IMA Banaras

29/07/2020

*CME INDIA HIGHLIGHT*
29TH July

🌿🌿🌿☘️☘️☘️

Key points from the discussion from *Paradigm Shift* from March to July 20 Webinar
(Faculty:
Dr K K Agarwal
Dr RV Asokan
Dr Ramesh K Datta,
Dr Jayakrishnan Alapet
Dr Brijendra Prakash
Dr Sanchita Sharma)



⭕Covid-19 was first considered to be a viral pneumonia, but now it is known as a mysterious virus, which is predictable unpredictable.

⭕It spares joints and larynx, so no joint involvement or hoarseness of voice; also, no lymph nodes involvement.

⭕
*Covid-19 was earlier believed to be non-inflammatory, but we now know that it is predominantly an inflammatory disease*.

⭕
*Earlier, it was thought that the patient could become critical on any day of the illness; now we know that Days 3-6 are the days to watch*.

⭕
*Social distancing has changed to physical distancing*.

⭕From macrodroplets (surface to human transmission) earlier, we now talk of microdroplets (crowded ill ventilated rooms) today.

⭕*
*Surface to human transmission was the most important route of transmission'now it has become less* important (heat and humidity)

⭕The shift from no masking to mandatory masking in public has become the norm.

⭕From simple masks, we have moved to N95 masks for all high risk patients (COPD, asthmatics)

⭕Masking only when going out, now adds *masking also at home*.

⭕Distancing of 3 feet has changed to 6 feet; with microdroplets, this distance is now 9 feet.

⭕*
*We started the pandemic with very high mortality (10%)*; *now mortality is around 0.3%*.

⭕
*Institutional care has shifted to home care*

⭕In the early days, no treatments were available; but individualized treatment is now available. If inflammatory parameters are raised, then give steroids, if d-dimers are high, give anticoagulant, if early presentation, give antiviral etc.

⭕
*From mandatory ventilation, the concept has changed to noninvasive ventilation*.




⭕Children to grandparents; now children are no risk for transmission to adults or other children.

⭕Menstruation reduces severity of illness.

⭕We have shifted to no steroids to early low dose steroids.

⭕Hydroxychloroquine (HCQ) for all to no HCQ for mild cases.

⭕Late discharge – earlier patients were kept for 30-40 days; now patients are discharged early (Day 6) if no complications, to home quarantine

⭕Thinking of death to thinking recovery

⭕No pooled test to pooled test

⭕We have now understood that after 9 days of illness, the virus is non-culturable and the person is non-infectious, the presentation is post-Covid sequelae due to persistent inflammation, or hypercoagulable state. Before 9 days, it is covid.

⭕No Ct value to Ct value of RTPCR to find out if cohort isolation can be done; low Ct value means high viral load.

⭕
*Testing has moved from antigen RTPCR to rapid antigen and now antibodies testing (total vs IgG)*

⭕
*Isolation to cohort isolation (multiple infected persons in a family can stay together)*

⭕Isolation and now isolation/quarantine/monitoring

⭕
*From no oxygen at home to oxygen at home*

⭕
*Closed camps/OPDs to open sunlight camps – microdroplets are killed in sunlight*

⭕Earlier testing was done only for symptomatic persons, but now liberal testing

⭕
*A mandatory government prescription has now become non-mandatory*

⭕When it first began in Wuhan, China, it was pulmonary COVID and CT diagnosis was a must; but now it is also recognized as non-pulmonary COVID, involving GIT, CNS.

⭕
*Typically, fever at the time of presentation; now no fever presentation*

⭕
*Asymptomatic persons are really not asymptomatic; they may have some atypical symptoms such as diarrhea, sore throat etc*.

⭕High grade fever, which is classically associated with viral illness to low grade (100oF) exertional persistent fever, due to persistent inflammatory process

⭕
*The six minute walk test (6MWT) was meant for only COPD, heart failure patients, but it is now mandatory from Day 3-6*. If the patient desaturates by *5%* on walking, this is indicative of pneumonia with thrombosis. This is an emergency.

⭕Transmission from joint families to nuclear families

⭕
*No toilet transmission*, *now toilets are recognized as a covid chamber*

⭕Contact time from 30/10 minutes to 15/5 minutes in closed areas

⭕Testing till Ag negative to no testing to confirm when Ag will become negative

⭕Fear to no or less fear

⭕Mortality is two times that of the government figures reported

⭕For every 1 tested people, there are 20 untested; for every 20 Covid patients, there are 80 patients with corona-like illness.

