come at a high cost: the health, or potentially the life, of
the volunteers.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">These trials
can be faster than conventional field trials, partly because fewer participants
must be exposed to provide early estimates of efficacy and safety; if one
vaccine doesn't work, researchers can move on to other candidates. In challenge
trials, volunteers receive the vaccine candidate or a placebo, just as
participants in traditional trials do. After waiting a period for the vaccine
to take effect, the volunteers are exposed to the virus.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Whereas
traditional vaccine trials may enroll 30,000 participants in phase 3 studies
and have results in 6 months, challenge trials may need only about 150
participants and have results in 6 weeks. In addition, the studies can compare
multiple vaccine candidates at once; the most promising are selected to move on
to larger studies.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Can a
volunteer really give informed consent when there are so many unknowns about
COVID-19? Clinicians say they would communicate the pros and cons should one of
their patients ask about joining up.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">In the past
50 years, the WHO says, ''challenge studies have been performed safely in tens
of thousands of consenting adult volunteers under the oversight of research
ethics committees." The studies have helped to speed development of
vaccines against cholera and typhoid and to evaluate immune protection against
influenza.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Shaving even
1 day off vaccine development time could save 7120 lives, according to
estimates by experts.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Reducing
development time by 3 months would save more than a half million lives,
estimated, assuming that one sixth of the world would acquire COVID-19 annually
and that a vaccine would prevent 0.2% of those people from dying.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Study
participants may be high-risk individuals who volunteer because they believe
that these first vaccine attempts could prevent them from contracting COVID-19,
a belief of the "prevention misconception."<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Guidance On
Glycemia in Dexamethasone-Treated COVID-19<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">New guidance
from the UK National Diabetes COVID-19 Response Group <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Triple
insult of dexamethasone-induced impaired glucose metabolism, COVID-19-induced
insulin resistance, and COVID-19 impaired insulin production.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">August 2 in
Diabetic Medicine<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Randomised
Evaluation of COVID-19 Therapy (RECOVERY) trial, showed that dexamethasone
reduced deaths in patients with COVID-19 on ventilators or receiving oxygen
therapy.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">The advice
is not intended for critical care units but can be adapted for that use.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">The dose
used in RECOVERY — 6 mg daily for 10 days — is five- to sixfold greater than
the therapeutic glucocorticoid replacement dose.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"> </span>High glucocorticoid doses can exacerbate
hyperglycemia in people with established diabetes, unmask undiagnosed diabetes,
precipitate hyperglycemia or new-onset diabetes, and can also cause
hyperglycemic hyperosmolar state (HHS).<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">The guidance
recommend a target glucose of 108-180 mg/dL and up to 216 mg/dL is "acceptable."<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Use of once-
or twice-daily NPH insulin is recommended for patients whose glucose has risen
above 216 in some cases with the addition of a long-acting analog. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">The guidance
says that patients already taking premixed insulin formulations can continue
using them while increasing the dose by 20% to 40%.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;">Given the
risk of hypoglycemia associated with those formulations, many experts say they
would switch those patients to NPH during the time that they're on
dexamethasone.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-22593644511996625492020-08-10T11:21:00.001+09:002020-08-10T11:21:26.439+09:00180 CMAAO CORONA FACTS and MYTH RTPCR<p> </p><p class="MsoNormal">180 CMAAO CORONA FACTS and MYTH RTPCR<o:p></o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With inputs from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1046:<o:p></o:p></p>
<p class="MsoNormal">New York Times:<span style="mso-spacerun: yes;"> </span>A
flurry of recent studies has revealed that a large proportion of the population
— in some places, 20 to 50 percent of people — might harbor immunity assassins
called T cells that recognize the new coronavirus despite having never
encountered it before. It’s too early to tell how helpful they might be, but
even a modest influence on immune response could make the disease milder.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Eight months ago, the new coronavirus was unknown. But to
some human immune cells, it was already something of a familiar foe.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">These T cells, which lurked in the bloodstreams of people
long before the pandemic began, are most likely stragglers from past scuffles
with other related coronaviruses, including four that frequently cause common
colds. It’s a case of family resemblance: In the eyes of the immune system,
germs with common roots can look alike, such that when a cousin comes to call,
the body may already have an inkling of its intentions.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">The presence of these T cells has intrigued experts, who say
it is too soon to tell whether the cells will play a helpful, harmful or
entirely negligible role against the current coronavirus.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">But should these cross-reactive T cells exert even a modest
