Wednesday, April 29, 2020



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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