very cheap and long-known drugs help save the lungs with coronavirus

Cloving hospital on the basis of the Medical Scientific and Educational Center (ISSC) Moscow State University named after M.V.Lomonosov took the first patients on April 21 and completed his work on June 13. It turned out that it was possible to achieve the best treatment results for COVID-19 in Moscow. Over the entire period, 4 patients died, and among severe patients who got mechanical ventilation, the mortality rate was less than 14% (for comparison, the average for the city and the world was up to 70 – 80%). Eighteen doctors out of 220 employees of the hospital were infected with coronavirus, there were no deaths among the medical staff.

What approaches were used at the University Hospital of Moscow State University to achieve such results? We continue the conversation with the head. Department of Therapy, Faculty of Fundamental Medicine, Moscow State University, Head of the Department of Age-Associated Diseases, Medical Scientific and Educational Center, Doctor of Medical Sciences, Cardiologist Yana Orlova.

MEDICINE FOR COUGH FOR 80 RUBLES

– Most of those who are ill or are afraid to get sick are worried about fibrotic changes in their lungs. They say that you have developed special therapy that can reduce the risk of developing fibrosis. Is it possible?!

– Yes, we launched an appropriate clinical study. There are no final results yet, but we have developed clinical practice.

“What did you do to save the lungs?”

– We used a combination of bromhexine and spironolactone (both are long-known very cheap drugs. – Ed.). Bromhexine is an expectorant that has been prescribed to patients with pneumonia and cough for many years. At the same time, experimental data showed that this drug can block a specific enzyme and impede the penetration of coronavirus into cells. True, it was on this effect that we counted to a lesser extent in inpatients, since such an effect is important mainly in the early stages of the disease. But the expectorant effect of bromhexine really helps patients with COVID. I heard that our colleagues in Peter launched a study of bromhexine for prophylactic purposes. We will wait for the results.

Coronavirus infected 18 doctors from 220 employees of the hospital, there were no deaths among the medical staffPhoto: Ivan MAKEEV

FIBROSIS OBSTACLE

– The second drug – spironolactone – is traditionally widely used in cardiology for the treatment of heart failure, severe hypertension. It has a small diuretic, magnesium and potassium-preserving effect, continues Yana. Orlova. – It has several mechanisms through which it can be useful in coronavirus infection.

Firstly, a mechanism that prevents the development of fibrosis in general in the body. There are works that, in particular, show that spironolactone reduces fibrosis in the heart. At the same time, it is known that the tendency to fibrosis is not local, but systemic – where there is more inflammation, there will certainly be fibrosis. And we see, of course, fibrotic changes in the “covide” in our patients. Therefore, we prescribed spironolactone as a drug for the prevention of this process.

Secondly, this drug blocks sex hormone receptors, in particular testosterone. Some published studies suggest that “high-testosterone” men suffer from “covid” more often and develop more severe fibrotic changes. Therefore, blocking these receptors for several weeks during COVID treatment may be useful in reducing the severity of complications. We are not talking about a longer intake, since male patients are unlikely to agree with a decrease in testosterone levels in the long term.

And perhaps the most important point. In almost all of our patients, we observed hypokalemia (a decrease in potassium levels. – Ed.). With coronavirus infection, potassium is intensely excreted from the body, and scientific articles even suggest that hypokalemia serves as the trigger for a cytokine storm. So spironolactone has a real chance to reduce the risk of this dangerous complication. But the main thing, in my opinion, is that lowering the level of potassium in the body is extremely harmful to the heart and triggers life-threatening rhythm disturbances, increasing the risk of sudden death. We, like all others, replenished potassium with droppers, but it was more effective to retain it in the body with the help of spironolactone.


Men certainly get worse than women;  the elderly are heavier than the young;  overweight people are heavier than patients without excess weight Photo: Ivan MAKEEV

Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patientsPhoto: Ivan MAKEEV

WHEN PRESCRIBED PATIENTS

– Yana Arturovna, how many patients did you have on average?

