Sandbox:BSoni

Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 56030

26) Can I still get my recommended diagnostic test (eg colonoscopy)?

• Since the pandemic has not yet ended, routine screening is performed when the benefit outweighs the risk of transmission of virus. It is best to contact your Doctor/Nurse practitioner/other Healthcare provider to discuss the situation and determine the risk of delaying the procedure.[1]

Are face-masks effective against COVID-19?

• The use of face-masks has been demonstrated to slow the spread of COVID-19.
• Studies conducted in community and healthcare settings observed that the use of face-masks was helpful in reducing the spread of the virus.

Can you have COVID-19 without a fever?

• Yes, one can be diagnosed with COVID-19 without having a fever. Although a majority of patients diagnosed with COVID-19 have fever as a symptom, there are patients who develop other symptoms like shortness of breath, cough and fatigue without developing a fever.

Can COVID-19 be spread through feces?

• There is a lot of research being done regarding this, and there is no conclusive evidence that COVID-19 can be transmitted through feces.

Is there a vaccine for COVID-19?

• No, currently there is no vaccine that can prevent COVID-19. Researchers from all over the world are working on developing a vaccine for this virus, and are hopeful that a viable vaccine will be developed in the coming months.

Does drinking alcohol inactivate the coronavirus?

• Drinking alcohol does not inactivate the coronavirus and does not prevent one from catching the virus. Additionally, excessive use of alcohol can lead to a weakened immune system, leading to a greater risk of becoming sick.

I got my tonsils removed 3 months back, am I more vulnerable than the general population?

• Currently, there is no research linking the removal of tonsils and the vulnerability of getting sick with COVID-19. There have been several studies that have been performed to check the relationship between getting a tonsillectomy and its effect on the immune system. These have found that in a majority of cases, there is no negative effect of removing tonsils on the body's immune system.

I have been on HCQ for many years for an autoimmune condition, does that make me immune to COVID-19?

• Studies have shown that the use of hydroxychloroquine for prevention does not decrease the incidence of COVID-19; and does not make one immune to COVID-19.

Can COVID-19 be transmitted through food?

• There is no current evidence that the COVID-19 virus can be transmitted through food.
• It is highly encouraged to frequently wash hands with soap for at least 20 seconds before eating or handling food.
• Additionally, all food packaging and frequently used surfaces should be cleaned and disinfected thoroughly.

What are the symptoms of COVID-19?

• There are several different symptoms of COVID-19. Below are the majority of them:
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
• This is not a comprehensive list and it will be updated as more research is conducted.
• Please see your doctor if you feel sick or if you have come in contact with anyone who has been diagnosed with COVID-19.

Can COVID-19 be transmitted through water?

• There is no evidence that COVID-19 can be transmitted through water.
• Disinfection and chemical treatment of water by water treatment plants has demonstrated the removal of the virus.

I am a consented organ donor, if I die from COVID-19 can my organs still be used for transplantation?

• Unfortunately, if someone passes away due to COVID-19, their organs are unable to be used for transplantation.
• Although the risk of transmission of the virus through transplantation is low, the American Society of Transplantation current guidance is not to use a COVID-19 positive patients's organs for transplantation.
• This guidance may change in the future as more research is conducted and more information is known about the COVID-19 virus.

Where do I go to get tested for COVID-19?

• With the availability of viral tests becoming more common, there are several locations to get tested for COVID-19.
• The best way to find a testing location is to visit your state's health department website, which will have a detailed guide on available testing locations.
• Here is the list of all United States state and territorial public health department websites provided by the Center for Disease Control and Prevention (CDC): State and Territorial Health Department Websites
• Several of these testing locations do not charge for getting tested for COVID-19.

Should an immunosuppressed patient take any drugs to prevent contracting the virus during their hospital visits?

• Currently, there are no drugs that can be taken to prevent from contracting COVID-19.
• Immunosuppressed patients have weakened immune systems, and have a higher risk of getting sick from COVID-19. These patients should continue their regular treatment plan and continue taking their regular medications.

Are there any trials to study the long term effects in immunity, relapses, the effectiveness of drugs in patients?

• Yes, there are more than 450 different trials in the United States that are studying different aspects of COVID-19; and researching immune responses and effectiveness of drugs. For a full list of current clinical trials that are being conducted, please visit: COVID-19 Clinical Trials
• Trials being performed to research the immunity response to COVID-19 are primarily being carried out by the National Institute of Allergy and Infectious Diseases (NIAID); amongst others around the world. Example Trial 1 Example Trial 2

39) Can we consume raw fruits and vegetables?