influence on the body’s immune response, they might make the disease milder —
and perhaps partly explain why some people who catch the germ become very sick
while others are dealt only a glancing blow.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">SARS-CoV-2-specific T cell immunity in cases of COVID-19 and
SARS, and uninfected controls<o:p></o:p></p>
<p class="MsoNormal">•<span style="mso-tab-count: 1;"> </span>Nina Le
Bert, Anthony T. Tan, Kamini Kunasegaran et al: Nature (2020)<o:p></o:p></p>
<p class="MsoNormal">Memory T cells induced by previous pathogens can shape the
susceptibility to, and clinical severity of, subsequent infections.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Little is known about the presence of pre-existing memory T
cells in humans with the potential to recognize SARS-CoV-2. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Here, we first studied T cell responses to structural
(nucleocapsid protein, NP) and non-structural (NSP-7 and NSP13 of ORF1) regions
of SARS-CoV-2 in COVID-19 convalescents (n=36). <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">In all of them we demonstrated the presence of CD4 and CD8 T
cells recognizing multiple regions of the NP protein. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">We then showed that SARS-recovered patients (n=23) still
possess long-lasting memory T cells reactive to SARS-NP 17 years after the 2003
outbreak, which displayed robust cross-reactivity to SARS-CoV-2 NP. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Surprisingly, we also frequently detected SARS-CoV-2
specific T cells in individuals with no history of SARS, COVID-19 or contact
with SARS/COVID-19 patients (n=37). <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">SARS-CoV-2 T cells in uninfected donors exhibited a
different pattern of immunodominance, frequently targeting the ORF-1-coded
proteins NSP7 and 13 as well as the NP structural protein. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Epitope characterization of NSP7-specific T cells showed
recognition of protein fragments with low homology to “common cold” human
coronaviruses but conserved amongst animal betacoranaviruses. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Thus, infection with betacoronaviruses induces multispecific
and long-lasting T cell immunity to the structural protein NP. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Understanding how pre-existing NP- and ORF-1-specific T
cells present in the general population impact susceptibility and pathogenesis
of SARS-CoV-2 infection is of paramount importance for the management of the
current COVID-19 pandemic.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-36947965799657566752020-08-09T10:21:00.001+09:002020-08-09T10:21:19.559+09:00179 CMAAO CORONA FACTS and MYTH New Zealand Eliminates<p> </p><p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">179 CMAAO CORONA FACTS and MYTH New Zealand Eliminates<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">With inputs from Dr Monica Vasudev<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">1045: Successful Elimination of Covid-19 Transmission
in New Zealand<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">NEJM Excerpts: </span></b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Despite
New Zealand’s geographic isolation, introduction of SARS-CoV-2 was imminent
because of the large numbers of tourists and students who arrive in the country
each summer, predominantly from Europe and mainland China. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">New Zealand began implementing its pandemic influenza
plan in earnest in February, which included preparing hospitals for an influx
of patients. It also began instituting border-control policies to delay the
pandemic’s arrival.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">SARS-CoV-2 was behaving more like severe acute
respiratory syndrome (SARS) than like influenza, which suggested that
containment was possible.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">By mid-March, it was clear that community transmission
was occurring in New Zealand and that the country didn’t have sufficient
testing and contact-tracing capacity to contain the virus. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Informed by strong, science-based advocacy, national
leaders decisively <b>switched from a mitigation strategy to an elimination
strategy.<o:p></o:p></b></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">The government implemented a stringent countrywide
lockdown (designated Alert Level 4) on March 26. After 5 weeks, and with the
number of new cases declining rapidly, New Zealand moved to Alert Level 3 for
an additional 2 weeks, resulting in a total of 7 weeks of what was essentially
a national stay-at-home order.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">In early May, the last known Covid-19 case was
identified in the community and the person was placed in isolation, which
marked the end of identified community spread. On June 8, the government
announced a move to Alert Level 1, thereby effectively declaring the pandemic
over in New Zealand, 103 days after the first identified case.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">New Zealand is now in the post-elimination stage. The
only cases identified in the country are among international travellers, all of
whom are kept in government-managed quarantine or isolation for 14 days after
arrival so they don’t compromise the country’s elimination status. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">New Zealand remains vulnerable to future outbreaks arising
from failures of border-control and quarantine or isolation policies. Most
jurisdictions pursuing containment (including mainland China, Hong Kong,
Singapore, South Korea, and Australia) have experienced such setbacks and have
responded with rapid reescalation of control measures. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">New Zealand needs to plan to respond to resurgences
with a range of control measures, including mass masking, which hasn’t been
part of the response to date.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">New Zealand’s total case count (1569) and
