COVID-19 Pathology

COVID‑19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs).The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested decreasing ACE2 activity might be protective,though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective as

the alveolar disease progresses, respiratory failure might develop and death may follow. 
SARS-CoV-2 may also cause respiratory failure through affecting the brainstem as other coronaviruses have been found to invade the central nervous system (CNS While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain.
The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.
The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease.Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis (31%) and venous thromboembolism (25%) have been found in ICU patients with COVID‑19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia.
Another common cause of death is complications related to the kidneys.Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.
Autopsies of people who died of COVID‑19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung.

Read More

COVID-19 Immunopathology

 SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation.

Pathogenesis of COVID-19

The ACE2 enzyme plays a vital role in the conversion of angiotensin Ang I to Ang-(1-9) and Ang II to Ang-(1-7) which have vasodilatory, antithrombotic and anti-inflammatory effects. The interaction of SARS-CoV-2 with ACE2 downregulates the anti-inflammatory function and increases angiotensin II effects in individuals who are predisposed. An initial immune response to the SARS-CoV-2 infection is triggered off by macrophages and dendritic cells with lymphocytosis and release of cytokine. The inflammatory response causes a destruction of the lymphocytes that are trying to defend against the virus, which results in lymphopenia. The production of cytokine rapidly becomes dysregulated and healthy cells are damaged, primarily the cells in the lungs but can involve other organs. The cytokine storm is presumed to be responsible for some of the severe manifestations of COVID-19. The cascade of damage associated with the cytokine storm disrupts the epithelial barrier, predisposing the lungs and other affected tissues to bacterial infection. Coagulation abnormalities ensues from the systemic inflammation and microcirculatory dysfunction caused by endotheliitis.

Tissue injury from COVID-19 can also occur via a direct cytotoxic effect. SARS-CoV-2 causes hypoxaemia which results in accumulation of oxygen free radicals, alteration in intracellular pH, accumulation of lactic acid, electrolyte imbalance and cellular damage.

. Clinical laboratory findings of elevated CRP ,LDH ,IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients.

CRP means C Reactive Protein which is helpful marker in this inflammatory disease which increases in various inflammatory conditions but in relates to covid disease its very important. 

This Protein synthesized by liver.

CRP Increases in response to inflammation.It helps in their removal of dead or dying cells by binding.

CRP Value Increases in the TB,PNEUMONIA, autoimmune disease etc.

And in Normal conditions like pregnancy or oc pills,C REACTIVE PROTEIN values going to become high.

CRP test determine risk of heart disease 

C Reactive Protein Less than 1 is a low risk for heart disease. 

CRP 1 to 3 Which is a moderate or intermediate risk of developing heart disease 

More than 10....high risk for developing heart disease. But if patient having Cough,fever,loss of smell or taste sensations and increased CRP more than 10 is point towards COVID-19 infection more likely .

IL6 increases CRP. Inflammation subsiding then value of CRP going to  becomes normal.

IL6 is  estrogen hormone dependent.

Estrogen increases then IL6 Will decrease.

Read More

कोरोना रुग्णालयातील वार्ड

  #रूग्ण सेवा हीच ईश्वर सेवा #

#GOVERMENT SDH KALLAMB

गेल्या कित्येक दिवसांपासून आपण सर्व जण कोरोनासारख्या जागतीक महामारीचा सामना करत आहोत. परंतु दिवसेंदिवस कोरोना केसेस खूप वाढत आहेत.त्यामूळे आपण सर्वांणी आपली काळजी घ्या,आवश्यक असेल तेंव्हाच योग्य ती काळजी घेऊन घराबाहेर पडा.कोरोना युद्धात काम करत असताना रोजचा अनुभव हा वेगळा असतो, राञी दहा वाजता अगदी स्टेबल दिसनारा पेशंट सकाळी अचानक गंभीर होऊन जातो,ही बाब नक्कीच काळजाचे ठोके वाढवनारी असते,त्यामूळे कोरोना सारख्या आजाराला हलक्यात घेऊ नका, योग्य ती काळजी घ्या आणि सुरक्षीत रहा.

