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Started By
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Would steroids, along with the Hydroxychloroquinine/zpac help at all?
Posted on 4/6/20 at 4:54 pm
Posted on 4/6/20 at 4:54 pm
You could come out of it, ready to rassle maybe.
Posted on 4/6/20 at 4:58 pm to auggie
Patients stacked, ventilators fricked.
Posted on 4/6/20 at 4:59 pm to auggie
I thought I remember steroids being bad for Corona.
Posted on 4/6/20 at 5:00 pm to auggie
Steroids are bad for all viruses. It literally feeds them and makes them stronger.
Posted on 4/6/20 at 5:03 pm to russellvillehog
quote:
Steroids are bad for all viruses. It literally feeds them and makes them stronger.
Yeah, I don't know much about them, except they can help with some things.
Posted on 4/6/20 at 5:05 pm to auggie
They suppress your immune system so generally bad for infections.
Posted on 4/6/20 at 5:06 pm to russellvillehog
Steroids are immunosuppressants to some degree, but they are also strong anti-inflammatory.
Many say that there immunomodulating effects of hcq are what help, but that's not proceed.
Steroids have already been tried and are not helpful in preventing the ards that can be associated with this virus.
Now other drugs have shown some promise in this regard. They have suggested that the cytokine storm that some feel cause the ards is driven at least in part by the il-6 pathway and we do have done drugs effecting this.
Many say that there immunomodulating effects of hcq are what help, but that's not proceed.
Steroids have already been tried and are not helpful in preventing the ards that can be associated with this virus.
Now other drugs have shown some promise in this regard. They have suggested that the cytokine storm that some feel cause the ards is driven at least in part by the il-6 pathway and we do have done drugs effecting this.
Posted on 4/6/20 at 5:41 pm to thetempleowl
My hospital was trying to get on the tocilizumab trial, but no openings.
And to add to the above, people that are given steroids are doing worse.
I’ve been wanting to write this for a while, and put it in its own thread: Plaquenil doesn’t work. In the 3 hospitals were talk to every day, plus us, we have all stopped using it. There’s been deaths from cardiac arrhythmias, and in one hospital, everyone that got plaquenil died.
In addition, those who take it regularly as part of RA or SLE treatment, are having worse outcomes (though idk if that’s due to then being unhealthy to begin with).
And since many are saying the side effects are minimal, there’s a 3% change of cardiac arrhythmia that can lead to death. The mortality rate of COVID is 1%. So, we would be hurting more people than we are actually saving,
And to add to the above, people that are given steroids are doing worse.
I’ve been wanting to write this for a while, and put it in its own thread: Plaquenil doesn’t work. In the 3 hospitals were talk to every day, plus us, we have all stopped using it. There’s been deaths from cardiac arrhythmias, and in one hospital, everyone that got plaquenil died.
In addition, those who take it regularly as part of RA or SLE treatment, are having worse outcomes (though idk if that’s due to then being unhealthy to begin with).
And since many are saying the side effects are minimal, there’s a 3% change of cardiac arrhythmia that can lead to death. The mortality rate of COVID is 1%. So, we would be hurting more people than we are actually saving,
Posted on 4/6/20 at 5:50 pm to pngtiger
quote:
And since many are saying the side effects are minimal, there’s a 3% change of cardiac arrhythmia that can lead to death. The mortality rate of COVID is 1%. So, we would be hurting more people than we are actually saving,
You realize that what you are saying here completely contradicts the American College of Cardiology. As far as a 3% rate of fatal cardiac arrhythmias, particularly after taking it for a week, BS.
Another thing I am going to call BS on is your “worse outcomes in the RA and SLE population.” There are any number of drugs that can be used to manage these conditions, including newer monoclonal antibody treatments. At any rate, there is no way you could possibly know this given the amount of time that has passed since Hydroxychloroquine began to be used off label for China Virus.
This post was edited on 4/6/20 at 5:53 pm
Posted on 4/6/20 at 5:55 pm to auggie
AAS suppresses the immune system, but HGH strengthens it.
Put everyone on HGH.
Put everyone on HGH.
Posted on 4/6/20 at 6:37 pm to Boatshoes
You can call BS all you want, I’m reporting what is actually happening at these 4 hospitals (all level 1 centers).
And the official release by the American College of Cardiology says, “ several hundred million courses of chloroquine have been used worldwide making it one of the most widely used drugs in history, without reports of arrhythmic death under World Health Organization surveillance”.
I can tell you it’s false because we had an arrhythmic cardiac death.
*i am a critical care physician
And the official release by the American College of Cardiology says, “ several hundred million courses of chloroquine have been used worldwide making it one of the most widely used drugs in history, without reports of arrhythmic death under World Health Organization surveillance”.
I can tell you it’s false because we had an arrhythmic cardiac death.
*i am a critical care physician
Posted on 4/6/20 at 7:04 pm to pngtiger
It will be interesting to see how this board reacts to this doctors anecdotes.
Posted on 4/6/20 at 7:05 pm to auggie
Hold on I'll text aranda your suggestions.
Posted on 4/6/20 at 7:14 pm to pngtiger
quote:
I can tell you it’s false because we had an arrhythmic cardiac death.
Well, share the anonymized HIPPA compliant details then.
