COVID-19 Precautions Recommended by Dr Nishtha Singh Saans doctor in Jaipur - PowerPoint PPT Presentation

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COVID-19 Precautions Recommended by Dr Nishtha Singh Saans doctor in Jaipur

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Title: COVID-19 Precautions Recommended by Dr Nishtha Singh Saans doctor in Jaipur


1
The New Work TimeCYTOKINE STORMThe Coronavirus
patients Betrayed by their own Immune systemsA
cytokine storm becomes an all-too-frequent
phenomenon , particularly among the young. But
treatments are being tested.
  • The immune system keeps raging after the virus is
    no longer a threat 15 of all severely ill
    COVID-19 patients younger patients more often- -
    Diagnosed by elevated Interleukin -6, interferon
    gamma, TNF alpha Elevated Ferritin levels may be
    the most simple and specific test Tocilzumab ,
    Sarilumab in severe cases
  • HCQS in milder cases

2
Tocilizumab / Actemra (Roche)
  • An IL-6 receptor antagonist
  • FDA approved treatment in
  • Severe , active ,RA
  • CAR T cell induced cytokine release storm - -
  • IL-6 drives overactive inflammatory response in
    lungs of severely ill COVID-19 patients

3
Chloroquine / HCQS
  • CHLOROQUINE a widely used anti-malarial
  • HYDROXYCHLOROQUINE less toxic analogue
  • Both have immunomodulatory effects
  • Old drugs in use over gt 50 years
  • Safe drugs In WHO list of safe and essential
    medicines.
  • Widely used gt 5 million prescriptions / year in
    U.S alone (2018)

4
Safety
  • Whilst majority of patients require no special
    caution - -
  • Dangerous hemolysis in patients with G6PD
    deficiency
  • Gastric side effects
  • Caution in diabetics
  • Significant drug interactions
  • Risk of cardiac arrhythmias (by QTc prolongation)

5
Anecdotal evidence for HCQS
  • Doctors in Wuhan observed patients with SLE on
    HCQS did not seem to develop COVID-19
  • None of wuhan hospitals dermatology departments
    80 lupus patients were infected
  • They hypothesized that this may be due to
    long-term use of HCQS
  • Anecdotal case reports of its use in the previous
    SARS outbreak in 2002-2003

6
Virology Journal
  • Chloroquine is a potent inhibitor of SARS
    coronavirus infected and spread
  • martin J Vincent1, Eric Bergero,n2, Suzanne
    Benjannet2, Bobbie R Erickson1,
  • Pierre E Rollin1, Thomas G Ksiazek1, Nabil G
    Seidah2 and Stuart T Nichol
  • 1.Chloroquine is effective in preventing the
    spread of SARS Co V in cell culture.
  • 2.Favourable inhibition of virus spread observed
    when cells were treated with chloroquine either
    prior to or after SARS Co V infection.

7
Cellular evidence for HCQS
  • I) pH related
  • An acidic pH at the surface of the host cell
    facilitates coronavirus entry
  • HCQS alters pH at cell membrane surface thus
    inhibiting fusion of virus to cell membrane ie
    inhibiting endocytosis
  • II) Other antiviral mechanisms
  • Inhibits nucleic acid replication
  • Glycosylation of viral proteins
  • Inhibits virus assembly, virus particle
    transport, virus release
  • III) Other receptor mechanisms
  • May involve ACE2 cellular receptor inhibition

8
Clinical Infectious Diseases
  • In vitro Antiviral Activity and Projection of
    Optimized Dosing Design of Hydroxychloroquine for
    the Treatment of severe Acute Respiratory
    Syndrome Coronavirus 2 (SARS CoV-2)
  • xueting Yao, Fei Ye ,Miao Zhang, Cheng Cui,
    Baoying Huang, Peihua Niu, Xu Liu, Li Zhao, Erdan
    Dong,
  • Chunli Song Show more
  • Author Notes
  • PK study which showed
  • 1) HCQS more effective than Chloroquine in
    inhibitory effect on COVID-19
  • 2) Reaches high lung concentration
  • 3) Optimal dose 400mg bid on Day 1, than
    200mg Day 2 - 5

9
Results after 5 days of HCQS
  • Overall faster TTCR
  • Faster improvement in cough
  • Faster improvement in temperature
  • Faster imp
  • None progressed to severe disease (4 in the non-
    HCQS group)

Our results confirm the short- term efficacy of
HCQS in the treatment of COVID-19 pneumonia
10
Group de veille coronavirus GVC
  • ACTUALITES ARTICLES SCIENTIFIQUES Int J
    of Antimicrobial Agents 2020
  • Clinical and microbiological effect of a
    combination of hydroxychloroquine and
    azithromycin in 80
  • COVID-19 patients with at least a six-day follow
    up
  • an observational study
  • 28 mars 2020
  • Source Mediterranee Infection
  • Auteur Philippe Gautret and AI.
  • Corresponding author Didier Raoult
  • 80 hospitalized COVID-19 patients
  • Rx with HCQS 200 mg TDS for 10 days
  • Azithromycin for 5 days

11
Results too good to be true?
  • Clinical improvement in all but 2 of the 80
    patients
  • Rapid decline in nasopharyngeal viral PCR load by
    Day 8 93
  • Viral cultures from resp samples negative by Day
    5 97
  • Allowed rapid discharge from contagious wards
    after mean stay of 5 Days

12
Reply to Gautret et al. 2020 A Bayesian
reanalysis of the effects ofhydroxychloroquine
and azithromycin on viral carriage in patients
with COVID-19
  • Oliver J Hulme. Eric Jan Wagenmakers.
    Per Damkier. Christoffer Fugl Madelung. Hartwig
    Roman Siebner.
  • Jannik Helweg Larsen. Quentin Gronau. Thomas
    Lars Benfield.
  • Kristoffer H Madsen

13
Criticism
  • Small size
  • No control limb
  • Physicians not blinded
  • Milder cases only
  • Selection bias could have skewed data
  • 6 patients dropped out their data excluded from
    analysis- -
  • PCR tests not consistently performed
  • Conflicts of interest
  • Promoted on YouTube, Fox News by
    author/colleagues before
  • review

A deeply flawed study The article does not
meet the societys expected standard Int J
Antimicrob Agents
14
  • This is insane! Many scientists lament
    Trumps
  • embrace of risky malaria drugs for coronavirus
  • Lets put our work into running score proper
    trials, and see if this effect holds up in well-
  • Conducted studies, Dahly says

15
To those who say we need 30 multi center
studies and 1000 patients I say when you have a
Rix that works against zero others, this should
become a benchmark. It is unethical not to
administer it. Its that simple
The evidence is anecdotal. The president is
talking abut hope .My job, as a scientist, is to
prove, without a doubt, that a drug is not only
safe by that it actually works.
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