• Yes, raw fruits and vegetables can be consumed after washing them thoroughly under running water.
• Firmer vegetables like potatoes and carrots should be scrubbed with a brush before consumption.
• Disinfectants, chemicals or soap should NOT be used to clean raw fruits and vegetables, as well as the food packaging containing these foods.

40) What’s a good respiratory hygiene?

• Good respiratory hygiene includes doing the following things to protect yourself and others from spreading the virus:
  • Wear a mask or face covering when outside in a public setting.
  • Cover your nose, mouth and face while coughing and sneezing.
  • Use a hand sanitizer with at least 60% alcohol or wash your hands with soap for at least 20 seconds after touching your mouth or nose.
  • Use tissues and throw them away responsibly after every use.

44) Is air conditioning really bad and does it worsen the spread?

• Like a lot of other things associated with COVID-19, there is not enough research on the correlation between air-conditioning and the spread of the virus.
• One study conducted in Guangzhou, China showed evidence that supported the use of air conditioners increased the spread of the virus BECAUSE of the direction of the air flow.
• It is to be noted that the direction of air flow and the ventilation in a room is more significant than the actual use of air conditioners. A well ventilated room with good air flow is less likely to spread the virus than a closed room with bad ventilation.

50) Can I undergo elective surgery like hernioplasty, tonsillectomy, appendectomy, cataract now?

• Hospitals are slowly beginning to perform elective procedures like tonsillectomies under the strict guidance prepared by the CDC.
• Conducting such elective procedures is dependent on the local health department guidelines, and the availability of Personal Protective Equipment and Surgical supplies at the hospital.
• Anyone who is going to have an elective procedure performed on them shall be tested for COVID-19 prior to the procedure.
• Please talk with your healthcare provider prior to scheduling any elective procedures.

1) What is COVID-19?

• COVID-19 is a new type of illness that is caused by a coronavirus. The primary mode of transmission of this virus is from person to person.
• The coronavirus disease (COVID-19) is caused by a new strain of coronavirus (SARS-CoV-2) that has not been previously identified in humans. The name of the disease is abbreviated as COVID-19, where "CO" stands for Corona, "VI" stands for Virus, "D", stands for Disease and the number "19" signifies that it started spreading in 2019.
• It was first reported to WHO on the 31st of December, 2019 in Wuhan, China.
• Coronaviruses are zoonotic, meaning they are normally transmitted between animals and people.

4) Can COVID-19 be transmitted through the air over long distances?

• Ongoing research suggests that COVID-19 can remain in aerosol form for up to a few hours, and can be transmitted to a distance of a few feet when an individual coughs or exhales.
• When a person with coronavirus coughs or exhales, droplets land on objects and surfaces around the person. Other individuals can then catch the virus by touching these objects or surfaces, then touching their eyes, nose, or mouth.
• The CDC recommends maintaining social distancing of at least 6 feet (2 meters) from other individuals when going outside.

6) Is COVID-19 serious?

• Although most people with COVID-19 experience mild to moderate symptoms, the disease can cause severe medical complications and lead to death in some people.
• Older adults or people with existing medical conditions are at greater risk of becoming seriously ill with COVID-19.
• More than 123,000 have died in the United States, and more than 477,00 have died worldwide due to COVID-19 in the past few months; making it extremely serious.

7) What is the source of the virus?

• Scientists and public health officials are working hard to identify the source of the SARS-CoV-2; which is the virus that causes COVID-19.
• The initial transmission appears to be from an animal source, but there has been person-to-person transmission in all countries affected by this virus.

11) How can I help protect myself?

