Monday, August 31, 2020
Nail Biting ana COVID-19 - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
Nail Biting and COVID-19
- M.A.Aleem Neurologist #Trichy #Tamilnadu #India
The news of the COVID-19 pandemic has a lot of people on edge. And for some of us, that anxiety can lead to some nervous habits.
Nail-biting is the most common of the typical nervous habits.
During the spreading pandemic, that bad habit could be dangerous.
The virus needs to get in the lining of mouth, nose or eyes to infect a person.
And so anything you do to kind of help the virus get from the outside world into those moist parts of your face is going to increase your risk of catching the virus.
The bacteria, viruses, dirt, and debris can collect under the nails, and can then be transferred to your mouth if you bite your nails.
You may bite your nails without realizing you are doing it. You might be involved in another activity, such as reading, watching television, or talking on the phone, and bite your nails without thinking about it.
Every time you touch your face — especially your mouth, nose, and eyes — you’re transferring all of those germs under your nails and you can get sick.
The germs going into the mouth is the easiest way you can contract any infection.
In addition to oral health, nail biting also makes humans more likely to become infected by bacteria or a virus like COVID-19.
The hands can easily transfer germs into the body through the saliva, and also through abrasions in the skin around the nail bed that can form during constant nibbling.
Biting your nails can seriously increase your risk of contracting coronavirus.
Any pre existing nail conditions may make nail difficult to cleanse, increases the carriage of pathogens, and the potential to transmit infections to self and others. This concern holds more importance during COVID-19.
The COVID-19 has the potential to remain stable on the surface like metal or plastic objects for at least 48-72 hours. Although it's not yet known how long the virus can remain stable on skin and nails, it can still spread during spontaneous self-touch to face with infected hands or nails.
However, special attention to nail care is of utmost importance during this COVID-19 Pandemic .
The nails should be kept short and well-trimmed (free edge being <0.5 cm or ¼ inch long). Long nails besides harboring pathogens on the undersurface, can also cause puncture of gloves if you are wearing.
Excessive trimming and cuticle cutting should also be avoided as it can disrupt the barrier protection of nail. During hand washing, the undersurface of the nails should not be missed and diligently cleaned with soap or alcohol-based hand rub for 20 seconds.
Nail-biting and chewing must be avoided. In case of a hangnail, it should not be pulled out or ripped. Rather it should be cut with a clean nail cutter.
Manicure, cuticle cutting, and nail filing should be avoided. Artificial and gel nails should be avoided as they are difficult to clean and harbor more pathogens than normal nails. Studies have shown that after cleansing, pathogen clearing was significantly lower in artificial or acrylic nails than healthy nails. It is recommended to avoid the application of nail polish. If applied, the film should not be cracked or chipped and must be regularly removed. Nail polish worn for more than four days or chipped nail coat has a potential to carry pathogens that resist cleansing by handwashing.
The nail care is an important aspect of maintaining hygiene, more so during COVID-19 Pandemic. The health care workers exposed to the high-risk areas of hospitals, need to give special attention to nail hygiene in addition to hand hygiene.
Sunday, August 30, 2020
Prof.Dr.M.A.Aleem Emeritus Professor of Neurology The Tamilnadu Dr. MGR Medical University and Neurologist and Epiletologist ABC Hospital Trichy has Participated as Moderator at LEVNEUE EXPERT TALK - Unlocking Challenges of Epilepsy on What to do with Pharmaco-resistance Epileptic Patients talk by Dr.Sathish Kumar V. Chennai through Webinar organised by Alkem on 29.8.2020 from 6 to 7PM
Wednesday, August 26, 2020
Covid management - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
*Covid management:*
Once covid is diagnosed get a baseline CBP, LFT, RFT, CRP, d-Dimer, IL6 (if available), LDH, Ferritin, Trop-T, ECG, baseline CXR and CT chest.
Ask for replication score in RT PCR test. It indicates how infective you are for other people. Any score above 25 is generally non-infectious especially if you crossed 10 days & asymptomatic for 3 consecutive days.
Viral replication generally stops by 9th day which means if you want any benefit of anti-viral it should be given within 9 days. There is doubt regarding the efficacy of Remdesevir if given late.
RT PCR may be negative in late stages of infection. So dont forget to rely on clinical, epidemiological and radiological guidance to DIAGNOSE A CASE !!
Best time for RT PCR after symptom onset 5th to 8th day. False negatives lowest in these days.
The pathology of Covid disease is that the inflammation which causes damage not virus.
Covid , SLE, APLA, TIDM Macrophage activation syndrome , HLH are all similar... Host immune system reacts against its own tissues... Covid has a know antigen SARS CoV2... "" Frustrated phagocytosis '" occurs when the antigen cannot be eliminated leading to hyperactivation of macrophages and lymphocytes leading to destruction of tissues.
Even CT changes occur a little late but CRP and LDH are the first to raise. Clinically the 3 dangerous symptoms are fever , myalgia and exhaustion which indicate high inflammation in the body.
Steroids and anti coagulation are going to be the CORNER STONE of treatment.
At present steroids are recommended for people who become hypoxic. Start early steroid irrespective of hypoxia especially if CRP and other inflammatory markers are elevated.
Oral prednisolone 20mg or Tab Dexa 4mg /day for 5 to 7 days will do the job if there are mild symptoms.
Steroids will definitely make patient feel better.
Steroids also prevent long term lung fibrosis.
Regarding anti coagulation Inj Clexane 0.5mg s/c bd if d -Dimer is normal and 1mg s/c bd if d-Dimer is elevated.
There is a controversy regarding when to start anticoagulant.
Better to start it early if CT changes are seen, as the changes in CT are actually microvascular thrombi.
After 5 days, you can switch to oral anticoagulant Tab Rivaroxaban 10mg OD for 4 weeks.
Early steroids and anticoagulant will prevent longterm complications.
It may not make difference in acute phase.
If there is hypoxia both are mandatory.
Preferable Inj Methylprednisolone 40mg iv bd or tid based on weight and severity of hypoxia.
HCQ should not be combined with Remdesevir.
Switch to oral Dexa once course of anti viral is finished.
Steroids may be needed for 2 to 3 weeks if hypoxia is present.
Is preferable to prolong anticoagulant for 6 weeks if oxygen is needed.
It is mandatory to monitor CRP, D Dimer every alternate day till patient is in hospital.
IL6 on day 5 and day8.
Any raise in IL6 is a marker for an impending cytokine storm and ensure to have access to Tocilizimab if symptoms worsen.
IL6 can return to normal with steroids and anticoagulant.
Most dangerous period is 8 to 12 days.
That is when most people die.
There are rare reports of late cytokine storm after 12 days.
But if treatment is started early as mentioned above it is very unlikely patient will land up in complications.
Again to reiterate it is inflammation which kills, not virus.
Hit inflammation hard and early and be alive for 2 weeks.
Body will automatically clear the virus after that.
Prone ventilation for 18 hours a day will make a big difference if patient is hypoxic.
No need to repeat CT chest after baseline.
CXR every 3 days is sufficient to monitor progress.
Remember radiological changes may take weeks or months to clear. Don't get panicked. Remember they are blood clots not regular pneumonia.
Improvement in oxygen levels is the marker for clinical improvement.
No need to monitor anything else once oxygen starts improving.
If Tocilizimab is given keep monitoring procalcitonin for secondary infection and the risk of infection is present or for n ext 2 weeks.
Once Tocilizimab is given patient don't manifest fever or raised counts as marker of infection.
Keep a low threshold for antibiotic if patient received Tocilizimab.
It's might be better not to use any antibiotic in Covid illness.
Patients will do absolutely well without antibiotic provided you keep changing lines regularly and stop IV medications early.
Don't forget Dexamethasone is highly pro diabetic.
So even if sugars are normal in first week keep monitoring blood sugars regularly as long as patients are on steroids.
10 to 15% dont develop antibodies post covid. Reason for it are probably some truly dont develop antibodies, or develop some T cell immunity, or dominant IgA antibody response in respiratory mucosa and not systemic IgG response.
So post covid immunity passport is INVALID
Covid 19 : RT PCR test* - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
*Covid 19 : RT PCR test*
*Frequently asked questions*
1. *What is the full form of RT PCR?*
Ans : Reverse Transcription Polymerase Chain Reaction
2. *Why test is only 67% specific & not 100% ? What are the pitfalls?*
Ans : Problem can be at 4 levels :
- very low viral load at the time of sample collection
- faulty sample collection
- improper trans port of the sample &
- faulty laboratory technique.
