Napping can be used to recharge energy, however, a study warns that it should last less than an hour, well the longest are associated with a 34% greater likelihood of cardiovascular disease compared to those who do not practice this habit.
The study presented at the annual meeting of the European Society of Cardiology also suggests that short naps (especially those of less than 30 to 45 minutes) “could improve heart health in people who don’t get enough sleep at night”.
One of the authors of the text Zhe Pan, from Guangzhou Medical University (China) points out that this study “challenges widely held views” such as that napping improves performance and counteracts the negative consequences of nighttime ‘sleep debt’.
How would they affect health?
The reasons why napping would negatively affect the body “are still uncertain”, according to Pan, but some studies suggest that when they are long they are related to higher levels of inflammation, posing a risk to heart health and longevity.
Other research has linked naps with hypertension, the diabetes and poor physical health in general, indicates in a statement the European Society of Cardiology.
The study, which not only takes into account the duration of the nap but also the amount of nighttime sleep, analyzed data from 313,651 participants in other investigations, of which 39% took naps.
The analysis determined that naps longer than 60 minutes “were associated with a 30% higher risk of death from all causes and a 34% more likely to have cardiovascular disease compared to not taking a nap, “the statement highlights.
Naps of less than half an hour, according to the expert, are not a risk factor for developing cardiovascular diseases.
Pan stressed that if you want to take a nap the study “It indicates that the safest thing is to keep it below an hour”While for those “who are not in the habit of a daytime dream, there is no convincing evidence to begin with” to do so.
Although preventive isolation has managed to flatten the curve of coronavirus infections, many people minimized other symptoms and stayed at home instead of going to see a specialist with advanced stages and complications associated with their basic symptoms. Cardiologists have asked the population not to pay full attention to the pandemic due to the risk of not noticing other problems of Health.
Many pre-existing pathologies ran their course without being controlled. This is due to a mix of situations; cancellation of medical controls and reuse of spaces and personnel to deal with cases of covid-19; If we add to this the restricted emergency care in clinics and sanatoriums as well as in clinical analysis laboratories in the initial phase of quarantine plus the high compliance of the adult population, we can understand the decrease in the controls of hypertension, laboratory checks and other follow-ups of other pathologies.
We must emphasize that we are currently working with scheduled shifts so as not to leave patients unprotected. The health sector counted on the rapid implementation of telephone consultations, telemedicine and electronic prescriptions to meet the demands of the largest number of patients.
According to WHO data, more than half (53%) of the countries have partially or totally discontinued hypertension treatment services. Something similar occurs in the case of diabetes (49%), Cancer (42%) and cardiovascular emergencies (31%).
Along with a greater sedentary lifestyle, many of these pathologies are associated with being overweight and obesity, which can also be potentiated in a pandemic. Remember that there are diseases related to overweight and obesity such as hypertension, type 2 diabetes, cardiovascular diseases, dyslipidaemia, some types of cancer, joint problems, apneas, non-alcoholic fatty liver (NAFLD), gynecological and fertility problems, low self esteem and depression.
These are some of the problems that will begin to emerge or grow as a side effect of the pandemic.
The scenario is complex, in September 2019 the Second National Nutrition Survey yielded alarming figures, 68% of the Argentine population, over 18 years of age, were overweight. According to specialists, malnutrition in all its forms is the main cause of global health problems. Excess weight leads to overweight and this can continue on its way to obesity, although this is of multifactorial origin, one of the main causes of obesity would be an inadequate nutritional level, prioritizing foods high in fat, sugar -including sugary drinks and insufficient physical activity. These unhealthy habits are often associated with eating disorders such as snacking or binge eating due to negative emotions (anxiety, anguish, fear and uncertainty) that have taken center stage during this long confinement.
According to the survey of the Argentine Nutrition Society (SAN), during the quarantine 56% of the population gained weight. Almost 80% gained between one and three kilos.
Currently, patients who were in treatment for overweight or obesity are returning to face-to-face or virtual consultations, and so are people who before the pandemic had no weight problems.
In obese people there is a chronic inflammatory condition that is greater as the degree of excess weight increases since their immune response is not properly regulated, making them at risk population since these patients lose the ability to respond effectively to block infection of the virus. Through a good diet and healthy habits, the immune system is strengthened, especially at times when defenses need to be as high as possible.
Pathologies on the rise
He stress It is a physiological response to a situation of adversity and when it occurs it triggers chemical changes in our body that affect our immune, endocrine and neurological systems.
He stress generated by the pandemic is one of the main causes of the increase in hair loss.
Excessive hand washing along with the frequent application of alcohol spray or gel generated an increase in dermatitis contact in the general population.
