The coronavirus disease 2019 (COVID-19) pandemic is an evolving condition in the absence of established treatment and vaccines. The few autopsy studies on COVID-19 patients suggested the presence of pulmonary microvascular thrombosis. Hence, it is imperative to understand the pathobiology of thrombus formation and speculate the therapeutic goals in combating COVID-19. This paper focuses on a holistic approach by integrating the previous concepts and current concepts of thrombosis to better understand the pathogenesis of thrombosis.

Introduction:There is a growing clinical awareness about the influence of gut–lung axis on lung injury and coexisting manifestations of disease processes in both the intestine and lungs. Patients of chronic lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma very often present with coexistent gut symptoms. In the present study, we have tried to establish the correlation of severity of pulmonary pathology of COPD and asthma patients with functional gastrointestinal (GI) symptoms of the patients.Materials and Methods:This is a prospective, questionnaire-based study comprising patients with asthma and COPD. After following strict inclusion and exclusion criteria, a total of 200 patients (100 patients of bronchial asthma and 100 patients of COPD) were included in the study. Functional GI symptom questionnaire [Annexure 1-Bowel Disease Questionnaire] is based on ROME III diagnostic criteria. On the basis of GOLD (Global Initiative for Obstructive Lung Disease) guidelines, COPD patients were divided into 4 categories (mild - GOLD 1, moderate – GOLD2, severe – GOLD3 and very severe – GOLD4). Asthma patients were divided into three categories (well controlled, partly controlled, uncontrolled) on the basis of GINA (Global Initiative for Asthma) guidelines.Results:Highest percentage of patients with maximum GI symptoms was found in “GOLD-4” group among COPD patients and “uncontrolled” group among asthma patients. Highest percentage of patients with least GI symptoms was found in “GOLD-1” group among COPD patients and “well controlled” group among asthma patients.Conclusion:We can conclude from our study that the phenomenon of gut–lung axis not only exists but also the severity of symptoms of one system (gut) carries a high degree of concordance with severity of other (lung).

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The ongoing pandemic of COVID-19 has forced us to consider using available drugs in the shortfall of vaccines and established treatment. Cotrimoxazole is one of the oldest drugs presently used in the prevention and treatment of opportunistic infections in the human immune deficiency virus (HIV) etc. It is a combination of two drugs Trimethoprim and Sulfamethoxazole. This cost-effective old drug is well tolerated among the population with the concomitant use of folic acid; moreover, it also looks after the secondary infections. To conclude, Cotrimoxazole can be used as critically ill COVID-19 patients.   References Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive care Med. 2020;46(5): 846–48. https://doi.org/10.1007/s00134-020-05991-x Rozin A, Schapira D, Braun-Moscovici Y, Nahir AM. Cotrimoxazole treatment for rheumatoid arthritis. Semin Arthritis Rheum. 2001;31(2):133-41. Bourke CD, Gough EK, Pimundu G, Shonhai A, Berejena C, Terry L, et al. Cotrimoxazole reduces systemic inflammation in HIV infection by altering the gut microbiome and immune activation. Sci Transl Med. 2019;11(486): eaav0537. https://doi.org/10.1126/scitranslmed. aav0537 Liu B, Li M, Zhou Z, Guan X, Xiang Y. Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)? J Autoimmun. 2020; 111:102452. https://doi.org/10.1016/j.jaut.2020.102452 Vickers IE, Smikle MF. The immunomodulatory effect of antibiotics on the secretion of tumour necrosis factor alpha by peripheral blood mononuclear cells in response to Stenotrophomonas maltophilia stimulation. West Indian Med J. 2006;55(3):138-41. https://doi.org/10.1590/s0043-31442006000300002 Onyebuagu PC, Kiridi K, Pughikumo DT. Effects of septrin administration on blood cells parameters in humans. Int. J. Basic Appl. Innov. Res, 2014;3(1): 14 -8. https://www.ajol.info/index.php/ijbair/article/view/104688 Ho JMW, Juurlink DN. Considerations when prescribing trimethoprim– sulfamethoxazole. CMAJ. 2011; 183(16):1851-8. https://doi.org/10.1503/cmaj.111152 Mahan CS, Walusimbi M, Johnson DF, Lancioni C, Charlebois E, Baseke J, et al. Tuberculosis treatment in HIV infected Ugandans with CD4 counts .350 cells/mm3 reduces immune activation with no effect on HIV load or CD4 count. PLoS one.2010;5(2): e9138. https://doi.org/10.1371/journal.pone.0009138 Varney VA, Smith B, Quirke G, Parnell H, Ratnatheepan S, Bansal AS, et al. P49 the effects of oral cotrimoxazole upon neutrophil and monocyte activation in patients with pulmonary fibrosis and healthy controls; does this relate to its action in idiopathic pulmonary fibrosis. Thorax. 2017;72: A109. http://dx.doi.org/10.1136/thoraxjnl-2017-210983.191