So test must be repeated in high clinical suspicion.
3. *How the test is correctly interpreted ?*
Ans : Correct interpretation - at least two or more antigens should be tested with same reagents & same laboratory.
4. *Is there any false positive result ?*
Ans : No false positives- positive is certainly positive. It can be false negative. (Repeat the Test- if high clinical suspicion)
5. *How many types of antigen are present in COVID- 19 virus?*
Ans : Covid-19 virus has 6(six) antigens-
- E
- S
- N
- ORF 1a
- ORF 1 b &
- RDRP.
6. *Which antigen is common to all corona viruses?*
Ans : E antigen is common to all CORONAVIRUSES.
If E is negative - No Corona.
Other 5 are specific to Covid-19.
7. *Do all countries test same antigens?*
Ans : Testing of antigen differ from one country to another.
8. *What is is the implication of it on international travellers?*
Ans : As testing of antigen differ from country to country. So person declared negative in one country may test positive elsewhere. It depends on antigen/s being tested.
9. *Is positive/ Negative report enough?*
Ans : No, simply mentioning positive/ negative in certificate has no meaning.
10. *How can a Doctor certify that patient is non- infectious?*
Ans : Along with positive/negative report, Doctor must be able to certify that person is infectious/non- infectious under following conditions.
a) Patient demonstrates presence of IgG antibodies with or without presence of antigen.
b) Patient is asymptomatic after 10 days without doing antigen test.
c) Patient is positive for two weeks and his/ her ESR , CRP are normal
11. *After how many days in body virus becomes non replicable/ non culturable?*
Ans : After 10 days virus is nonreplicable. So test is not required after 10 days.
Post COVID-19 Neuropsychological Effects - M.A.Aleem BMJ 2020;370:m3218
Bmj British Medical Journal
News
Covid-19:
Impact of long term symptoms will be profound, warns BMA
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3218 (Published 13 August 2020)
Cite this as: BMJ 2020;370:m3218
Rapid response
Re: Covid-19: Impact of long term symptoms will be profound, warns BMA
Dear Editor
Post COVID-19 Neuropsychological Effects.
About 1 in 3 patients recovering from COVID-19 could experience neurological or psychological after effects of their infections due to lasting impact on the brain.
These after COVID-19 longer problems may present as fatigue, tiredness, body pain, muscle pain, headache, dizziness, mood disorders like aanxiety depression, sleep problems, cognitive disturbances, tremors lingering loss of smell or taste.
It may also present with difficulty in walking due to muscles weakness, nerves damages or due to paralysis.
During COVID-19 infection, the brain can be affected and results in stroke, dementia like syndromes and psychosis.
Post COVID-19 patients can also have lasting damage to their heart, kidneys and liver due to inflammation and blood coagulation problems.
Sometimes these patients can present like post traumatic stress disorder and mental health problems.
Competing interests: No competing interests
21 August 2020
M.A. Aleem
Emeritus Professor of Neurology * Visiting Specialist in Neurology ** Consultant Neurologist ***
The Tamilnadu Dr.M.G.R. Medical University * Dhanalakshami Srinivasan Medical College ** ABC Hospital ***
Chennai 600032* Perambalure 621212** Trichy 620018*** Tamilnadu India
@drmaaleem
Tuesday, August 25, 2020
Elections and COVID-19 Pandemic - M.A.Aleem BMJ 2020;370:m3245
Bmj British Medical Journal
The Big Picture
Covid-19: World “has to recover together” and help vulnerable states
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3245 (Published 19 August 2020)
Cite this as: BMJ 2020;370:m3245
All rapid responses
Re: Covid-19: World “has to recover together” and help vulnerable states
Dear Editor
Elections and COVID-19 Pandemic.
The current COVID-19 Pandemic leads to many issues in each and every country.
One of the cascading effects of COVID-19 Pandemic has been its impact on democracies.
Some countries have pushed ahead with elections. Some other countries have postponed their elections and some other countries are in a dilemma.
Hong Kong, Ethiopia, Italy, UK, Somalia, Solomon Islands, Spain and Syria have postponed their local and national elections because of problems arising out of the COVID-19 Pandemic.
France has conducted its municipal elections with some postponement.
Israel conducted its legislative elections on March 2, 2020.
In Germany municipal elections were conducted in March 2020.
South Korea held its legislative elections on 5th Apirl 2020 without any newer Outbreak of COVID-19 cases.
Burundi held its Presidential and parliamentary elections on 20th May 2020.
Iceland held Presidential elections on 27th June 2020.
Serbia had its parliamentary elections on June 21, 2020.
Mongolia held its legislative elections on 24th June 2020.
Dominican Republic had its general election from May 17 to July 5, 2020.
General election 2020 in Singapore was held on 10th July.
In Poland the Presidential election was held from 10th May to 12th July 2020.
In Croatia parliamentary election was held on July 5, 2020.
Sri Lankan parliamentary election took place on 5 August 2020.
Belarusian presidential election 2020 was held on 9th August.
New Zealand Parliamentary elections are scheduled in September 2020 without any postponement.
Tanzanian general elections are scheduled on 28th October 2020.
US presidential elections 2020, are going to take place on 3 November.
Americans were alarmed on July 30th, when their president suggested on Twitter that the November 3 presidential election should be delayed because mail-in ballots would be fraudulent.
A series of tweets by the American President has also suggesting that the upcoming presidential election should be delayed on account of the Covid-19 pandemic.
“Delay the Election until people can properly, securely and safely vote???” Trump tweeted.
Romanian legislative elections are scheduled on 31 December 2020. But it may be postponed till 21 March 2021.
2020 Ghanaian presidential election Is scheduled on 7 December.
In India, Bihar will be the first state where assembly elections will be held amid the COVID-19 pandemic. The polls are likely to be held sometime in October-November 2020.
The Election Commission (EC) of India on Friday 21.8.2020 issued the new guidelines for the conduct of elections amid the COVID-19 pandemic.
Postal ballot facility has been extended to the electors with disabilities, people above age of 80 years, people employed in notified essential services and who are COVID-19 positive/possibly infected.
Face mask, sanitizer, thermal scanners, gloves, face shield and PPE kits will be used during the electoral process, ensuring social distancing norms.
Hand gloves will be provided to all electors for signing on the voter register and pressing button of electronic voting machines (EVM) for voting.
Candidates are asked to file the nomination papers online and people are advised to wear face masks during election-related activities.
The EC of India has also revised the norms of the number of people accompanying the candidate and number of vehicles at the time of filing nomination.
For the first time, the candidates will have the option to deposit security amount online for contesting the elections.
The EC has limited the number of persons including candidate for door to door campaign to five.
Public meeting and road shows will be allowed with suitable instructions subject to containment instructions issued by the government of India.
World “has to recover together” and help the vulnerable states to overcome all their issues including conducting elections during the current COVID-19 Pandemic.
Despite the COVID-19 Pandemic, democracy should not be indefinitely postponed to choose a Government or a local body.
Competing interests: No competing interests
21 August 2020
M.A. Aleem
Emeritus Professor of Neurology * Visiting Specialist in Neurology ** Consultant Neurologist ***
The Tamilnadu Dr.M.G.R. Medical University * Dhanalakshami Srinivasan Medical College ** ABC Hospital ***
Chennai 600032* Perambalure 621212** Trichy 620018*** Tamilnadu India
@drmaaleem
Elections in India and COVID-19 Pandemic - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
Elections and COVID-19 Pandemic.
The current COVID-19 Pandemic leads to many issues in each and every country .
One of the cascading effects of COVID-19 Pandemic has been its impact on democracies.
Some countries have pushed ahead with elections. Some other countries has postponed their elections and some other countries are in dilemma.
Hongkong, Ethiopia, Italy, UK,Somalia Solomon Islands Spain and Syria has postponed their local and national elections because of problems arising out of the COVID-19 Pandemic.
France has conducted its municipal elections with some postponement.
Israel has conducted its legislative elections in March 2, 2020.
In Germany municipal elections were conducted in March 2020.
South Korea held its legislative elections in 5th Apirl 2020 without any much newer Outbreak of COVID-19 cases.
Burundi held its Presidential and parliamentary elections in 20th May 2020.
Iceland has undergone Presidential elections in 27th June 2020.
Serbia had its parliamentary elections in June 21,2020.
Mongolia held its legislative elections in 24th June 2020.
Dominican Republic had its general election in from May 17 to July 5, 2020.
General election 2020 in Singapore was held in 10th July .