deaths (22) have remained low, and its Covid-related mortality (4 per 1
million) is the lowest among the 37 Organization for Economic Cooperation and
Development countries. <o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Public life has returned to near normal. Many parts of
the domestic economy are now operating at pre-Covid levels. Planning is under
way for cautious relaxing of some border-control policies that may permit
quarantine-free travel from jurisdictions that have eliminated Covid-19 or that
never had cases (e.g., some Pacific Islands).<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">The lockdown and consequent deferral of routine health
care have undoubtedly had negative health effects, although total national
weekly deaths declined during the lockdown. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">To mitigate adverse economic effects, the government
instituted a spending program to support businesses and supplement the incomes
of employees who lost their jobs or whose jobs were threatened.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">There are several lessons from New Zealand’s pandemic
response. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Rapid,
science-based risk assessment linked to early, decisive government action<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Implementing
interventions at various levels (border-control measures,
community-transmission control measures, and case-based control measures)<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Prime
Minister Jacinda Ardern empathic leadership and effectively communicated key
messages to the public<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;">Framing
combating the pandemic as the work of a unified “team of 5 million” — which
resulted in high public confidence and adherence to a suite of relatively
burdensome pandemic-control measures. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt; line-height: 107%;"><o:p> </o:p></span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-81787955991201825322020-08-08T11:11:00.001+09:002020-08-08T11:11:08.610+09:00178 CMAAO CORONA FACTS and MYTH RTPCR<p> </p><p class="MsoNormal">178 CMAAO CORONA FACTS and MYTH RTPCR<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With inputs from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1044: RTPCR can be redetected but not re-positive<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Medscape excerpts<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1.<span style="mso-tab-count: 1;"> </span>A positive
rRT-PCR antigen test is highly accurate, indicating presence of SARS-CoV-2 RNA.
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">2.<span style="mso-tab-count: 1;"> </span>There
appears to be no significant cross-reactivity with other respiratory viruses or
even other coronaviruses.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">3.<span style="mso-tab-count: 1;"> </span> A small
study conducted in Korea suggests that patients with persistent positive tests
who are beyond 10 days from the initial positive test and are now symptom free
are no longer infectious.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">4.<span style="mso-tab-count: 1;"> </span> For
patients with a high suspicion of COVID-19, a negative test should not rule out
the infection. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">5.<span style="mso-tab-count: 1;"> </span>The number
of false-negative results is not well known, though the resultant risk is
"substantial." <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">6.<span style="mso-tab-count: 1;"> </span>A number of
factors affect the likelihood of a false-negative test, including when the
sample was collected relative to the timing of illness and the type of specimen
collected<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">7.<span style="mso-tab-count: 1;"> </span>nasopharyngeal
swabs are more likely to be accurate vs nasal or throat specimens. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">8.<span style="mso-tab-count: 1;"> </span>Repeat or
serial testing increases the sensitivity but may not always be available. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">9.<span style="mso-tab-count: 1;"> </span>Although
rRT-PCR is the current criterion standard, more inclusive consensus-based
criteria are likely to emerge because of the concern about these false-negative
results.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">10.<span style="mso-tab-count: 1;"> </span>Patients who
are discharged from isolation after recovering from COVID-19 and who again test
positive for SARS-CoV-2 are unlikely to be infectious, according to a report
from the Korea Centers for Disease Control and Prevention (KCDC).<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">11.<span style="mso-tab-count: 1;"> </span>There's no
relapse<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">12.<span style="mso-tab-count: 1;"> </span>Although the
disease is now known to linger and that it affects more than one system of the
body, other viral diseases, such as influenza and mononucleosis, also
"work that way," <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">13.<span style="mso-tab-count: 1;"> </span>As of May 15,
Korean researchers had identified 447 patients who again tested positive on
real-time reverse transcriptase–polymerase chain reaction (RT-PCR) testing for
viral RNA. Of those, 285 (63.8%) patients had undergone epidemiologic
investigation and contact investigation. Among the tested individuals, 59.6%
were tested for screening purposes, and 37.5% underwent testing because of
their having symptoms. Almost half (44.7%) of the 284 patients who underwent
investigation were symptomatic.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">14.<span style="mso-tab-count: 1;"> </span>Data from
three groups of patients from different cities showed that between 25.9% and
48.9% of patients again tested positive after they had been discharged.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">15.<span style="mso-tab-count: 1;"> </span>Among the 226
patients who were symptomatic when their case was initially confirmed, a repeat
positive test result after discharge occurred an average of 44.9 days (range, 8
