Editorial Note on Changing the Climate in Nerve diseases

Nerve Presentations

Elderly population is continuously increasing all over the world including India. Old age is associated with significant prevalence of chronic illnesses. Population based study to find prevalence & pattern of respiratory diseases in elderly in India is difficult to find. Present study was done in an urban locality of Ghaziabad inhabited mainly by low socio – economic status population and Given the possible harm from inhaled nitric oxide and the absence of a clear mortality benefit, recently published guidelines on the management of critically ill adults with Coronavirus Disease 2019 issued a strong recommendation against the routine use of nitric oxide in patients with ARDS. However, the guidelines recommend a trial of inhaled nitric oxide as a "rescue" therapy, after trying other options, in view of the finding of improved oxygenation. The guidelines further caution that if inhaled nitric oxide is used without a good response in terms of oxygenation, it should be tapered off to avoid rebound pulmonary vasoconstriction that can occur with prolonged use and abrupt discontinuation.While the activation of blood coagulation is essential in counteracting viral infections along with the immune system trapping viruses by forming a fibrin network, a massive inflammatory and coagulative response is dangerous because it can lead to a local thrombosis in the lungs. Furthermore, this severe acute inflammation induces a local consumption coagulopathy, i.e. Disseminated Intravascular Coagulopathy (DIC), resulting in ARDS. ARDS may be associated with pulmonary vascular microthrombosis The authors concluded that it is possible that these PAH-specific medications, including nitric oxide, may offer a protective benefit in COVID-19 patients through mediation of pulmonary vasodilatation