Monday, April 6, 2020



Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania

333: Ivermectin drug can stop the SARS-CoV2 virus growing in cell culture.
A team of Australian scientists at Monash University in Melbourne has shown a single dose of the Ivermectin drug was able to stop the SARS-CoV2 virus growing in cell culture. The Food and Drug Agency approves the drug as an anti-parasitic drug that is effective in fighting viruses such as HIV, influenza, and Zika. Their study was published in the journal Antiviral Research

334: Tonic water can prevent Corona
Accepted Name: Cinchona officinalis L.
Used in: Ayurveda, Unani, Homeopathy, Chinese, Bitter and astringent
Habit: Tree
Distribution: This species is native to Eucador, globally distributed in Columbia, Peru and Bolivia. It is cultivated in South India and Sri Lanka. It has been recorded in West Bengal and Tamil Nadu (Palni between an altitude range of (1600) 1800-2100 m., Nilgiris). It thrives well at higher elevations up to 2600 m in South India.       
crown bark, jesuits bark, loxa bark
cinchona, kunain
koyina, kvayna, sinkona
kunayana, kunayanah, sinkona
cinkona, curappattai, koyina


·      Cinchona bark contains quinine and related chemicals. Medical experts recommend that only purified quinine or other appropriate medications be used to prevent or control malaria.
·      Tonic water is a carbonated soft drink in which quinine is dissolved. Originally used as a prophylactic against malaria, tonic water usually now has a significantly lower quinine content and is consumed for its distinctive bitter flavor, though it is nowadays also often sweetened. It is often used in mixed drinks, particularly in gin and tonic.
·      In the United States, the US Food and Drug Administration (FDA) limits the quinine content in tonic water to 83 ppm (83 mg per liter if calculated by mass), while the daily therapeutic dose of quinine is in the range of 500–1000 mg, and 10 mg/kg every eight hours for effective malaria prevention (2100 mg daily for a 70 kg adult). It is often recommended as a relief for leg cramps, but medical research suggests some care is needed in monitoring doses.
·      Cinchona bark has historical value to homeopathists as being the drug which led Hahnemann to the discovery of THE law of cure, and enabled him to establish homeopathy

Fact: Malaria-endemic countries in all WHO regions have reported cases of COVID-19. In the WHO African Region, which carries more than 90% of the global malaria burden, 37 countries had reported cases of the disease as of 25 March; of these, 10 countries reported local transmission of the disease.
336: What is the maximum case fatality rate?
Case fatality rate 33.7% reported among nursing facility residents in King County, Washington N Engl J Med 2020 Mar 27 early online

337: Ways of reusing or extending use of masks
2.    Vapor phase hydrogen peroxide" to sanitize masks, allowing them to be reused up to 20 times.
3.    Cloth or fabric face masks for home use can be sterilized by washing them in the washing machine.

Extended use: Practice of wearing the same N95 respirator for repeated encounters with several patients, without removing the respirator between the encounters.  It is implemented when multiple patients are infected, and patients are placed together in dedicated waiting rooms, clinics or hospital units.  Eye protection may be left in place with the N95 respirator for extended use.

Reuse: The practice of using the same N95 respirator for multiple encounters with patients but removing it (‘doffing’) between at least some of the encounters.  The N95 respirator is stored in between encounters and reused. Face shields will be dedicated for use by individual healthcare personnel. Disinfection of the face shield will be required between uses.

Guiding Principles

Extended use is preferred over re-use. It is appropriate for team members following this extended use guidance to remove PPE during breaks and lunch periods. Item that are approved for reuse can be removed, stored and reused following break/meals.

Facemasks, N95 respirators and eye protection can be re-used in a careful and limited way during periods of short supply. Facemasks that fasten to the provider via ties may not be able to be undone without tearing and should be considered only for extended use, rather than re-use.

Guidance is for reuse by a single person (no sharing).   This principle applies to Facemask & N95 respirators

Disposable N95 respirators may be re-used or worn for extended use, as long as they are covered by face shield during aerosol generating procedure, or have reached the end of their use by being visibly soiled, obviously damaged or wet.

Limit room traffic where possible by ensuring that only those essential for patient care enter the room; strategies include bundling of care, limiting or avoiding bedside clinical teaching, limiting operating room traffic, and use of telemedicine where possible Applicability These guidelines apply to all health care personnel (HCPs) who need to wear respiratory protection during patient care or as a requirement of their work responsibilities.

 Guidance for Reuse N95

All supplies of N95 respirators will be stored in locked or secured, designated areas and will be issued to staff with a paper bag or container that allows breathability.

Once the disposable N95 respirator is donned, a full-face shield should be applied over the N95 respirator. Perform hand hygiene and remove the face shield. The front is potentially contaminated, so remove carefully by bending forward and using the elastic band.
Use a germicidal wipe to prepare a surface upon which the face shield will be placed then remove face shield and disinfect before placing it on the prepared surface. Face shield is disinfected using a germicidal wipe

Storage of Previously Worn N95 Respirators:  After removing N95 respirators, visually inspect and discard if visibly soiled, obvious damage or wet.  The N95 respirators should be stored in a well-ventilated container (i.e., paper bag) with username & date.
A disposable N95 respirators can be worn for several hours and multiple shifts if not wet or damaged, and not involved in an aerosol-generating procedure unless it is covered by face shield.

References Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH) This document was adapted from Guidance for Extended Use and Reuse of Facemasks, Respirators, and Protective Eyewear, University of Maryland/Nebraska Medicine

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