Changes in habits during confinement generate conditions that are altering the health of the population, in the world they already speak of an epidemic of myopia in the medium term, especially in children and adolescents, due to the greater use of screens and less exposure to natural light due to confinement. High levels of anxiety are disturbing the sleep of children and adults, generating more bruxism (excessive clenching or grinding of teeth).
Less mobility works against the health of bones and muscles, favoring the bone decalcification and loss of muscle mass generating greater risk of falls in the future, especially in older adults.
As the cases of Covid-19 begin to decrease, a series of pathologies that were brewing during this time will begin to emerge, which is why today more than ever we must maintain the usual medical controls and go to the specialist before it is too late.
Clinical Physician with a diploma in obesity, dermatologist and member of the Bionut Obesity Team. (MN 103495).
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
– 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 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
“They used a cure for gout against COVID”: How patients were treated in a hospital that showed the best results in Moscow
The results of treatment at the university clinic of Moscow State University were the best in the capital. “Komsomolskaya Pravda” learned the details of how doctors and scientists saved severe patients [Часть 1]
Virologist told whether it is possible to disinfect masks from coronavirus in sunlight
And also why the epidemic is gaining strength in southern countries and whether the sun affects the incidence – all this in an interview with George Vikulova (details)
– Has long been known that overweight people have lowered immunity, says head of the Department of endocrinology of the medical faculty Russian national research medical University. N. And. Pirogov Tatiana Demidova. Research and practice show that in these patients increases the risk of atherosclerosis sharply increases the risk of heart attacks, strokes and heart failure. Increased risk of endocrinological, oncological diseases, joint diseases, psychological disorders.
Epidemic COVID has added another item to the list of high threats to people who are overweight. It turned out that when infected with coronavirus patients with obesity more often require hospitalization, fall into the ICU, on the ventilator (artificial lung ventilation). Alas, is growing and the risk of death.
– If the original messages from China on the most severe cases COVID it was mainly about the older people with severe chronic diseases, according to the latest data from Europe and USA the risk group includes people with obesity – says Tatiana Demidova.
FACTS AND FIGURES
In what diseases most often develop complications due to coronavirus
90% of patients admitted with severe COVID-19 US hospitals, were the following comorbidities:
– hypertension — 49.7%,and
– obesity or 48.3%,
– chronic lung disease — 34,6%,
– diabetes type 2 diabetes was 28.3%,
– cardiovascular disease — 27,8%.
Thus, obesity is second among the States in which CouId be severe.
CORONAVIRUS, INFLUENZA, AND HIV, “LIKE” ADIPOSE TISSUE
Visceral adipose tissue, that is, one that is in the abdomen, is, in fact, highly individual body, experts explain. This body affects the immune, endocrine system and metabolism in the body as a whole.
– People who are overweight fat cells are much larger. So, is synthesized in much more of various hormones and inflammatory cells. Among them, including interleukin-6, interleukin-1, tumor necrosis factor, and others, – says Tatiana Demidova. Often in the body, there is a creeping inflammation.
At the same time observed that many viral infections and especially COVID-19 amplify the effects cytokines and lead to the extension of the generalization of inflammation. “It was proved that adipose tissue serves as a reservoir for some viruses, such as influenza, HIV and cytomegalovirus. Also, according to the latest data, it can be activated and coronavirus,” adds Demidov.
INSULATION NEEDS TO BE LONGER?
Studies have shown one more feature of coronavirus. As it turned out, he is able to spread rapidly in adipose tissue surrounding internal organs – lungs, liver, kidneys, heart, etc. because Of this, developing severe damage to these vital organs and people with excess weight, excess amount of adipose tissue increases the risk of death from multiple organ failure.
There is evidence that such patients are also unable to stay longer carriers of the virus, require longer hospital stay and isolation, said Tatyana Demidova.
AFTER INFECTION — DIABETES
There is evidence and that not less than one-third of patients hospitalized with COVID-19 in China, European countries and the United States, the infection resulted in damage of the pancreas. This was confirmed by elevated enzymes amylase and lipase, and glucose levels in the blood plasma.
– This is a very disturbing circumstance. Since we talking about high risk of developing diabetes type 2 diabetes in people with the original obesity after recovery from infection, says Dr. Demidov.
It is not excluded that after the break the pace of the epidemic COVID, we will see a worldwide surge in the incidence of diabetes, experts say.
So now, when the opportunity walks, sports, seasonal ripe fruits and vegetables rich in fiber, doctors suggest the obese individuals to exert their maximum effort for getting rid of really dangerous extra pounds.
