Preparing for COVID-19: The lessons from SARS 2003 in Canada

Acute cough

Background. Acute respiratory viral infections (ARVI) rank first in the general structure of infectious pathology and remain a critical problem of healthcare systems. ARVI pathogens can spread rapidly among human population, become resistant to antiviral drugs, cause severe diseases and are associated with secondary complications. The purpose of the study was to analyse the effectiveness of enisamium iodide in the treatment of outpatients with an established diagnosis of acute respiratory viral infection, influenza or COVID-19 by studying the changes in the main clinical manifestations of the disease. Materials and methods. The study included a large-scale recruitment of outpatients (n = 6114) with an established diagnosis of acute respiratory viral infection, influenza and COVID-19, who were prescribed enisamium iodide as part of comprehensive treatment, with subsequent retrospective analysis of completed questionnaires. Changes in the severity of the following clinical manifestations were studied: sore throat, cough, runny nose and nasal congestion, shortness of breath and difficulty breathing, body temperature. The questionnaires used 4 gradations of symptom severity, including absence of symptoms, mild, moderate and significant severity of symptoms. The relevant data were collected on the day of the first consultation with a doctor, as well as on the third and fifth days of treatment. Results. According to the results obtained, the largest share of diseases was represented by cases of ARVI — 82.51 % (95% CI: 81.58–83.44). COVID-19 was diagnosed in 11.60 % of patients (95% CI: 10.82–12.38), the smallest share belonged to influenza — 5.89 % (95% CI: 5.32–6.47). The proportion of patients in whom complaints of sore throat disappeared on the fifth day of treatment was 67.59 versus 7.19 % on the day of the first visit, with an absolute increase of 60.40 % (95% CI: 58.59–62.14). Identical trends were observed for all analysed clinical manifestations in the indicated observation intervals: cough — 45.87 versus 10.34 %, an increase of 35.53 % (95% CI: 33.55–37.47); shortness of breath and difficulty breathing — 90.16 versus 55.83 %, an absolute increase of 34.33 % (95% CI: 32.37–36.25); runny nose and nasal congestion — 48.89 versus 5.00 %, an absolute increase of 43.89 % (95% CI: 42.10–45.62); normalization of body temperature — 71.89 versus 1.67 %, an absolute increase of 70.22 % (95% CI: 68.76–71.59). Conclusions. According to the results of the study, enisamium iodide was highly effective in the treatment of outpatients with a diagnosis of ARVI, influenza or COVID-19. Analysis of the main clinical symptoms (cough, shortness of breath and difficulty breathing, fever, runny nose and nasal congestion, sore throat) revealed a statistically significant improvement in the patients’ state already on the fifth day from the start of therapy compared to the first day, both in terms of reducing the severity of an individual symptom and its disappearance. Thus, the data obtained indicate the high clinical effectiveness of enisamium iodide in reducing the severity of symptoms of acute respiratory viral infections.

About Coronavirus and Coronavirus Disease 2019 Coronavirus belongs to a large family of single-stranded RNA viruses Elderly people, and those with medical conditions such as hypertension, cardiac problems or diabetes, chronic obstructive airway disease, are more likely to develop serious illness [[2]] Thyroid Disorders in India Thyroid diseases are common worldwide The prevalence of hypothyroidism in T2DM and hypertension in India was found to be about 33% [[6]] Hypothyroidism and Coronavirus Disease 2019 There is no information on how it affects individuals with hypothyroidism [Extracted from the article] Copyright of Thyroid Research & Practice is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

At the center of the COVID-19 pandemic: Lessons learned for otolaryngology-head and neck surgery in China.

