CMAAO CORONA FACTS
and MYTH BUSTER 75
Dr K K Aggarwal
President Confederation of Medical Associations of Asia
and Oceania, HCFI and Past National President IMA
With regular inputs from Dr Monica Vasudev
775: Evidence on spironolactone safety, COVID-19
reassuring for acne patients
Concerns about potential risks about the use of
spironolactone for acne during the COVID-19 pandemic were raised on social media
last month, but spironolactone and other androgen blockers might actually
protect against the virus, according to a report in the Journal of the American
Academy of Dermatology.
The virus needs androgens to infect cells, and uses
androgen-dependent transmembrane protease serine 2 to prime viral protein
spikes to anchor onto ACE2 receptors. Without that step, the virus can’t enter
cells. Androgens are the only known activator in humans, so androgen blockers
like spironolactone probably short-circuit the process, said the report’s lead
author Carlos Wambier, MD, PhD, of the department of dermatology at Brown
University, Providence, R.I (J Am Acad Dermatol. 2020 Apr 10. doi:
10.1016/j.jaad.2020.04.032).
The lack of androgens could be a possible explanation as to
why mortality is so rare among children and why fatalities among men are higher
than among women. At least one study is underway to see if spironolactone is
beneficial: 100 mg twice a day for 5 days is being pitted against placebo in
Turkey among people hospitalized with acute respiratory distress. The study
will evaluate the effect of spironolactone on oxygenation.
776: Buy a
pulse oximeter
1. Some COVID-19
patients have dangerously low levels of oxygen, but appear completely comfortable.
This is being called “silent hypoxia.”
2. COVID-19
patients monitor their oxygen levels at home with a pulse oximeter.
3. A normal
oxygen level measured by a pulse oximeter is around 97%, unless you have other
underlying health problems like COPD. Start to worry when this level drops
under 90% because this can affect the amount of oxygen going to your brain and
other vital organs. People can experience confusion and lethargy at low levels.
Levels below 80% are considered dangerous and increase the risk of organ
damage.
4. Normally, when
parts of the lung are damaged, blood vessels constrict (or get smaller) to
force blood to go to areas of the lung that are not damaged, keeping up the
oxygen levels. With COVID-19, this response may not be working, so blood flow
continues even to areas with damaged lung, where oxygen can’t make it across to
the blood stream.
5. There’s also
the newer finding of “microthrombi” or tiny blood clots that can block oxygen
flow into the blood vessels in the lungs which may be causing the drop in
oxygen levels.
6. Checking
oxygen levels at home is beneficial mostly for those who have diagnosed
COVID-19 or symptoms that are highly suggestive of infection. Monitoring your
oxygen levels can provide reassurance as symptoms of shortness of breath ebb
and flow during the course of the illness. If you notice your levels dropping,
it can also help you know when to reach out to your doctor for help.
7. Along with the
risk of device malfunction, small things like wearing dark nail polish, false
nails, and having cold hands can all throw off the reading, and the readings can
change a little depending on your position. So, it’s important to track the
trend in your levels, not to react to a single reading.
8. If you do
notice your oxygen levels dropping, contact your doctor for advice.
9. Many people
are being given oxygen through nasal tubes or facemasks and are also being
placed in what’s called “prone positioning.” This is basically where you are
put on your stomach or side to help open up air sacs at the bottom and back of
your lungs to allow for more oxygen exchange into the blood stream.
10. The key to taking
care of yourself at home with COVID-19 is to monitor your symptoms. If you
choose to use a pulse oximeter, do not rely on it to measure your condition.
Keep a close eye on all your symptoms and be sure to contact your doctor if you
experience worsening symptoms like weakness, confusion, chest pain, shortness
of breath, regardless of your oxygen levels.
777: Learn to strengthen your lungs
1. Learn to sleep
prone or on the side
Belly breathing. Sit with one hand on your chest and the
other on your belly. Take a deep breath in through your nose and feel your
belly move out, not your chest. Then slowly breathe out through pursed lips as
if you are whistling. Feel your belly move back in. Repeat this a few times
slowly, take your time and stay comfortable. This has the added bonus of
relieving stress because it is relaxing.
Incentive spirometer. This is a device used by people after
surgery or after a lung illness like pneumonia to take deep breaths that expand
the lungs. It has a mouthpiece with tubing that connects with an air chamber
that has an indicator inside it. As you inhale, the indicator rises to a goal
marked on the spirometer and lets you know you’ve achieved the appropriate deep
breath.
778: European Doctors Warn Rare Kids' Syndrome May
Have Virus Tie
Doctors in Britain, Italy, and Spain have been warned to
look out for a rare inflammatory condition in children that is possibly linked
to the new coronavirus. A multi-system inflammatory state requiring intensive
care with features of toxic shock syndrome or Kawasaki disease. School-age
children suffering from “an unusual picture of abdominal pain, accompanied by
gastrointestinal symptoms” that could lead within hours to shock, low blood
pressure and heart problems.
779: Diabetes
risk
In Diabetes the risk for death from COVID-19 is up to 50%
higher in people with diabetes than those without. Evidence also suggests risks
associated with COVID-19 are greater with suboptimal glycemic control, and that
the virus appears to be associated with an increased risk for diabetic
ketoacidosis and new-onset diabetes.
780: COVID-19
is not ARDS
PEEP be set to zero,
inspiratory time to 1.4 seconds, pCO2 to less than 35 mmHg, and that tidal
volume be increased to at least 800 mL. The regimen runs in direct contrast
with widely held ventilation strategies and current guidance on COVID-19
treatment. [MESscape]
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