By the WAY
Experts do not exclude that people who are seriously ill with mers may become disabled for life
The disease leaves a dangerous reminder – blood clots (details)
Patients COVID-19 seems to destroy not only coronavirus, but the micro-plastic particles
American scientists believe the Earth has no more places, not infected with the smallest stuff (details)
The most fragile, and the most likely to join a resuscitation service for a respiratory problem linked to a Covid infection, are the elderly, even more if they are hypertensive. 40% of people over 65 are actually hypertensive , warns Professor Jean-Jacques Mourad, head of the internal medicine service at Saint-Joseph Hospital in Paris.
To treat hypertension in normal times, several families of drugs are used, including “enzyme converting inhibitors” (ACE inhibitors) or “sartans”. These widely prescribed drugs work at different levels of a kidney-driven system.
The latter must therefore be fully operational and not be overly stressed elsewhere, such as during a fever, a heat wave episode, pneumonia and resuscitation in particular. Regardless of Covid infection. In these situations, ACE inhibitors or sartans in particular can be temporarily stopped, as a precaution , reminds Professor Mourad.
It turns out that Covid binds to a converting enzyme (similar to that inhibited by ACE inhibitors) to infect cells. A first hypothesis has circulated that ACE inhibitors or sartans would facilitate the acquisition of the disease or worsen it.
A hypothesis today weakened by several studies which deny this risk. One of them even evokes a relative protection conferred by these molecules. These results remain to be confirmed before any interpretation or recommendations. In the meantime, the usual advice given on a case-by-case basis by a doctor prevails.
Medicine has long relied on statistics for its predictions. Doctors have long communicated with their patients and families calculating the healing percentage once the disease and its speed of development have been diagnosed. One no longer suffers from an evil, with all the negative charge that clinical semantics entails, but the mathematics favorable to healing is valued.
Communication has always been difficult between medical knowledge and fear of the patient. Among the latter there are those who blindly follow the decisions of their trusted doctor, there are also those who do not want to know anything, but there are many others who try to understand their state or that of their loved ones. This last segment is on the rise as corroborated by the fact that some very successful television series have clinical debates in hospitals as a narrative element of interest, from ‘Emergencies’ to’ House ‘,’ The Good Doctor ‘,’ Grey’s Anatomy ‘or’ The Knick ‘, to name just a few of the most relevant fictions.
However, statistics applied to medicine had not had such a central role as in the current coronavirus epidemic. Between the curve and the peak, mathematicians and government spokesmen go out every day to count cases and deaths, including acceleration or braking rhythms in the evolution lines of the epidemic, with more and more abundant detailed calculations and infographics by country, autonomy, age range and gender, etc.
Four weeks after the alarm decree and absorbed by statistics, there is already evidence that, with the current chaos in counting methodology from the data provided, nothing can be predicted; not even carry out a minimal approximation to the course of events. Get used to the idea, because I walk from the 200,000 infections As announced by the Spanish health authorities, some international computer centers – from Imperial College to the University of Oxford – speak of millions of infected people in Spain, around 7 according to their average calculations, being optimistic.
As any seasoned person can verify, it has been a long time since the measurement of infections and deaths is very different from one place to another, the accounting method has even been modified depending on the control or lack of control of the epidemic. And in countries where healthcare has been federalized, such as the United States or our own country, it is even more complex to get a good idea of what is actually happening in numerical terms with the virus. Furthermore, China is under suspicion that they have not provided as much information as possible about its original outbreak, trying to avoid penalizing its prestige as a nation. So the data, let alone the data comparisons, are chaotic right now. In this context, it is possible that only the figures on people admitted to hospital intensive care units are relatively reliable to know the evolution of the epidemic.
Western Health offside
That is one of the debates that arose around the pandemic. The other is the lack of foresight by political and health authorities about. The countries of the Far East, the so-called Pacific dragons, have understood it at first because they had the experience of the previous SARS and the fact that China is often the origin of a good part of the known coronaviruses, which include some pathogens that cause the usual winter constipates and have their reservoir in wild animals, especially in bats.
In countries where healthcare has been federalized, such as the United States or our country, it is even more complex to get a good idea of what is happening
The hypotheses about the supposed success of Asian countries They are diverse in their fight against the coronavirus, invoking both the disciplined spirit of the collectivity derived from the philosophical teachings of Confucius and the authoritarian character of the Chinese Communist Party. Perhaps the Orientals, as selfish as the Westerners, believe more in the group as a protective agent against individualism than the freethinking autonomy of the West has fostered in our advanced societies.
But it will also have to be taken into account that ChinaAs we have commented, it is a permanent and original source of viruses that are transmitted from animals to humans, among other reasons for the exotic culinary customs of some of their territories, where they continue to practice the dangerous consumption of wild animals without sanitary controls. In this sense, it is worth recalling the advances in food hygiene that have occurred in recent decades in the West, with measures such as controls on food handling or product ban like the blood of animals, certain viscera or unpasteurized milk.