Objective To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment. Methods A retrospective analysis of 26 cases of listeriosis, including their demographic and clinical features, was conducted, involving 16 pregnant women from Civil Aviation General Hospital, Xiamen Humanity Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing Tiantan Hospital, Tangshan Maternal and Child Health Hospital, the Fourth Hospital of Tianshui City from October, 2011 to May, 2018, and 10 newborns from the Fourth Hospital of Tianshui City, Tangshan Maternal and Child Health Hospital, Zhengzhou Children's Hospital from February, 2016 to April 2018. Descriptive methods were used for data analysis. Results (1) Among the 16 gravidas, one, five and 10 developed the infection in the 1st, 2nd and 3rd trimester of pregnancy, respectively, and eight had pregnancy complications. Furthermore, all of them developed fever [(38.9±0.5) ℃]. Symptoms such as cough, nasal congestion, runny nose, sore throat, dizziness, headache and other flu-like symptoms were observed in six cases. Gastrointestinal symptoms and flu-like symptoms were presented in four. Fetal distress, tachycardia and decreased fetal movement occurred in 11 cases. Elevated C-reactive protein and white blood cell count were detected in 16 and 14, respectively. Eight underwent placental pathological examination which shown various degrees of pathological changes, including neutrophil infiltration, acute chorioamnionitis and inflammatory necrosis. The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes. Only two delivered at term, while the others (14/16) ended in miscarriage, premature delivery or stillbirth. (2) Among the 10 newborns with listeriosis, there were eight early-onset infections and two late-onset infections. All of them were febrile [(38.6±0.6)℃]. Six had cyanosis, groaning, foaming and three concave sign; five showed shortness of breath; meningitis and skin rash were found in one, respectively. All had elevated white blood cell and C-reactive protein. Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment. Four were treated with cephalosporins alone, one of which died after the treatment was withdrawn. One was cured by initial treatment with meropenem alone, while eight recovered after adjustment of treatment with ampicillin, penicillin, meropenem, vancomycin alone, or meropenem combined with ampicillin or vancomycin. (3) The isolates that were susceptible to penicillin, ampicillin and meropenem accounted for 96.1% (25/26) all together and 88.5% (23/26) were susceptible to compound sulfamethoxazole. Conclusions There is no specific clinical manifestations of maternal or neonatal listeriosis. Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes. Key words: Pregnancy complications, infectious; Listeriosis; Pregnancy outcome; Infant, newborn

Corona viruses are a large family of viruses which may cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus disease is COVID-19. The COVID-19 epidemic has spread very quickly. It took only 30 days to expand from Hubei to the rest of China since first detected in December 2019. The virus has spread to over 210 countries and territories across the globe in 3 months, and was characterised as a pandemic by the WHO. ICTV announced ‘severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)’ as the name of the new virus. The most common symptoms of COVID-19 are fever, tiredness and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. This disease spreads primarily through contact with an infected person when they cough or sneeze through their droplets generated of saliva or discharge from the nose. People of all ages can be infected by the new coronavirus. Older people and people with pre-existing medical conditions, such as asthma, diabetes, heart disease, appear to be more vulnerable to becoming severely ill with the virus. To date, there is no vaccine and no specific antiviral medicine to prevent or treat COVID-19. Antibiotic is not useful in this disease. Also hydroxychloroquine has not yet been proven to cure coronavirus. It is still under clinical trial. Few countries have approved the use of convalescent plasma therapy as an experimental treatment in clinical trials and for critically ill COVID-19 patients without other treatment options. The most effective way is to protect yourself and others against COVID-19 by frequently cleaning your hands with an alcohol based hand rub or with soap and water, covering your cough with the bend of elbow or tissue, and maintaining a distance of at least 3 to 6 feet from people who are coughing or sneezing and avoiding touching eyes, nose or mouth and following good respiratory hygiene. Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Today the world is worried about increasing number of COVID-19 cases. In future, the cases of the COVID-19 may start decreasing when enough people develop immunity, either through infection or vaccination. Another possibility is that the virus will continue to circulate and establish itself as a common respiratory virus. Every beginning has an end and every end has a new beginning. But instead of waiting for future, people must take steps to reduce the spreading of this virus by precautionary measures and following the guidelines by authorities.

