Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Med j club mm covid20

COVID updates

Livres associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir

Livres audio associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir
  • Soyez le premier à commenter

  • Soyez le premier à aimer ceci

Med j club mm covid20

  1. 1. Kurdistan Board GEH/GIT Surgery J Club 2020 Supervised by Professor Dr. Mohamed Alshekhani.
  2. 2. Introduction:  Coronaviruses typically cause common cold symptoms, but two beta coronaviruses — SARS-CoV&Middle East respiratory syndrome coronavirus (MERS-CoV) — can cause pneumonia, respiratory failure&death.  In late 2019, infection with a novel betacoronavirus, subsequently named SARS-CoV-2, was reported in people who had been exposed to a market in Wuhan, China, where live animals were sold.  Since then, there has been rapid spread of the virus, leading to a global pandemic of Covid-19.
  3. 3. Introduction:  Coronaviruses typically cause common cold symptoms, but two beta coronaviruses — SARS-CoV&Middle East respiratory syndrome coronavirus (MERS-CoV) — can cause pneumonia, respiratory failure&death.  In late 2019, infection with a novel betacoronavirus, subsequently named SARS-CoV-2, reported in people exposed to a market in Wuhan, China, where live animals were sold&rapid spread of the virus, leading to a global pandemic of Covid-19 occured.  Coronaviruses are RNA viruses divided into four genera; alphacoronaviruses &betacoronaviruses are known to infect humans.  SARS-CoV-2 is related to bat coronaviruses &to SARS-CoV, the virus that causes SARS.  Similar to SARS-CoV, SARS-CoV-2 enters human cells through the ACE2 receptor.  SARS-CoV-2 has RNA-dependent RNA polymerase&proteases, targets of drugs.
  4. 4. Transmission:  SARS-CoV-2 is primarily spread from person to person through respiratory particles, probably of varying sizes, released when an infected person coughs, sneezes, or speaks.  Because both smaller particles (aerosols) & large particles (droplets) are concentrated within a few meters, the likelihood of transmission decreases with physical distancing & increased ventilation.  Most SARSC arenCoV-2 infections are spread by respiratory-particle transmission within a short distance (<2 m from an infected person).  Aerosols can be generated during certain procedures (e.g., intubation or the use of nebulizers) but also occur with other activities & under special circumstances, such as talking, singing, or shouting indoors in poorly ventilated environments; in these situations, transmission over longer distances may occur.  Because respiratory transmission is so prominent, masking&physical distancing markedly decrease the chance of transmission.
  5. 5. Transmission:  SARS-CoV-2 RNA detected in blood & stool, although fecal–oral spread has not been documented.  A small cluster of cases suggested the possibility of fecal aerosol– associated airborne transmission after toilet flushing, but rare.  SARS-CoV-2 may persist on cardboard, plastic&stainless steel for days&contamination of inanimate surfaces proposed to play a role in transmission,but its contribution is uncertain & may be relatively small.  Major challenge is that asymp& presymptomatic people are infectious.  Patients may be infectious 1-3 days before symptom onse&up to 40- 50% may be attributable to transmission from asymp or presymptomatic.  Just before & soon after symptom onset, patients have high nasopharyngeal viral levels, which then fall over a period of 1 - 2 weeks.  Patients may have detectable SARS-CoV-2 RNA on PCR tests for weeks - months, but the duration of infectivity is much shorter;recommendations support lifting isolation in most patients 10 days after symptom onset if fever has been absent for at least 24 hours (without antipyretic)&other symps decreased.
  6. 6. Clin features:  Ranges from asymptomatic infection to critical illness.  Among symptomatics, the median incubation period is 4 -5 days, 97.5% have symptoms within 11.5 days after infection.  Symptoms may include fever, cough, sore throat, malaise,myalgias.  Some patients have GI symptoms, including anorexia, nausea, diarrhea.  Anosmia a&ageusia have been reported in up to 68%, more common in women than in men.  In some patients, shortness of breath developed in median of 5 - 8 days after initial symptom onset; its occurrence is suggestive of worsening disease.  Risk factors for complications of Covid-19 include older age, CVD, chronic lung disease, diabetes& obesity.  It is unclear whether other conditions (e.g., uncontrolled  HIV or use of immunosuppressive medications) confer an increased risk of complications, but because these conditions with worse outcomes after infection with other may be associated