What is clear is that Western Health has had no insight regarding the Covid-19. Despite the fact that most of the best international medical journals very soon released access to new articles on the coronavirus, many from Chinese scientists themselves who warned about its distinctive characteristics, for too long there was no field study —In Wuham— from Western or WHO scientists. For weeks, Western health authorities – and not only Spanish – compared Covid-19 to a simple flu, scorning its fatality rates – which we now know that were weighted inappropriately—, thinking that it was too far away and that, in any case, it would be relatively easy to isolate and mitigate it, as happened with influenza A, SARS or even Ebola.
But two factors completely collapsed the forecasts: around 80% of those infected were asymptomatic but, at the same time, they transmitted the virus, and in a world more globalized than ever and with a capacity for interconnection with China that has multiplied in the last years. Not all of the medical community reacted this dismissively. In Italy, just know each other the first infections that caused the confinement of Codogno and other small towns near Milan in Lombardy, a prestigious Italian virologist with medical practices in the USA compared the Covid-19 with the Spanish flu of 1918, the pandemic that killed 50 million people. Most of his colleagues refuted his omens and called him apocalyptic and seeking prominence in the media. In our country, there have also been medical scientists who have mocked the forecasts of the National Center for Health Alerts and Emergencies, whose spokesperson is the well-known and criticized Fernando Simón, the jersey doctor. Some of these criticisms, however, have been ideologically interested since they come from people closely linked to the political opposition, and even to Catalan nationalism.
The truth is that Simón and the advisers in the first moments of the Ministry of Health they had no plan B. They trusted the prestige of the National Health Service – now scattered by the autonomies and with little coordination capacity, as has been verified. They did not even notice that the Spanish pharmacies had been totally depleted of disinfectant masks and gels throughout the month of February and that even hoarding phenomena occurred. Almost at the same time, another prestigious doctor, a Spaniard at the head of the Institute of Emerging Pathogens at the Monte Sinai Hospital in New York, Adolfo García-Sastre, warned of the dangers that the collapse of the health system could produce. It was a question of averaging the infections – which they already considered inevitable – given the Covid-19’s high capacity to transmit itself and its extremely rapid multiplication in the upper respiratory tract. For García-Sastre it was evident that no current health system would be able to bear the stress of a massive contagion of coronavirus in a few days, as it has finally been happening first in Wuhan and then in Lombardy, Madrid, New York itself and now in France and England.
These are the “creepy” parallels of the 1918 flu with Covid-19
Agustín Rivera. Malaga
The historian Elías de Mateo dissects in an extensive article the repercussion of a pandemic of 102 years ago that caused 50 million deaths. “You work just as helpless”
By the time this has happened, both medical and political authorities have discovered that the western industry, including the health industry, has been delocalized for years, precisely in China, and that it operates according to ‘just in time’ criteria, that is, that buys daily according to order and no longer has storage capacity of raw materials for its manufactures: neither alcohol nor plastics, nor special fabrics … with which to produce emergency items in this crisis: masks, gels and, especially, respirators and personal protective equipment for toilets. The criminalization of plastic, essential for making latex gloves, goggles, and breathing tubes, has done the rest. García-Sastre himself, who predicts the recurrence of major viral epidemics every 20 to 30 years in the near future, exonerates Western health systems of the current disaster for none was prepared for such a rapid spread of Covid-19.
Only an adequate research and hospital implementation policy could more effectively combat future pandemics. For this, in addition to the obvious increase in investment in these areas, there must be a increased flow of specialized information, more coordinated clinical trials and much more collaboration between different medical areas, since an expert in public health and epidemiology is not the same as a biochemical researcher focused on knowing the genetic chain of a virus or bacterium, much less an internist, a pulmonologist or intensive care doctor. And all of them are protagonists in the current Covid-19 pandemic.
Medicine to the rescue
We have already seen that public health experts and even many epidemiologists, including those at the WHO, have been outspoken by the pandemic. Neither they nor the politicians they were advising should know the moral of the tale of the Hindu prince and his subject Sissa, thanks to which it is easy to understand how fast and how much more exponential growth can increase. Authorities and health officials have seen in just two weeks go from having an outbreak confined in a small circle of people to runaway with thousands of infected and hundreds of deaths. So is exponential growth.
With the population becoming infected at breakneck speed due to the high transmission that characterizes Covid-19, and with microbiologists still studying substantial parts of the behavior of this new pathogen, and beginning a busy race to develop research that will find a vaccine or Some effective pharmacological treatment (there are more than 50 global vaccine projects and nearly a hundred international therapeutic studies at the moment), the battlefield soon moved to hospitals. And there yes, in the main line of fire against the deadly action of the virus, medicine, eastern and western, have shown unusual courage and ability to work, to the point that citizens have originated —in our country— an unprecedented formula of recognition: the ritual of collective applause from windows and balconies as a sign of gratitude to the army of restrooms who have been working in less than optimal conditions against the great microscopic enemy. The part of casualties in the toilets is also overwhelming, and is still not sufficiently justified for medical reasons.
