Loss of smell and first UK ICU patients

Well welcome, I would just like to share a couple of very interesting articles that we have been looking at and we are always learning new things about this virus, it is a new coronavirus so I guess it is not surprising because it is a new virus now in this

first

article . is from the UK Society of Otorhinolaryngology, the Society of ENT Medical Specialists, a very prestigious national organisation. It has been known for some time that the

loss

of

smell

is called nas mia a nas Mia. Loss of

smell

can be a symptom of several viral respiratory infections.

In fact, approximately 40% of cases are NAS Mia. People losing their sense of smell is actually caused by viral infections, so it has been observed in several countries that maybe 30 to 50 percent. of

patients

with 19 covered lose their sense of smell, we think over a period of time, although that's not entirely clear yet, so it's a common symptom as it is in other viral infections, but what's interesting is that I heard this for the

first

time around six. weeks ago from an email from Iran, but I didn't report it because I had no way to validate it, but it seems to have been corroborated by the otorhinolaryngology society, is the possibility that the nineteen covered will present themselves with a nas mia for will present themselves with a nas mia, so what this means is that in a minority of cases the first presenting features may be the

loss

of smell and of course when we lose our sense of smell because smell is such an important part of taste that we think that we have lost meaning. of taste too, so the tasks go hand in hand, although technically the nas meter is just the smell, so it's interesting now what ENT doctors say is that sometimes they treat this with steroids, so they advise their ENT doctors to don't do it. treat it with all steroids like prednisolone because that can exacerbate the infection so we advise against the use of all steroids in treating new onset nas mia during the pandemic so that's fair enough and that concerns specialist doctors more than you. and me, but the other thing they pointed out was that if people can have NAS Mia and in some

patients

this is the only clinical feature they have, that won't make them feel sick or think they need to self-isolate, so This is the key message that these otorhinolaryngologists tell us.

If someone has an acute loss of the sense of smell, is a NAS Mia, then it is reasonable to consider the real probability or certainly a strong possibility that that is caused by corona virus 19 infection. and of course that means that these people have to isolate themselves for at least a week, which is interesting, it comes from the people in charge of the British society of otorhinolaryngology and obviously I will post the website of the second article that came to me there. attention is another fascinating one and again it's a UK audit document now this is a it gnarrk gnarrk is the national intensive care research and audit centre, so when I was in the intensive pie we spent quite a bit of time completing to ignore I think I never I knew what small businesses stood for in those days, but this national intensive care audit and research center of all the people who come into intensive care units in the UK data is collected and that allows us people to learn.

There's a lot about what's happening in intensive care, so again it's a very good source of data and again, of course, I'll post the link. Now what this audit has done is that they have reviewed the first 196 patients in the UK who were admitted. to the intensive care unit, probably yesterday or even today, when this was published, 196 patients had been admitted to critical care in the UK as a result of 19 covered infections, so determining some of their characteristics. Now the first characteristic that they determined was age and the average age were sick 33 now, this doesn't necessarily mean that that was the average age of people who suffered serious complications because some patients would not be selected for intensive care because we only want to select patients for intensive care, which is To be fair, it is quite a rigorous process, we only want to select patients from this program if they are going to benefit, so it may have been decided that some older patients did not benefit, so I'm not putting too much emphasis on that age, but what this article pointed out was concerning and I know it's true that there are some cases of younger, fitter people with no pre-existing comorbidities or pre-existing illnesses who for some reason have developed really quite serious coverage 19 illness to the point where they require intensive care.

Yesterday we analyzed the distribution by age. It was clear that the risk of serious complications increases with age, but cannot be ruled out in younger people, so it is very important to remember that we can. Without discounting it, we always have to observe everyone who may have this infection to monitor their clinical condition or have some way to monitor their clinical condition now 496 patients the monitor monitors this data during the first 24 hours in the intensive care unit and in that first In 24 hours, 16 patients died and 17 patients were discharged from the intensive care unit and at the end of the 24 hours, 163 of the 196 were still in intensive care, which is not surprising, it seems that a period fairly prolonged intensive care might be necessary to treat the respiratory and cardiovascular complications of this covered disease 19.

Now this is very interesting and is consistent with data from other places, so the number of people who acquired mechanical ventilation was 175, so which is 170,596. That wasn't the interesting thing, of course, but then the rest probably required, let's say, high flow oxygen and things like that, but what I was going to say, this really interesting thing is that of these 196 patients, there are one, nine and six patients, 57 of them were women and 139 were men, so this is interesting, so the number of the percentage of women admitted from this is the entire population, so you take the entire population that has developed, turn 19 and need to go to the hospital, these are the ones that required critical care and the ones that were bad enough to require critical care. 30% of them were women and 70% of them were men, twenty-nine point one and seventy point nine, so there are more men than women who get serious illnesses by a wide margin.

It must be said that a significant number of men are more likely to contract serious illnesses than women and I do not know why this is so. Some people say it's because men have a greater history of daytime alcohol and tobacco use, so that may be the case, but it's actually not clear, but it's consistent with data accumulated from elsewhere. like China and Italy that we saw yesterday, this is WHO data, so the fatality rate is 1.7 percent in women and that is the female figure and 2.8 percent in men, so The case fatality rate is the percentage of people who die and become infected.

