Dr. Laertes B. Amihan shared some insights to military men during government imposed locale lockdowns.

 

INTRODUCTION:

While the medical authorities and big pharmaceutical industries are racing against time in developing drugs that can cure Covid19 disease… sometime in June of 2020, medical experts and scientists in the United Kingdom mentioned and hailed the wonder drug dexamethasone a cheap readily available drug that can reduced death rate by 20% when given in patients which need oxygen and when further given to patients with mechanical ventilator it can decrease mortality rates in one third of cases of in-hospitalized patients with CoViD19 ( The UK-RECOVERY THERAPY TRIAL ).

THE UK RECOVERY THERAPY TRIAL:

What the Uk scientists and medical experts are referring to was the not yet peer reviewed nor published results of the Randomised Evaluation Covid19 Therapy Trial or the RECOVERY TRIAL done in hospitalized patients with Covi19 at the Oxford University in the United Kingdom. In the RECOVERY TRIAL dexamethasone was given 6mg intravenously once daily regularly for ten days to 2,104 patients compared to the 4,321 patients who received usual care. Professor Peter Hornby, MD, PhD head of the emerging infectious disease at the University of Oxford in UK was the lead author of the study.

DEXAMETHASONE:

 

 

It was a known fact that dexamethasone is a broad spectrum corticosteroid and it is widely used for the treatment for allergies, asthma, blood and bone marrow cancers, psoriasis, rheumatoid arthritis, skin diseases, renal diseases, SLE and other autoimmune diseases and is cheap and can be access readily.

Likewise the drug gained popularity due to its broad systemic effects to curb the ” dreaded Cytokine Storm Syndrome ” that caused morbidity and mortality in some patintes infected by the novel coronavirus. That the drug was repurposedly approved by the US-FDA for the treatment of the novel coronavirus infected patients that were hospitalized. And was even included in the June 25, 2020 updates of the United States-National Institute of Health ( US-NIH ) and World Health Organization’s ( WHO ) guidelines and clinical treatment protocol for hospitalized CoviD19 patients.

Dexamethasone is modestly effective in dampening cytokine storm syndrome in the severely and critically ill patients thus increasing survival rate. But the downside of dexamethasone treatment are its many systemic side effects especially if given in a large dose for a longer period of time. And it should not be use in CoviD19 patients with mild symptoms.

NEW STUDY ON DEXAMETHASONE:

A new observational study published just recently… dated July 22, 2020 in the Journal of Hospital Medicine that entails the used of systemic steroids such as dexamethasone within 48 hours period after admission in 1,946 hospitalized patients. The new study was conducted and led by the Albert Einstein College of Medicine and the Montefiore Health System. The primary goal or purpose of the study is the giving of steroids or glucocorticoid in the early part ( within 48 hours ) of the viral infection or disease process will decrease or reduced mortality or mechanical ventilation in patients with CoViD19.

PATIENT’S DIAGNOSTIC PARAMETERS:

Laboratory or diagnostic blood parameters are also performed such as blood glucose, C-reactive protein ( CRP ), D-dimer, troponin T, serum ferretin, LDH, serum electrolytes, liver function tests, creatine kinase, serum creatinine, CBC, including serum procalcitonin.

PATIENT’S COMORBIDITIES AND CLINICAL CHARACTERESTICS:

The comorbidities of all the patients was also included and noted in the study together with their demographic and clinical characteristic data with all the laboratory results. Many of them are latinos, black, male, obese, hypertensive, diabetic, with existing coronary artery disease, asthmatic, with chronic obstructive pulmonary disesase, a few with HIV, a few with ends stage renal disease and lupus, rheumatoid arthritis, then a few with acute renal injury.

TABLE 1 : PATIENTS CHARACTERISTICS AND DIAGNOSTIC RESULTS:

 

RESULTS OF THE STUDY:

The most interesting findings and results of the studies are…

1.) There is a risk reduction rate of 75% of going on mechanical ventilation and death when steroids are given to CoViD19 patients with C-reactive protein ( CRP ) level of greater or more than 20mg/dl.

2.) There is an associated increased risk of 200% of going on mechanical ventilation and death when steroids are used or given to CoViD19 patients with C-reactive protein ( CRP ) level lower than 10mg/dl.

 

3.) Any formulation of steroids when given to CoViD19 patients with critical illness due to intense inflammation in the body will offer life saving benefits.

4,) The high C-reactive protein also corresponds to greater amount of systemic inflammation.

Figure A. As Showed or indicated by a red arrow pointing down on the left, that patients with C-reactive protein ( CRP ) of more than 20mg/dl benefited much when given with glucocorticoids by reducing in-hospital death and mechanical ventilation.