It is true that Chinese doctors in emergency hospital centers, the main trenches of this health war, have been leaving clues to the problems and solutions they were encountering. However, the epidemic in Europe had not yet escalated when a medical controversy occurred in France that has caused rivers of ink to flow in French healthcare: From the prestigious university hospital in Marseille (the IHU), the director of the Institute unit Infectious Mediterranean, the renowned virologist Didier Raoult announced in a video “the end of the game” against Covid-19. Raoult, with a certain aspect of druid, echoed some Chinese and Korean recommendations and had used in her patients a medication that was recommended against malaria, chloroquine, of which there were also many and cheap stocks. Raoult was answered by the French Ministry of Health and the Inserm (the official health research institute), the same as alerted against ibuprofen. Recommending chloroquine was premature and there were risks involved.
To complicate the situation, other French hospital doctors added a second therapy to antimalarial medicine: azithromycin, an antibiotic widely used against pneumonia. While in France the controversy has continued, it has now moved to the U.S, with President Donald Trump defending the use of chloroquine against the opinion of his own health advisers, in Italy and Spain the Ministry of Health itself has recommended this therapy. So in Spain antimalarial hydroxychloroquine is being administered despite its side effects because, it seems, it works, and even more so combined with the mentioned antibiotic. Perhaps this medical daring explains the high rate of cures that Spanish hospitals have, or perhaps it is the self-denial and the value of their human resources, since the materials have been out of control for weeks, for which half the country has had to start looking for masks or making respirators.
In Spain, the battle to Covid-19 is being won in the ICUs, also having unprecedented levels of social collaboration
In any case, in Spain the UCI battle is being won, also having unprecedented levels of social collaboration. Spanish doctors have also cleared the development of Covid-19 pneumonic disease and have adapted their therapies to it. Apparently it is not the infection itself that causes the death of the patient but rather the overacting of the immune system once the virus multiplies in both lungs. That immune excess would cause widespread inflammation of vital organs and it would lead to an irreversible situation. The Spanish pulmonologists and emergency internists have understood, however, that in the phase of infection, the virus must be fought with chloroquine, but once it passes or is close to passing into the inflammatory phase, one must forget about the virus and proceed to deflate the patient with corticosteroids. Knowing how to manage the times and the medication would be the key to healing the seriously ill with the virus.
Why the big outbreaks in Italy and Spain
The last question we would like to raise is not intended to explain any of the abundant conspiracy theories circulating around the SARS-CoV-2 coronavirus. Some are very widespread, such as those that indicate the existence of a military biological laboratory in Wuhan, from where the bug could have escaped. Or others, more specular and related to alleged microbiotic wars between the United States and China, in addition to those that suppose that Bill Gates is a kind of guru with powers in the afterlife because after the Ebola crisis he tried to make humanity aware of the risks of viral epidemics. There are even more incredible theories, such as those of the American doctor Thomas Cowan, who at the recent health and human rights summit in Tucson, Arizona, came to explain the close relationship between viruses – a biological excrescence as defined – and contamination radiological. For Cowan it is no coincidence that the 1918 Spanish flu occurred at a time of strong expansion of radio emissions, or that Covid-19 now coincides with the arrival of 5G in telecommunications.
Much more significant than such conspiracies is the knowledge that is being acquired regarding the behavior of the specific coronavirus caused by Covid-19, of which there was no more idea than its similarity to other previous pathogens – SARS or MERS – but little plus. It is true that very soon its primary composition was deciphered and it was learned that it used its protein “crown” to bind —coarse, apparently— with the enzyme ECA2 —ACE2 in English— thanks to which it penetrated into human cells from where it reproduced by the millions. But fundamental aspects of the virus are still unknown, so many that the general misunderstanding suffered by public health groups in the world is understood. Once again, statistics are the one that throws a cable to medicine: the data show that the virus is mostly asymptomatic, that it presents with mild symptoms and that it affects more seriously older people, men more than women, and patients with previous pathologies. like heart disease, hypertension or diabetes. But it is not yet known why these traits, or the causes for which exceptions occur, as well as the repercussions of overexposure to the virus or the so-called viral load of infected droplets that an individual can transmit or for which it can be known. be infected.
