The New England Journal Of Medicine: The Toughest Triage — Allocating Ventilators in a Pandemic

x-ray chest of first case of Corona virus pneumonia patient aged 61 years male who died during treatment in WUHAN city of China.

30 year old male, 10 day history of diarrhoea and reduced oral intake, presented with lethargy and ongoing abdominal cramps. No respiratory symptoms, but O2 sats noted to be on the lower side, exertional O2 sats dropped to 86%. No past medical history of note, normal white cell count, not lymphopenic, urea 18.9 mmol/L, creatinine: 489 µmol/L, amylase 600 (30-118), ALT: 65, CRP: 100, Trop I 267 (0-46). Chest X-ray as shown. What do you think the patient is suffered from?

Dr Anuja Vasudev Surveillance Officer South District Delhi Mob 7827981376 Any Suspected Case - Refer to RML Hospital which is designated hospital for Screening and Blood Testing *Please share your areas helpline no*

UNCOMMON MANIFESTATIONS of COVID-19 Recent findings suggest that a significant number of people with COVID-19 may experience digestive symptoms. New research data says that out of all the patients who approached for medical care half of them have come up with the symptoms of the digestive system, such as loss of appetite and diarrhea. As the world races to find the best ways to cope with the new coronavirus, researchers continue to contribute to our understanding of COVID-19, the disease that the virus causes. The exact symptoms are the main point of interest. As with many other viral infections, SARS-CoV-2 infections cause different symptoms in different people. But WHICH SYMPTOMS ARE THE MOST COMMON? According to information from the World Health Organization (WHO), three of the most common symptoms are fever, coughing, and some difficulty breathing. However, people with COVID-19 have reported many other symptoms, including digestive ones. While the WHO still consider digestive symptoms to be uncommon, a new study from the Wuhan Medical Treatment Expert Group for COVID-19 suggests that such symptoms may be more widespread than specialists had thought. Digestive symptoms in 50.5% of patients were observed. The expert group behind this new study — the findings of which appear in The American Journal of Gastroenterology — analyzed data from 204 people who received medical care for COVID-19 between January 18 and February 28, 2020. The patients had an average age of 52.9 years, and of the total, 107 were male and 97 female. When they presented to a hospital, 103 of the 204 people — or 50.5% — were experiencing digestive symptoms. The main symptom reported was diarrhea, and other symptoms included vomiting, in four individuals, and abdominal pain, in two. Moreover, the digestive symptoms among the larger group grew more severe as the severity of COVID-19 increased the researchers' report.

Therapeutic Potential for Tetracyclines in the Treatment of COVID‐19 This article is protected by copyright. All rights reserved Conflict of interest: The authors declare no conflicts of interest. Currently there is a race against time to identify prophylactic and therapeutic treatments against COVID-19. Until these treatments are developed, tested and mass produced, it might be prudent to look into existing therapies that could be effective against this virus. Based on the available evidence we believe that tetracyclines may be effective agents in the treatment of COVID-19. Tetracyclines (e.g. tetracycline, doxycycline, and minocycline) are highly lipophilic antibiotics that are known to chelate zinc compounds on matrix metalloproteinases (MMPs). Coronaviruses are also known to heavily rely on host MMPs for survival, cell infiltration, cell to cell adhesion, and replication, many of which have zinc as part of their MMP complex. It is possible that the zinc chelating properties of tetracyclines may also aid in inhibiting COVID-19 infection in humans limiting their ability to replicate within the host. Tetracyclines might be also able to inhibit RNA replication on positive-sense single stranded RNA, like COVID-19. For example, one study deduced a mechanism discerning how doxycycline could potentially treat the dengue virus. They also showed that at normal human body temperature and fever conditions, doxycycline significantly inhibited the virus’ own serine protease as well as noting a concentration dependent decrease in viral replication. They also found that doxycycline inhibited the post infection replication in addition to reducing the viruses’ ability to enter the cultured cells. Another study showed that retroviral load was decreased by 70% when cells were treated with the doxycycline at human body temperature We believe that tetracyclines can be potential therapeutic agents for COVID-19 that is hiding in plain sight. Moreover, tetracyclines overall are much safer agents than other potential agents that have been considered to treat COVID-19, such as chloroquine or antiretroviral drugs. We strongly urge international research groups to consider investigating the potential therapeutic efficacy of tetracycline antibiotics in treating COVID-19. To read more- https://accpjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/phar.2395 Source- accpjournals