• Due to the unavailability of vaccine, the mainstay of prevention lies with minimizing the exposure and limiting the contact with another person.
• Current guidelines by CDC (Center for disease control & Prevention) are: [2]
  • Wearing a mask helps both you and the person you are conversing with by avoiding cross infection. Always remember to have a spacing of about 6 feet or 2 meters while you are in a public place or with a person you are meeting even if they seem to be free of any symptoms as there are some studies emphasizing the possibility of spread by asymptomatic people.
  • Washing hands with soap and water thoroughly for about 20-30 seconds allows a brief contact period for the soap to completely wash away the virus frequently between two chores.
  • Alcohol based Hand sanitizer are a very good alternative for washing hands, but make sure of the percentage of alcohol is at least 60% or above.
  • Cough/sneeze to your elbows or in a tissue. Make sure to discard the tissue you used and wash your hands thoroughly or use a sanitizer following that.
  • Every time you go out - maintain social distancing.
  • Regularly monitor for any symptoms like fever, breathing difficulties, and be prompt to notify a health care provider if you develop any symptoms.
  • If you have a person with COVID-19 illness in your family, isolate them, provide them care and love but maintain a 6 feet or 2 meters distance mandatory.
  • People who are more vulnerable like children, people over the age of 60, immunocompromised people like pregnant woman, diabetics, pre and post transplant patients, people who are on chemotherapy and people with other co morbidities are requested to strictly follow all the suggested preventive measures to avoid being infected.

18) Can I still have sex during the COVID-19 pandemic?

• Information from a study in Mayo Clinic [[3]] concludes that:
  • Since the virus can spread through droplets, irrespective of the sexual activity the virus may continue to spread.
  • You may have sex with a person you live with provided they are healthy and negative for any symptoms or risk factors.(Caution:Asymptomatic people may contain the virus)
  • It is not recommended to engage in sexual activity with a person you have met newly or briefly.
  • In case of any consideration of engaging sexual activity with a person you are not living with, follow measures to avoid transmission of virus like bathing before and after the act, minimizing sexual behavior like oro-genital contact, as there are some evidences of spread of virus through contaminated feces.
  • There is a need for further data and research to verify the transmission of virus through sexual activities.

24) How can I avoid getting infected with COVID-19?

• Due to the unavailability of vaccine, the mainstay of prevention lies with minimizing exposure and limiting the contact with another person.
• Current guidelines by CDC (Center for disease control & Prevention) are:[4]
  • Wearing a mask helps both you and the person you are conversing with by avoiding cross infection. Always remember to have a spacing of about 6 feet or 2 meters while you are in a public place or with a person you are meeting even if they seem to be free of any symptoms as there are some studies emphasizing the possibility of spread by asymptomatic people.
  • Washing hands with soap and water thoroughly for about 20-30 seconds allows a brief contact period for the soap to completely wash away the virus frequently between two chores.
  • Alcohol based Hand sanitizers are another alternative for washing hands, but make sure of the percentage of alcohol is at least 60% or above.
  • Cough/sneeze to your elbows or in a tissue. Make sure to discard the tissue you used and wash your hands thoroughly or use a sanitizer following that.
  • Maintain social distancing every time you go out in public.
  • Regularly monitor for any symptoms like fever, breathing difficulties, and be prompt to notify a health care provider if you develop any symptoms.
  • If you have a person with COVID-19 illness in your family, isolate them, provide them care and love but maintain a 6 feet or 2 meters distance mandatory. Clean all regularly used surfaces thoroughly with disinfectant to prevent the spread of the virus inside the house.
  • People who are vulnerable, including children, people over the age of 60, immunocompromised people like pregnant woman, diabetics, pre and post transplant patients, people who are on chemotherapy and people with other co-morbidities are requested to strictly follow all the suggested preventive measures to avoid being infected.

Small bowel obstruction vs Ileus
	SBO	Ileus
Etiology	Prior surgery	Recent surgery
Abdominal exam	Distension Increased bowel sounds	Possible distension Reduced/absent bowel sounds
Small bowel dilation	Present	Present
Large bowel dilation	Absent	Present

USING ALGORITHM

Box 1 in Row 1

Box 2 in Row 2

Box 3 in Row 3

Box 4 in Row 4

Another flowchart

Chest Pain

Stable angina

Unstable angina

MI

NSTEMI

STEMI

Heart bundle branch blocks are RBBB and LBBB

Case courtesy of OpenStax College, Radiopaedia.org, rID: 26403

• list

1. list 2
   1. numbered
      • 2
      • 3

text in bold text in italics text in bold and italics

• font in blue test
• font in green test
• font in hexadecimal color test

1. Centered red text.

semi colon test

• indentation for new paragraph with list

---

indentation for new paragraph without list and bold

Historical Perspective

• Disease Name and discovery
• Gene mutations
• 1st diagnosis in year

Classification

• Disease classification
  • group 1
  • group 2
• variations of disease