– About 10 – 14 days. But someone and 50 days.

– Have you noticed signs by which it can be assumed that the disease in the person brought is likely to go the hard way?

– Such studies were carried out in the world, our clinical practice confirmed them. Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patients. Men with a classic male type of baldness, a lot of facial hair, we can say brutal men get sick harder.

– Under what conditions did you discharge patients?

– We acted as close as possible to the recommendations Ministry of Health: so that the temperature for three days was not higher than 37.5 degrees; so that C-reactive protein (an indicator of inflammation) is lower than 10 mg / l, and saturation, that is, the level of oxygen in the blood, is higher than 96%.

“HEAD OF EPIDEMIOLOGY DEPARTMENT OF ITSELF WORKED AT SANPROPUSNIK”

– How often do you get sick doctors and nurses?

– In the first month no one got sick at all. We have a very powerful epidemiological service. The head of the sanitary-epidemiological department, a senior researcher, correctly organized the whole process, and for the first two weeks she personally worked in the sanitary inspection room at the exit from the “red zone” and helped doctors and nurses who were exhausted after the shift safely remove protective clothing.

Then both people’s fatigue and viral load accumulated. By the middle of the second month, sick people began to appear. There were no seriously ill patients. We treated part of the staff in our observation, part of it was treated at home. In total, 18 people were infected from the medical staff (less than 10%).

– Doctors take something for prevention? Vitamins C, D, Zinc?

– I saw the recommendations of American nutritionists, they speak out positively about taking zinc, melatonin and vitamin C. There were somewhat conflicting data on vitamin D. But we did not give any such recommendations to our employees. We have all the prevention was associated with minimizing contacts and other measures of epidemiological safety.

Physicians are the heroes of our time.“If you think that you are special and that a pandemic will not affect you, you are deeply mistaken,” listen to what the doctors who are fighting with coronavirus say

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Dr. Myasnikov told how dangerous moles look

The chief physician of the Zhadkevich hospital №71 and part-time TV presenter Alexander Myasnikov talked about a way to recognize dangerous moles until they turned into melanoma. According to the physician, for this there is a special system “A, B, C, D, E”.

A – symbolizes asymmetry. This implies that if you divide the mole visually into two parts, they will not be similar to each other.

In (from English – border) – means the border. In a healthy mole, they are clear, and in one that can be dangerous, they are blurry.

C (color) – color. As the doctor explained, a potentially malignant mole is usually colored unevenly.

D is the diameter. The size of normal moles is within six millimeters.

“E – means the evolution of a mole. If it does not grow, its borders and color do not change, then such a formation, as a rule, is not a doctor’s danger to the body, ”explained Dr. Myasnikov on the air of the Russia 1 channel.

Alexander Myasnikov specified that, most often, white-skinned, fair-eyed and fair-haired people usually suffer from malignant melanomas. In case of suspicion, you must always consult a doctor, do a biopsy and get rid of malignant neoplasms surgically.

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Dr. Myasnikov told how dangerous moles look

The chief physician of the Zhadkevich hospital №71 and part-time TV presenter Alexander Myasnikov talked about a way to recognize dangerous moles until they turned into melanoma. According to the physician, for this there is a special system “A, B, C, D, E”.

A – symbolizes asymmetry. This implies that if you divide the mole visually into two parts, they will not be similar to each other.

In (from English – border) – means the border. In a healthy mole, they are clear, and in one that can be dangerous, they are blurry.

C (color) – color. As the doctor explained, a potentially malignant mole is usually colored unevenly.

D is the diameter. The size of normal moles is within six millimeters.

“E – means the evolution of a mole. If it does not grow, its borders and color do not change, then such a formation, as a rule, is not a doctor’s danger to the body, ”explained Dr. Myasnikov on the air of the Russia 1 channel.

