COVID-19: The Jury is Back on Hydroxychloroquine

At this time, I recommend against using chloroquine or hydroxychloroquine to prevent or treat COVID-19 infection. This recommendation is mostly based on the study published in the Lancet online, May 22, 2020.[1]

Included in this study were 96,032 hospitalized patients from 671 hospitals who were diagnosed with COVID-19 between Dec 20, 2019, and April 14, 2020 and met the inclusion criteria for said study. It was convincingly a large multinational real-world analysis.

The authors (who I agree with), did not observe any benefit of hydroxychloroquine or chloroquine (when used alone or in combination with a macrolide) on in-hospital outcomes, when initiated early after diagnosis of COVID-19. Each of the drug regimens of chloroquine or hydroxychloroquine alone or in combination with a macrolide was associated with an increased hazard for clinically significant occurrence of ventricular arrhythmias and increased risk of in-hospital death with COVID-19.[1]

[1]       M. R. Mehra, S. S. Desai, F. Ruschitzka, and A. N. Patel, “Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis,” Lancet, vol. 0, no. 0, 2020. Link to study.

Can the Surgical N95 Respirator Mask Halt the SARS-CoV-2 Virus?

How does the surgical N95 respirator mask by 3M stop the SARS-CoV-2 virus from accessing the airway passages of the wearer?

Coronavirus virions are spherical with diameters of approximately 125 nm. Where an ‘nm’, indicates a nanometer which is a billionth of a meter.

The indicated mask is documented to have a filter efficiency level of at least 95% against particulate aerosols free of oil and was tested against a 0.3 micron (0.0000003 meter) particle (mass median aerodynamic diameter). Where a micron is one millionth of a meter.

Given above facts where the virion (0.000000125 meter) is 2.4 times smaller than the mask’s preventive ‘entry’ capacity of 0.0000003 meter, one may wonder is it not going to go through?

Answer: viruses do not fly through the air all by themselves, rather they are carried in the aerosol particles expelled from the infected with or carrier person of the virus. This originates from the coughing or sneezing process. And since aerosols seem to average at 1.25 microns (0.00000125 meter), which is larger than the 0.3 micron above, therefore the virus conveying aerosol should be stopped by the mask.

Notably here, the aerosols with its virions lodge in the outside of the mask and therefore the wearer should avoid touching the outward surface of the mask.

COVID-19: Should I wear a protective mask? Masks for general public?

Question (TK): Hi there, what are your thoughts on the general public buying masks online to wear when shopping or going outside? I know there is a shortage of masks in hospitals, but it seems like there’s a surplus online, so I assume hospitals aren’t buying the ones I am finding. An example:

Amazon Link

Answer (Dhia Aldoori): I think it is a good idea for all to wear masks in public at this time, particularly when you are going to be in a place which may force too close person proximity, and always if you are sick with the possibility  people may come near you (especially  important in a closed environment).

That said, let us (health professionals) have first dibs on the really useful kind, the NIOSH N95 version by 3M which I couldn’t find on Amazon.  

The ones in the link are apparently abundant and will help prevent aerosol projection from a cougher and sneezer, and prevent a person from unconsciously hand-face touching. It won’t protect against incoming viruses. The other kind does, and isn’t currently very available to many caregivers.

Running Notes COVID-19

COVID-19: Using Anti-inflammatory Medications

At this time I am of the opinion that avoidance of NSAIDs for flu like symptoms is the way to go [non steroidal anti-inflammatory drugs are like ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac (Voltaren), meloxicam (Mobic), etc.]. Of course, that is if you even feel inclined to band-aid your symptoms. Barring an allergy or medical condition where it is contraindicated, I would go with acetaminophen (Tylenol). Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists.
The theory behind this is that NSAIDs may hinder the natural inflammation cascade of events otherwise needed to fight against viral infections. That said, even acetaminophen, has an antipyretic action which I am not sure I want to impede during this process. I change my stance if there is excessive fever making the patient uncomfortable or symptomatic (e.g. delirious).
I am more a fan of rest, hydrate, good nutrition (beef barley soup rocks) and stay warm. After you do the preceding, hydrate some more. 🙂

COVID-19: Running Notes (quick link above or click on my picture above)

Clicking on the quick link above or the link below within this post will take you to the diagram.