In Poland , its Presidential election was held from 10th May to 12th July 2020.
In Croatia parliamentary election was held on July 5, 2020.
Sri Lankan parliamentary election was taken place on
5 August 2020.
Belarusian presidential election 2020 was held on
9th August .
New Zealand Parliamentary elections are scheduled in September 2020 without any postponement
Tanzanian general elections are scheduled on 28th October 2020.
US presidential elections 2020, are going to take place on
3 November.
Americans were alarmed on July 30th, when their president suggested on Twitter that the November 3 presidential election should be delayed because mail-in ballots would be fraudulent.
A series of tweets by the American President has also suggesting that the upcoming presidential election should be delayed on account of the Covid-19 pandemic.
“Delay the Election until people can properly, securely and safely vote???” Trump tweeted.
Romanian legislative election are scheduled on
31 December 2020 . But it may be postponed to 21 March 2021.
2020 Ghanaian presidential election
Is scheduled on 7 December .
In India,
Bihar will be the first state where assembly elections will be held amid the COVID-19 pandemic. The polls are likely to be held sometime in October-November 2020.
The Election Commission (EC) of India on Friday 21.8.2020 issued the new guidelines for the conduct of elections amid the COVID-19 pandemic.
Postal ballot facility has been extended to the electors with disabilities, people above age of 80 years, people employed in notified essential services and who are COVID-19 positive/possibly infected.
Face mask, sanitizer, thermal scanners, gloves, face shield and PPE kits will be used during the electoral process with ensuring social distancing norms.
Hand gloves will be provided to all electors for signing on the voter register and pressing button of electronic voting machines (EVM) for voting.
Candidates are asked to file the nomination papers online and people are advised to wear face masks during election-related activities.
The EC of India has also revised the norms of the number of people accompanying the candidate and number of vehicles at the time of filing nomination.
For the first time, the candidates will have the option to deposit security amount online for contesting the elections.
The EC has limited the number of persons including candidate for door to door campaign to five.
Public meeting and road shows will be allowed with suitable instructions subject to containment instructions issued by the government of India.
World “has to recover together” and help the vulnerable states to overcome all their issues including in conducting the elections during the current COVID-19 Pandemic.
Despite the COVID-19 Pandemic, democracy should not be indefinitely postponed to Choice a Government or a local body .
Post COVID-19 Neuropsychological Effects - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
Post COVID-19 Neuropsychological Effects.
About 1 in3 patients recovering from COVID-19 could experience neurological or psychological after effects of their infections due to lasting impact on the brain.
These after COVID-19 longer problems may present as fatigue, tiredness, body pain , muscle pain, headache, dizziness, mood disorders like aanxiety depression, sleep problems, cognitive dissonance, tremors lingering loss of smell or taste.
It may also present with difficulty in walking due to muscles weakness, nerves damages or due to paralysis.
During COVID-19 infection brain can be affected and results in stroke, dementia like syndromes and psychosis.
Post COVID-19 patients can also have lasting damage to their heart, kidneys and liver due to inflammation and blood coagulation problems.
Some time these patients can present like post traumatic stress disorder and mental health problems.
Monday, August 24, 2020
Sunday, August 23, 2020
Friday, August 21, 2020
Thursday, August 20, 2020
COVID-19 ManagementManagement- M.A.Aleem Neurologist #Trichy #Tamilnadu #India
Covid-19 management:
Once covid is diagnosed get a baseline CBP, LFT, RFT, CRP, d Dimer, IL6 (if available), LDH, Ferritin, Trop T, ECG, baseline CXR and CT chest.
Ask for replication score in RT PCR test. It indicates how infective you are for other people. Any score above 25 is generally non infectious especially if you crossed 10 days & asymptomatic for 3 consecutive days.
Viral replication generally stops by 9th day which means if you want any benefit of anti viral it should be given within 9 days. There is doubt regarding the efficacy of Remdesevir if given late.
RT PCR may be negative in late stages of infection. So dont forget to rely on clinical, epidemiological and radiological guidance to DIAGNOSE A CASE !!
Best time for RT PCR after symptom onset 5th to 8th day. False negatives lowest in these days.
The pathology of Covid disease is that the inflammation which causes damage not virus.
Covid , SLE, APLA, TIDM Macrophage activation syndrome , HLH are all similar... Host immune system reacts against its own tissues... Covid has a know antigen SARS CoV2... "" Frustrated phagocytosis '" occurs when the antigen cannot be eliminated leading to hyperactivation of macrophages and lymphocytes leading to destruction of tissues.
Even CT changes occur a little late but CRP and LDH are the first to raise. Clinically the 3 dangerous symptoms are fever , myalgia and exhaustion which indicate high inflammation in the body.
Steroids and anti coagulation are going to be the CORNER STONE of treatment.
At present steroids are recommended for people who become hypoxic. Start early steroid irrespective of hypoxia especially if CRP and other inflammatory markers are elevated.
Oral prednisolone 20mg or Tab Dexa 4mg /day for 5 to 7 days will do the job if there are mild symptoms.
Steroids will definitely make patient feel better.
Steroids also prevent long term lung fibrosis.
Regarding anti coagulation Inj Clexane 0.5mg s/c bd if d Dimer is normal and 1mg s/c bd if d Dimer is elevated.
There is a controversy regarding when to start anticoagulant.
Better to start it early if CT changes are seen, as the changes in CT are actually microvascular thrombi.
After 5 days, you can switch to oral anticoagulant Tab Rivaraxaban 10mg od for 4 weeks.
Early steroids and anticoagulant will prevent longterm complications.
It may not make difference in acute phase.
If there is hypoxia both are mandatory.
Preferable Inj Methylprednisolone 40mg iv bd or tid based on weight and severity of hypoxia.
HCQ should not be combined with Remdesevir.
Switch to oral Dexa once course of anti viral is finished.
Steroids may be needed for 2 to 3 weeks if hypoxia is present.
Is preferable to prolong anticoagulant for 6 weeks if oxygen is needed.
It is mandatory to monitor CRP, D Dimer every alternate day till patient is in hospital.
IL6 on day 5 and day8.
Any raise in IL6 is a marker for an impending cytokine storm and ensure to have access to Tocilizimab if symptoms worsen.
IL6 can return to normal with steroids and anticoagulant.
Most dangerous period is 8 to 12 days.
That is when most people die.
There are rare reports of late cytokine storm after 12 days.
But if treatment is started early as mentioned above it is very unlikely patient will land up in complications.
Again to reiterate it is inflammation which kills, not virus.
Hit inflammation hard and early and be alive for 2 weeks.
Body will automatically clear the virus after that.
Prone ventilation for 18 hours a day will make a big difference if patient is hypoxic.
No need to repeat CT chest after baseline.
CXR every 3 days is sufficient to monitor progress.
Remember radiological changes may take weeks or months to clear. Don't get panicked. Remember they are blood clots not regular pneumonia.
Improvement in oxygen levels is the marker for clinical improvement.
No need to monitor anything else once oxygen starts improving.
If Tocilizimab is given keep monitoring procalcitonin for secondary infection and the risk of infection is present or for n ext 2 weeks.
Once Tocilizimab is given patient don't manifest fever or raised counts as marker of infection.
Keep a low threshold for antibiotic if patient received Tocilizimab.
It's might be better not to use any antibiotic in Covid illness.
Patients will do absolutely well without antibiotic provided you keep changing lines regularly and stop IV medications early.
Don't forget Dexamethasone is highly pro diabetic.
So even if sugars are normal in first week keep monitoring blood sugars regularly as long as patients are on steroids.
10 to 15% dont develop antibodies post covid. Reason for it are probably some truly dont develop antibodies, or develop some T cell immunity, or dominant IgA antibody response in respiratory mucosa and not systemic IgG response.
So post covid immunity passport is INVALID
Symtomatology of COVID-19 - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
*Dos & Don'ts in COVID-19*
It’s been now seven months since COVID-19 was first detected last year in December in Wuhan, China.
We have come a long way since then and the knowledge and experience gained over this time has certainly helped to better manage the patients.
Timely diagnosis and treatment give the patient the best chance to recover from COVID-19.
It is important to carefully elicit the medical history.
Otherwise, important health cues can be missed and the disease may be misdiagnosed, which may prove to be costly for the patient. It is crucial to know what should be done and what should not be done in the given clinical situation.
Here are few dos and don’ts with regard to the diagnosis and management of COVID-19. Ignoring atypical minor symptoms
The symptoms of COVID-19 are no longer limited to the respiratory system (dry cough, fever, and difficulty in breathing).