  7. 7. Diagnosis:  Usually involves the detection of SARS-CoV-2 nucleic acid by PCR assay.  Just before &soon after symptom onset, the sensitivity of PCR testing of nasopharyngeal swabs is high.  If testing is negative in a person who is suspected to have Covid, repeat testing is recommended. The specificity is nearly 100% as long as no cross- contamination occurs during specimen processing.  Multiple specimen types, including nasopharyngeal, oropharyngeal, and mid-turbinate and anterior nares (nasal) swabs, saliva.  The FDA EUA allows patient collection of an anterior nares specimen with observation by a HCW ,to decrease exposure.  Antigen tests less sensitive than PCR tests but are less expensive &can be used at the point of care with results in 15 minutes.  Anti–SARS-CoV-2 antibodies are detectable in the majority of patients 14 days or more after the development of symptoms, reserved for people who are suspected to have Covid-19 but have negative PCR&whom symptoms began at least 14 days earlier&after 2 weeks when there is a clinical or epidemiologic reason for detecting past infection, as serosurveillance.
  8. 8. Evaluation:  81% of people with Covid-19 had mild or moderate disease (including without pneumonia or mild pneumonia), 14% severe disease& 5% had critical illness.  Patients who have mild signs / symptoms generally do not need additional evaluation, but some will subsequently have precipitous clinical deterioration that occurs approximately 1 week after onset.  In patients who have risk factors for severe disease,close monitoring for clinical progression is warranted, with a low threshold for additional evaluation.If new or worsening symptoms (e.g., dyspnea) develop in patients with initially mild illness, additional evaluation is warranted.  Physical examination should be performed to assess for tachypnea, hypoxemia&abnormal lung findings. In addition, testing for other pathogens(e.g., influenza virus, depending on the season&other respiratory viruses) should be performed, if available&chest imaging should be done.
  9. 9. Evaluation:  Hallmarks of moderate disease are the presence of clinical or radio evidence of lower respiratory tract disease but with PaO2 of 94% or higher while the patient is breathing ambient air.  Indicators of severe disease are marked tachypnea (respiratory rate, ≥30 breaths per minute), hypoxemia (oxygen saturation, ≤93%; ratio of partial pressure of arterial oxygen to fraction of inspired oxygen,<300)& lung infiltrates (>50% of the lung field involved within 24 - 48 hours).  Lab in hospitalized pats should include CBC&metabolic panel.  In most instances&esp if a medication that affects the QTc interval is,a baseline ECG should be obtained.  Chest XR is usually the initial imaging method. Some also use lung U/S.  ACR recommends against the use of computed tomography as a screening or initial imaging to diagnose Covid-19, it should be used “sparingly” & only in hospitalized patients when there are specific indications.  Additional tests sometimes performed include coagulation studies (e.g., d- dimer)&inflammatory markers (e.g., CRP&ferritin),LDH, CK, procalcitonin.
  10. 10. Evaluation:  Patients with mild dis usually recover at home, with supp care& isolation&if high risk for complications use pulse oxi to self-monitor.  Moderate disease should be monitored closely& sometimes hospitalized.  Those with severe disease should be hospitalized.  If evidence of bacterial pneumonia, empirical antibacterial therapy is reasonable but should be stopped as soon as possible.  Empirical treatment for influenza may be considered when seasonal influenza transmission is occurring until results of specific testing known.  Treatment of Covid-19 depends on the stage&severity of disease.  Because SARSCoV-2 replication is greatest just before or soon after symptom onset, antiviral medications (e.g., remdesivir & antibody-based treatments) are likely to be most effective when used early.  Later, hyperinflammatory state&coagulopathy lead to clinical complications; antiinflammatory medications, immunomodulators, anticoagulants, or a combination may be more effective than antivirals.  HCQ&CQ with or without azithro did not improve clinical outcomes.

    Soyez le premier à commenter

COVID updates

Vues

Nombre de vues

287

Sur Slideshare

0

À partir des intégrations

0

Nombre d'intégrations

3

Actions

Téléchargements

2

Partages

0

Commentaires

0

Mentions J'aime

0

×