जिवन अमुल्य आहे आणि आपण या जीवनात जगत आहोत खेळत आहोत जन्माला आले पासून ते मरेपर्यंत आपण जगण्यासाठी आवश्यक ते करत आहोत गरीब माणसं ते शिरमंत सर्व जण..जिवन हे एक सत्य आहे तसेच मृत्यु हे पण एक सत्य आहे .......आपण प्रत्येकजण  आपले नातेवाईक तसेच कुटुंब  निरोगी  ठेवण्यासाठी प्रयत्न करत असतो पण  आजारी पडल्यानंतर काही केल्यापण लाखो लोक  त्यांना वाचवू शकत नाही .covid-19 च्या ward मध्ये जात असताना आम्ही खूप काळजी घेतो. MASK शिवाय जाने म्हणजे Coronavirus संसर्ग होण्यास मदत होईल हे नक्की 

Read More

Coronavirus disease झाले नंतर चा आहार

शाकाहारी हे खाऊ शकता.

* पूर्ण धान्य खा, उदा. हातसडीचा तांदूळ, पूर्ण गव्हाचे पीठ, ओट, ज्वारी वर्गीय धान्ये इ.

* शेंगा, कडधान्ये व बळींचा आहारात समावेश करा, यात भरपूर प्रथिने असतात.

* ताजी फळे व भाज्यांचा समावेश करा. (लाल ढोबळी मिरची, गाजर, बीट, हिरव्या भाज्या अशा गडद रंगाच्या भाज्या व फळे)

* ८-१० ग्लास पाणी प्या व शरीरातील पाण्याची पातळी कायम ठेवा, पाण्याने शरीरातील विषद्रव्ये निघून जाण्यास मदत होते.

* लिंबे, संत्री अशा आंबट चवीच्या फळांमधून भरपूर क जीवनसत्त्व मिळते, प्रतिकारशक्ती वाढवण्यास व रोगसंसर्गाशी मुकाबला करण्यासाठी हे फार महत्त्वाचे आहे.

* आले, लसूण, हळद अशा मसाल्याच्या पदार्थांचे सेवन करा, याने रोगप्रतिकार शक्ती नैसर्गिकरीत्या वाढते.

* घरी शिजवलेले अन्न खा. कोलेस्टेरॉल कमी असलेले तेल स्वयंपाकासाठी वापरा.

* वापरण्यापूर्वी फळे व भाज्या धुवून घ्या. कमी फॅटचे दूध, दही घ्या कारण त्यातून भरपूर प्रथिने कॅल्शियम मिळते.

हे खाऊ नये:

* मैदा, तळलेले आणि जंक फूड (चिप्स, कुकीज इ.) खाणे टाळा.

* साखरयुक्त किंवा पॅकबंद फळांचे रस आणि कार्बनयुक्त पेये टाळा कारण त्यात पोषणमूल्ये कमी असतात.

* चीज, नारळाचे व पामचे तेल, बटर खाणे टाळा कारण त्यात असंपृक्त फॅटस् असतात आणि ती आरोग्यासाठी चांगली नाहीत.

मांसाहारी खाऊ शकता:

* ताजे पदार्थ आणि मांसाहारी वस्तू वेगवेगळ्या ठेवा.

* सोललेली कोंबडी (स्किनलेस चिकन), मासे, अंड्यातील पांढरा भाग अशा 'लीन' प्राणिजन्य प्रथिनांचा समावेश करा.

हे खाऊ नये

* मटण, लिव्हर, तळलेले व प्रक्रिया केलेले मांसाहारी पदार्थ टाळा.

* आठवड्यातून २-३ वेळांपर्यंत मांसाहार मर्यादित ठेवा.

* सबंध अंड्यांचे सेवन आठवड्यातून एक वेळपर्यंत मर्यादित ठेवा.

Read More

Mask a Weapon in COVID pandemic

In this era of Corona panic and fear, 

there are lot of confusions and misconceptions existing regarding the use of mask, not only amongst the lay persons but also among the health care providers.