– 82 days) from the date symptoms initially developed. It took an average of
14.3 days (range, 1 – 37 days) from the time of discharge to the time of the
second positive test.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">16.<span style="mso-tab-count: 1;"> </span>More than
half (59.6%) of patients who tested positive a second time were tested for
screening purposes, without regard to symptoms. Of those who again tested
positive, 44.7% had symptoms that included cough and sore throat.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">17.<span style="mso-tab-count: 1;"> </span>To help
determine whether a positive result on a second test is associated with
infectivity, the Korean researchers investigated 790 contacts of the 285
patients who tested positive a second time. Of those patients, 351 were family
members, and 439 were others. Among the contacts, the researchers identified
three new cases; however, for all three patients, other sources of infection
were possible. These sources included religious groups or family groups in
which there were persons who were confirmed to have COVID-19.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">18.<span style="mso-tab-count: 1;"> </span>The
researchers tried to culture virus from 108 patients who tested positive a
second time; all such cultures were negative.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">19.<span style="mso-tab-count: 1;"> </span>Further,
first and second serum samples were obtained from 23 patients who had tested
positive a second time. Of those, 96% tested positive for neutralizing
antibodies.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">20.<span style="mso-tab-count: 1;"> </span>Based on
active monitoring, epidemiological investigation, and laboratory testing of
re-positive cases and their contacts, no evidence was found that indicated
infectivity of re-positive cases<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">21.<span style="mso-tab-count: 1;"> </span>Patients who
have been discharged from isolation need no further testing and are not likely
to be infective, even if they again test positive on RT-PCR assay.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">22.<span style="mso-tab-count: 1;"> </span>The patients
will no longer be regarded as "re-positive cases" but as "PCR
re-detected after discharge from isolation"<o:p></o:p></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-8485287486165337092020-08-07T10:40:00.000+09:002020-08-07T10:40:45.969+09:00175 CMAAO CORONA FACTS and MYTH COVID Informed Consent<p class="MsoNormal"><span lang="EN-US">175 CMAAO CORONA FACTS and MYTH COVID
Informed Consent<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Dr K Aggarwal<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">With inputs from Dr Monica Vasudev<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">1041:<span style="mso-spacerun: yes;">
</span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: red; font-family: "Verdana",sans-serif;">SARS-CoV-2 virus shows
little variability regardless of mutations</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Verdana",sans-serif; mso-ansi-language: EN-IN;"><o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">(Science
Daily): SARS-CoV-2 mutation rate remains low. Across Europe and Italy, the most
widespread is strain G, while the L strain from Wuhan is gradually
disappearing. These mutations, however, do not impinge on the process of
developing effective vaccines.<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">The
virus causing the COVID-19 pandemic, SARS-CoV-2, presents at least six strains.
<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">Despite its mutations, the virus shows
little variability, and this is good news for the researchers working on a
viable vaccine.<o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">These
are the results of the most extensive study ever carried out on SARS-CoV-2
sequencing. <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">Researchers
at the University of Bologna drew from the <b style="mso-bidi-font-weight: normal;">analysis
of 48,635 coronavirus genomes</b>, which were isolated by researchers in labs
all over the world. This study was published in the <b style="mso-bidi-font-weight: normal;">journal Frontiers in Microbiology</b>. It was then possible for researchers
to map the spread and the mutations of the virus during its journey to all
continents.<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">The
first results are encouraging. <b style="mso-bidi-font-weight: normal;">The
coronavirus presents little variability, approximately seven mutations per
sample.</b> <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">Common influenza has a variability
rate that is more than double.<o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">"The
SARS-CoV-2 coronavirus is presumably already optimized to affect human beings,
and this explains its low evolutionary change," explains Federico Giorgi,
a researcher at Unibo and coordinator of the study. "This means that the
treatments we are developing, including a vaccine, might be effective against
all the virus strains."<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">Currently, there are six strains of
coronavirus</span></b><span lang="EN-US" style="font-family: "Verdana",sans-serif;">.
<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">The <b style="mso-bidi-font-weight: normal;">original one is the L strain</b> that appeared in Wuhan in
December 2019. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">Its
first mutation -- the S strain</span></b><span lang="EN-US" style="font-family: "Verdana",sans-serif;"> -- appeared at the beginning of
2020 <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">Since mid-January 2020, we have
had <b style="mso-bidi-font-weight: normal;">strains V and G</b>. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">To date strain G is the most
widespread: it mutated into <b style="mso-bidi-font-weight: normal;">strains
GR and GH</b> at the end of February 2020.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">"Strain
G and its related strains GR and GH are by far the most widespread,
representing 74% of all gene sequences we analysed," says Giorgi.
