2804NRS Human Pathophysiology and Pharmacology

Risk factors

First of all, considering the case scenario of Steve, a few risk factors which have contributed in development of the disease for the patient can be clearly understood. According to Zhou et al., (2021), it has been suggested that obesity, being one of the most prevalent comorbid conditions of diabetes mellitus, can be counted as a risk factor for COVID-19 disease. The reason underlying this correlation can be explained as increased immune dysfunction among obese people. Since obesity is an inflammatory state characterized by persistent immune activation, which has a detrimental impact on immune functions and host defense processes, leading to a high rate of infectious complications. Body mass index above 30 kg/m2 is remarked as obese condition (Müller & Geisler, 2017). Since Steve has shown a BMI of 35, his obese state has been linked as a risk factor for his current health condition.

One non- modifiable risk factor that can be considered in Steve’s case is his age. COVID-19 serious results tend to be strongly linked to increasing age (Romero Starke et al., 2020).  It has been suggested by many researchers that people above the age of 60 years are the vulnerable population for COVID- 19 disease and they are more likely to experience complications (Cai et al., 2020). Age- related physiological changes are held responsible for weakened immunity among the older adults and thus increases the susceptibility to get infected by viable microorganisms. Higher prevalence of comorbidities such as hypertension, diabetes, respiratory problems, cancer among this population can also be interlinked with age being a risk factor for this disease (Zodpey et al., 2020).

Regardless of age, men with COVID-19 are more likely than women to have poor results and die. Symptoms and comorbidities were similar for men and women. Men had higher hemoglobin levels, as well as higher levels of serum creatine, white blood cells, and neutrophils, as anticipated (Jin et al., 2020).

Pathophysiology and Clinical manifestations

Clinical manifestations that are reported in this case include fever, sensory loss of smell and taste, low blood oxygen saturation level, low urinary output and presence of inspiratory crackles. According to Villalba et al., (2021), COVID-19 cannot be consistently isolated from other forms of viral respiratory infections due to the lack of clear clinical symptoms. However, anosmia and dysgeusia (loss of smell and taste) which are together called “Olfactory and taste dysfunction (OTD)” have been marked as one of the potential symptoms of this disease (Zahra et al., 2020). Considering the pathophysiological mechanism of this symptoms, it can be said that COVID-19 damages the integrity of olfactory epithelium and thus mediates inflammatory alterations which results in loss of smell.

After invasion of the virus in the respiratory system, active viral replication takes place resulting into rapid cell death in the lung (pyroptosis). This leads to inadequate functioning by the lung tissue s and gaseous exchange process is interrupted eventually. As a result, blood coming to the lung gets deprived of adequate amount of oxygen which is reflected through low oxygen saturation level in the patient. Increased damage of the lung tissues leads to leaking of fluid from the pulmonary blood vessels and causation of pneumonia progression. Inspiratory crackles indicate pulmonary edema. Release of cytokines and chemokines (such as IL- 6, IP- 10) and macrophage inflammatory protein (MIP1a, MIP1b, MCP1) is facilitated in the host body by the mean time (Bal et al., 2020). This is manifested through increased body temperature and persistent fever. The angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in many organs including the lungs, kidneys, heart and intestines, is used by SARS-CoV-2 to infect the host. As a result, decrement in kidney function may also be anticipated and this is manifested through low urinary output.

Pharmacological Approach

The treatment modalities aim to manage acute symptoms so that the deterioration can be prevented. According to the research conducted by Pascarella et al., (2020) it has been recommended that blood oxygen saturation level (SpO2) below 93% indicative towards acute hypoxia and thus oxygen should be administered. Since (SpO2) was extremely low (85%) in Steve, he was given oxygen therapy. As per Selby et al., (2020) regular assessment of fluid status as well as appropriate fluid management plans are essential in COVID patients. Intravenous fluid administration was facilitated to restore normal renal function. Persistent fever is another clinical manifestation which also affected patient’s quality of life and needs to be controlled with appropriate pharmacological approach. Antipyretic drugs are administered in order to control mild symptoms such as fever (Lampton, 2021).

References

Bal, A., Agrawal, R., Vaideeswar, P., Arava, S., & Jain, A. (2020). COVID-19: an up-to-date review–from morphology to pathogenesis. Indian Journal of Pathology and Microbiology, 63(3), 358. https://www.ijpmonline.org/text.asp?2020/63/3/358/291689

Cai, G., Cui, X., Zhu, X., & Zhou, J. (2020). A hint on the COVID-19 risk: population disparities in gene expression of three receptors of SARS-CoV.  https://doi.org/10.20944/preprints202002.0408

Jin, J.M., Bai, P., He, W., Wu, F., Liu, X.F., Han, D.M., Liu, S., & Yang, J.K. (2020). Gender differences in patients with COVID-19: focus on severity and mortality. https://doi.org/10.3389/fpubh.2020.00152

Minami, T., Iwata, Y., & Wada, T. (2020). Renal complications in coronavirus disease 2019: a systematic review. Inflammation and Regeneration, 40(1), 1-6. https://doi.org/10.1186/s41232-020-00140-9

Müller, M. J., & Geisler, C. (2017). Defining obesity as a disease. European journal of clinical nutrition, 71(11), 1256-1258. https://doi.org/10.1038/ejcn.2017.155

Pascarella, G., Strumia, A., Piliego, C., Bruno, F., Del Buono, R., Costa, F., ... & Agrò, F. E. (2020). COVID‐19 diagnosis and management: a comprehensive review. Journal of internal medicine, 288(2), 192-206. https://doi.org/10.1111/joim.13091

Romero Starke, K., Petereit-Haack, G., Schubert, M., Kämpf, D., Schliebner, A., Hegewald, J., & Seidler, A. (2020). The age-related risk of severe outcomes due to COVID-19 Infection: a rapid review, meta-analysis, and meta-regression. International journal of environmental research and public health, 17(16), 5974. https://doi.org/10.3390/ijerph17165974

Selby, N. M., Forni, L. G., Laing, C. M., Horne, K. L., Evans, R. D., Lucas, B. J., & Fluck, R. J. (2020). Covid-19 and acute kidney injury in hospital: summary of NICE guidelines. Bmj, 369. https://doi.org/10.1136/bmj.m1963

Villalba, N. L., Maouche, Y., Ortiz, M. B. A., Sosa, Z. C., Chahbazian, J. B., Syrovatkova, A., ... & Zulfiqar, A. A. (2020). Anosmia and dysgeusia in the absence of other respiratory diseases: should COVID-19 infection be considered?. European journal of case reports in internal medicine, 7(4). https://dx.doi.org/10.12890%2F2020_001641

Zahra, S. A., Iddawela, S., Pillai, K., Choudhury, R. Y., & Harky, A. (2020). Can symptoms of anosmia and dysgeusia be diagnostic for COVID‐19?. Brain and behavior, 10(11), e01839. https://doi.org/10.1002/brb3.1839

Zhou, Y., Chi, J., Lv, W., & Wang, Y. (2021). Obesity and diabetes as high‐risk factors for severe coronavirus disease 2019 (Covid‐19). Diabetes/Metabolism Research and Reviews, 37(2), e3377. https://doi.org/10.1002/dmrr.3377

Zodpey, S., Negandhi, H., Dua, A., Vasudevan, A., & Raja, M. (2020). Our fight against the rapidly evolving COVID-19 pandemic: A review of India's actions and proposed way forward. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 45(2), 117. https://dx.doi.org/10.4103%2Fijcm.IJCM_221_20