The US digs in for the worst phase of the coronavirus: “It will be our Pearl Harbor”
Argemino Barro. NY
Confirmed cases of Covid-19 in the US exceed 312,000, although the actual numbers may be much larger. Thousands of sick could go on in the dark
The case of the hypertension it is particularly opaque. During the first great wave of the virus in China, a Mexican virologist interviewed by a prestigious national media came to say that the hypertensive problem stemmed from their hyperactivity, which facilitated their spread. Some time later it was concluded that the problem was not high blood pressure, but medication to moderate it. Specifically, it was alerted to the fact that some medicines inhibited the enzyme ECA2, the same that the coronavirus uses to penetrate cells and is present in the lungs, which could accelerate the severity of the viral infection.
Faced with this news, both the French and the Spanish Ministry of Health were positioned to stop the conclusions against antihypertensive medication: there is no clinical study that corroborates such assumptions. But many doctors, when in doubt, have been choosing to change their patients the therapeutic group with which they control blood pressure. Until Chinese hospital doctors and renowned Harvard internist Leo Galland have ruled quite the opposite: hypertensive patients treated with BRA drugs that block angiotensin II – a vasoconstrictive hormone – that is produced thanks to our friend the enzyme ECA2 from the lungs, would be in better conditions to improve against Covid-19, since the virus causes the enzyme “depletion”, and the more enzymes the less depletion. Quite a mess in a passionate medical debate right now.
And something similar happens with the thermal and geographic hypotheses. At this point, for example, we know little about the possible transmission of the coronavirus through water, food, or even sexual activity. The heat is supposed to mitigate its activity, but nobody is sure of it, nor of the seasonal nature of the virus, while everyone prepares for a second wave of Covid-19 once the quarantines are over, the second wave that in the case of the 18 flu was the really deadly one. A North American university study, also statistical, concluded one month ago, that Covid-19 showed much more intense outbreaks in a geographic strip in the northern hemisphere, coinciding with temperatures between 6 and 22 degrees and humidity below 60%.
None of this has been demonstrated, even though Chinese Wuham, Italy, Spain and the United States coincide in that strip, as well as many other countries with a much lower incidence of infections. Another geographic study, this one from the University of Alicante, concludes that the virus is not transmitted through the air, since if this were the main current from China it would take the east direction and not the opposite, as it has happened with the Covid-19: then it would be the direct contagion between people that acts in this disease. Some people, on the other hand, attribute to the social culture of Latinos the persistence and intensity of the viral outbreak in Spain and Italy. More sociability, a better quality of life thanks to the Mediterranean diet, a more immunological genetics, a demography with pyramids of an older population also thanks to the healthy attitude towards the existence of Spaniards and Italians … all this separately or at the same time, would be playing against both countries. But it is also contradictory that it only occurs here, and that countries such as Greece, Portugal or Malta, as Mediterranean as us, have very low rates of Covid-19 disease.
Neither New York or New Jersey, where now the virus is attacking with greater virulence, are too similar to Mediterranean ways of life, and it is time to see, in the same way, how the Covid-19 behaves in countries such as the United Kingdom, Germany, Russia or the Scandinavian territories, peripheral to the health crisis to date.
As you can see, a whole ocean of doubts. And that is the main current conclusion of the pandemic caused by this coronavirus: that science is not all-powerful and that it needs time and resources to reach complex knowledge of things, and that no matter how much we have turned the planet into our vacation villa , we continue to be at the mercy of the gods of nature and suffering from a certainly inevitable biological fragility. Every time man faces the drama of existence, he receives a lesson in humility.
One of the ways the virus enters the body is through ACE2, the enzyme that converts angiotensin I to angiotensin II in the lungs and other tissues and organs, suggesting to some that medications may increase virus susceptibility and disease severity.
In a new review published in Mayo Clinic Proceedings, published by Elsevier, scientists have been working on the frontline of fighting the coronavirus in Spain, Italy and the United States. “Under current guidelines, we recommend that patients with hypertension continue to take antihypertensive medications without interruption,” said lead author, Fabian Sanchis-Gomar.
In fact, after reviewing more than 60 published studies, have concluded that no work has reported an increase in circulating ACE2 levels or expression so far, and that a increased expression would not necessarily imply a increased risk of infection or disease severity.
Current evidence indicates that RAAS inhibitors significantly reduce mortality in cardiovascular disease, the progression of chronic kidney disease and are the cornerstone of treatment for heart failure and hypertension. «Therapy with ACEI or BRA should be maintained or be initiated, as indicated, in patients independently of Covid-19 “, the experts have settled.
Japanese researchers use genetic and clinical information from 700,000 people to demonstrate that these two factors are the most important in reducing the life expectancy of the current generation
What makes some people live longer than others? What is special about centennial individuals? For a long time it has been considered that the genetic code -DNA- determines our ability to resist diseases.
