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Novel coronavirus (COVID-19) etiological characteristics, clinical manifestations and management

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Novel coronavirus (COVID-19) etiological characteristics, clinical manifestations and management

  1. 1. Novel coronavirus (COVID-19) etiological characteristics, clinical manifestations and management Presented By Dr Izharul Hasan M.D (U) Consultant Unani Karol Bagh, New Delhi Ph: 8287833547
  2. 2. ETIOLOGICAL CHARACTERISTICS:- • The epidemic of novel coronavirus (COVID- 19) infections that began in China in late 2019 has rapidly grown and cases have been reported worldwide. Covid-19 is a zoonotic, new viral respiratory illness against which we have no natural immunity. • Virus is sensitive to ultraviolet and heat. Exposure to 56 0C for 30 minutes and lipid solvents such as ether. 75% ethanol, chlorine containing disinfectants and peracetic acid can effectively inactivate the virus.
  3. 3. ETIOLOGICAL CHARACTERISTICS:- • The patients infected by coronavirus are main source of infection. • Asymptomatic infected people can also be an source of infection. • Transmission of the virus mainly through respiratory droplet and close contact. (Coronavirus disease spreads primarily through contact with an infected person when they cough or sneeze. It also spreads when a person touches a surface or object that has the virus on it, then touches their eyes, nose, or mouth).
  4. 4. ETIOLOGICAL CHARACTERISTICS:- • There is possibility of aerosol transmission in a relatively closed environment for a long exposure in high concentration of aerosol. • Attention should be made to feces or urine contaminated environmental that leads to aerosol or contact transmission.
  5. 5. CLINICAL MANIFESTATION:- • Illness ranges in severity from asymptomatic or mild to severe; a significant proportion of patients with clinically evident infection develop severe disease. • The Incubation period is 1 to 14 days, generally 3 to 7 days. • Main symptoms fever, fatigue and dry cough. • Nasal congestion, running nose, sore throat, myalgia are in few cases. • Severe cases mostly developed dyspnea or hypoxemia after one week. • It is important to notice that for severe and critical ill patients fever could be moderate to low or even barely noticeable
  6. 6. CLINICAL MANIFESTATION:- • The patients with mild symptoms did not develop pneumonia but only low fever and mild fatigue. • Mostly patients have good prognosis and a small number of patients critically ill. • Symptoms in children are relatively mild. • Mortality rate among diagnosed cases (case fatality rate) is generally about 2% to 3% but varies by country to country. • Reported cases in adults of middle age or older are on more risks.
  7. 7. DIAGNOSTIC PROCEDURES:- • Infection should be suspected in persons with a compatible respiratory illness and exposure history (if identified). • In the early stages of disease peripheral WBC count normal or decreased and the lymphocytes count decreases. • Some patients see an increase in liver enzymes, lactate dehydrogenase (LDH), muscle enzyme and myoglobin. • Mostly patients have increased C-reactive protein and ESR. • In severe and critically ill cases elevated inflammatory factors.
  8. 8. DIAGNOSTIC PROCEDURES:- • Novel coronavirus nucleic acid can be detected in nasopharyngeal swabs (Nasopharyngeal swab is preferred; oropharyngeal swab may be submitted in addition), sputum, lower respiratory tract secretion, blood, feces and other specimen using RT-PCR method. Polymerase chain reaction tests are the standard for diagnosis. Specific methods and availability vary; public health authorities may assist in arranging diagnostic testing in some areas. • It is more accurate if specimen from lower respiratory tract (sputum) are tested. • NCP virus specific IgM becomes detectable around 3-5 days after onset.
  9. 9. DIAGNOSTIC PROCEDURES:- • Chest Imaging: In early stage, chest X-ray shows multiple small shadows and interstitial changes appear in outer lateral zone of lungs. • As the disease progress, imaging then shows multiple ground glass opacities and infiltration in both lungs (Chest imaging eg. plain radiography, CT, ultrasonography) has shown abnormalities in most reported patients). • In severe cases, pulmonary consolidation may occur.
  10. 10. DEFINITIONS:- Epidemiological history: • History of travel or residence in communities where cases have been reported within 14 days prior to the onset of disease. • In contact with novel coronavirus infected people with positive results for the nucleic acid test within 14 days prior to the onset of the disease. • In contact with patients who have fever or respiratory symptoms from communities where confirmed cases have been reported within 14 days before the onset of disease. • Clustered cases or more cases with fever, and or respiratory symptoms in a small area such families, offices, schools etc within weeks.
  11. 11. DEFINITIONS:- Epidemiological history: • Clinical manifestations: Fever and or respiratory symptoms. Normal or decreased WBC count, normal or decreased lymphocyte count in the early stage of onset. • A suspect case has any of the epidemiological history plus any two clinical manifestations or all three clinical manifestations if there is no clear epidemiological history. • Suspect cases with one of the following etiological or serological evidence can be CONFIRMED. • Real time fluorescent RT-PCR indicates positive for new coronavirus nucleic acid. • Viral gene sequence is highly homologous to known new coronaviruses. • NCP virus specific IgM and IgG are detectable in serum.