On one hand masks are not available for the risk group while on other hand, who are not at risk, spending unnecessary money and energy to procure these masks.

Hope this blog help to keep your health corona free by using mask.

Q1 ... What are the common types of masks

Ans... 

1 Cloth mask

2 Surgical mask

Q2... What are the Respirators

Ans.

N- 95

N- 99

N- 100

are the respirators

Q3.. what is the difference between mask and respirator

Ans..

Mask has  loose fit, it doesn't seal nose and mouth snugly.

During respiration air moves along the edges of the mask, while respirator has tight seal and most of the times air passes only through its material after filtration.

Q4... Are all respirator masks are same

Ans...

No, respirators are graded according to their filtration efficiency.

According to the used filter type

According to the type of materials used 

And additional features

They are of different types.

Q5... what is the efficiency grading

Ans...

According to the efficiency of filtration these are usually graded as-

95, 99 and 100

Means these respirator masks are capable of traping 95%, 99% and 99.9% of particles, smaller up to the 0.3 micron size.

This grading can also be done as

P1 (FFP1) - 80%

P2 (FFP2) - 95%

P3 (FFP3) - 99.95%

Filtration efficiency.

Kawach mask made by IIT ...

Q.6.. what is the N,R or P meaning written over mask

Ans...

N - not oil proof

R- oil resistant

P- oil proof

(Eg. N 95 is not oil proof).

Q7. Few repirator masks have valve, what is that.

Ans..

That valve is nothing but a simple exhalation port with one way valve mechanism, it reduces effort of expiration, reduce heat inside the mask, dissipate humidity and reduce co2 the amount of from the  dead space of mask.

Q.8.. When to use surgical masks.

Ans... Surgical mask or procedure mask is the most common mask used by health workers. 

It is not designed to protect wearer from inhaling the air born bacteria and viruses.

 It is used to block only large particle droplets, splashes, sprays or splatter.

It also reduce the exposure of wearer's saliva and respiratory secretions to  others. Surgical mask also remind wearer not to touch their mouth/nose which could otherwise transfer virus/bacteria after having touched a contaminated surface.

Q9... what is the filtration capacity of surgical mask

Ans... It can vary between 10-90% according to the manufacturer.

Q..10.. how one can assure about the quality of mask

Ans..

Mask should be certified by the

NIOSH (National institute for occupational safety and health)

Or

NPPTL (National personal protective technology laboratory)

Q.11... Does cloth mask effective?

Ans.

Cloth is a wooven material thus pore size is bigger than surgical mask which is made up of non wooven polypropylene material thus cloth mask is less effective than surgical mask in terms of filtration efficiency.

Q..12 ... Does extra layer improve efficacy of cloth mask

Ans.. No, it's not advisable. Each extra layer adds only 2% of extra protection on the cost of comfort .

Q.13... Can surgical/cloth mask be used routinely

Ans.

Yes these can be used routinely. 

Few studies done on normal population concluded that the use of simple mask can decrease the incidence of flu up to 75%.

Few east asian countries following this practice of routine use of mask.

Q.14.. Can mask be reused?

Ans. -Cloth mask can be reused after washing

- Surgical mask should be discarded after single use or after soiled

- Respirator mask should be discarded when resistance of breathing get increased or get solied.

Viruses/bacterias can grow and flourish inside the reused mask.

Q..15.. what are the WHO recommendations for using masks?

Ans...

- For the normal population, any type of mask is not required, maintaining the social distance and hand hygiene are the sufficient.

- Sick person should wear surgical mask

- Any person who is taking care of sick person should also wear the surgical mask.

- N 95 mask should be used by the person who is potential to get expose with the respiratory secretions of the infected patient eg. During the Endotracheal intubation, CPR, Ventilation, Bronchoscopy and Tracheostomy etc.

All types of masks Are available on 

Click here Amazon.com 

Summary - 

Please don't create panic and use this precious commodity judiciously. 

Stay safe..

Read More