Hi, Sam,
Can you put this in our Blog as this is the best Video on the Virus – only Physicians will be able to comprehend this.
Faizal Zavahir
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News, Views and More from Batch'64, Faculty of Medicine, Colombo, SriLanka
"Best and the Brightest from 1964"
News, Views and More from Batch'64, Faculty of Medicine, Colombo, SriLanka 
Thanks Faizal, I saw the whole complete vidio. Very good pathophysiological presentation.
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Dear Faizal,
Thanks for posting this.
Very talented lecturer – explained very well. I am going to listen again.
Recently – 3 weeks ago, in Rockhampton (Queensland) I saw a similar CT scan – “Crazy paving pattern” with air bronchogram, but at that time it didn’t click my mind about Covid 19 as one of the D.D. I reported it as Broncho-pneumonia.
Now that I have seen the examples of Xray, CT & US shown in this video as well as in other Radiology articles gives me some confidence.
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Thanks Faizal& Sam for the posts.The ” Ninja” doc is super in explaining the management of SARS-CoV-2 induced ARDS syndrome.This chap is a born teacher and should be applauded.Although, many of us have stopped treating patients, it is invigorating to listen to a man who seems to know what he is talking about.There are a few studies due to commence soon on treatment strategies, one of which he did not mention is the combination of Remdesivir plus interferon beta.As regards early treatment, the Chinese have tried the combination of hydroxy chloroquine with Azithromycin with some benefit.I was alerted to a very small study from France which showed that early treatment with Hydroxy chloroquine plus Azithromycin showed clearing of the virus in 3/4 days.On this basis, I think a trial of these two drugs( which we have experience with), being aware of the problem of Torsades des pointes secondary to QTc prolongation in some patients on Azithromycin,is not unreasonable, in this condition,especially in patients with co morbidities and old age.If one waits for the onset of ARDS to treat it will be too late.Although, markers like procalcitonin, d dimer and HS troponin are useful and indicate a poor prognosis, I think an early treatment strategy with 2 known drugs in order to try and eliminate the virus ASAP will be good, Additional antivirals and IL6 inhibitors will be essential later.Interesting times ahead.! Eddie.
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Dear Faizal,Sam,Indragee,Seelan and Eddie
Very detailed accounts are shown to understand all what we should know.Not sure whether there are different medications prescribed in U.K.
Amongst the medications mentioned in the 2nd Video in the treatment section in U.S.A Chloroquine is the one to stop the alveolar damage.That appears to be the only Medication we seem to have prescribed and were familiar with.My thinking was :
The moment the tests confirmed Covid 19-Corona Virus Infection if for the 14 days Chloroquine is given with Quarantine lot of unwanted expenses could be avoided..All the others are new and we are coming to know of them only now.
But it is really worrying when you find the Warnings,Interactions and Side Effects with Chloroquine. With the new drugs it would be real nightmare as they are all completely new.
I know Seelan is still practising.Has any one from U.K joined the volunteers ? They are inviting Retired Doctors country wise from Wales,Scotland,Nothern Ireland and England for Temporary Registration with GMC to work for NHS.
Isolation and preventive measures appear to be the best we can do.
Sreetharan.
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Thanks Feizel for posting the video. This young guy ia an amazing teacher , explains the Patho- physiology and treatment so very well.
Covid-19 is a wake up call for the entire world. This is what happens in Bio -terrorism. Many countries are involved in creating biological weapons. I sincerely hope all these countries will abandon their biological weapons programs.They should concentrate on avenues to save the world from, global warming, cleaning our oceans and waterways, protecting the fauna and flora for the sake of our grand children , and future generations.
Nisantha
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Thanks to all of you for posting your perspectives on treatment aspects. Did any of you consider using Quercetin? I started taking this as a preventative agent. This is a supplement that has the ability to prevent the binding of the virus to ACE 2 receptors. If you are on ACE inhibitors for BP control, remember ACE inhibitors can upregulate the cellular receptors making the cells to produce more receptors. So, Quercetin (which is a natural anti-aging product) can be helpful as a preventive agent. Click below for more details I found in a blog from Chris Centano MD, the founder of Regenerex, who is well versed with cellular microbiology https://regenexx.com/blog/coronavirus-episode-9-can-quercetin-help-covid-19/
Sam
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Thanks Sam for reminding us about the issues of the ACE2 receptor in the entry of the virus into the cell.It has been known that ACEI upregulate the ACE receptors.ARBs of course block the receptor.It is also likely that most elderly who died to date would have been on these drugs for Cardiac conditions, hypertension and diabetes.Is this the reason for the high mortality in these patients.? If the detailed statistics do show this correlation then it would be reasonable to discontinue these drugs in the elderly at the first sign of the disease during this epidemic.It will of course will require careful monitoring of BP and of heart failure but it should not affect the diabetics in the short term.Based on the effects ACEI vs ARBs,did those on ARBs fare any better ? We do not know.??? I do not know anything about Quercetin to make a useful comment.! Eddie.
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Eddie,
Quercetin is a pigment derived from plants that are in the bioflavonoid category. It is found in common foods that we consume such as onions, berries red wine green tea apples, etc. It is a good antioxidant.
