COVID-19: Cardiovascular complications

Hi everyone... 

Virus infections are the most common cause of myocarditis. The previous severe acute respiratory syndrome (SARS) beta-coronavirus SARS-CoV-1 was associated with tachyarrhythmias, signs, and symptoms of heart failure.

Let's learn about SARS-CoV-2:

• COVID-19 patients who died had higher levels of troponin, myoglobin, C-reactive protein, serum ferritin, and IL-6.
• This is because of the high inflammatory burden in COVID-19.

Let’s find out and understand about CVS complications by COVID-19:

• Mainly, vascular inflammation, myocarditis, and cardiac arrhythmias
• The possible late phenomenon of the viral respiratory infection
• Commonly observed in severe cases
• Strongly associated with mortality

Cardiovascular complications of COVID-19 

COVID-19: The journey of a viral pandemic

Modes of transmission of SARS-CoV-2

A novel human coronavirus that emerged in Wuhan, China in the later months of 2019 has now dissipated all around the world, causing a pandemic. Let's analyze how this virus manages to spread so virulently breaching our usual barriers.

Modes of transmission of SARS-CoV-2

COVID-19: Remdesivir (GS-5734)

Here is a short post about Remdesivir (GS-5734).

Compound:
A '-cyano-substituted adenosine nucleotide analog prodrug.

COVID-19: Water transmission and the effects of heat on the SARS-CoV-2 virus

Hi!

I am going to be writing a series of COVID-19 posts and answering frequently asked questions by patients. Today's post is about water transmission and the effects of heat on the SARS-CoV-2 virus.

Recent updates about treatment of COVID19

All things you need to know about COVID19 

https://www.youtube.com/watch?v=A6WpCkjqJSM

Recent Updates: 

At present Best Option = HydroxyCQ +/- Azithromycin 

HydroxyCQ for 10 day ( 200 mg TDS ) 

As ACE 2 enzyme is receptor for SARS-Cov-2 & these RAS inhibitors ⬆️ ACE2 enzyme. So hypothetically, there's an ⬆️ Risk of Covid19. But the guidelines recommend that ACEI / ARBs should not be discontinued. 

Drugs under Clinical Trials:

Remdesivir (USA) 

Ritonavir-Lopinavir 

Tocilizumab (IL6) 

Sarilumab (IL6) 

Favipiravir+ Tocilizumab 

Meplazumab (CD147) 

Fingolimod 

Darunavir + Cobicistat 

Which Rx is used in your country now?  Please comment below ⬇️

Thank you.. 

- Drashtant 

Everything you need to know about coronavirus COVID-19

Resources: CDC, UpToDate, WHO website.
Video by Drashtant Prajapati, MBBS.

Everything you need to know about coronavirus COVID-19

Resources: CDC, UpToDate, WHO website.
Video by Drashtant Prajapati, MBBS.

Cataract in Rubella- interesting fact

The progressive nuclear cataract in Rubella may harbor live virus particles.

How to read CSF analysis report?

Video by Jay!

Leptospirosis

Rats, rains, ricefields? Ring any bells? Sewer workers coming in with jaundice and fever? Still no?
Assam/Odisha/Kerala floods?

AASLD guidelines for treatment of chronic hepatitis B in pregnancy

Hello!

Here is a quick summary.

Mnemonic: Duke’s Criteria for Infective Endocarditis

Infective endocarditis is diagnosed using the modified Duke’s criteria.
Let’s look at them in an easy-to-remember way.

MAJOR CRITERIA
It’s, quite literally, proving the name Infective Endocarditis to be true.

Infective, that is, positive blood culture:
• Typical bugs in 2 separate cultures
• Persistently positive blood cultures, say > 12h apart
• Single positive blood culture for Coxiella burnetii

Endocarditis, that is, endocardium involvement:
• On imaging with 2D Echo or CT, look for vegetation, abscess, pseudoaneurysm or dehiscence of prosthetic valve
• On clinical exam, find new regurgitation murmur

MINOR CRITERIA
Remember, patients feel very ill when they have infective endocarditis.
Predisposing factors: congenital heart disease, prosthetic heart valves, iv drug abuse
Fever > 38 °C
Vascular phenomena: emboli, Janeway’s lesions
Immunologic phenomena: glomerulonephritis, Osler’s nodes

What if the blood culture is positive but does not meet the major criteria?
It’s considered as a minor criterion (casually speaking, problematic but not majorly problematic).