Many extra-pulmonary symptoms of COVID-19 have now been reported. These may differ even in different members of the same family.
Several atypical symptoms of COVID-19 have been reported. These include: nausea/vomiting, diarrhea, headache, increased frequency of urination, right abdominal pain, sudden loss of taste and/or smell (bitter and sour tastes are retained), skin lesions (rash, vesicles), conjunctivitis, COVID- toes (presenting as gout-like symptoms), hiccups, calf pain, tiredness, malaise, dizziness, etc.
Such unusual symptoms of COVID-19 are likely to be missed.
Do think of COVID-19 in these times and get the patient tested.
COVID-19 can present with isolated diarrhea
Diarrhea may sometimes be the only symptom of COVID-19. Later on fever, cough may or may not develop.
Acute diarrhea in COVID-19 is always small intestinal diarrhea. It is painless, there is no blood or mucous in stool.
The virus may remain in the stool for up to 3 months.
A patient who has diarrhea may be a superspreader, i.e., he can spread the infection to other members of the family.
If a patient presents with new-onset, intermittent diarrhea for 48 hours duration, do have a high index of suspicion for COVID-19.
Do not ignore fever after exertion
Fever of COVID-19 is typically low grade (<100.40F) and occurs after exertion. The fever is inflammatory and not due to the viral infection.
It does not respond to paracetamol, instead the fever responds to anti-inflammatory drugs like mefenamic acid, naproxen, nimesulide and indomethacin.
Do not miss first time detected, low grade fever after exertion. This may often be the first symptom of COVID-19.
Missing Day 1 of the illness
A person can test positive for COVID-19 even when there is a single symptom.
This can be single loose motion, headache, loss of smell, calf pain, isolated skin rash and any other non-specific symptom as discussed above.
Other symptoms may appear after 48-72 hours.
If you have been exposed to COVID-19, the first symptom is most important.
Do not ignore any symptom, which cannot be explained.
This is Day 1 of the illness; test may or may not be positive.
Day 1 is important as pneumonia usually will develop around Day 3 of the infection.
Ignoring Days 3-6 of the illness
Critical days are Day 3-6 after the first symptom or positive test, whichever is earlier.
The patient may develop pneumonia around the third day of the illness, although not every patient develops pneumonia.
Look for fall in SpO2 on 6MWT by 4 (hypoxia; this may be a sign of micro-or macrovascular emboli) or development of exertional tachycardia or difficulty in talking or cough; these are suggestive of pneumonia.
If undetected and untreated, complications may set in after Day 5.
If the patient is given steroid (dexamethasone)/LMWH/antiviral at the onset of pneumonia (Day 3), mortality should be an exception and not a rule.
Not recognizing red flags
Not taking due precautions for any comorbid condition, fall in SpO2 or development of shortness of breath or cough on 6MWT, CRP >26, absent eosinophils and absolute lymphocyte count <1000 on CBC are red flag signs of COVID-19.
Do baseline CBC, ESR, CRP, CRT, ferritin and/or D-dimer.
Repeat ESR, CBC and CRP daily.
Do not ignore isolated lymphopenia and eosinopenia on Day 1 of the illness.
These may sometimes predate inflammation and may be a sign of oncoming inflammation. Treating the report, not the patient
The RT PCR test using throat/nasal swab is the gold standard test for the diagnosis of COVID-19. But it has a sensitivity of around 67%.
This means that about 33% of the results may be false negative.
If the patient has classical symptoms of COVID-19 and the report is negative, repeat the test.
A CT scan or chest X-ray can be done on Day 1 itself.
If you suspect that the patient has COVID-19, don’t wait for the confirmation.
You may miss Day 3 of the illness, so then you will miss pneumonia, happy hypoxia. Isolate the patient and start treatment.
Rapid antigen tests may also give false negative results.
Therefore, always interpret the test results with the clinical presentation of the patient.
Mistaking COVID-19 as typhoid because typhoid test is positive
Typhoid antigen test can give a false-positive result in COVID-19.
Patient with COVID-19 can have fever and diarrhoea.
If you miss COVID-19, thinking it to be a case of typhoid fever, this can be dangerous for the patient.
If you miss COVID-19, you will miss pneumonia on Day 3-6 and complications can develop, which may be irretrievable at times.
If you suspect that the patient has typhoid, do not do a Typhidot or Widal test.
Instead, send a blood culture. Unless the blood culture is positive, do not treat these patients for typhoid.
Gargling may reduce the viral load in the throat
Evidence has shown that the virus is present in high quantities in the throat, making it a major reservoir of the virus, not only for the symptomatic patients, but also the asymptomatic ones.
Although gargling will not eliminate the virus, it may reduce the viral load in the throat thereby reducing the risk of transmission.
Gargling with an oral antiseptic such as povidone-iodine along with use of face mask and hand washing may be advised as a preventive measure against the virus.
Wednesday, August 19, 2020
Monday, August 17, 2020
Sunday, August 16, 2020
PM heads this ministry of grievance, Initiative of Govt of India- M.A.Aleem Neurologist #Trichy #Tamilnadu #India
*PM heads this ministry of grievance, Initiative of Govt of India*
(Very Informative !!! )
Government of India has an online Grievance forum at
*http://www.pgportal.gov.in*
Can you imagine this is happening in INDIA ?
The govt. wants people to use this tool to highlight the problems they faced while dealing with Government officials or departments like
1) Railways
2) Posts
3) Telecom
4) Urban Development
5) Petroleum & Natural Gas
6) Civil Aviation
7) Shipping , Road Transport & Highways
8) Tourism
9) Public Sector Banks
10) Public Sector Insurance Companies
11) National Saving Scheme of Ministry of Finance
12) Employees' Provident Fund Organization
13) Regional Passport Authorities
14) Central Government Health Scheme
15) Central Board of Secondary Education
16) Kendriya Vidyalaya Sangathan
17) National Institute of Open Schooling
18) Navodaya Vidyalaya Samiti
19) Central Universities
20) ESI Hospitals and Dispensaries directly controlled by ESI Corporation under Ministry of Labour.*
Many of us say that these things don't work in India .
A few months back, the Faridabad Municipal Corporation laid new roads in an area and the residents were very happy about it. But 2 weeks later, BSNL dug up the newly laid roads to install new cables which annoyed all the residents. A resident used the above listed grievance forum to highlight his concern. To his surprise, BSNL and Municipal Corporation of Faridabad were served a show cause notice and the guy received a copy of the notice in one week. Government has asked the MC and BSNL about the goof up as it's clear that both the government departments were not in sync at all.
So use this grievance forum and educate others who don't know about this facility.
This way we can at least raise our concerns instead of just talking about the 'System' in India .
Invite your friends to contribute for many such happenings.
*PLEASE SPREAD THIS MESSAGE IF U WANT OUR INDIA TO HAVE A BETTER TOMORROW & FORWARD THIS MAIL TO AS MANY AS POSSIBLE*
Friday, August 14, 2020
On the 11th day of each month of the pandemic - M.A.Aleem BMJ 2020;370:m3076
News
Seven days in medicine: 29 July to 4 August 2020
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3076 (Published 06 August 2020)
Cite this as: BMJ 2020;370:m3076
Rapid response
Re: Seven days in medicine: 29 July to 4 August 2020
Dear Editor
On the 11th day of each month of the pandemic
Currently about 0.27% of the world population are infected with COVID-19 as of 14.8.2020
In the 33rd week of the COVID-19 Pandemic, the 11th day in each month has had some significance.
11 January 2020
China makes genome sequencing of the novel coronavirus publicly available
WHO tweeted that it had received the genetic sequences for the novel coronavirus from the People’s Republic of China and expected these to soon be made publicly available.
Chinese media also reported the first death from the novel coronavirus.
The genetic sequence is very important for other countries to develop specific diagnostic kits.
11 February 2020
WHO named the Novel coronavirus disease as COVID-19.
11 March 2020
WHO declared the global COVID-19 situation a Pandemic.
11 April 2020
WHO published a draft landscape of COVID-19 candidate vaccines, on the basis of a systematic assessment of candidates from around the world.
Yemen became the 210th country with COVID-19.
11 May 2020
WHO joined forces with the UK government to run 'Stop The Spread', a global campaign to raise awareness on COVID-19.
11 June 2020
The number of COVID-19 cases in the U.S. surpassed 2 million.