Check below this recent study from LSU, suggesting that the older population who are on ACE inhibitors may be one of the reasons for their higher morbidity from Corvid-19. Conversely, children are almost completely protected perhaps due to the fact that they have cross-protective antibodies from frequent URI due to alphacoronaviruses and also having fewer ARB’s in their alveoli. Should we discontinue our ACE inhibitors and ARB’s and switch to an alternative drug during the pandemic? Good question. I am taking Quercetin for now.
https://www.sciencedaily.com/releases/2020/03/200323101354.htm
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Thanks Sam.It maybe of interest for our readers to know the price of Quercertin and dosage that you are taking now.! I am still following the old advice of “an apple a day keeps the doctor away”, but I have a preference for Royal Gala, not the green apples.!!
About children, it is interesting, for if they have frequent “snotty noses” then the better they are in not catching the virus.The mystery will soon be solved as the experts all over the world are working on it.Interestingly they have tried “convalescent serum” too.This virus is going to be around forever as more and more people get infected and develop “herd immunity”.Next year, we will all be taking our annual Corona virus vaccine?.Yes, this virus seems to be mutating fast and therefore we will have a different vaccine every year,(due to the mutating nature of this virus) much like what happens to our annual influenza vaccine composition.Keep communicating and keep the self isolation productive and interesting. Eddie
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Eddie,
Quercetin comes in pure form or in combination with other supplements. I use the former, 500mg tablets once a day. It can be taken up to 1000mg or more daily. 500mg bottle of 60 cost me around $17.00 from Amazon. I am going to discuss all this with my Family doctor tomorrow. Will see what he recommends.
Anyone interested in this, if you are on BP meds, please discuss it with your doctor.
I agree with all your comments. Convalescent serum was just approved here and hopefully be used in NY very soon. We are on self-isolation in Florida more or less on a voluntary basis except for essential outings such as golf!!
Stay well
Sam
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Eddie
There are some readers of Dr. Centana’s blog who take Quercetin every time they take the annual Flu vaccine and report that they never contracted flu even in a mild form, that occurs at times.
Sam
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Thanks Sam.But, is it the annual flu vaccine or the Quercertin that is benefitting that group of people.? Eddie.
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Eddie
One never knows. These are anecdotal reports. Combined with information on Quercetin it sounds reasonable. We have no time to wait for multicenter double-blind scientific studies we are so used to. The virus is here!
Sam
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Thanks Sam. I agree.Today , I want to refer to an article that appears in the NEJM of 31.3.2020, in which the pros and cons of ACEI therapy in Acute Covid 19 infections is discussed..In a well argued conclusion,they indicate that ACEI should NOT be stopped in the accutely ill patient with Covid 19 infection..Stopping the drug acutely will theoretically cause more harm, by propagating lung fibrosis etc..Interestingly, only 20-30% of patients in Wuhan were on medications for hypertension. and even in this group only about 20-30 % were on an ACEI.Hence the large number of deaths was an unlikely match with ACEI treatment!!.I hope this makes the previous assumptions not valid at this point in time. Eddie.
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Eddie,
Thank you for forwarding the NEJM article. I agree with their advice regarding the discontinuation of ACE blockers. I did send the links to my PCP as well. I am sure he is very busy with lot of Telemedicine appointments these days.
Sam
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Thank you to every one, and specially to Zava who had Sam post this . Zava, we talked about this article, the other day, – when I was listening to your songs, while cooking, while on Home Isolation – having returned from AZ a week ago .
I checked with my Internet Service Provider- and I have enough data quota to listen to both episodes .
I hope my brain can comprehend all that you guys are talking about ! and seems very interesting –
I am sure this is like being back again at the Phys Lect Theatre , listening to Bull Seneviratne /
/ DNW Lionel / O. A Peiris
In the middle of all this ” Keep The Distance”- ” Go Home- Stay Home ‘ orders from our PM , I have been summoned for Jury Duty — on Apr 28th – will call and get it cancelled . Gotta be crazy to call in anyone over 70 for Jury Duty Gathering, when only 10 people are allowed in one given space at any given time and that too at 6 ft apart !
Only goes to show, how crazy this world is .
Take care all of you – eagemd
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Just viewed the entire presentation , and amazing that I was even able to follow it , even though I have been ‘off work ‘ for over 18 yrs ! Very well presented . I even took down notes, and photographed some of the presentation, so I can get a better recall call as I view my photos . I must learn , or get my IT son, to help me to ‘download ‘ this so I can watch this again at my leisure .
Who is this young guy ? A Brilliant teacher he is- like Bull Seneviratne, DNW Lionel and O.A. Peiris , all rolled into one . . . by the way, he reminded me of a youthful Siri Kannangara !
Thank you Faizal and Sam for the post and Eddie and Sam for the discussion on the treatment . I will just keep taking my Apple A Day, and eat berries and other Antioxidant vegts.
And of course- Hand Washing +++ and would not touch any one, even with the end of a barge pole !, for the next twelve full moons . Good thing I live alone , so Home Isolation is nothing new to me .
I always have my trees, rocks, birds, snakes rabbits, deer , coyotes, coywolves to keep me company .
I did not see seen any evidence of Deer Damage to the garden, during my time away from home for the winter . Perhaps, they too got The Corona !
Keep well my dear Class of 64 – eaglemd
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Zach Murphy has a degree in Science & Biology, now a Physicians Assistant, who created a very popular Ninja Nerd medicine u-Tube series. He appears to be a good instructor.
https://www.pcom.edu/admissions/student-stories/zachary-murphy.html
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Thanks Sam for the info on Ninja Medicine link by Zach Murphy .
Eddie and Sam , I too read with interest , the March 30 -2020 – NEJM article last night , and noted the observations made in Wuhan- on ACE Inhibitors – Hypertension etc .
Good to know, that we are still keeping our Medicine Neurons Alive and Well !
eaglemd
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