How do we use this for diagnosing?
2 major OR
1 major + 3 minor OR
All 5 minor criteria, make up the diagnosis.

Clinical Pearl: Fever with any new-onset murmur is taken as infective endocarditis, unless proven otherwise.



Hope this helps. Happy studying!
- Ashish Singh.

Antibiotics: Action and Resistance

A series of fortunate events - including a cancelled holiday and an unpredictable British summer - in 1928 began the antibiotic revolution, when Alexander Flemming’s observation that a contaminating Penicillium colony caused lysis of Staphylococci.

Here’s a pictorial summary of various sites of action of modern-day antibiotics.

[Please click on the image to enhance it]

However, the capacity for prokaryotic bugs to develop resistance far outweighs the human capacity to develop new antiobiotic drugs.

Antibiotic resistance can be:

- Intrinsic: Inherent structural or functional characteristics, eg: vancomycin cannot cross the outer membrane of Gram negative bacteria.

- Extrinsic: Acquired through years of mutation and/or transfer of resistance properties. This evolutionary phenomenon is accelerated by selection pressure from antibiotic use, eg: beta lactamase producing Gram positive bacteria.

- Ashish Singh

Catheter Removal Timing

Removal — Following diagnosis of catheter-related infection, catheter removal is warranted in the following circumstances :

●Severe sepsis

●Hemodynamic instability

●Endocarditis or evidence of metastatic infection

●Erythema or exudate due to suppurative thrombophlebitis

●Persistent bacteremia after 72 hours of antimicrobial therapy to which the organism is susceptible

Source :Uptodate

Bhopalwala. H

Catheter Related Candidemia Treatment Indications

Empiric therapy for suspected catheter-related candidemia should be administered for septic patients with the following risk factors:

●Total parenteral nutrition

●Prolonged use of broad-spectrum antibiotics

●Hematologic malignancy

●Hematopoietic cell or solid organ transplant

●Femoral catheterization

●Colonization due to Candida species at multiple sites

Source: Uptodate

Bhopalwala. H

Antibiotic Lock Therapy

Antibiotic lock therapy —

The premise of ALT is to achieve sufficient therapeutic concentrations to kill microbes growing in a biofilm . ALT may be a useful adjunctive therapy together with systemic antibiotic therapy for intraluminal infections due to coagulase-negative staphylococci or gram-negative organisms in the setting of CRBSI (Catheter Related Blood Stream Infection) when the catheter cannot be removed .

ALT should not be used for extraluminal infections nor for management of infections due to S. aureus, P. aeruginosa, drug-resistant gram-negative bacilli, or Candida.

Source: Uptodate

Bhopalwala. H

Timing of Catheter Replacement in CRBSI

In general, the patient should receive antibiotic therapy for at least two to three days following device removal prior to device replacement. At the time of device replacement, the patient should be hemodynamically stable with negative blood cultures and no sequelae of bloodstream infection .In addition, for patients with CRBSI ( Catheter Related Blood Stream Infection) due to S. aureus, a new catheter may be placed if additional blood cultures demonstrate no growth at 72 hours

Source: Uptodate

Bhopalwala. H

qSOFA Score for Sepsis

The qSOFA (quick Sequential Organ Failure Assessment) score is easy to calculate since it only has three components, each of which are readily identifiable at the bedside and are allocated one point:

●Respiratory rate ≥22/minute

●Altered mentation

●Systolic blood pressure ≤100 mmHg

Bhopalwala. H

Zebra series: Lemierre's syndrome

Hello everyone!

Let's talk about Lemierre's syndrome today.

Lemierre's syndrome is characterized by disseminated abscesses and thrombophlebitis of the internal jugular vein after infection of the oropharynx. The predominant pathogen is a gram-negative anaerobic bacillus, Fusobacterium necrophorum.

That's the Zebra for the day!

IkaN

Congenital syphilis picmonic

This was submitted by Ri. Thanks girl!

With reference to this post: http://www.medicowesome.com/2017/03/buzz-words-for-congenital-syphilis.html

-IkaN