  12. 12. DEFINITIONS:- Epidemiological history: • Mild Cases: The clinical symptoms are mild, no sign of pneumonia on imaging. Moderate cases showing fever and respiratory symptoms with radiological findings pneumonia. • Severe cases: Adult cases meeting any of the following criteria. • Respiratory distress (>30 breaths/min) • Oxygen saturation <93% at rest; • Arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) < 300mmHg (1 mmHg = 0.1333kPa). • Cases with chest imaging that showed obvious lesion progression within 48 hours >50% shall be managed as severe cases.
  13. 13. DEFINITIONS:- Epidemiological history: • Critical Cases: meeting any of the following criteria. • Respiratory failure and requiring mechanical ventilation. • Shock • With other organ failure that requires ICU care.
  14. 14. WARNING INDICATORS:- • of time. Adults • Peripheral blood lymphocytes decrease progressively. • Peripheral blood inflammatory factors such as IL-6 and C-reactive proteins increase progressively. • Lactate increases progressively; • Lung lesions develop rapidly in a short period
  15. 15. DIFFERENTIAL DIAGNOSIS:- • Bacterial pneumonia • Other known viral pneumonia such as influenza virus, adenovirus etc. • Mycoplasma pneumonia infections.
  16. 16. GENERAL TREATMENT • A suspect case should be treated in isolation in a single room. • Confirmed cases can be treated in isolation in single room. • Critical cases should be admitted to ICU as soon as possible. • Strengthening support therapy • Closely monitoring vital signs and oxygen saturation. • Monitoring blood routine result, urine routine result, c-reactive prtein (CRP), Liver enzyme, myocardial enzyme, renal function test, arterial blood gas analysis, chest imaging and cytokines detaction. • Providing effective oxygen therapy.
  17. 17. TREATMENT OF SEVERE AND CRITICAL CASES:- • Symptomatic Treatment • Prevent complications • Treat underlying diseases • Prevent secondary infections • Provide organ function support. • Respiratory support • Oxygen therapy • Noninvasive mechanical ventilation • Rescue therapy • Immunotherapy
  18. 18. DISCHARGE CRITERIA:- • Body temperature is back to normal for more than 3 days. • Respiratory symptoms improve obviously. • Pulmonary imaging shows absorption of inflammation. • Nuclei acid tests negative twice consecutively on respiratory tract samples such as sputum and nasopharyngeal swabs being at least 24 hours. • In hospitalized patients with proven COVID-19, repeated testing is recommended to document clearance of virus, defined as 2 consecutive negative results on polymerase chain reaction tests at least 24 hours apart.
  19. 19. THE EXPERIENCE:- • Early Detection • Promote reporting to authorities • Swift isolation • Early Treatment
  20. 20. KEY POINTS OF SELF PROTECTION FOR MEDICAL STAFF:- • Hand hygiene • Wearing and removing mask • Correct removal of protective equipment
  21. 21. PREVENTION • There’s currently no vaccine to prevent coronavirus disease (COVID-19). • Wash your hands regularly for 20 seconds, with soap and water or alcohol-based hand rub • Cover your nose and mouth with a disposable tissue or flexed elbow when you cough or sneeze • Avoid close contact (1 meter or 3 feet) with people who are unwell • Stay home and self-isolate from others in the household if you feel unwell. Physical distancing should be used as much as possible. • Don't Touch your eyes, nose, or mouth if your hands are not clean.
  22. 22. ADJUVANT UNANI FORMULATION:- • Arq Ajeeb 1 ml + sharbat khakshi 100 ml, mix together. Adult dose: 2 tsf twice a day, children 1 teaspoon twice a day for 7 days. Very helpful preparation to prevent in most types of Flu's. Magic effects. • You can put 5 to 7 drops of Arq ajeeb in 2 let of water and consume this water as needful in divided amount. Very beneficial effects to prevent mostly flu's.
  23. 23. ADJUVANT UNANI FORMULATION:- • Aforesaid Unani formulation can be used as prophylaxis or as adjuvant therapy with other allopathic medication or issued by Govt of India. However researches/studies are required to conduct beneficial effects of these Unani medicines in such epidemic conditions.
  24. 24. REFERENCE: • World Health Organization. Infection prevention and control during health care when COVID-19 is suspected. • WHO: Coronavirus Disease 2019 (COVID-19): Situation Report--51. WHO website. Published March 11, 2020. Accessed April 7, 2020. • https://www.who.int/docs/default- source/coronaviruse/situation-reports/20200311-sitrep-51- covid-19.pdf • Oke J et al; Centre for Evidence-Based Medicine: Global Covid-19 Case Fatality Rates. CEBM website. • CDC: Coronavirus Disease 2019 (COVID-19) Situation Summary. CDC website. Updated March 26, 2020. Reviewed March 26, 2020. Accessed April 8, 2020
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