Alexander Myasnikov specified that, most often, white-skinned, fair-eyed and fair-haired people usually suffer from malignant melanomas. In case of suspicion, you must always consult a doctor, do a biopsy and get rid of malignant neoplasms surgically.

.

Dr. Myasnikov told how dangerous moles look

The chief physician of the Zhadkevich hospital №71 and part-time TV presenter Alexander Myasnikov talked about a way to recognize dangerous moles until they turned into melanoma. According to the physician, for this there is a special system “A, B, C, D, E”.

A – symbolizes asymmetry. This implies that if you divide the mole visually into two parts, they will not be similar to each other.

In (from English – border) – means the border. In a healthy mole, they are clear, and in one that can be dangerous, they are blurry.

C (color) – color. As the doctor explained, a potentially malignant mole is usually colored unevenly.

D is the diameter. The size of normal moles is within six millimeters.

“E – means the evolution of a mole. If it does not grow, its borders and color do not change, then such a formation, as a rule, is not a doctor’s danger to the body, ”explained Dr. Myasnikov on the air of the Russia 1 channel.

Alexander Myasnikov specified that, most often, white-skinned, fair-eyed and fair-haired people usually suffer from malignant melanomas. In case of suspicion, you must always consult a doctor, do a biopsy and get rid of malignant neoplasms surgically.

.

Dr. Myasnikov told how dangerous moles look

The chief physician of the Zhadkevich hospital №71 and part-time TV presenter Alexander Myasnikov talked about a way to recognize dangerous moles until they turned into melanoma. According to the physician, for this there is a special system “A, B, C, D, E”.

A – symbolizes asymmetry. This implies that if you divide the mole visually into two parts, they will not be similar to each other.

In (from English – border) – means the border. In a healthy mole, they are clear, and in one that can be dangerous, they are blurry.

C (color) – color. As the doctor explained, a potentially malignant mole is usually colored unevenly.

D is the diameter. The size of normal moles is within six millimeters.

“E – means the evolution of a mole. If it does not grow, its borders and color do not change, then such a formation, as a rule, is not a doctor’s danger to the body, ”explained Dr. Myasnikov on the air of the Russia 1 channel.

Alexander Myasnikov specified that, most often, white-skinned, fair-eyed and fair-haired people usually suffer from malignant melanomas. In case of suspicion, you must always consult a doctor, do a biopsy and get rid of malignant neoplasms surgically.

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Occupational medicine, a profession that feels unloved

The occupational physicians have they deserted in full ” war ” against the coronavirus ? This is what suggest the 158 deputies of the majority in a column published on 15th may by the Sunday newspaper. “Companies have found themselves alone and feeling helpless for several days, which, in a climate of anxiety, has contributed to penalize the maintenance of economic activity in certain sectors “, judge elected, reviving the discussion around a “major reform of the health at work “ expected in 2021.

→ TO READ. The reform of the medicine and the work revived by the crisis of the sars coronavirus

A critical harm experienced by the profession, on the contrary very active during the crisis, according to Thibaut Fleury, the director-general Efficiency health at work, an occupational health service, located in the Île-de-France. “In this period unprecedented, we are suited to assist companies on a daily basis : we have called our clients to offer them solutions adapted to their activity, organized webinars and tele-consultation, set up a toll-free number… “ lists there.

“A service that is costly to the leaders “

“This kind of attacks against the profession is chronic. Who wants to drown his dog accuses him of rage “, reacts to his side Jean-Michel Sterdyniak, the secretary-general of the national Union of health professionals at work. The doctors would they be at this point disliked ?

According to Marc Sanchez, secretary general of the Union of freelancers, they are often poorly perceived by business managers, particularly smaller ones. “This is a service that is costly to the leaders, between 80 and 110 € per year per employee, but they don’t see the benefits “summarizes-t-he severely.

A situation of numerical disadvantage

“The problem comes in large part from their situation digital “says Jorge Munoz, a lecturer in sociology of work at the university of western Brittany. In France, there are about 5,000 doctors work for more than 18 million employees.