India reached 4th place in COVID-19 cases
11 July 2020
A U.K. study that analyzed 90 patients and health care workers finds that only 17% of patients retained a potent antibody response to COVID-19 three months later.
11 August 2020
Russia registered the first Covid-19 vaccine, "Sputnik V".
Competing interests: No competing interests
14 August 2020
M.A. Aleem
Emeritus Professor of Neurology * Visiting Specialist in Neurology ** Consultant Neurologist ***
The Tamilnadu Dr.M.G.R. Medical University * Dhanalakshami Srinivasan Medical College ** ABC Hospital ***
Chennai 600032* Perambalure 621212** Trichy 620018*** Tamilnadu India
@drmaaleem
Wednesday, August 12, 2020
World Brain Day 2020 July 21st - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
World Brain Day 2020 0n July 21st in Trichy
World Brain Day 2020 : Moves to End Parkinson’s Disease
HIDDEN SORROWS IN PARKINSON DISEASE
PROF DR.M.A.ALEEM M.D., D.M.,(NEURO)
EMERITUS PROFESSOR OF NEUROLOGY
THE TAMILNUDU DR.M.G.R. MEDICAL UNIVERSITY
PAST PRESIDENT TAMILNADU PONDICHERY ASSOCIATION OF NEUROLOGISTS
FORMER OF VICE PRINCIPAL HOD& PROFESSOR OF NEUROLOGY KAPV GOVERNMENT MEDICAL COLLEGE& MGM GOVERNMENT HOSPITAL
CONSULTANT NEUROLOGIST AND EPILEPTOLOGIST (TRAINED AT INSTITUTION OF NEUROLOGY QUEEN`S SQUARE . LONDON.UK.) ABC HOSPITAL, ANNAMALAI NAGAR , TRICHY -620018
SECRETARY NEUROLOGIST ASSOCIATION TIRUCHIRAPPALLI
DIRECTOR ABC HOSPITAL TRICHY
drmaaleem@hotmail.com
World Brain Day was launched in 2014. Since then, the World Federation of Neurology (WFN), chooses a topic with a view to drive home the importance of brain health and promote better neurological care globally on 22 july every year.
The 7th World Brain Day 2020 is a joint collaboration between the World Federation of Neurology and the International Parkinson and Movement Disorders Society (IPMDS) and the theme is “Move Together to End Parkinson’s Disease” campaign throughout the year.
Move Together to End Parkinson’s Disease
Based on this background, the WFN chose the topic of Parkinson’s disease jointly with the International Parkinson and Movement Disorders Society (IPMDS) as the topic for World Brain Day 2020. As in preceding World Brain Day events, the aim of World Brain Day 2020 is to alert the public on critical neurological issues.
Facts of Parkinson's Disease
Prevalence: Parkinson’s disease is a chronic neurodegenerative brain disease that affects more than 7 million people of all ages worldwide, and its prevalence continues to increase.
Disability: Parkinson’s disease is a whole-body disease that affects the mind, movement, and almost all aspects of brain function, with symptoms worsening over time.
Standard of Care: Access to quality neurological care, life-changing treatments, and essential medication is unavailable in many parts of the world for Parkinson's disease
Research: Additional resources are needed to help unlock the cause, onset, progression, and treatment of this disease across all ages.
Advocacy: It’s important to work together to diagnose earlier, treat more effectively, and improve the lives of those living with Parkinson’s disease and their caregivers.
Risk Factors for Parkinson's Disease
People do not know exactly what causes Parkinson’s disease, but there is evidence that certain factors may make it more likely to occur.
Read on to find out more about genetic factors and environmental exposures that might make Parkinson’s disease (PD) more likely to appear in some people.
Some of these are unavoidable, but for others, early lifestyle choices and caution may help reduce the risk.
Age and sex
Older age and being male increase the risk of PD.
Two unavoidable factors that affect the risk of having PD are increasing age and whether a person is male or female.
Age: In most people who have PD, symptoms become noticeable at the age of 60 years or over.
However, in 5–10 percent of cases they appear earlier. When PD develops before the age of 50 years, this is called “early onset” PD.
Sex: Men appear to have a 50-percent higher chance of developing PD than women.
However, at least one study has found that, as women get older, their chance of developing it increases.
Researchers have suggested that this could be due to a variety of factors, including:
lifestyle exposures
Read on to find out more about genetic factors and environmental exposures that might make Parkinson’s disease (PD) more likely to appear in some people.
Some of these are unavoidable, but for others, early lifestyle choices and caution may help reduce the risk.
Age and sex
Older age and being male increase the risk of PD.
Two unavoidable factors that affect the risk of having PD are increasing age and whether a person is male or female.
Age: In most people who have PD, symptoms become noticeable at the age of 60 years or over.
However, in 5–10 percent of cases they appear earlier. When PD develops before the age of 50 years, this is called “early onset” PD.
Sex: Men appear to have a 50-percent higher chance of developing PD than women.
However, at least one study has found that, as women get older, their chance of developing it increases.
Researchers have suggested that this could be due to a variety of factors, including:
lifestyle exposures
genetic features
hormonal and reproductive factors
differences in the brain structures that relate to the production of dopamine.
Genetic factors and family history
A person who has a close relative — such as a sibling or parent — with PD has a slightly higher risk of developing it, compared with others.
Around 10 to 15 percent of cases of Parkinson's disease are probably due to hereditary genetic factors.
The others are “sporadic.” There is currently no way to predict that they will occur.
Autosomal dominant: In 1 to 2 percent of people with PD, the condition results from a change in just one copy of a specific gene. Genes that it can affect include Alpha-synuclein (SNCA) and leucine-rich repeat kinase 2 (LRRK2).
Men of North-African Arab origin have a higher chance of having this trait.
Autosomal recessive: If changes occur in two copies of a certain gene, PD can occur. These changes may involve the genes known as PARK7, PINK1, and PRKN.
Risk-factor modifier genes: These genes affect the risk of developing PD, but they do not cause symptoms. The gene known as GBA is one of these. This gene makes the enzyme glucocerebrosidase.
Not everyone with a gene mutation will develop PD. Some people with a family history of PD choose to undergo genetic testing to have some idea of how likely they are to have this problem.
This can be useful to know, but it is not always a good idea. Some people have a genetic factor but never develop PD. This can lead to unnecessary anxiety.
Head trauma
Footballers must wear helmets for protection against a head injury. Traumatic brain injury (TBI) appears to be a risk factor for PD.
People who receive a blow to the head on at least one occasion may have a higher chance of developing PD.
A study published in 2018 found that, among military veterans, even a mild traumatic brain injury (TBI) can increase the risk of PD by 56 percent, even after taking psychological and other factors into consideration.
This link has raised concerns among sporting associations, as concussion is a common injury in football and many other activities.
To prevent this, people who participate in sports where a head injury is likely should wear protective headgear and seek medical help if they do experience a blow to the head.
Everyone should use a safety belt or helmet or other age-appropriate restraint when traveling in a motor vehicle.
Exposure to chemicals
People who work in certain professions may have a higher chance of developing PD because of exposure to certain chemicals.
Toxins
There is some evidence that exposure to certain toxins can increase the chance of developing PD.
Herbicides and pesticides
These may include:
some herbicides, such as paraquat
fungicides, such as maneb
insecticides, such as the colorless, odorless rotenone
pesticides
Chemicals that were present in the defoliant Agent Orange, used in the Vietnam War, have been linked to PD.
Studies have suggested that there is a higher rate of PD among people who work as farmers, those who are exposed to well water, and those who live in the countryside.
Although more studies are necessary to confirm any precise links, researchers believe that exposure to toxins, such as pesticides, increases the risk.
Metals
Researchers have noted a probable link between long-term exposure to certain metals and a higher risk of PD.
Exposure to chemicals, including solvents and metals, may increase the risk.
The metals that might do this are:
mercury
lead
manganese
copper
iron
aluminum
bismuth
thallium
zinc
People who work in an environment where exposure is common may have a higher risk of PD.
However, the risk is difficult to measure, and there is no evidence to confirm an exact that any of these metals specifically pose this type of hazard.
Solvents
Trichloroethylene (TCE) is a solvent that many industries use.
It is also commonly present in groundwater. People who experience long-term exposure to TCE may be more likely to develop PD later in life.
However, several studies, including a large cohort study in the United States, have not confirmed a link between PD and solvent exposure.
Polychlorinated biphenyls (PCBs)
Some scientists have found that people with PD have higher levels of PCBs in their bodies than those without the disease. This suggests that PCB exposure may increase the risk.