Figure B. As showed or indicated by a red arrow pointing up on the right,that glucocorticoids when given to patients with lower C-reactive protein ( CRP ) level in the blood resulted to increased risk of in-hospital death/mortality or mechanical ventilation.

DR. William Southern MD.,M.S. Professor of Medicine, Chief of the Division of Hospital Medicine at Einstein and Montefiore is the study’s senior author.

Dr. maria Keller MD., vice chair for research in the Department of Medicine at Einstein and Montefiore is the study’s lead author.

Shitji Arora MD., associate professor of Medicine at Einstein and Montefiore co-autthor of the study.

 

Conclusion:

Steroids in the formulation of dexamethasone, prednisone or methylprednisolone are cheap and readily available drug in the market today in injectable or oral form and if timely given to patients with severe or critical illness due to Sars C0V-2 infection will result to decrease in-hospital mortality and mechanical ventilation, but the giving of glucocorticoids must be guided by the level of C-reactive protein of the patient in association or in correlation with other clinical parameters of the patients. And as mentioned for the past few months that corticosteroid as represented by dexamethasone was already a repurposed drug for the treatment of CoViD19 patients through US-FDA approval and it gained popularity and success due to favorable cost effective results in the treatment for CoViD19 patients as shown by many clinical trials and real world data all over the world. In the past, the chinese government was already using steroids in their treatment of the coronavirus infected patients since early 2003 and that includes in their treatment for the novel coronavirus infected patients in Wuhan China and that would be one of the reason why they had more or less succeeded in their medical management of treating mild to critical symptoms CoViD19 patients. Yes, as shown in their studies and some anecdotal reports that chinese people already took chinese formulary pills with steroids content as a chemoprophylaxis against the coronavirus and treatment for mild symptoms of the illness. Their vast secret knowledged of the coronavirus including its cousin the novel coronavirus was unprecedented…to note they shared and provided the world’s best scientific minds with the first genetic sequence and characteristics of the novel coronavirus…we should not forget that.

Authors Opinion:

Dr. Laertes B. Amihan do patient’s home service checked-up with oral medications home delivery during strict government lockdowns to provide and ensure continued flow of health services to patients at the comfort of their home in the midst of the pandemic.

 

 

Dr. Laertes B. Amihan and clinic staff…

As a medical practitioner in my local place of practice…I medically managed patients in my clinic presented with the classic flu-like signs and symptoms of CoViD19 disease but unfortunately they are not tested due to lack of testing kits during that time period when CoViD19 disease begun to spread. We didnt stopped seeing patients in the clinic since the viral disease starts last December of 2019 up to the present. Our local hospital run by the government refused to accept and managed patients with signs and symptoms of the disease and referred patients to other far distant healthcare facilities as was told and narrated by many of my patients during the height of the pandemic, so many of them went to my clinic and we accepted and medically managed them with the implementation and strict adherenced to proper preventive protocol or measures against coronavirus transmission. Proper medical advised was given to the patients, medications was given to boost up their immune system and antibiotic treatment was instituted if needed by the patients based from pneumonia standard of care but as what I have mentioned for patients that presented with flu-like signs and symptoms of coronavirus disease,if without contraindication… I gave them short courses of steroid treatment combined with an anti-allergy drug added with fixed dosed of anticholesterol/antiplatelet pills for my high risks patients with co-morbidities/chronic disease and monitored them clinically including their blood parameters. The giving of multiple drugs to my patients was individualized and tailored fit based from their clinical characterestics and needs, every clinician has its own ways and strategy of treating their individual patients. And I think we do have succeed on our treatment…so far, none of my patients suffered adverse events from the treatment and none of them progressed to severe disease or was hospitalized. Until now many of them had regular check-up or visits in the clinic and if they cant visit the clinic for follow-up…then we visit them at home for a home service check or follow-up…we performed these clinic services long before the pandemic started last December of 2019 and there is no valid reason why we will stop of doing such thing especially at these unprecedented times where we don’t have yet a definite treatment for SARS CoV-2 infection. The promised of having an available vaccine before this year 2020 ends is a remote possibility but we are hoping that it will be available the soonest possible time.

Before I end this…kindly allow me to extend my warmest fraternal regards to all the brethren of Hamtik lodge # 76 and members of The Free and Accepted Masons evenly disperse in the whole wide world especially to their respective masonic families and friends…Keeping Strong And Resilient Amidst The pandemic!!!

My Warmest regards to my readers in Panay island ( keep safe Northern Antique, Iloilo, Capiz and Aklan ), to my classmates of the Iloilo Doctors College of Medicine Inc…IDCM batch 96 and likewise to all our mentors during our medical student days…then to all the filipinos living in the beautiful island of the Philippines and to the rest of the world……

 

Keep Safe…Stay healthy and Look Cool Always !!!

Laertes B. Amihan MD

 

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