Saturday, May 2, 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

766:  Dear KK : From Professor Russell Franco D'Souza

Thanks to 50 autopsies carried out on patients who died from COVID-19, scientists found that

1.     Strictly speaking It is NOT PNEUMONIA. The virus does not only kill pneumocytes but also uses an inflammatory storm to create an endothelial diffuse vascular thrombosis

2.     The lungs are the most affected because they are the most inflamed. But it also produces a heart attack or stroke, and many other thrombotic diseases.

3.     New protocols are concentrating on the inflammatory and anti-clotting.

4.     These therapies must be started early

5.     It is like DIC

6.     An Italian anatomical pathologist reports that the Pergamo hospital made a total of 50 autopsies, Milan 20; the Chinese have only made 3

7.     Chest radiographs that were discussed a month ago as interstitial pneumonia, it could actually be fully consistent with a disseminated interstitial coagulation DICA.

8.     If thromboembolism is not resolved first, ventilating a lung where blood does not reach is useless.

9.     Inflammation induces thrombosis. So what the scientific literature said especially from China until the middle of March was that anti-inflammatories should not be used. Now the therapy that is being used in Italy is with anti-inflammatories and antibiotics as in influenzas, and the number of hospitalized patients has been reduced.

10. Patients with rheumatoid arthritis have never been admitted to the covid departments, because they are on cortisone therapy, which is a great anti-inflammatory.

11. This weekend the comparison was made of the data of 50 patients between those who breathe badly and those who do not and the situation seems very clear. In Italy the protocols are changing. According to valuable information from Italian pathologists, ventilators and Intensive Care Units are not required.

767: Cardiac Arrests On the Rise During COVID-19 Crisis

Stress placed on the heart by COVID-19, a hesitancy by people to call emergency number and even reluctance on the part of bystanders to perform CPR may be boosting rates of out-of-hospital cardiac arrest, a new report finds. The data comes from four provinces in northern Italy, a region that was hit very hard and very early by the coronavirus pandemic. The researchers said that between Feb. 21 and March 31, 2020, there was a 58% jump in the number of cardiac arrests that occurred before victims could get to the hospital, compared to the same time frame last year. In more than three-quarters of the cases, COVID-19 was diagnosed in the affected patients, said a team led by Dr. Enrico Baldi, of the University of Pavia. His team reported their findings online April 29 in the New England Journal of Medicine.

768: The Coronavirus Still Is a Global Health Emergency, W.H.O. Warns

The World Health Organization extended its declaration of a global health emergency on Friday. The move comes exactly three months after the organization’s original decision to announce a “public health emergency of international concern” on Jan. 30. At the time, only 98 of the nearly 10,000 confirmed cases had occurred outside China’s borders. But the pandemic continues to grow. More than 3.2 million people around the world are known to have been infected, and nearly a quarter million have died, according to official counts. There is evidence on six continents of sustained transmission of the virus. All of this has led experts in the W.H.O.’s emergency committee to reconvene to assess the course of the outbreak, and to advise on updated recommendations, said Dr. Tedros Adhanom Ghebreyesus, the organization’s director-general.

The pandemic remains a public health emergency of international concern. The crisis “has illustrated that even the most sophisticated health systems are struggling to cope with a pandemic. A rapid rise in new cases in Africa and South America, where many countries have weak health care systems, is alarming. The acceleration is occurring even as the spread of the virus has appeared to slow in many countries in Asia and Europe.

769: Umifenovir does not appear to improve outcomes in patients with COVID-19

According to a study published in Clinical Microbiology and Infection, treatment with umifenovir is not associated with improved outcomes in patients with COVID-19.

770: Fact: Another study, published in Emerging Infectious Diseases, suggests that pulmonary embolisms (PEs) can occur after the cytokine storm in patients with COVID-19, despite deep vein thrombosis prophylaxis.

771:  Convalescent plasma therapy fails to reduce mortality in patients with severe COVID-19

Convalescent plasma treatment can discontinue severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) shedding, but cannot reduce mortality in critically ill patients with end-stage coronavirus disease 2019 (COVID-19), according to a study published in The Journal of Infectious Diseases.

772: Mist drugs in viral conditions are helpful only if started early

Regarding antiviral—and we know this from influenza—the earlier you give treatment, the better. For example, oseltamivir is given for influenza virus. If you take it within 6 hours of onset of symptoms, you might abbreviate your duration of illness by 4 days. If you wait until 2 days of illness, it might only abbreviate it by a day. For any antiviral effect, it has to be taken early. People are using drugs in hospitalized COVID patients who have probably been infected for an average of 5 or 6 days, and perhaps symptomatic for 1 to 3 to 5 days. It is difficult to discern whether there will be an effect.

773: New York hospitals are studying a common heartburn drug as treatment for Covid-19

(CNN)Hospitals in New York are giving Covid-19 patients heartburn medicine to see if it helps fight the virus. Preliminary results of the clinical trial of famotidine, the active ingredient in Pepcid, could come out in the next few weeks, said Dr. Kevin Tracey, president of Feinstein Institutes for Medical Research at Northwell Health, which runs 23 hospitals in the New York City area. So far, 187 patients have enrolled in the clinical trial, and Northwell eventually hopes to enroll 1,200.  The patients in the study are in the hospital taking mega-doses intravenously -- doses about nine times what someone would normally take for heartburn. Tracey and his colleagues got the idea to study famotidine after it was observed that some patients in China taking the drug fared better than patients not taking the drug. He said studies on the Chinese patients have not yet been published, but that Dr. Michael Callahan, an infectious disease specialist at Massachusetts General Hospital who worked with coronavirus patients in China, observed that some people with lower incomes were surviving longer than their wealthier counterparts who also had heartburn. The famotidine study was first reported in Science Magazine.

774: The FDA approved an emergency use authorization (EUA) for remdesivir, an investigational antiviral agent, to treat patients hospitalized with severe COVID-19

Authorization was granted on the basis of two clinical trials, including results from a randomized trial of remdesivir released by the National Institute of Allergy and Infectious Diseases in a press release this week. Interim analyses of the trial showed the drug met its primary endpoint, a 31% significantly faster time to recovery over controls.

775: Baby Masks Are Dangerous

Twitter sounded the alarm on masks for very young children over the weekend. In response to an Amazon ad for Jonigo breathable gauze masks for children 0–3 years old, pediatric physician assistant Alyson Smith tweeted,
"Hey @Amazon this product could be deadly to babies and must be removed immediately."

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