This post was edited on 4/6/20 at 7:15 pm
Posted on 4/6/20 at 7:58 pm to pngtiger
Z-pak like HCQ also affects the QT interval of your heart and can lead to arrhythmias, but no one thinks it is generally dangerous because it isn’t, like HCQ isn’t. This idea that HCQ is some super dangerous drug when it is well tolerated by most people like z-pak is wrong, especially when taken short term.
Posted on 4/6/20 at 9:13 pm to PickupAutist
Yes, most tolerate it well. However, the percentage that have arrhythmias is greater than the mortality of the virus.
Posted on 4/6/20 at 9:16 pm to pngtiger
Fatal arrhythmias or just arrhythmias because z-pak arrhythmias are also >1%
Posted on 4/6/20 at 9:20 pm to Tacoma Tiger
I take steroids for sinus infection. I would think all 3 might put stress on heart and blood vessels
Posted on 4/6/20 at 9:38 pm to auggie
Interestingly enough, this pdf gets updated(and I have posted it about 2-3 other times), one talks about the data behind corticosteroids. Another shows data behind methylprednisolone (based on a single retrospective review from one hospital in Wuhan).
What we know:
In SARS and MERS, steroids didn't offer a survival benefit. In ARDS, they have been studied. Results are mixed at best
Specific to solu-medrol and COVID19, the group that got steroids in the one study referenced in that spreadsheet actually had a lower mortality rate.
Now, this Lancet publication which is just an observation , you can see if you scroll down to the table about treatments, 191 patients who were looked at. 54 of them died. 137 survived. 48% of the ones who died got steroids. 23% of the survivors got steroids.
This is where medicine and observations get confusing:
This data is what some of the "steroids aren't good for COVID19" comes from. But it doesn't tell the whole story. It is unclear if the ones who were going to die got steroids just because there wasn't much else to try and the patient was getting worse or the patients that got steroids died at a higher rate (well, both are true, but we have no hard evidence suggesting that steroids are what caused their demise). When looking at the other data (ventilator use, NIPPV, high-flow o2 use), I would tend to think the group that died was just plain sicker and that steroids were happenstance. But they're another treatment that is often used with little evidence to really support that they should be. At least in this case, there is no clear evidence of benefit with the exception of the one retrospective look where people who got them died less (and subsequently another study linked above where it shows that those who got them died more often).
What we know:
In SARS and MERS, steroids didn't offer a survival benefit. In ARDS, they have been studied. Results are mixed at best
Specific to solu-medrol and COVID19, the group that got steroids in the one study referenced in that spreadsheet actually had a lower mortality rate.
Now, this Lancet publication which is just an observation , you can see if you scroll down to the table about treatments, 191 patients who were looked at. 54 of them died. 137 survived. 48% of the ones who died got steroids. 23% of the survivors got steroids.
This is where medicine and observations get confusing:
This data is what some of the "steroids aren't good for COVID19" comes from. But it doesn't tell the whole story. It is unclear if the ones who were going to die got steroids just because there wasn't much else to try and the patient was getting worse or the patients that got steroids died at a higher rate (well, both are true, but we have no hard evidence suggesting that steroids are what caused their demise). When looking at the other data (ventilator use, NIPPV, high-flow o2 use), I would tend to think the group that died was just plain sicker and that steroids were happenstance. But they're another treatment that is often used with little evidence to really support that they should be. At least in this case, there is no clear evidence of benefit with the exception of the one retrospective look where people who got them died less (and subsequently another study linked above where it shows that those who got them died more often).
Posted on 4/6/20 at 9:57 pm to PickupAutist
Looking for a source to cite the percentage, but I’m not finding it (search is overloaded with recent media reports). Number I was quoted today was 3%, but don’t know if just arrhythmia or fatal.
In one study, of those that developed an arrhythmia and associated cardiomyopathy, close to half had progression even after the drug was stopped (some had heart transplants because of it, others died suddenly).
Most of the reports are from long-term use, however I know of 2 now with arrhythmia from short term use.
There also neuro and retinal toxicity, and the neuro can progress after cessation, as well.
We always balance risk-benefit (I do it almost daily with patients on blood thinners and risk of major bleeding, especially in the head). Right now, we know the risk of HCQ. What we don’t know is the benefit. I have yet to see a positive trial with a control group. I have yet to see a positive trial that details the timing and/or proper dosage. I have seen a study that showed poor results, but that info was buried in the results section of the paper and not addressed in the conclusion (so if you’re just perusing the abstract, you never see the negative data). All the other studies are case series, which is not evidence-based medicine.
In one study, of those that developed an arrhythmia and associated cardiomyopathy, close to half had progression even after the drug was stopped (some had heart transplants because of it, others died suddenly).
Most of the reports are from long-term use, however I know of 2 now with arrhythmia from short term use.
There also neuro and retinal toxicity, and the neuro can progress after cessation, as well.
We always balance risk-benefit (I do it almost daily with patients on blood thinners and risk of major bleeding, especially in the head). Right now, we know the risk of HCQ. What we don’t know is the benefit. I have yet to see a positive trial with a control group. I have yet to see a positive trial that details the timing and/or proper dosage. I have seen a study that showed poor results, but that info was buried in the results section of the paper and not addressed in the conclusion (so if you’re just perusing the abstract, you never see the negative data). All the other studies are case series, which is not evidence-based medicine.
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