Part of DNA is made up of genes, from which proteins are produced that participate in practically all the processes within our cells and organs. And while variations in the genetic code determine biological traits, such as eye color, blood type, and disease risk, it is often a group of numerous mutations with small effects that influence a phenotypic trait.
Now, taking advantage of a large amount of genetic and clinical data around the world and new technologies, it is possible to identify people who have an increased risk of human disease using genetic information.
While genetic information-based risk stratification could be a potential strategy to improve population health, a major challenge is that the genetic code itself cannot be modified even if there is a known increased risk of a particular disease.
A new study conducted at the Osaka University (Japan) has found that people who have a genetic susceptibility to certain traits, such as high blood pressure or obesity, they have a shorter useful life. “The genetic code contains a lot of information, most unknown, says study author Yukinori Okada. The objective of our study was to understand how we can use this genetic information to discover risk factors in which we can directly influence ».
To achieve their goal, the researchers analyzed clinical and genetic information from 700,000 individuals from biobanks of the United Kingdom, Finland and Japan. Based on these data, they calculated polygenic risk scores, which are an estimate of genetic susceptibility to a biological trait, such as disease risk, to find out which risk factor causally influences life expectancy.
“Biobanks are an incredible resource,” says study lead author Saori Sakaue. By collaborating with large biobanks in the United Kingdom, Finland and Japan, We not only had access to large amounts of data, large amounts of data, but also to genetically diverse populations necessary to reach clinically meaningful conclusions. ”
The indications so far are that people with diabetes and other chronic medical conditions, such as cardiovascular disease (CVD), will have a worse prognosis if they become infected with COVID-19, the new coronavirus that has emerged from China.
There is also evidence that diabetes can increase the risk of COVID-19 infection two to three times, regardless of other medical problems, such as CVD.
Although more detailed analyzes are needed to show a clearly defined connection between conditions such as diabetes and a worse prognosis with COVID-19, statistics suggest that this virus affects the hardest among the most vulnerable, namely, the elderly and people with multiple medical problems, especially those with long-lasting diabetes that has not been well controlled.
“The message we want to emphasize is that emergencies unmask the vulnerabilities of diabetes. The old and the sick are the most vulnerable,” said Juliana C. N. Chan, MD, Medscape medical news in an interview.
Chan is director of the Hong Kong Institute of Diabetes and Obesity at the Chinese University of Hong Kong.
Chan and other experts therefore ask that diabetic patients, those with CVD and patients with other chronic medical conditions be more vigilant in their efforts to avoid contact with the virus, although they also note that individual responses vary widely.
In the past, epidemics of infectious diseases, including severe acute respiratory syndrome (SARS) and H1N1 flu, people with diabetes were at increased risk of serious disease and death.
“I don’t think it’s an exaggeration to say that people with diabetes … are at greater risk of developing COVID-19, because the data is suggestive,” Chan observed, although he warned that long-term research will give a lot more photos. clear.
Poor control of diabetes is a risk factor for infection
Chan was a senior coauthor of a study published in Diabetology, as reported by Medscape medical news, who found that mortality rates among people with diabetes in Hong Kong have plummeted in recent years, with the exception of young people, who may be more likely to have poorly controlled diabetes.
And – especially in the context of the COVID-19 epidemic – although in that study deaths from most conditions such as CVD and cancer decreased among people with diabetes, deaths from pneumonia among people with diabetes remained virtually unchanged. .
In severe cases of infection, the COVID-19 virus invades the cells that line the respiratory tract and lungs and enters the mucus, causing pneumonia. Severe lung damage from pneumonia can cause acute respiratory distress syndrome (ARDS), which in turn can cause septic shock.
ARDS and septic shock are the leading causes of death from COVID-19.
To date, Hong Kong has had only 70 confirmed cases of COVID-19, although the first Hong Kong resident to die from the virus was a 39-year-old man with diabetes. That death was soon followed by a second death – a 70-year-old man with diabetes and other medical problems, including hypertension and kidney disease.
“Our message is to ask people with diabetes to do things early to protect themselves and reduce the risk of having problems if something happens,” Chan told Medscape.
Although the mechanism for this increased susceptibility remains unclear, research suggests that high blood glucose levels can lead to impaired immune system function.
Not yet pandemic, but Virus has claimed many more lives than SARS
By February 25, COVID-19 had infected around 80,000 people and had caused nearly 2,500 deaths worldwide.
Although the vast majority of these infections and deaths have been in China, there are now pockets of infection in Iran, Italy, Japan and South Korea, as well as a handful of cases in many other countries.
The World Health Organization (WHO) yesterday stopped calling the epidemic a pandemic, but stressed that status could change at any time.
Although COVID-19 appears highly transmissible, only a small percentage of people seem to develop a serious disease and an even smaller number die from the infection.