According to World Health Organization, Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. The virus COVID-19 is transmitted through droplets generated when an infected person coughs, sneezes, or exhales. The droplets are too heavy to hang in the air and quickly fall on floors or surfaces. A person gets infected by touching a contaminated surface and then his eyes, nose, or mouth (WHO,2020). COVID-19 affects different people in different ways. Most infected people develop mild to moderate illness and recover without hospitalization. The most common symptoms are fever, dry cough, tiredness. The fewer common symptoms are aches and pains, sore throat, diarrhea, conjunctivitis, headache and loss of taste or smell, a rash on the skin, or discoloration of fingers or toes. Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment. 80% will recover from the disease without needing special treatment (WHO,2020). Around one in every five people who are infected with COVID-19 develop difficulty in breathing and require hospital care. People aged over 60 years and people who have underlying medical conditions such as diabetes, heart disease, respiratory disease, or hypertension are among those who are at greater risk. (WHO,2020).

The common cold is the most frequently experienced infection among humans, but limited data exist to characterize the onset, duration, severity and intersection of symptoms in community-acquired colds. A more complete understanding of the symptom frequency and burden in naturally occurring colds is needed. We characterized common cold symptoms from 226 cold episodes experienced by 104 male or female subjects. Subjects were enrolled in the work environment in an attempt to start symptom evaluation (frequency and severity) at the earliest sign of their cold. We also assessed the symptom that had the greatest impact on the subject by asking them to identify their single most bothersome symptom. Symptom reporting started within 24 hours of cold onset for most subjects. Sore throat was a harbinger of the illness but was accompanied by multiple symptoms, including nasal congestion, runny nose and headache. Cough was not usually the most frequent symptom, but was present throughout the cold, becoming most bothersome later in the cold. Nasal congestion, pain (eg, sore throat, headache, muscle pains) or feverishness and secretory symptoms (eg, runny nose, sneezing), and even cough, were simultaneously experienced with high incidence over the first 4 days of illness. The single most bothersome symptom was sore throat on day 1, followed by nasal congestion on days 2-5 and cough on days 6 and 7. There is substantial overlap in the appearance of common cold symptoms over the first several days of the common cold. Nasal congestion, secretory and pain symptoms frequently occur together, with cough being somewhat less prominent, but quite bothersome when present. These data establish the typical symptomatology of a common cold and provide a foundation for the rational treatment of cold symptoms typically experienced by cold sufferers.

The common cold is the most frequently experienced infection among humans, but limited data exist to characterize the onset, duration, severity and intersection of symptoms in community-acquired colds. A more complete understanding of the symptom frequency and burden in naturally occurring colds is needed. We characterized common cold symptoms from 226 cold episodes experienced by 104 male or female subjects. Subjects were enrolled in the work environment in an attempt to start symptom evaluation (frequency and severity) at the earliest sign of their cold. We also assessed the symptom that had the greatest impact on the subject by asking them to identify their single most bothersome symptom. Symptom reporting started within 24 hours of cold onset for most subjects. Sore throat was a harbinger of the illness but was accompanied by multiple symptoms, including nasal congestion, runny nose and headache. Cough was not usually the most frequent symptom, but was present throughout the cold, becoming most bothersome later in the cold. Nasal congestion, pain (eg, sore throat, headache, muscle pains) or feverishness and secretory symptoms (eg, runny nose, sneezing), and even cough, were simultaneously experienced with high incidence over the first 4 days of illness. The single most bothersome symptom was sore throat on day 1, followed by nasal congestion on days 2-5 and cough on days 6 and 7. There is substantial overlap in the appearance of common cold symptoms over the first several days of the common cold. Nasal congestion, secretory and pain symptoms frequently occur together, with cough being somewhat less prominent, but quite bothersome when present. These data establish the typical symptomatology of a common cold and provide a foundation for the rational treatment of cold symptoms typically experienced by cold sufferers.