However, other studies have not found a link.
Medications and other drugs
Some medications — such as antipsychotics for treating severe paranoia and schizophrenia — can also cause Parkinsonism, or Parkinson-like symptoms.
Synthetic heroin
There is evidence that the use of a synthetic heroin product, MPTP, can lead to Parkinson-like symptoms.
In April 2018, scientists published notes on case studies of seven young adults who had used the drug. The individuals showed symptoms of Parkinsonism after short-term use of the drug.
The researchers do not conclude that the people developed PD, but the symptoms suggest that they have undergone similar processes.
Impact of smoking
Interestingly, people who smoke cigarettes appear to have a smaller chance of developing PD than those who do not.
This does not mean that people should smoke in order to stave off PD, because smoking is responsible for a host of unwanted health problems.
However, researchers are interested in the role nicotine could play in a future treatment for the disease.
Prevention
People who do the following may have a lower risk of PD:
drinking coffee or tea that contain caffeine
using statins to reduce cholesterol levels
having a higher level of vitamin D
Exercise
One point that may be worth noting, however, is that people who participate in physical activity early in life appear to have a lower risk of developing PD in their later years.
A review published in 2018 concluded that exercise can play a preventive role and it can help to treat symptoms and slow the progression of PD, especially in the early stages.
Takeaway
As with many conditions that can have both genetic and environmental causes, it may be neither one nor the other that produces symptoms.
In most cases, a person probably has a genetic tendency, or predisposition, to develop particular PD, but it takes an environmental trigger to cause it.
However, exactly which triggers activate the disease remain unclear.
The 2016 Global Burden of Disease of Parkinson’s disease studied its global burden between 1996 and 2016 to identify trends and to enable necessary public health, scientific, and medical responses in 2018. Over the past generation, the global burden of Parkinson’s disease has more than doubled with potential longer disease duration and environmental factors. We can expect that the trend will continue in the next few decades with the possibility of 12 million patients with Parkinson’s disease worldwide by about 2050.
Hidden Sorrows
The comorbid diagnosis itself has not emerged as a specific risk factor for poor outcomes of COVID-19. The hidden sorrows (potential medication supply issues, disruption to research, and clinical trials), and emerging opportunities (telemedicine, how the pandemic influences the course of Parkinson’s disease, and taking advantages of technology, such as wearable technology) have been visible during the COVID-19 pandemic.
Parkinson’s disease is a complex disease process of the human brain that results in a broad spectrum of clinical features encompassing all aspects of human function. These primarily motor dysfunctions as well as non-motor symptoms can significantly limit the patient’s ability to take part in typical day-to-day activities with poor quality of life
It is indeed essential to understand the caregiving aspects and burden in Parkinson’s disease. Findings from a published meta-analysis indicate that motor symptoms and dependence in activities of daily living have a moderate relationship with caregiver distress. Non-motor symptoms such as impaired cognitive function, including hallucinations, confusion, and affective disorders such as depression and anxiety, have a significant effect on caregiver strain. It is the hours spent on caregiving activities and sleepless nights that are strongly associated with caregiver burden.
The comorbid diagnosis itself has not emerged as a specific risk factor for poor outcomes of COVID-19. The hidden sorrows (potential medication supply issues, disruption to research, and clinical trials), and emerging opportunities (telemedicine, how the pandemic influences the course of Parkinson’s disease, and taking advantages of technology, such as wearable technology) have been visible during the COVID-19 pandemic.
Parkinson’s disease is a complex disease process of the human brain that results in a broad spectrum of clinical features encompassing all aspects of human function. These primarily motor dysfunctions as well as non-motor symptoms can significantly limit the patient’s ability to take part in typical day-to-day activities with poor quality of life
It is indeed essential to understand the caregiving aspects and burden in Parkinson’s disease. Findings from a published meta-analysis indicate that motor symptoms and dependence in activities of daily living have a moderate relationship with caregiver distress. Non-motor symptoms such as impaired cognitive function, including hallucinations, confusion, and affective disorders such as depression and anxiety, have a significant effect on caregiver strain. It is the hours spent on caregiving activities and sleepless nights that are strongly associated with caregiver burden.
Tuesday, August 11, 2020
COVID-19 situations on 10.8.2020
In the world , at the end of the 32nd week of the COVID-19 Pandemic number is COVID-19 cases surpasses the mark is 20 Million on 9.8.2020
Slowly the epicenter of COVID-19 is seems to be sifted to India at the beginning of 33rd week of the COVID-19 Pandemic
India has registered ever higher number of 621,17 cases and highest 1013 deaths in the global single day cases list on 9.8.2020
As of now today on 10.8.20 in 213 countries and territories in all continents and in 2 International conveyances over 20 Million cases (20,022,265) with India over 2.2 Million (2,214,137) and 296,901 in the State of Tamilnadu , and in Trichy 5123 cases were reported with COVID-19 infection . Recovered cases were over 12.8 Million (12,897,799) and over 7.3 lakh ( 733,971) deaths which include 44,466 in India and 4927 in Tamilnadu and 71 at Trichy has been recorded as of 10.8.2020.
- M.A.Aleem Neurologist Trichy Tamilnadu India
Monday, August 10, 2020
Stand Behind Science to Keep COVID-19 at Bay- M.A.Aleem in BMJ 2020;370:m2982
BMJ British Medical Journal
Editorials
Behavioural, environmental, social, and systems interventions against covid-19
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2982 (Published 28 July 2020)
Cite this as: BMJ 2020;370:m2982
Rabid Response
Re: Behavioural, environmental, social, and systems interventions against covid-19
Dear Editor
Stand Behind Science to Keep COVID-19 at Bay
In the 32nd week of the COVID-19 Pandemic, more than six months after the the 6th health emergency declared by the WHO (there have been five other global health emergencies by WHO, for Ebola (two outbreaks), Zika, polio and swine flu), a plateau has not yet been reached.
Global COVID-19 cases crossed the 19 Million mark on 6.8.2020 in all continents.
Every day during this 32nd week over 2.75 lakh COVID-19 cases are reported daily (280,044 cases on 6.8.2020) in the world.
COVID-19 has become a huge public health global crisis.
As of now, in a few countries the first wave of COVID-19 spread is not yet over. In some countries, the second wave is in progress. In a few other countries the third wave is now started.
Currently in the 32nd week after 7 months of the COVID-19 Pandemic, as of 7.8.2020, there are over 19.3 Million (19,309,146) confirmed COVID-19 cases with over 7 lakh (718,597) deaths. Recovery has been registered in more than 12.3 Million (12,397,744) cases.
As of 7.8.2020, the US has the maximum cases, with more than 5 Million (5,033,723) confirmed COVID-19 cases and 162,854 deaths. Brazil is in second position with 2,917,562 cases and 98,644 COVID-19 related deaths. India is in third place with 2,040,261 cases with the lower death rate of 2.04%.
India has registered highest ever 62,170 cases and tops the global table of the number of cases on a single day (7.8.2020).
India has crossed 2 Million COVID-19 cases on 6.8.2020
During this Pandemic many International events including the Olympics 2020 and the Oscars 2020 are postponed and many religious festivals like Eid-Ul-Fitr , Eid-Ul-Adha, and Hajj 2020 are celebrated with restrictions and social distancing.
Now, WHO is tracking over 140 vaccine candidates. A few vaccines from the UK, the US, Russia and India are in phase I/II/III trials.
Vaccines are the only answer to prevent COVID-19. Until then behavioral changes like not spitting in public places, environmental protection by not throwing used masks in streets, and by adopting social distancing, wearing of masks and respiratory hygiene with all other systemic interventions are important to over come the current COVID-19 Pandemic.
This will help to break the chain of COVID-19 spread.
So we have to stand behind science and not behind demons and misconceptions to get away from COVID-19 infection.
This attitude definitely will help to overcome the COVID-19 Pandemic and improve the world economy in each and every country.
Competing interests: No competing interests
07 August 2020
M.A. Aleem
Emeritus Professor of Neurology * Visiting Specialist in Neurology ** Consultant Neurologist ***
The Tamilnadu Dr.M.G.R. Medical University * Dhanalakshami Srinivasan Medical College ** ABC Hospital ***
Chennai 600032* Perambalure 621212** Trichy 620018*** Tamilnadu India
@drmaaleem
Sunday, August 9, 2020
Elderly and COVID-19 - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
Elders and COVID-19
Government of India and the state government of Tamilnadu is able to manage Covid-19 treatment and reduce deaths better than many other countries.