A recent study of 44,672 confirmed cases of COVID-19 that had been reported until 11 February and which have been analyzed by the Chinese Centers for Disease Control and Prevention (CCDC) shows that 80.9% of people at who was diagnosed with COVID-19 had a mild illness.
So far, the overall case death rate (CFR) in China is 2.3%, lower than the previous coronavirus outbreaks caused by SARS (CFR: 9.6%) and Middle East respiratory syndrome (MERS) (CFR: 34.4%).
That being said, since COVID-19 has infected many more people than SARS or MERS, the latest coronavirus on the block has already caused many more lives.
This in turn raises the question: who is most at risk of serious disease and death from COVID-19?
Case mortality rates vary based on factors such as age, gender, basic medical conditions, and geography. Outside the Hubei province in China, the epicenter of the epidemic, the CFR can reach 0.4%, compared to 2.9% within the province.
The mortality rate for diabetes is high, but the interpretation is complicated
So far, for all age groups, the highest CFR is among people aged 80 or over, at 14.8%. CFRs were higher in people with other medical conditions than in healthy people.
CVD and diabetes are high on the list, in the event that mortality rates of 10.5% and 7.3%, respectively, compared to 0.9% for people without any previous disease, according to the latest CCDC report above.
Prior to the publication of this report, two relatively small case series of COVID-19 hospitalized patients in Wuhan also suggested that older men with underlying medical problems, especially CVD and diabetes, are more likely to develop disease. serious from the virus.
However, experts warn that for COVID-19 and similar infections, several factors can distort the data, making interpretation difficult.
“The identified cases tend to be in patients who have a more serious disease than younger and healthier individuals who stay at home and do not seek medical treatment,” said Preeti N. Malani, MD, an infectious disease and health specialist. principal officer of the University of Michigan medical school, Ann Arbor.
“This is also the case for individuals who are sick enough to be hospitalized. There are more people with more chronic conditions, including diabetes [among hospitalized individuals]”Malani told Medscape via email.
“Overall, diabetes can be an indicator of other chronic health conditions such as heart disease and obesity, which could contribute to an increased risk of infection,” added Malani.
“Diabetes is also much more common with age and will continue to be an indicator of poor results [all of] these reasons, “he said.
Every person with diabetes is different; Use common sense
All this makes it difficult to make fun of the individual contribution of diabetes to the risk of infection.
“The percentage in which each medical condition contributes to … the risk of infection is difficult to analyze,” explained Andrea Luk, MBChB, FHKCP, FHKAM.
Luk is an associate professor at the Chinese University of Hong Kong and is the other senior coauthor of the study Diabetology.
“Certainly a person with diabetes and cardiovascular disease would have more risks than a person with diabetes and good glucose control and without other comorbidities,” he continued.
But because every person with diabetes is different, it’s important to consider the whole package, he stressed.
If someone with diabetes succumbs to infections, it has a lot to do with glycemic control, the duration of diabetes and the comorbid conditions related to diabetes, such as heart disease, kidney disease and stroke, as well as their age, weight and if they smoke.
Chan further clarified: “We have to judge this case by case. It is not possible to apply it across the board to all people with diabetes. A person with well-controlled diabetes is very different from someone with poorly controlled diabetes. They have a different set of factors. of risk and complications “.
Pending more detailed analysis, Chan, Luk and Malani all suggest common sense measures for patients with diabetes, CVD and other chronic conditions: stay up to date with vaccinations, avoid large crowds, wash hands frequently, avoid touching the eyes or the mouth (the so-called T zone) and wearing facial masks in the areas where COVID-19 is prevalent.
People with symptoms should also wear a mask to avoid spreading the infection to others.
Even a bad year for the flu, difficult to distinguish between the two
Malani added: “Although there is a lot of attention and concern for COVID-19, this one has [also] it has been a terrible year for seasonal flu. I recommend flu shots, especially for … patients with diabetes. “
He also suggested being considerate of the trip.
“This may not be a good time for a non-essential trip to Asia as the situation is evolving. The COVID-19 risk is still low, depending on where you go, but the risk of an interrupted trip is real,” he said. observed.
Even without an emergency like COVID-19, Chan and Luk say they can’t emphasize enough the importance of optimal glucose control for people with diabetes.
“People with diabetes or other chronic conditions should be much more careful about protecting themselves from infections,” reiterated Luk.
They should also have a lower threshold for seeking treatment if they feel they are developing symptoms of infection, he noted.
“At first, it’s hard to tell if it’s flu or COVID-19 because it looks the same way,” he said.
Chan, Luk and Malani have not disclosed relevant financial reports.
For more information on diabetes and endocrinology, follow us on chirping and Facebook.