37-Year-Old Man With Headache and Nasal Congestion

The purpose of the study was to test the hypothesis that infants with higher levels of prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) from fossil fuel combustion may be at greater risk of developing respiratory symptoms. The study was carried out in a cohort of 333 newborns in Krakow, Poland, followed over the first year of life, for whom data from prenatal personal air monitoring of mothers in the second trimester of pregnancy were available. The relative risks of respiratory symptoms due to prenatal PAHs exposure were adjusted for potential confounders (gender of child, birth weight, maternal atopy, maternal education as a proxy for the socio-economic status, exposure to postnatal environmental tobacco smoke, and moulds in households) in the Poisson regression models. Increased risk related to prenatal PAH exposure was observed for various respiratory symptoms such as barking cough (RR = 4.80; 95% CI: 2.73-8.44), wheezing without cold (RR = 3.83; 95% CI: 1.18-12.43), sore throat (RR = 1.96; 95% CI: 1.38-2.78), ear infection (RR = 1.82; 95% CI: 1.03-3.23), cough irrespective of respiratory infections (RR=1.27; 95% CI: 1.07-1.52), and cough without cold (RR = 1.72; 95% CI: 1.02-2.92). The exposure to PAHs also had impact on the duration of respiratory symptoms. The effect of PAHs exposure on the occurrence of such symptoms as runny nose or cough was partly modified by the simultaneous exposure to postnatal passive smoking. The analysis performed for the duration of respiratory symptoms confirmed significant interaction between PAHs exposure and postnatal ETS for runny or stuffy nose (RR = 1.82; 95% CI: 1.57-2.10), cough (RR = 1.18; 95% CI: 0.99-1.40), difficulty in breathing (RR = 1.39; 95% CI: 1.01-1.92) and sore throat (RR = 1.74; 1.26-2.39). Obtained results support the hypothesis that prenatal exposure to immunotoxic PAHs may impair the immune function of the fetus and subsequently may be responsible for an increased susceptibility of newborns and young infants to respiratory infections.

Purpose: Several atypical presentations of COVID-19 like anosmia, conjuctivitis, and gastrointestinal findings are seen in the literature. The purpose of this study was to investigate the common and atypical symptoms of COVID-19 among the patients admitted to the otorhinolaryngology (ENT) outpatient clinic. Materials and Methods: This case series was conducted with 49 patients who applied to hospital between April 1, 2020 and April 30, 2020. Common and atypical otolaryngological findings were recorded. Sociodemographic findings and blood parameters were also evaluated. Results: Of the patients, 59.18% were aged 40 and over, 46.94% were of the A blood group, 55.10% were male and 24.49% were smokers, 51.02% had a chronic disease. Among typical symptoms; fever (71.43%), a dry cough (46.94%), shortness of breath (42.86%) was seen. Diarrhea (48.98%), runny nose (51.02%), nasal congestion (42.85%), sore throat (22.44%), headaches (32.65%), 18.36% olfactory disorder, 26.53% gustatory disturbance were noted. Olfactory and gustatory disturbances are found to be related to good prognosis and mild clinical course. The difference between Hg and D–dimer levels of the female and male patients were found to be statistically significant. The D-dimer levels determined in the present study were higher than those reported in the literature. Conclusion: While COVID-19 present with common symptoms, sometimes atypical symptoms can be the only finding during initial application to the hospital. Olfactory and gustatory disturbances point to the effects of COVID-19 on neurons. Neuronal effects like olfactory and gustatory disturbances should be closely monitored in COVID-19 patients in long term.