In line with international data, those above 60 years of age account for maximum percentage of COVID-19 deaths in India.
Epidemiologically, the elderly population also bears the heaviest burden of non-communicable diseases, leading to heightened vulnerability in the COVID-19 scenario.
The elderly, who constitute 10% of India’s population, accounted for over 60% of the country’s Covid-19 deaths.
Besides, 73% of Covid-19 deaths were among those with co-morbidities.
Globally, COVID-19 has impacted several lives and is steadily increasing its
reach. While Indian Government has taken stringent actions to contain the spread of
COVID-19, including nation-wide lockdown, it is also critical for each one of us to
follow the protocols and take necessary measures and precautions to break the
chain of transmission of the disease.
Elderly people are at a higher risk of COVID-19 infection due to their
decreased immunity and body reserves, as well as multiple associated co-
morbidities like diabetes, hypertension, chronic kidney disease and chronic
obstructive pulmonary disease. Also, course of disease tends to be more severe in
case of elderlies resulting in higher mortality.
However, COVID-19 transmission among elderly population can be reduced
by taking following measures:
DO’s
1. Stay at home. Avoid meeting visitors at home. If meeting is essential, maintain
a distance of one meter.
2. Wash your hands and face at regular intervals with soap and water.
3. Sneeze and cough either into your elbow or into tissue paper / handkerchief .
After coughing or sneezing dispose of the tissue paper/ wash your
handkerchief.
4. Ensure proper nutrition through home cooked fresh hot meals, hydrate
frequently and take fresh juices to boost immunity.
5. Exercise and meditate.
6. Take your daily prescribed medicines regularly.
7. Talk to your family members (not staying with you), relatives, friends via call
or video conferencing, take help from family members if needed
8. Postpone your elective surgeries (if any) like cataract surgery or total knee
replacement
9. Clean the frequently touched surfaces with disinfectant regularly.
10.Monitor your health. If you develop fever, cough and/or breathing difficulty
immediately contact nearest health care facility and follow the medical advice
rendered
DON’Ts
1. Do not cough or sneeze into your bare hands or without covering your face.
2. Don’t go near your contacts if you are suffering from fever and cough.
3. Don’t touch your eyes, face, nose and tongue.
4. Don’t go near affected/ sick people .
5. Don’t self-medicate.
6. Don’t shake hands or hug your friends and near ones.
7. Do not go to hospital for routine checkup or follow up. As far as possible make
tele-consultation with your healthcare provider.
8. Don’t go to crowded places like parks, markets and religious places.
9. Don’t go out unless it is absolutely essential.
The case fatality rate (CFR) seems to be age-dependent, with a higher percentage among the elderly, especially in men.
In Tamil Nadu, the percentage of people over 60 years of age among the total number of positive cases has been increasing over the months.
Hand Hygiene to prevent COVID-19 spread - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
Hand Hygiene
Hand wash is culturally , traditionally and religiously is adopted my many in the community . This is also hygienic and it can prevent the fecal-oral route transmitted diseases and the respiratory route of spreading diseases like COVID-19 .
COVID-19 is a respiratory viral illness, meaning it is mostly spread through virus-laden droplets from coughs and sneezes. If you don’t catch your coughs and sneezes in a hygenic way , the virus can end up on surfaces. If someone else touches that contaminated surface, the virus can transfer onto their hand.
If you have the virus on your hands, you can infect yourself by touching your eyes, mouth or nose. You might think that you don’t touch your face very often, but it’s much more than you realise. A study found that people touch their faces an average of 23 times an hour.
So washing your hands is useful in preventing yourself from getting infected.
It also help to stop the spread spread of COVID-19. When it comes to stopping the spread of the serious infection in this country, the public have a huge role to play.
COVID-19 is an ‘enveloped virus’. This means it has a protective outer layer known as a ‘lipid bilayer’. The molecules making up this layer are shaped like a tadpole, with a water-loving (hydrophilic) round head and a water-hating (hydrophobic) tail.
These molecules arrange themselves into a ‘bilayer’: two layers piled on top of each other into a sheet, with tails pointing inwards and heads pointing outwards.
The molecules are pulled closely into each other to protect the hydrophobic tails from the water in your respiratory droplets when you cough or sneeze.
The hydrophilic heads are very ‘sticky’, meaning the virus is very effective at sticking to your hands – perfect for a microbe that’s trying very hard to infect you.
Soap molecules also have this tadpole structure, which is what makes it so useful. When you have something oily on your hands, running water won’t get rid of it. Add soap to your hands – the hydrophobic tail will cling to the oil, and the hydrophilic head will stick to the water. Now, the oil will come straight off.
Because the soap molecules are so similar to the ones making up the outer layer of the virus, the molecules in the lipid bilayer are as strongly attracted to soap molecules as they are to each other.
This disrupts the neatly-ordered shell around the virus, dissolving it in the running water and killing the virus
Alcohol-based hand sanitiser will also kill the viruses if soap and water are not available. Alcohol is an antiseptic and can kill enveloped viruses such as COVID-19, but make sure it contains 60 to 95 per cent alcohol.
However, if your hands are visibly dirty, you need to
use soap and running water to clean the dirt off.
So hand hygiene by frequent washing hands with soap water or alcohol based sanitizer can kill the COVID-19 and help to break the chain of COVID-19 spread
Thursday, August 6, 2020
#pudukottai is historic city - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
புதுக்கோட்டை சில செய்திகள்....
✔ஆசியாவிலேயே மிகப்பெரிய அனந்த சயண பெருமாள் - திருமெய்யர்
✔உலகில் உள்ள அணைத்து நீர்நிலைகளின் பாவங்களை போக்குவது திருமயம் சத்திய புஷ்கரணி
✔உலகிலேயே சிவன் மற்றும் பெருமாளை ஒருங்கே கிரிவலம் வரும் ஊர் - திருமயம்.
✔புதுக்கோட்டை மாவட்டத்தில் உள்ள ஒரே திவ்ய தேசம் - திருமயம்
✔இமயமலையை விட அதிக சக்தி வாய்ந்தது திருமயம் மலைக்கோட்டை
✔உலகிலேயே வடக்கு திசை பார்த்து தனி சன்னதியில் வீற்றிருக்கும் பைரவர் - திருமயம் கோட்டை பைரவர்
✔தமிழகத்திலேயே மிகப்பெரிய லிங்கோத்பவர் திருமயம் சத்தியகிரீஸ்வரர் கோவிலில் வீற்றிருக்கும் லிங்கோத்பவர்
( பெரிய நந்திக்கு பின்புறம்).
✔ஆசியாவிலேயே மிகப்பெரிய குதிரை சிலை - புதுக்கோட்டை குலமங்களம் பெருங்கரையாடி மீட்ட அய்யணார் கோவில் குதிரை சிலை
✔தென்னிந்தியாவிலேயே மிகப்பெரிய சிவன் சிலை - புதுக்கோட்டை கீரமங்களம்
✔தமிழத்திலேயே ஏழு சகோதரிகளாக (சப்தகன்னியர்களாக) அழைக்கப்படும்
1). திருவப்பூர் முத்துமாரியம்மன்
2). இளஞ்சாவூர் முத்துமாரியம்மன்
3). கொன்னையூர் முத்துமாரியம்மன்
4). நார்த்தாமலை முத்துமாரியம்மன்
5). கீரணிப்பட்டி முத்துமாரியம்மன்
6). கண்ணணூர் முத்துமாரியம்மன்
7). சமயபுரம் முத்துமாரியம்மன்
ஆகிய ஏழு முத்துமாரியம்மன்களில் நான்கு சகோதரிகள்
(திருவப்பூர், இளஞ்சாவூர், கொன்னையூர், நார்த்தாமலை)
வீற்றிருப்பது புதுக்கோட்டை மாவட்டத்தில் மட்டுமே.
✔தமிழ் நாட்டிலேயே சமணர்கள் அதிகமாக தங்கிய குகைகளும் மலைகளும் நிறைந்த மாவட்டம் புதுக்கோட்டை. (சித்தன்னவாசல், நார்த்தாமலை, குடுமியான்மலை)
✔இராஜராஜ சோழன் பதவி ஏற்றவுடன் முதல் கோவில் கட்டியது புதுக்கோட்டை நார்த்தாமலை அருகில்.
✔தமிழகத்திலேயே இரண்டாவது பெரிய அருங்காட்சியகம் இருப்பது புதுக்கோட்டை
✔தமிழகத்திலேயே இரண்டாவது பெரிய அரசு அச்சகம் இருப்பது புதுக்கோட்டை.