Of all the data collected so far, for every hundred people diagnosed, that has been the mortality rate among women and that has been the mortality rate among men, so we see that men die more often than women from the data we have so far, and that is. backed by UK intensive care audit data now this is petechiae interesting body mass index now body mass index if you go to the NHS website you can calculate your own body mass index is it's basically how overweight you are has and basically the limit is around here, a BMI of more than 25, so what we could say is that between 25 and 30 people are moderately overweight.

The BMI is 30 to 40, they are obese and a BMI of more than 40, they are morbidly obese, so the first thing we noticed is that the patients who had a very low body mass index, only zero point six of those they needed intensive care and well, nothing, nothing, neither point six of the sample who were admitted to intensive care nor point six 196 had a very low body weight, which indicates that low body weight is associated with not suffering from serious illness Now, normal weight could be said that between 18 and 25 is a normal weight, so it is normal weight, so twenty-seven point seven percent, basically twenty-eight percent were not overweight, but in total 71, 7 percent of those who needed intensive care did have it. overweight, whether overweight, obese or morbidly obese, a very interesting finding, so obesity here correlates with increasing severity and intensive care requirement in covered infection 19.

Now, this does not mean that it is the It is obesity that is causing it, in no way because obesity is also associated with cardiovascular disease, it is associated with diabetes and obese people often find it more difficult to breathe because in order for the diaphragm to lower and they can breathe, they have to move more abdominal fat if you have abdominal obesity, for example, so it is well known that people with obesity have breathing difficulties, but anyway that is interesting and, based on this information, I would be happy to advise you to lose weight if you are overweight , obesity or morbid obesity. people so people who were independent who had an independent lifestyle who could just go around and take care of their own activities of daily living which was most patients so most patients could take care of themselves before Of the admission only 12.9% needed help with daily living activities, so previous mobility does not seem to be an important factor, although this is minimal, in reality people who need help need help with living activities daily, like washing and dressing, so all this means that if they are independent it is that they can wash and dress themselves, it does not mean saying that they are going for a run or anything like that.

Now they have serious comorbidities. What they looked at here was people who had comorbidities and this is interesting, so they looked at people with pre-existing cardiovascular disease. paddling spiteful disease pre-existing kidney disease pre-existing liver disease metastatic disease meaning cancer that spreads and metastasis is a cancer that spreads hematological malignancies and immunocompromised people now the bar here was pretty high to be fair, so the cardiovascular system were people who had symptoms at rest, which is a pretty serious cardiovascular disease, the rumors of breathing, people with difficulty breathing with light or moderate activity, again, a pretty serious respiratory disease, they were people who needed dialysis or end-stage renal failure, the liver were people with cirrhosis. or severe liver disease, metastatic disease was distant metastasis, in other words, people with advanced cancer, Hemi illogical hematological malignancies were acute or chronic leukemia, multiple myeloma or lymphoma or very serious medical conditions and the immunocompromised were things like radiation therapy , chemotherapy and HIV, so they're actually It's actually a pretty high bar to qualify as having that, so someone, for example, with mild angina when they exercised, which wouldn't qualify for that, but it's still interesting. see it and it's a limited showing in Soho, only one hundred and ninety. six patients, so we can't accept too much, but we know it's definitive data because it comes from him.

This is immaculate data, so one point six of the total admissions address paya teri problems two point one adrenal problems one point one had blood cancer, blood and hematological cancers and immunocompromised three point seven, so we can see that the Immunocompromised people are a risk, so these are people who take steroids, people who have had organ transplants, people with HIV, people who are receiving other immunosuppressive therapies for things like autoimmune diseases. This seems clear that you're going to have a higher risk and interesting people with pre-existing kidney disease also seem to have a higher risk and the respiratory risk factor was only the third one, so that's pretty interesting, so again we can't.

I took massive amounts of it and the bar was pretty high so we'll wait more in our data on that and that's based on data from the first 24 hours after mission to the critical care unit so what I found Particularly interesting was this correlation with overweight or obesity, whereby more than 70% of these patients were overweight or obese. Interesting facts about the United Kingdom. We hope more quick messages come from this video. If you lose your sense of smell, consider that you may have the infection. may be the presentation feature, it may notchange your sex, but it can change your body mass index, so try to lose some weight and optimize any medical treatments you are on at the moment, but this just gives us more indications as to who we can.

However, I expect to develop a more serious disease, as we have said, we have been taken by surprise, I actually know of some cases where young adults have suffered a severe form of 19 covered, which was not anticipated, but fortunately, the cases . That is difficult to explain in a minority and the cases in which we have these risk factors already identified and others that we analyzed yesterday when we analyzed the mortality rate give us some indication of those who are at higher risk and, of course, the government of the NHS. I have recently written or am writing to all the people who are considered high risk, more than a million and a half people, and I advise them to completely isolate themselves at home, have other people do their shopping and all kinds of things like that. so that they can avoid coming into contact with the coronavirus 19 covered in the first place.