"They present four mutations, two of which are able to change the sequence
of the RNA polymerase and Spike proteins of the virus. This characteristic
probably facilitates the spread of the virus."<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">If
we look at the coronavirus map, we can see that strains G and GR are the most
frequent across Europe and Italy. According to the available data, GH strain
seems close to non-existence in Italy, while it occurs more frequently in
France and Germany. This seems to confirm the effectiveness of last months'
containment methods.<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">In North America, the most widespread
strain is GH, while in South America we find the GR strain more frequently.</span></b><span lang="EN-US" style="font-family: "Verdana",sans-serif;"> <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">In Asia, where the Wuhan L strain
initially appeared, the spread of strains G, GH and GR is increasing. <o:p></o:p></span></b></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">These
strains landed in Asia only at the beginning of March, more than a month after
their spread in Europe.<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Verdana",sans-serif;">Globally, strains G, GH and GR are
constantly increasing. Strain S can be found in some restricted areas in the US
and Spain. The L and V strains are gradually disappearing.</span></b><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p><br />Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-71281163119643546202020-08-07T10:34:00.001+09:002020-08-07T10:34:52.884+09:00177 CMAAO CORONA FACTS and MYTH COVID Informed Consent<p class="MsoNormal">177 CMAAO CORONA FACTS and MYTH COVID Informed Consent<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With inputs from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">1043:<span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Minutes of Virtual Meeting of CMAAO NMAs on “Asian
Countries Update – Part 1” <o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">1<sup>st</sup>
August, 2020<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">9.30am-10.30am<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Participants<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Member
NMAs<o:p></o:p></span></i></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
KK Aggarwal, President CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Yeh Woei Chong, Singapore Chair CMAAO<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Marthanda Pillai, Member World Medical Council<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Alvin Yee-Shing Chan, Hong Kong<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Subramaniam Muniandy, Malaysia<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Marie Uzawa Urabe, Japan<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Ashraf Nizami, Pakistan<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Prakash Budhathoky, Nepal<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Invitees<o:p></o:p></span></i></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Russell D’Souza, UNESCO Chair in Bioethics, Australia<o:p></o:p></span></p>
<p class="MsoNormal" style="tab-stops: 190.2pt;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr S Sharma, Editor IJCP Group<span style="mso-tab-count: 1;"> </span><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Marthanda Pillai spoke about Covid situation in the Gulf countries. Dr KK
Aggarwal analysed the Covid data in South Asia and Dr Yeh Woei Chong gave an
update on Covid in China, South Korea and Singapore. Dr Alvin Yee-Shing Chan
spoke on the current scenario of Covid in Hong Kong.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Verdana",sans-serif; font-size: 10.0pt;">Covid in
Gulf countries<span style="background: aqua; mso-highlight: aqua;"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr Marthanda Pillai<o:p></o:p></span></i></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Many of Gulf countries have been
proactive in response to Covid-19 launching tremendous efforts to control
the infection prior to detecting the first case.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Iran was the first country to be
affected; it continues to be a hotspot.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Saudi Arabia: Spread from Iran;
disease detected in Jan/Feb, quick to implement measures to control the
infection.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">UAE reported four cases on 29<sup>th</sup>
January. Subsequently, Bahrain, Kuwait, Oman, Iraq and Qatar reported
their first case in late February. These cases were either Iranians or
citizens of Gulf countries who had recently visited Iran.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Lockdown has been implemented,
schools/religious places have been closed, no public transport in
operation.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">There is a good system of
testing.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The entire treatment is free,
especially Covid-19 treatment, for all citizens.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Overall, total cases are around
2.3 lakh; the cure rate is around 45-50%. Mortality is less than 1% except
in Iran, where mortality is 3.2%.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Non-Covid patients are restricted;
e prescriptions are being given, which has helped to control the
infection.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Restrictions are in place; there
is no international travel except chartered flights for people who wish to
go back to their country of origin. Their status is checked.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l3 level1 lfo3;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The status of these countries has
an indirect impact on the situation in our countries.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Verdana",sans-serif; font-size: 10.0pt;">Covid-19 in
South Asia<o:p></o:p></span></b></p>
<p class="MsoNormal"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr KK Aggarwal<o:p></o:p></span></i></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The south Asian region includes 8
countries: Afghanistan, <b style="mso-bidi-font-weight: normal;">Bangladesh</b>,
Bhutan, <b style="mso-bidi-font-weight: normal;">India</b>, Maldives, <b style="mso-bidi-font-weight: normal;">Nepal, Pakistan </b>and<b style="mso-bidi-font-weight: normal;"> Sri Lanka</b>.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">If the population density is
more, the number of cases will be more in the first wave. If density is
more than 1000, the number of cases is higher. Among the 5 countries,
Bangladesh is the most densely populated at 1174/sq km. In all the rest,
the density varies between 200 and 400. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">India has the maximum number of
cases in the South Asia region. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">India, Pakistan and Bangladesh
are almost the same in terms of total deaths per million population
(20-25) and also same case fatality rate, which is around 2%. The total
deaths per million population is 2 in Nepal; this may be because Nepal is
yet to peak and spread is not yet seen.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">The situation in Sri Lanka is however
different despite similar population density. The case fatality rate is
low (1%) as is the total number of cases. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Analysis of the indicators of
health infrastructure shows that all five countries have almost similar
number of physicians per 1000 people. But in terms of hospital beds per
1000 population, Sri Lanka has the highest number (3.6); in India,
Pakistan, Nepal and Bangladesh, this number if 0.5-0.8.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Sri Lanka and India reported
their first case of Covid-19 at nearly the same time; 27<sup>th</sup>
January and 30<sup>th</sup> January, respectively.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">All five countries implemented
lockdown around the same time, but Sri Lanka extended the lockdown much
longer. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">More than 10% positive rate
practically means community transmission and if less than 5%, then
lockdown can be lifted. India, Pakistan and Bangladesh have more than 10%
positivity rate<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Reasons for low mortality in Sri
Lanka: First in the region to eliminate malaria, better hygiene index,
educated population, better infrastructure, extended lockdown.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo2;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Kerala has similar mortality as
that of Sri Lanka (0.3%); total cases are 23,000 cases and only 74 deaths.