✔தமிழகத்திலேயே நூற்றாண்டு கண்ட முதல் நகராட்சி புதுக்கோட்டை நகராட்சி.
✔ஹெலிகாப்டரில் புனித நீரும் பூக்களும் தூவி, அம்மன் கோவில் இராஜகோபுரம் கும்பாபிஷேகம் செய்தது கொத்தமங்கலம் கிராமம் புதுக்கோட்டை மாவட்டம்.
✔தனி நாணயம், தனி தபால் தலையுடன் விளங்கிய ஒரே சமஸ்தானம் புதுக்கோட்டை சமஸ்தானம்.
✔முதன்முதலில் கார் வாங்கியது புதுக்கோட்டை மன்னர்.
✔இந்தியாவின் முதல் பெண்மருத்துவர் DR.முத்துலெட்சுமி ரெட்டி பிறந்த ஊர் புதுக்கோட்டை.
🔅வாஸ்த்து கோவில் புதுக்கோட்டை குழிபிறை அருகே செவலூர் மற்றும் பல சிறப்பு அம்சங்களை உள்ளடக்கிய
🔅 நற்சாந்துபட்டி அருகே உள்ள நாகதேஷம் நீக்கக்கூடிய பேரையூர் நாகநாத சுவாமி ஆலயம்.
🔅நற்சாந்துபட்டி அருகே உள்ள மலையக்கோயில்
🔅ஸ்ரீவிஸ்வரூப ஆஞ்சநேயராகக் கோயில்கொண்டிருக்கிறார் அனுமன், வேகுப்பட்டி கிராமத்தில். புதுக்கோட்டை மாவட்டம். 21 அடி உயரத்தில் தமிழகத்தின் மூன்றாவது பிரமாண்ட அனுமன் என்கின்றனர்.
🔅நூற்றாண்டு கண்ட கணேசர் செந்தமிழ் கல்லூரி இருக்கும் மேலைச்சிவபுரியும்
🔅நெய் நந்தி அருள் பாலிக்கும் வேந்தன்பட்டியும் இருப்பது புதுக்கோட்டை மாவட்டத்தில்தான்.
✔பாரீஸ் மற்றும் பாண்டிச்சேரி நகருக்கு அடுத்தபடியாக அழகான நகர அமைப்பையும் நேர் வீதிகளையும் கொண்ட ஊர் புதுக்கோட்டை.....
Monday, August 3, 2020
Sunday, August 2, 2020
COVID-19 and children - M.A.Aleem Neurologist #Trichy #Tamilnadu
COVID-19 and Children
COVID-19 have been reported in a few children than in adults. Usually, the virus causes a milder illness in kids, though some children have become more sick.
In children
the most common signs of COVID-19 are a fever, cough, and difficulty in breathing. Some children may have ,symptoms of a cold such as a sore throat, congestion, runny nose ,
chills,
muscle pain,
headache,
a loss of taste or smell,
nausea or vomiting,
diarrhea, and
tiredness.
Some kids are having symptoms caused by inflammation throughout the body, sometimes several weeks after they were infected with the virus. This is called multisystem inflammatory syndrome in children (MIS-C).
Symptoms of MIS-C may include:
fever
belly pain
vomiting or diarrhea
neck pain
a rash
red eyes
feeling very tired
red, cracked lips
swollen hands or feet and
swollen lymph nodes.
Most kids with MIS-C get better after they get special care in the hospital.
If any of this problem consult your doctor or take your child to Government or private hospital for check up and testing if required.
If the child's symptoms could be of COVID-19, everyone in the household should stay home until testing is done or symptoms are gone.
Keep other people and pets in the house away from your child as much as possible.
Everyone in the family should wear mask and adopt social distancing.
Try to have one person only care for the sick child so others are not exposed.
If your child is over 2 years old and can wear a face mask or cloth face covering without finding it hard to breathe, have them wear one when the caregiver is in the room. Don't leave your child alone while they're wearing a mask or cloth face covering. The caregiver also should wear one when in the same room.
If possible, have your sick child use a different bathroom from others. If that isn't possible, wipe down the bathroom often.
Everyone in your family should wash their hands well and often. Wash with soap and water for at least 20 seconds, or use alcohol-based hand sanitizer.
Use regular household cleaners or wipes to clean things that get touched a lot (doorknobs, light switches, toys, remote controls,
phones, etc.). Do this every day.
- M.A.Aleem
Tiruchi
Persons with Disabilities And COVID-19 - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
Persons with Disabilities And COVID-19
Even at the best of times, persons with disabilities face challenges in accessing health-care services, due to lack of availability, accessibility, affordability, as well as stigma and discrimination.
The risks of infection from COVID-19 for persons with disabilities are compounded by other issues, which need specific action: disruption of services and support, pre-existing health conditions in some cases which leave them more at risk of developing serious illness or dying, being excluded from health information and mainstream health provision, living in a world where accessibility is often limited and where barriers to goods and services are a challenge, and being disproportionately more likely to live in institutional settings.
General individual self-care and other preventive measures against the COVID-19 outbreak can entail challenges for persons with disabilities. For instance, some persons with disabilities may have difficulties in implementing measures to keep the virus at bay, including personal hygiene and recommended frequent cleaning of surfaces and homes. Cleaning homes and washing hands frequently can be challenging, due to physical impairments, environmental barriers, or interrupted services. Others may not be able to practice social distancing or cannot isolate themselves as thoroughly as other people, because they require regular help and support from other people for every day self-care tasks.
To ensure that persons with disabilities are able to access to information on COVID-19, it must be made available in accessible formats. Healthcare buildings must also be physically accessible to persons with mobility, sensory and cognitive impairments. Moreover, persons with disabilities must not be prevented from accessing the health services they need in times of emergency due to any financial barriers.
- M.A.Aleem
Tiruchi
COVID-19 Diagnosis and treatment at Trichy - M.A.Aleem Neurologist #Trichy #Tamilnadu #India
TRICHY IMA& API
COVID UPDATE
(Complied list as of 02/08/2020)
*COVID DEDICATED HOSPITALS*
1.KAPV Government Hospital.
2.Kauvery Hospital- Thennur.
3.Sundaram Hospital, Puthur.
4.Retna Global Hospital.
5.Maruti Hospital
6.SRM Medical College Hospital.
7.Apollo Multispeciality Hospital.
8.GVN - Mambalasalai
9.Pankajam Hospital (GVN) - Srirangam .
10.QMED Hospital, Puthur
11.TMCH, Thillainagar
12.Venkateshwara Hospital, Thiruvanaikkovil
For COVID positive Psychiatric patients: ATMA HOSPITAL, Thillainagar
*COVID CARE CENTRES* :( for mild cases in society alloted by government medical college hospital )
(Eg. Yatri Nivas, Srirangam )
*COVID RTPCR TESTING CENTRES*
1.KAPV Government Hospital.
2.Magnum Labs, Annanagar. (No home collection)
3.Kauvery Hospital (inpatient only)
4.Apollo Hospital (inpatient only)
5.GVN Hospital, Srirangam (Inpatient only)
6.Lister Metropolis Lab, Thillainagar (Home collection & Clinic Samples)
7.Microbiologicals Lab (Only Clinic samples)
8.Bioline Lab (only clinic samples)
9.SRM Medical College
ABC Hospital Lab *Day 6 Test package* done
(LDH, D dimer, CRP, Ferritin, CBC, Procalcitonin, IL6)
- *ABC LAB Home Collection only for Doctors. No RTPCR* for now.
*COVID CT CHEST CENTRES:*
All CT scan centres
*IMA PROJECT CHARM DOCTOR'S MONITORING CENTRES*
(For Asymptomatic/Mild cases)
1.Scarlet Apartment ( Sri rangam )- *First preferance.*
Other options:
2.Child Jesus Hospital
3.Retna Global Hospital
4.IMA Hall ( will be ready for occupancy shortly )
5.Sree Paduka Speciality hospital, Thillainagar.
6.TMCH Hospital, Thillainagar
*Contact person for Bed facility:*
Dr Govindarajan (Jeyam Hospital) 7373753333
Dr Vikram (Paduga Hospital)
9677860006
Dr Sridharan (Child Jesus Hospital) 9944298199
NUMBER OF MEMBERS being monitored under *Project CHaRM:*
Presently 6 asymptomatic covid positive doctors.
IMA Helpline: 9655240708
Thank You.
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