QBank Newsletter (Volume 1, Issue 1)

Hello!

We are happy to announce our first-ever QBank newsletter! In this issue we have covered some of the recent updates that have happened within and beyond the world of Qbank. 

In this newsletter, the focus is entirely on COVID-19 related updates.

1, 6 new symptoms added:

Recently, the Centers for Disease Control & Prevention (CDC) has added 6 more symptoms to aid the diagnosis of COVID- 19. These are: 

  1. Chills
  2. Muscle pain
  3. Headache
  4. New Loss of taste or smell
  5. Sore Throat
  6. Diarrhoea

Source: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

2, Kavach ELISA

The Indian Council of Medical Research (ICMR) and the National Institute of Virology (NIV), Pune have developed and validated the indigenous IgG ELISA kit called KAVACH ELISA for antibody detection of COVID-19. This is an important surveillance tool to understand the proportion of the infected population.

Source:https://main.icmr.nic.in/sites/default/files/press_realease_files/ICMR_PressRelease_14052020.pd

3, Updated Guidelines on COVID-19 Sample Collection and Testing

The Ministry of Health and Family Welfare (MoHFW) has updated guidelines on sample collection and testing of COVID-19. 

  • Samples: Nasopharyngeal and Oropharyngeal swabs
  • Swab material: Dacron or polyester flocked swabs
  • Note: Calcium alginate swabs or swabs with wooden shafts are not used, as they may contain substances that inactivate the virus and inhibit PCR testing. 
  • Transport to Laboratory at 4 °C
  • Storage till testing: ≤5 days at 4 °C or >5 days at -70 °C

For the transportation of samples VTM (viral transport medium) containing antifungal and antibiotic supplements is to be used. Repeated freezing and thawing of specimens should be avoided.

The nasopharyngeal and oropharyngeal swabs should be placed in the same tube to increase the viral load.

4, 5th version of Clinical Management Protocol

The Ministry of Health and Family Welfare (MoHFW), recently, has issued the fifth version of the clinical management protocol for COVID 19. This has been tabulated as follows: 

MILDMODERATESEVERE
Fever
URTI
Pneumonia with no signs of severe disease
(RR ≥ 24 SpO2 <94%)
Respiratory distress
(RR ≥ 30 SpO2 <90%)
Admit to COVID Centre/Home QuarantineAdmit to Dedicated COVID Health CentreAdmit to Dedicated COVID Hospital
Precaution and Hygiene with Home quarantine

Symptomatic Management

Tab HCQ 400mg BD x1 Day
Followed by 400mg OD x4 Days (in high-risk case*)

Watch for warning signs and seek medical attention if needed
Oxygen: Target 92-96 % SpO2

Daily monitoring
(CBC and RFT, LFT, Absolute lymphocyte count, ECG )

48 hourly Monitoring
(CRP, D- dimer & Ferritin)

Tab HCQ 400mg BD x1 Day
Followed by 400mg OD x4 Days

Anticoagulation
(UFH or LMWH)
Enoxaparin 40mg SC OD

IV Methylprednisolone
0.5 to 1mg for 3- 5 days

Investigational therapies
Inj Remdesivir
200mg on Day 1 followed by 100mg for next 4 days

Convalescent Plasma 200ml/day for every 24 hours
CPAP or NIV

Intubation
if needed

Prone ventilation considered in refractory hypoxemia

IV Methylprednisolone 1 to 2mg/kg/day for 7 days

High prophylactic dose of Anticoagulation
(
UFH or LMWH)
Enoxaparin 40mg SC BD

Sepsis/ Septic Shock:
managed according to their protocol

Sedation or Nutrition therapy



Investigational therapies
Inj Tocilizumab
8mg/kg one dose, repeated after 12 to 24 hour if no improvement occurs with the first dose.
High-risk cases*: Age ≥ 60, HTN, DM, Obesity (BMI ≥ 25), Immuno-compromised status, Cerebrovascular disease, Chronic lung or liver or Kidney disease

Source: COVID 19 Management Protocol by MOHFW version 5 (03.07.2020)
https://www.mohfw.gov.in/pdf/UpdatedClinicalManagementProtocolforCOVID19dated03072020.pdf]

5, New Treatment Modalities

The MoHFW has approved the following for treating COVID 19 patients:

  1. Remdesivir, an RNA polymerase inhibitor (Emergency Use Authorization issued by FDA ) may be considered in adults and pediatric patients with the moderate-severe disease who require supplemental oxygen. 
    Note: Co-administration of Remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended as it may result in the reduced antiviral activity of Remdesivir. 
  2. Off label use of convalescent plasma and Tocilizumab may be considered in patients with moderate disease who are not improving despite the use of steroids and oxygen requirement is progressively increasing. 
    Note: The use of convalescent plasma therapy for the treatment of patients with Covid-19 is under open-label, randomized, controlled Phase II trial conducted by the ICMR.
  3. Hydroxychloroquine is to be used early in the disease in high-risk populations.
  4. Glucocorticoids can be used for a short period of time (3 to 5 days) in patients whose condition is deteriorating progressively. This is depicted by worsening oxygen indicators, imaging, and excessive activation of the body’s inflammatory response.
  5.  Favipiravir, the viral polymerase inhibitor has been approved in tablet form for mild to moderate COVID-19 infection.

Sources:

1, https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19dated27062020.pdf

2, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment

3, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-warns-newly-discovered-potential-drug-interaction-may-reduce

MCQ IDs of the updated MCQs in QBank:

Newly Added MCQs: MB3386 | MD0964 | MD3188 | MD3189 | MC4159 | MD3187 | MA8142 | MA6731 | MA7567 | MD3379 | MA6361 | Pearl No. 2444

You can copy the MCQ IDs and search for it on your App

Preview of Pearl No. 2444:

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5 Responses

  1. Maheshwaran. N says:

    Nice

  2. Dhiya says:

    Is HCQ useful in treating Covid -19 patients?

  3. Saurabh says:

    Kindly provide this information in app only

  4. Neeraj says:

    Kindly post this in App only tough to read and understand

  5. Anonymous says:

    Useful

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