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re: NY HCQ study is a joke. We are being lied to
Posted on 5/13/20 at 9:15 am to Roger Klarvin
Posted on 5/13/20 at 9:15 am to Roger Klarvin
Fair points. Thanks for reply. I understand that you have to be cautions at the point of institutional guidelines, but on case by case basis with less acute cases, we can agree to disagree.
1
Posted on 5/13/20 at 9:15 am to Taxing Authority
quote:
Good grief. That has to be intentional.
It’s an observational study
Posted on 5/13/20 at 9:19 am to Tiguar
quote:
HCQ/Azith/Zinc everyone who walks in the door with covid symptoms starting in the last 7 days and not on QT prolonging home meds
Where you working and btw what is the dosing you are Rxing?
Personally think we need to study HCQ/Z-pak way earlier. I keep hearing the Fauci “HCQ needs to be closely monitored”....which is BS. I took HCQ every time I deployed to a Malaria prone area....so 4 times and once was on it for +11 months.
Posted on 5/13/20 at 9:22 am to Roger Klarvin
quote:Not sure how that helps. The purpose of the control group it for comparison.
It’s an observational study
Posted on 5/13/20 at 9:22 am to ABearsFanNMS
quote:
Where you working and btw what is the dosing you are Rxing?
I'm not doxxing myself but we're doing 400mg BID x1 day followed by 200mg BID days 2-5
Posted on 5/13/20 at 9:23 am to IslandBuckeye
I don’t believe HCQ is hurting many people as it has a very well known side effect and toxicity profile. People are welcome to give it, I just have nothing to point to to say it works.
The addition of azithromycin I’m a little more opinionated about as an ID specialist by training. The rate of bacterial coinfection in this condition is very low (well below 1% by most data) in contrast to influenza, and most common pneumonia pathogens now have significant macrolide resistance to the point that IDSA guidelines removed it from the pneumonia guidelines as an option for mono therapy last year. Giving it prophylactically is just wasteful, and if I want to treat for superimposed CAP (say they have a more focal lobar infiltrate under the background GGO and a procal of 5) I’m just giving ceftriaxone plus doxycycline.
Zinc administration, at its root, stems from long-standing bad pseudoscience on how the human body absorbs and utilizes zinc and the in vivo ability of zinc to effect viral replication.
The addition of azithromycin I’m a little more opinionated about as an ID specialist by training. The rate of bacterial coinfection in this condition is very low (well below 1% by most data) in contrast to influenza, and most common pneumonia pathogens now have significant macrolide resistance to the point that IDSA guidelines removed it from the pneumonia guidelines as an option for mono therapy last year. Giving it prophylactically is just wasteful, and if I want to treat for superimposed CAP (say they have a more focal lobar infiltrate under the background GGO and a procal of 5) I’m just giving ceftriaxone plus doxycycline.
Zinc administration, at its root, stems from long-standing bad pseudoscience on how the human body absorbs and utilizes zinc and the in vivo ability of zinc to effect viral replication.
Posted on 5/13/20 at 9:24 am to Tiguar
I’ve listened to no less than a dozen doctors on television, YouTube, talk radio say HCQ is an effective therapeutic for Covid19 if administered before the patient is ready for a ventilator. The VA study was flawed from the get go because most patients were already deathly ill.
Posted on 5/13/20 at 9:24 am to IslandBuckeye
quote:
Please share your evidence to support. Also do you use the criteria: "it appears encouraging", when making decisions while helping determine institutional guidelines.
The PharmD puts the smack down on the MD....me likey!
Posted on 5/13/20 at 9:27 am to Tiguar
The leftist ghouls will manipulate stats to get the results they want.
Posted on 5/13/20 at 9:27 am to Roger Klarvin
quote:
Zinc administration, at its root, stems from long-standing bad pseudoscience on how the human body absorbs and utilizes zinc and the in vivo ability of zinc to effect viral replication.
not an argument
quote:
The addition of azithromycin I’m a little more opinionated about as an ID specialist by training. The rate of bacterial coinfection in this condition is very low
azithromycin administration is this context has nothing to do with bacterial superinfection
LINK
quote:
Azithromycin is a macrolide antibiotic with well-described anti-inflammatory properties which can be attributed, at least partially, to its action on macrophages. We have previously shown, with 18 different macrolide molecules, that IL-6 and PGE2 inhibition correlates with macrolide accumulation, as well as with their binding to phospholipids in J774A.1 cells. The present study was performed in order to substantiate the hypothesis that biological membranes are a target for macrolide anti-inflammatory activity. By analyzing the effect of azithromycin on overall eicosanoid production, we found that in LPS-stimulated J774A.1 cells, azithromycin, like indomethacin, inhibited the synthesis of all eicosanoids produced downstream of COX.
I'm a little worried if you're guiding your institution but dont understand the basic theory behind their administration
Posted on 5/13/20 at 9:28 am to Taxing Authority
quote:
The purpose of the control group it for comparison.
There is no attempt to randomize in an observational study. It’s simply, as the name implies, observing the data with regards to treated vs untreated patients.