⭕Stigma to less stigma

⭕Low mortality to high mortality amongst doctors

⭕Ignorance to knowledge

⭕Engineering (AII rooms) to social engineering (test for 5 parameters when screening - – temperature (low grade, does not respond to paracetamol), SpO2 (happy hypoxia), loss of smell, loss of taste (give jaggery – first taste to go is sweet taste) and hand grip strength)

⭕
*New loss of smell and taste has been seen in 20-30% of patients; the disease is mild in nature*.

⭕
*We now know that plasma therapy is effective if given early*.

If you are a Internal medicine specialist, and interested in CME INDIA whatsaap group,contact 9431122340(dr nk singh)

25/07/2020

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माननीय प्रधानमंत्री जी
भारत सरकार

विषय- बनारस में कोरोना के कारण लगातार बिगड़ती स्थिति के सम्बंध में

महोदय,

वैश्विक महामारी कोविड के तेजी से बढ़ते संक्रमण के फलस्वरूप वाराणसी (जो आपका संसदीय क्षेत्र भी है) में स्थिति लगातार बिगड़ती जा रही है और सीमित संसाधनों के साथ राज्य सरकार अपने अथक प्रयासों के बावजूद भी स्थिति को नियंत्रित करने में सफल नहीं हो पा रही है।
जैसी कि इस संक्रमण की प्रगति दिख रही है निकट भविष्य में स्वास्थ्य सुविधाओं की समुचित उपलब्धता न होने के कारण बढी संख्या में लोगों के इस संक्रमण की चपेट में आकर असमय ही काल कल्वित हो जाने की सम्भावना बनती दिख रही है।
गम्भीर मरीजों की चिकित्सा हेतु काशी हिन्दू विश्वविद्यालय में स्थित आर्यु विञान संस्थान का सुपर स्पेशियलिटी सेंटर ही एक मात्र सक्षम चिकित्सा केन्द्र के रूप में पूरे पूर्वांचल की आशा का केन्द्र है परन्तु लगातार विकट होती परिस्थितियों में इस केन्द्र में ICU बेड की सीमित उपलब्धता व स्थानीय प्रशासन से तारतम्य की कमी बड़ी बाधा के रुप में सामने आए हैं।
अतः महोदय से प्रार्थना है कि उपलब्ध संसाधनों के पूरे सामजस्य के साथ उचित प्रयोग हेतु अविलम्ब विश्वविद्यालय परिसर में सुदंरबगिया स्थित नवनिर्मित महामना मदन मोहन मालवीय केन्द्र को L2/L3 सुविधाओं से सुसज्जित करते हुए कोविड अस्पताल के रुप में उपलब्ध कराया जाय और पूरे जिले की चिकित्सा व्यवस्था को नियंत्रित करने व स्थानीय प्रशासन के सहयोग के लिए एक केन्द्रीय सीमीति भी गठित की जाय ,जो कि परिस्थितियों का सूक्ष्म पर्वेक्षण करते हुए ससमय उचित निर्णय लेने मे सक्षम हो।
सभी चिकित्सकीय संसाधनों (चाहे वह राज्य या केन्द्र सरकार के अधीन हों या फिर गैरसरकारी हों) का प्रयोग उचित रुप से किया जाय और सभी फ्रंट लाइन वारियर्स को उचित सुरक्षा, सम्मान व पारिश्रमिक सुनिश्चित करते हुए उनका सदुपयोग किया जाय।
आशा है आपके तेजस्वी व उर्जावान नेतृत्व में हम इन विकट परिस्थितियों का सामना अपनी पूरी क्षमता का प्रयोग करते हुए करने में सफल रहेंगे।
सधन्यवाद!

वाराणसी के सभी प्रबुद्ध नागरि क

29/10/2019

First Mega CME of IMA Banaras....this session
With Medantta the medicity Gurgaon
Date -2nd November
Time-9pm
Topic-Advanced and interventional treatment of heart failure
Speaker-Dr Nagendra Singh Chauhan
Associate Director, Interventional Cardiology,Medantta
Ventue-Hotel Taj Ganges
CME followed by Dinner n Cocktail
Regards
Dr AlokCBhardwaj
President
Dr SPSingh
Secretary
Dr AkTripathi
Fin.Secretary
Dr Abhishek
Scientific Sec

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