The seroprevalence is less than 10%. The seroprevalence in Delhi and
Mumbai and Pakistan is around 20-30%. In Bangalore, seroprevalence is
10-12%.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Verdana",sans-serif; font-size: 10.0pt;">Covid-19 in
China, South Korea & Singapore<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr
Yeh Woei Chong<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l2 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">China:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> Confirmed cases
84292 (discharged 78974, deaths 4634); cases have been rising from last
one week. From 11<sup>th</sup> June to 23<sup>rd</sup> June, there were
256 cases in Beijing. Prior to this, there were no cases for 55 days. The
trigger is a seafood market like in Wuhan and the source of infection
apparently is contaminated chopping boards. China has a huge testing
capacity; it is testing people in large numbers – half million tests
daily. Outbreaks in Dalian and Xinjiang in the last week; the new outbreak
in Dalian has been linked to a seafood company and contamination from
packaging is suspected. On 30<sup>th</sup> July, there were 11 cases in
Dalian and 112 in Xinjiang.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l2 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">South
Korea:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">
There are more than 14,000 confirmed cases; 13183 have been discharged and
around 300 have died due to the infection. There is a second wave in South
Korea. The number of cases is increasing. There were 113 cases on 30<sup>th</sup>
July (Friday). South Korea has done 1563796 tests. Their clusters are nightclubs,
door to door sales, churches, ports, and nursing homes.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l2 level1 lfo1;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Singapore:</span></b><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"> There are around
52,000 cases. Majority of cases in the country are in dormitories housing
migrant workers (around 50,000), while the community are only around 2000
cases. Last week there were 400 cases in dormitories and 5 in the
community. Around 5400 cases are in isolation. Since February, there are
128 ICU cases; this number has been zero since last 2 weeks. Number of
tests performed is 1.23 million. There are 323,000 migrant workers in
dormitories. Of these, 262,000 have recovered or cleared of the virus. Efforts
are on to clear all the dormitories of Covid-19 by 7th August. Migrant
workers are swabbed every month towards this end. 975 factory dorms + 64
blocks in 17 purpose built dorms have been cleared. Everybody is swabbed
and if there are any cases, swabbed again after a week. 13000 swab tests
are done in a day.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="color: red; font-family: "Verdana",sans-serif; font-size: 10.0pt;">Hong Kong
Update<o:p></o:p></span></b></p>
<p class="MsoNormal"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Dr Alvin Yee-Shing
Chan<o:p></o:p></span></i></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></b></p>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l1 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Hong Kong is experiencing the
third wave (July) with 3271 cases and 27 deaths, which is serious; up to
end of June, there were 1200 cases and 8 deaths; in 2<sup>nd</sup> wave in
April, the maximum number was only 65. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Origin of the third wave is from
sea men and air crew who were exempted from quarantine and routine testing
together with relaxation of rules of social gathering and fatigue set in. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">No capacity for en masse testing
; bottleneck of testing 13,000 daily; now screening started for high risk
groups – people working in restaurants, catering, sellers etc. No
exemption now from testing and quarantine. <o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Manpower is adequate; 6219
doctors in public hospitals, only half of public hospital beds are
occupied in the past two months as all elective surgeries have been
postponed in public hospitals.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">T614 gene mutation was found in
cluster of sailors entering Hong Kong from Kazakhstan and Philippines;
this DNA expression is similar to that seen in many people in Hong Kong
infected in the third wave. Patients became more serious and more
infectious.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Virology Dept in the University
of Hong Kong is working on research to produce a vaccine against Covid-19.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4;"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;">Holiday homes/villages/resorts
have been modified as isolation and quarantine centers for mild cases to
prevent cross infection to family members.<o:p></o:p></span></li>