Difficult, in this context, to ensure a close monitoring, especially as the expectations have changed. “Since the asbestos crisis, we ask them especially to manage the psychosocial risks, a mission is commendable, but to which they have very low “, says the sociologist. Especially as the doctor’s work has mainly an advisory role and does not have the right to prescribe (1).

A relationship of trust difficult to establish

On the side of the employees, the medical examination, which is mandatory, has often been a constraint. “Establish a relationship of trust is not easy when one is taxed to the employee “notes Roman Da Rocha, president of the national Association of internal medicine of the work.

“Drawn and quartered “ between a hierarchy to which he must report and accounts of the employees for whom it must ensure the well-being, the doctor of work is by nature “in an ethical position precarious “raises Roman Da Rocha. Because what is good for the health of the employee is not necessarily that of the company, and vice versa.

Of what to do with it “a business cannot “, according to dr. Jean-Louis Zylberberg, who shall exercise it yet since 1996, in the CONSTRUCTION industry. “We are in a balance of power social standing, relève-t-il. It is one of the reasons why students do not want to commit to it. “

The number of internal, if it is stable, is modest. “Today, the majority of recruitment takes place among doctors older that is to convert “reports Roman Da Rocha. In question, in particular, a lack of recognition. “This is part of the specialties traditionally considered” less noble “the tip Jorge Munoz.

The return of the thought hygienist ?

If this lack of attraction is not new, the evolution of management in the business confronts the doctors of the work of new difficulties. “We told the employees how to eat, sleep, relax. With the idea that if there is a problem, this is not because of the organization of the work, but because they did not follow our advice “laments Roman Da Rocha, who fears “a return of the thought of the hygienist, in order to optimize the performance of companies. ”

A drift which “it puts the responsibility on the shoulders of the physicians of the work, so that it is specific to the system “, writes Jorge Munoz, for whom the stakes of the reform is to first examine the meaning of prevention, in the heart of the mission of these doctors is not quite like the other.

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A role exclusively preventive

Occupational medicine was born with the law of 11 October 1946, that requires employers
to arrange medical surveillance for their employees.

Placed under the control of the ministry of labour, this specialty exclusively preventive for the preservation of the health of workers.

Since 2002, we no longer speak officially of occupational medicine, but health in the workplace. The medical doctors may practice in occupational health services-employer, common to several societies ; or in self-help services for large enterprises.

Since 2011, the follow-up of employees is based on a multidisciplinary team, involving doctors nurses and stakeholders in prevention of occupational risks.

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Coronavirus: the Who, up to dexamethasone for mild symptoms Covid – Medicine

(ANSA) – ROME, JUNE 23 – The corticosteroid drug
dexamethasone “should not be taken to prevent Covid-19 or
to deal with the mild symptoms”. To be mentioned is the Organization
The world Health organization (Who) in a section of the portal dedicated
Questions and Answers on the new coronavirus.

To the question “should I take dexamethasone to prevent
Covid-19 or treat my mild symptoms of the disease?”, the Who
replies to a recent study conducted in the United Kingdom “has
showed very promising results only for patients who
were seriously ill and in critical condition”, reducing the
mortality for patients undergoing ventilation of a third and
a fifth of the patients who are in need of support
oxygen. The same study, however, “found no
the benefit in patients with mild illness, i.e. those that
do not require the support of oxygen”. Dexamethasone,
in fact, says the Who, was used from the ’60s to
reduce inflammation in a number of conditions, including
inflammatory disorders and certain cancers in combination with other
drugs. This powerful anti-inflammatory medication but suppresses
“the immune system and may increase the risk of other
infections”.

The Who, he concludes, “is waiting for full report before
to make a change to the recommendations, but the doctors
may consider the use of dexamethasone for the
patients with serious illness and critical, as has been done in the
I study English”. (ANSA).

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