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
725:
Poison centres see 20% spike in calls related to cleaners, disinfectants
Poison centres in the United
States has seen more than 20% increase in calls for exposures to cleaners and
disinfectants during the first 3 months this year compared with the same time
period in 2019, according to a new MMWR report.
726: What is the link
The spike is likely related
to the COVID-19 pandemic. According to the report, there were 45,550 exposure
calls in the U.S. related to cleaners and disinfectants from January through
March —20.4% more than the first 3 months in 2019 and 16.4% more than in 2018.
727: What is the main poisoning
Among cleaners, exposure to
bleaches accounted for the largest percentage of the increase from 2019 to 2020.
Nonalcohol disinfectants and hand sanitizers were responsible for the largest
percentage of the increase among disinfectants.
The CDC recommends that
people “with precautions” clean and disinfect high-touch surfaces to help
mitigate the transmission of SARS-CoV-2 viruses.
According to the report,
children aged 5 years or younger “consistently represented at large percentage
of calls” during the study periods in all 3 years. The MMWR report briefly
described two cases
1.
A preschool-age
child was hospitalized in the paediatric ICU after ingesting “an unknown
amount” of ethanol-based hand sanitizer, which gave her a blood alcohol level
roughly 3 1/2 times the legal limit for driving in most states
2.
In the other, a
woman experienced difficulty breathing and called 911 after mixing bleach, vinegar and hot water in her sink to clean produce. Both patients
recovered.
Reference: Chang
A, et al. MMWR Morb Mortal Wkly Rep. 2020; doi:10.15585/mmwr.mm6916e1.
728: How is bleach be harmful
1. Bleach is caustic
2. It's important to dilute your bleach and
ensure that it's not used at full-strength and not mix it with other solutions
and chemicals.
3. Never mix it
with ammonia. Mixed with bleach converts the chlorine in bleach to chloramine
gas. Breathing in the fumes can cause coughing, shortness of breath, and pneumonia.
4. Never mix acidic compounds such as vinegar or window cleaner create chlorine gas in
bleach. When mixed with bleach, excessive exposure can cause chest pain,
vomiting, and even death.
5. Do not mix Alcohol as it converts
to chloroform when mixed with bleach. Breathing in chloroform can cause
fatigue, dizziness, and fainting.
729: NEJM-DG Alerts: Patients with COVID-19 who
had ST-segment elevation had a poor prognosis.
Sripal Bangalore, MD, New York
University Grossman School of Medicine, identified 18 patients with COVID-19
and ST-segment elevation treated at 6 New York City hospitals. The median age of the patients was 63 years,
83% were men, 33% had chest pain around the time of ST-segment elevation, 65%
had hypertension, 41% had hypercholesterolemia, 35% had diabetes, and 18% had a
history of coronary artery disease. Of the patients, 10 (56%) had ST-segment
elevation at the time of presentation, and in the other 8 patients, it
developed during hospitalisation (median, 6 days).
Of 14 (78%) patients with focal
ST-segment elevation, 5 (36%) had a normal left ventricular ejection fraction
(1 with regional wall-motion abnormality) and 8 (57%) patients had a reduced
left ventricular ejection fraction (5 with regional wall-motion abnormalities).
One patient did not have an echocardiogram. Of the 4 patients with diffuse
ST-segment elevation, 3 (75%) had a normal left ventricular ejection fraction
and normal wall motion and 1 patient had a left ventricular ejection fraction
of 10% with global hypokinesis.
Half of the patients underwent coronary
angiography; 6 of these patients had obstructive disease and 5 (56%) underwent
percutaneous coronary intervention (1 after the administration of fibrinolytic
agents).
The 8 patients (44%) who received a
clinical diagnosis of myocardial infarction had higher median peak troponin and
d-dimer levels (1,909 vs 858 ng/ml) than the 10 (56%) patients with noncoronary
myocardial injury. A total of 13 (72%) patients died in the hospital -- 4 with
myocardial infarction and 9 with noncoronary myocardial injury.
Conclusion: There was variability in
presentation, a high prevalence of nonobstructive disease, and a poor prognosis.
All 18 patients had elevated d-dimer levels. In contrast, in a previous study
involving patients who presented with ST-segment elevation myocardial
infarction, 64% had normal d-dimer levels. Myocardial injury in patients with
COVID-19 could be due to plaque rupture, cytokine storm, hypoxic injury,
coronary spasm, microthrombi, or direct endothelial or vascular injury.
Another study, published in Journal of
Thrombosis and Haemostasis, showed that D‐dimer levels on admission predict
in‐hospital mortality in patients with COVID-19.
Litao Zhang, and Xinsheng Yan, Wuhan
Asia Heart Hospital, Wuhan, China, and colleagues analysed data from 343
patients with COVID-19 treated at Wuhan Asia General Hospital from January 12,
2020, to March 15, 2020. Of the patients, 67 had D-dimer levels ≥2.0 µg/ml and
267 had D‐dimer levels <2.0 µg/ml on admission.
A total of 13 deaths occurred during
hospitalisation -- 12 deaths among patients with D-dimer levels ≥2.0 µg/ml and
1 in a patient with D-dimer levels <2.0 µg/ml (hazard ratio = 51.5; P <
0.001).
The optimum cut-off value of D‐dimer to
predict in‐hospital mortality was 2.0 µg/ml with a sensitivity of 92.3% and a
specificity of 83.3%.
Compared with patients with D-dimer levels
<2.0 µg/ml, patients with D-dimer levels ≥2.0 µg/ml had a higher incidence
of underlying disease, such as diabetes, hypertension, coronary heart disease,
and history of stroke. They also had lower levels of lymphocyte, haemoglobin,
platelet count, and higher levels of neutrophil, C-reactive protein, and
prothrombin time.
“D‐dimer on admission greater than
2.0µg/mL could effectively predict in‐hospital mortality… [And] improve
management in patients with COVID-19,” the authors concluded.
730: A case report published in the American Journal of Perinatology
suggests possible vertical transmission of SARS-CoV-2.
DG alerts: Maria Claudia Alzamora, MD,
British American Hospital, Lima, Peru, and colleagues describe the case of a
pregnant woman aged 41 years with diabetes presenting with a 4-day history of
malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal
swab was positive for COVID-19, but serology was negative. The patient
developed respiratory failure requiring mechanical ventilation on day 5 of
disease onset.
The patient underwent a caesarean
delivery, and neonatal isolation was implemented immediately after birth,
without delayed cord clamping or skin-to-skin contact.
The neonatal nasopharyngeal swab,
16 hours after delivery, was positive SARS-CoV-2 and immunoglobulin (Ig)-M and
IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on
postpartum day 4 (day 9 after symptom onset).
This is the earliest reported positive
polymerase chain reaction in the neonate, raising the concern for vertical
transmission. Pregnant women should be considered as a high-risk group and
minimise exposures for these reasons.
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