</ul>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Verdana",sans-serif; font-size: 10.0pt;"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p><br />Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-33414770734212894712020-08-06T10:54:00.001+09:002020-08-06T10:54:20.577+09:00176 CMAAO CORONA FACTS and MYTH COVID Informed Consent<p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; line-height: 19.9733px; margin: 0px; padding: 0px;">176 CMAAO CORONA FACTS and MYTH COVID Pool test<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; line-height: 19.9733px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; line-height: 19.9733px; margin: 0px; padding: 0px;">Dr K Aggarwal<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; line-height: 19.9733px; margin: 0px; padding: 0px;">President CMAAO<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; line-height: 19.9733px; margin: 0px; padding: 0px;">With inputs from Dr Monica Vasudev<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; line-height: 19.9733px; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 16.5pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">1042: </span><span style="border: 0px; color: #333132; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">Pooled COVID-19 Testing Feasible<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">Combining specimens from several low-risk inpatients in a single test for SARS-CoV-2 infection can allow hospital staff to stretch testing supplies and provide test results quickly for many more patients than they might have otherwise.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">This strategy conserves personal protective equipment (PPE)], led to a marked reduction in staff and patient anxiety, and improved patient care.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">The researchers </span><u><span style="border: 0px; color: #5757a6; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">published their findings</span></u><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> July 20 in <i>Journal of Hospital Medicine</i>.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">Pooled testing combines samples from multiple people within a single test. The benefit is if the test is negative, [you know that] everyone whose sample was combined…is negative. So you've effectively tested anywhere from three to five people with the resources required for only one test.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">The challenge is that if the test is positive, everyone in that testing group must be retested individually because one or more of them has the infection.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">For the current study, all patients admitted to the hospital, including those admitted for observation, underwent testing for SARS CoV-2. Staff in the emergency department designated patients as low risk if they had no symptoms or other clinical evidence of COVID-19; those patients underwent pooled testing.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px 0px 0.0001pt; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;">Patients with clinical evidence of COVID-19, such as respiratory symptoms or laboratory or radiographic findings consistent with infection, were considered high risk and were tested on an individual basis and thus excluded from the current analysis.<o:p></o:p></span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; line-height: normal; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">Between April 17 and May 11, clinicians tested 530 patients via pooled testing using 179 cartridges (172 with swabs from three patients and seven with swabs from two patients). There were four positive pooled tests, which necessitated the use of an additional 11 cartridges. Overall, the testing used 190 cartridges, which is 340 fewer than would have been used if all patients had been tested individually. <o:p></o:p></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">Among the low-risk patients, the positive rate was 0.8% (4/530). No patients from pools that were negative tested positive later during their hospitalization or developed evidence of the infection.<o:p></o:p></span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">Pooling tests seems to work best for three to five patients at a time.<o:p></o:p></span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">Larger batches increase the chance of having a positive test.<o:p></o:p></span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">Pooled testing is mainly dependent on the COVID-19 positive rate in the population of interest in addition to the sensitivity of the [reverse transcriptase-polymerase chain reaction (RT-PCR)] method used for COVID-19 testing.<o:p></o:p></span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">Pooled testing could increase testing capability by 69% or more when the incidence rate of SARS-CoV-2 infection is 10% or lower.<o:p></o:p></span></p><p style="background-color: white; border: 0px; box-sizing: border-box; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">Asymptomatic population or surveillance groups such as students, athletes, and military service members are [an] interesting population to test using pooling testing because we expect these populations to have low positive rates, which makes pooled testing ideal.<o:p></o:p></span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">[T]here is risk of missing specimens with low concentration of the virus.<o:p></o:p></span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;">These specimens might be missed due to the dilution factor of pooling (false negative specimens). We did not have a single false-negative specimen in our proof-of-concept study.<o:p></o:p></span></p><p style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0cm 0cm 0.0001pt; padding: 0px;"><span style="border: 0px; font-size: 14pt; margin: 0px; padding: 0px;"> </span></p><p class="MsoNormal" style="background-color: white; border: 0px; color: #222222; font-family: arial, helvetica, sans-serif; font-size: 13px; margin: 0px; padding: 0px;"><span style="border: 0px; font-family: "times new roman", serif; font-size: 14pt; line-height: 19.9733px; margin: 0px; padding: 0px;"> </span></p>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-4203275297893566582020-08-03T10:41:00.001+09:002020-08-03T10:41:57.196+09:00173 CMAAO CORONA FACTS and MYTH COVID <div>173 CMAAO CORONA FACTS and MYTH COVID </div><div><br /></div><div>Dr K Aggarwal</div><div>President CMAAO</div><div>With inputs from Dr Monica Vasudev</div><div><br /></div><div>1035: Studying primary human lung cells that were infected in the lab with SARS-CoV-2 showed how the cells began to accumulate large amounts of lipid droplets. After infection, the lung proteins downregulate the ability of lung cells to burn carbohydrates and fatty acids. Lung cells are not designed to hold fat, which could explain some of the severe damage to the lungs of patients with COVID-19. The virus is dependent on glucose uptake, cholesterol production, and fatty acid oxidation. More research is needed on the cholesterol drug fenofibrate before clinical trials can begin.