Pneumonia is a key criterion for the severity of COVID-19. Whether COVID-19 symptoms are indicators of pneumonia in patients infected with SARS-CoV-2 Omicron variants is unclear. 6200 non-hospitalized patients with COVID-19 from three sites in three hospitals were divided into three cohorts: Cohort 1 (n = 1971, Outpatient Department), Cohort 2 (n = 1073, Emergency Department), and Cohort 3 (n = 3156, Fever Clinic). The association of COVID-19 symptoms with pneumonia in the patients were analysed. In Cohort 1, dry cough, expectoration, fever, muscle or body aches, sore throat, headache or dizziness, shortness of breath, and difficulty breathing were associated with pneumonia. For Cohort 2, expectoration, fatigue, congestion or runny nose, sore throat, headache or dizziness, chills, chest stuffiness, shortness of breath, and difficulty breathing were related to pneumonia. With Cohort 3, dry cough, expectoration, vomiting, chest stuffiness, shortness of breath, and difficulty breathing had associations with pneumonia. Moreover, duration of symptoms > 7 days was associated with pneumonia in all three cohorts. In the study, expectoration, shortness of breath, difficulty breathing, and duration of symptoms > 7 days were useful predictors of COVID-19 pneumonia in the patients infected with SARS-CoV-2 Omicron variants. Among these predictors, shortness of breath and difficulty breathing were high-risk early-warning factors for pneumonia, and duration of symptoms > 7 days was also a high-risk factor for pneumonia.

The 2009 influenza A (H1N1) virus infection is associated with the high risk of severe complications and is spreading more rapidly throughout the world than other reported seasonal influenzas. This study aimed to evaluate the efficacy and safety of the nature herbal medicine Lianhuaqingwen capsule (LHC) in patients infected with influenza A (H1N1) virus. A total of 244 patients aged 16 - 65 years confirmed with influenza A (H1N1) virus infection by the real time RT-PCR were randomized to one of two treatment groups of 122 patients each. Each group assigned to receive either LHC or Oseltamivir for five days and observation for seven days. The patients were enrolled within 36 hours of illness onset if they had an axillary temperature of ≥ 37.4°C and with at least one of the following symptoms: nasal obstruction, runny nose, cough, sore throat, fatigue, headache, myalgia, chills and sweating. The primary end point was the duration of illness. Of 244 patients, 240 (98.36%) patients with a median age 21 years completed the study between October 24, 2009 and November 23, 2009. There were no significant overall differences between LHC treated and Oseltamivir treated patients in the median duration of illness (LHC 69 hours vs. Oseltamivir 85 hours P > 0.05) or the median duration of viral shedding (LHC 103 hours vs. Oseltamivir 96 hours, P > 0.05). However, it was worthwhile to note that LHC significantly reduced the severity of illness and the duration of symptoms including fever, cough, sore throat, and fatigue (P < 0.05). Both study medications were well tolerated. No drug related serious adverse events occurred during the study. Compared with Oseltamivir, LHC achieved a similar therapeutic effectiveness reduction of the duration of illness and duration of viral shedding. Therefore, LHC might be an alternative therapeutic measure for influenza A (H1N1) virus infections.

Signs and symptoms of a common cold reported in young children are those perceived by caretakers. Objective signs include cough, fever, and sneezing. Subjective symptoms include nasal congestion, feverishness, headache, and sore throat. School-aged children may provide a more accurate picture of the symptom profile during colds because they can self-report. Using preprinted diary sheets listing common signs and symptoms, diaries were kept for school-aged children for 10 days after onset of a cold. Nasopharyngeal aspirates were analyzed for respiratory viruses and potential bacterial pathogens. Out of 81 colds studied, the most common signs were cough and sneezing, although the most common symptoms were nasal congestion and runny nose. Other symptoms, including feverishness and headache, were each reported in 15% of children at onset. The majority of children (73%) continued to be symptomatic 10 days after onset. Rhinovirus was detected in 46% and 1 or more potential bacterial pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) in 29% of episodes. Symptom profiles for rhinovirus illnesses and those in which potential pathogenic bacteria were detected were not different from the rest. The common cold in school-aged children is characterized by nasal congestion, cough, and runny nose. Signs and symptoms usually continue for at least 10 days.