Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania,
HCFI and Past National President IMA
With regular inputs from Dr Monica Vasudev
Alcohol COVID link
As per WHO an increase of alcohol consumption can lead to "health vulnerability, risk-taking behaviours, mental health issues and violence." Alcohol compromises the body’s immune system and increases the risk of adverse health outcomes.
A pandemic myth that claims consuming high-strength alcohol can kill the virus is false and can lead to fatal health consequences.
While unhealthy drinking increases
the risk for infection, consumption within the recommended limits — one per day
for women, two per day for men — may be fine. With moderate drinking, “while we
do see some changes that happen in our immune system, they’re transient and
they go away rather quickly.
709: Echocardiography guidelines by
ASE
Only perform transthoracic
echocardiograms (TTE), stress echocardiograms, and transoesophageal
echocardiograms (TEE) if they are expected to provide clinical benefit.
Determine which studies are
"elective" and reschedule them.
Identify "nonelective"
(urgent/emergent) indications and defer all others.
Determine the clinical benefit of
echocardiography for symptomatic patients whose SARS-CoV-2 status is unknown.
Cautiously consider the benefit
of a TEE examination weighed against the risk for exposure of healthcare
personnel to aerosolization in a patient with suspected or confirmed COVID-19.
Postpone or cancel TEEs
if an alternative imaging modality can provide the necessary information.
Note that treadmill or bicycle
stress echo tests in patients with COVID-19 may lead to exposure because of
deep breathing and/or coughing during exercise. These tests should generally be
deferred or converted to a pharmacologic stress echo.
The
ASE statement also provides advice on safe imaging protocol and adequate
personal protection measures.
Limit the exposure of staff who
may be particularly susceptible to severe complications of COVID-19
Staff
who are older than 60 years, who have chronic conditions, are immunocompromised or
are pregnant may wish to avoid contact with patients suspected or confirmed to
have COVID-19.
710: Non pulmonary manifestations
1.
There's a case on Consult of a 37-year-old man with stomach pain,
vomiting, and diarrhoea, but no respiratory symptoms and a positive COVID test.
A chest CT incidental to his abdominal scan revealed significant bilateral lung
involvement.
2.
A 69-year-old woman with a
history of laparotomy and new onset intestinal sub occlusion had only adhesions
on a subsequent exploratory laparotomy and was doing okay otherwise. She
suddenly went into respiratory failure with progressive bradycardia and died 3
days later. Aspiration pneumonia, pulmonary embolism, and MI had been ruled
out. The pattern of cardiovascular failure was in favour of myocarditis.
3.
Elevated cardiac enzymes without
coronary artery obstruction in a positive patient who went into shock, with an
ejection fraction of 40% and markedly increased heart wall thickness, but no
lung involvement.
4.
There are two cases of idiopathic
thrombocytopenia without fever of hypoxia.
5.
Most patients become nauseated,
[and] the taste of any food is unbearable. When you find these symptoms by
history, the patient is COVID positive 100%.
6.
The ACE2 receptor the virus uses
to enter cells is common in many organs, plus there were extrapulmonary
manifestations
7.
Encephalopathy
8.
Liver impairment
9.
Kidney impairment
10.
Multiorgan dysfunction
711: Re use of N95 respirators
1.
Can be safely decontaminated without undermining functional integrity
only two or three times
2.
Both ultraviolet light and
vaporized hydrogen peroxide met the bar for killing the virus without impacting
fit testing for two rounds of wear and decontamination compared with control
respirators.
3.
Filtration remained "acceptable" after a third round for those
two methods as well.
4.
Vaporized hydrogen peroxide (VHP,
approximately 1,000 ppm) was the faster of the two. VHP eliminated viral growth
in media exposed to the mask after decontamination to zero in about 10 minutes,
whereas ultraviolet light (260-285 nm) dropped it to below the acceptable level
in about an hour.
5.
The CDC has not approved any
method for decontaminating masks, but it has said it "does not intend to
object to the distribution and use of sterilizers, disinfectant devices, and
air purifiers that are intended to be effective at killing SARS-CoV-2 .
6.
FDA believes such devices will not create such an undue risk, when
performance and labelling criteria are met.
7.
The study also looked at a 70% ethanol solution sprayed to saturation
and heat treatment in a 70°C (158°F) oven for 10 minutes.
Ethanol was quick to decontaminate
the respirators but didn't pass the test for respirator function on the second
round of decontamination.
8.
Dry heat was slow, taking about an hour to hit the viral kill threshold,
but kept proper function for two rounds of decontamination.
9.
A separate group studying N95
respirator decontamination has cautioned that soapy water, alcohol, bleach
immersion, and overnight storage are unsuitable.
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