This post was edited on 5/13/20 at 9:29 am
Posted on 5/13/20 at 9:30 am to GumboPot
quote:
Note in my previous post I was writing the zinc ion as Z+. The correct way to write is is Zn+2. I should have checked the periodic table before assuming. Elemental zinc has 2 outer electrons and when it oxidizes into a salt those two electrons are lost and has a charge of +2.
Will this ^^^ be on the test Friday?
Posted on 5/13/20 at 9:35 am to Tiguar
quote:
azithromycin administration is this context has nothing to do with bacterial superinfection
The anti-inflammatory properties of azithromycin have never been clinically demonstrated in vivo outside of acute exacerbations of chronic obstructive lung disease (and even then the data is...just ok). Some pulmonologists will use it in severe end stage COPD as a 3x week regimen for anti-inflammatory properties but there’s no good data for this and most will readily admit it’s anecdotal usage. Overall all we know it’s doing is generating microbial resistance which is why most bacteria (now even strep pneumo) have relatively high rates of resistance. Another negative effect is we’ve generated significant macrolide resistance to many non-TB mycobacterium species that tend to colonize and ultimately often cause pathological infection in the respiratory tract of chronic lung disease patients. Even MAC is starting to become problematic.
It’s one of those things that, because it’s been demonstrated in vitro and taught to internal medicine residents for so long, we’ve forgotten it’s largely a wives tale without good scientific backing.
This post was edited on 5/13/20 at 9:38 am
Posted on 5/13/20 at 9:36 am to Tiguar
quote:
I'm not sure if it's necessary for the general public. If you work in healthcare or another high-risk occupation, possibly.
If you get sick with covid19, definitely, but have to start it early.
Then I would take a quality zinc supplement for prevention. Your body will keep what it needs and get rid of the rest.
Posted on 5/13/20 at 9:37 am to Roger Klarvin
quote:I understand that. But observational doesn't mean you have no choice about who is included. Nor does it change the purpose of a control group.
There is no attempt to randomize in an observational study.
quote:Which cannot be done if the control group does not mimic the treated group.
observing the data with regards to treated vs untreated patients.
Posted on 5/13/20 at 9:38 am to Bass Tiger
the reason I don't suggest prophylactic use for the general public is long-term use is associated with other issues
LINK
it skews the risk/benefit ratio for something that "might help, probably won't hurt"
LINK
quote:
Yes, if you get too much. Signs of too much zinc include nausea, vomiting, loss of appetite, stomach cramps, diarrhea, and headaches. When people take too much zinc for a long time, they sometimes have problems such as low copper levels, lower immunity, and low levels of HDL cholesterol (the “good” cholesterol).
it skews the risk/benefit ratio for something that "might help, probably won't hurt"
This post was edited on 5/13/20 at 9:38 am
Posted on 5/13/20 at 9:38 am to Taxing Authority
quote:
Not sure how that helps. The purpose of the control group it for comparison.
Per the paper, they looked at consecutive admissions, which is the proper (less biased) way to do this. So they looked at 1446 patients who came in, and recorded what happened to them. To ensure a matched control group, they would have to cherry pick patients after the fact (and find x number of patients with similar baseline characteristics who did NOT receive HCQ, which may not be possible in an observational setting.) Honestly, the only way to do that is in a randomized controlled trial, where you set clear Inclusion and Exclusion criteria that all patients must meet, then randomly assign treatment.
My big takeaway from this study is that physicians at this hospital are biased in who they are prescribing HCQ to.
Posted on 5/13/20 at 9:39 am to Tiguar
You seem quite knowledgeable on this topic, mind if I ask you a question?
Regarding hypertension, and I've not seen this addressed anywhere, does it matter if it's well managed hypertension vs unmanaged hypertension?
Regarding hypertension, and I've not seen this addressed anywhere, does it matter if it's well managed hypertension vs unmanaged hypertension?
Posted on 5/13/20 at 9:40 am to shell01
quote:
My big takeaway from this study is that physicians at this hospital are biased in who they are prescribing HCQ to.
yeah, I don't attribute the prescribing to malice. I do find it questionable the mortality difference was not isolated and discussed in the paper and I absolutely attribute the treatment of this study by the media and Fauci to malice
Posted on 5/13/20 at 9:40 am to Tiguar
I knew that HCQ was not producing substantially better outcomes than doing nothing. I think this was originally identified as a possible treatment in a French study.
I'm not a doctor, but can we assume that intubation occurs in this case because a ventilator is being deployed? If so, it may as well be death.
If true, that is weird. But I'm not a doctor and can't speak to how these observational studies work.
Not saying that HCQ is a miracle drug or even a viable way to treat Covid-19....but you knew these kinds of headlines were going to happen. It became political.
quote:
They used a composite end-point that treated intubation and death equally
I'm not a doctor, but can we assume that intubation occurs in this case because a ventilator is being deployed? If so, it may as well be death.
quote:
50% of patients in the hcq group had history of hypertension vs 7% in the control group (relevant because we now know htn is a massive predictor of poor outcome)
If true, that is weird. But I'm not a doctor and can't speak to how these observational studies work.
quote:
yet, every headline reads "HCQ FAILS ANOTHER TEST"
Not saying that HCQ is a miracle drug or even a viable way to treat Covid-19....but you knew these kinds of headlines were going to happen. It became political.
This post was edited on 5/13/20 at 9:43 am
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