See "Black Box Warning" update for 4/3/20.
My COVID-19 Running Notes @ Diagrams.net

Depending on feedback I will answer questions within the updated diagram. 

Nightshade Vegetable Allergies

In response to:
[Bess Rhoades has left a new comment on your post "Why I'm a Fan of Copper": 
Dr. A- I do not know how to enter a question on this blog, so this is the best I could do. Could you please address what you believe about nightshade vegetable allergies- and their possible role in inflammatory process and perhaps even arthrities in certain individuals. I thought this was far fetched until I began reading. This article in particular caught my interest: 
https://www.westonaprice.org/health-topics/food-features/nightshades/
Thank you] 
Looking at your reference.
Paragraph 1: Claiming sensitivity to these plants without delineating a causal pathophysiology is always concerning to me and makes the content lack credibility.
Paragraph 3: If you have as claimed a sensitivity to a certain food, I don’t think it would be harmful to avoid them for a month or two, and monitor the improvement or lack thereof. I doubt with pretty good logic and science that nightshade plants "cause" heartburn. They may exacerbate symptoms but don’t cause relaxation of the lower esophageal sphincter, as far as I know at this time. (One of these days I will write up the causes of alluded to relaxation).
Paragraph 5: Potatoes causing dropsy. Anytime a human relies on a high carbohydrate low protein diet in tandem with a  deficiency of other important nutrients, expect there to be body swelling.
I stopped reading after paragraph 6 as the author's arguments and evidence presentation were excessively weak and lacking in logic and definite pathophysiological cause, not to mention heavily infused with loose associations being put forth as evidence. Also the author, although listing references, didn’t associate them with the facts being quoted and therefore very difficult to verify his studies/articles/references.
Notes: Tomatoes have evidence of being anticancer.
In summary I would say that it's possible some people may have increased sensitivities to certain foods, but I would hesitate to say that 'nightshade' plants are dangerous as a group.
DA

Mucuna Pruriens in Anxiety/Depression

Question: AnonymousNovember 13, 2015 at 2:45 PM
What are your thoughts on the herbal supplement, mucuna pruriens, for anxiety/depression? 

Answer: I have personally not been aware of this herb, Mucuna pruriens, till your question. After a quick research I found the following:

The major phenolic constituent of M. pruriens beans was found to be L-dopa (5%), along with 5-indole compounds, two of which were identified as tryptamine and 5-hydroxytryptamine.

The thought is that L-dopa being a precursor of dopamine, thence the different pharmacological effects. (Anti-diabetic, anti-inflammatory, neuroprotective, and anti-oxidant properties). 

I would think that the benefit of this herb would be via 1- the increased production of adrenaline (from the precursor L-dopa), outside the brain, 2- the provision of a significant amount of precursors (tryptamine and 5-hydroxytryptamine), for serotonin peripherally and centrally, and 3- provision of L-dopa to the brain (as it crosses the blood brain barrier), which is a precursor for dopamine centrally. The increased production of adrenalin physiologically, in addition to increased production of serotonin and dopamine centrally should have a positive impact on depression.

In India, the seeds of M. pruriens have traditionally been used as a nervine tonic, and as an aphrodisiac for male virility.

It looks promising logically for anxiety but more so for depression, but I'm afraid I can't endorse its use at this time as I am not familiar with its dosing, its safety profile, purity of preparation, and studies where it has been used for anxiety or depression.

[Ref.- Lampariello LR, Cortelazzo A, Guerranti R, Sticozzi C, Valacchi G. The Magic Velvet Bean of Mucuna pruriens. Journal of Traditional and Complementary Medicine. 2012;2(4):331-339.]