</div><div><br /></div><div>1036: The antihistamine cloperastine, which is mostly sold in Japan, blocks glucose uptake in lung cells and has shown a small effect in fighting COVID-19.</div><div><br /></div><div><br /></div><div>1037: Moderna: a robust immune response and protected against infection in a study on monkeys. The vaccine, MRNA-1273, given to non-human primates protected against infection in the lungs and nose, and prevented pulmonary disease in all animals. Results of the study in rhesus macaque monkeys were published in the New England Journal of Medicine.</div><div><br /></div><div>It appeared to be an improvement over results of AstraZeneca's COVID-19 vaccine in a similar study. In the study Iinvolving 24 monkeys, Moderna tested doses of 10 micrograms or 100 micrograms of the vaccine against no treatment.</div><div><br /></div><div>Both doses proved effective at protecting against viral replication in the lungs and lung inflammation, with the larger dose also protecting against viral replication in the nose of the animals.</div><div><br /></div><div>1038: AstraZeneca and Oxford University - among the most advanced in human trials - in a similar animal study also appeared to prevent damage to the lungs and keep the virus from making copies of itself there. But the virus still actively replicated in the nose in that study.</div><div><br /></div><div>1039: A cohort of 145 patients younger than age 1 month to 65 years separated by age found that the youngest children had significantly lower median cycle threshold (CT) values than older children or adults, suggesting they had equivalent or more viral nucleic acid in their upper respiratory tract than other age groups, reported Taylor Heald-Sargent, MD, PhD, of Ann & Robert H. Lurie Children's Hospital in Chicago, and colleagues. These differences approximated a 10- to 100-fold greater amount of SARS-CoV-2 in the nasopharynx of young children, the authors wrote in a research letter in JAMA Pediatrics. Importantly, the researchers noted that their findings were limited to detection of viral nucleic acid and not infectious virus.</div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div>Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0tag:blogger.com,1999:blog-8394195474849218097.post-22285841182248605932020-08-02T10:32:00.001+09:002020-08-02T10:32:06.360+09:00171 CMAAO CORONA FACTS and MYTH COVID Train Travel<p class="MsoNormal">171 CMAAO CORONA FACTS and MYTH COVID Train Travel<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Dr K Aggarwal<o:p></o:p></p>
<p class="MsoNormal">President CMAAO<o:p></o:p></p>
<p class="MsoNormal">With inputs from Dr Monica Vasudev<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b>1033: The risk of COVID-19 transmission in train
passengers: an epidemiological and modelling study; Maogui Hu, Hui Lin, Jinfeng
Wang, Chengdong Xu, et all; Clinical Infectious Diseases, 29 July 2020<o:p></o:p></b></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Train is a common mode of public transport across the globe;
however, the risk of COVID-19 transmission among individual train passengers
remains unclear.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Methods: The study quantified the transmission risk of
COVID-19 on high-speed train passengers using data from 2,334 index patients
and 72,093 close contacts who had co-travel times of 0–8 hours from 19 December
2019 through 6 March 2020 in China. We analysed the spatial and temporal
distribution of COVID-19 transmission among train passengers to elucidate the
associations between infection, spatial distance, and co-travel time.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Results: The attack rate in train passengers on seats within
a distance of 3 rows and 5 columns of the index patient varied from 0 to 10.3%,
with a mean of 0.32%. Passengers in seats on the same row as the index patient
had an average attack rate of 1.5%, higher than that in other rows, with a
relative risk (RR) of 11.2. Travellers adjacent to the index patient had the
highest attack rate of COVID-19 infections (RR 18.0,) among all seats. The
attack rate decreased with increasing distance, but it increased with
increasing co-travel time. The attack rate increased on average by 0.15% (p =
0.005) per hour of co-travel; for passengers at adjacent seats, this increase
was 1.3% (p = 0.008), the highest among all seats considered.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Conclusions: COVID-19 has a high transmission risk among
train passengers, but this risk shows significant differences with co-travel
time and seat location. During disease outbreaks, when travelling on public
transportation in confined spaces such as trains, measures should be taken to
reduce the risk of transmission, including increasing seat distance, reducing
passenger density, and use of personal hygiene protection.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p><br />Dr K K Aggarwalhttp://www.blogger.com/profile/06535202357396120070noreply@blogger.com0