(With regular inputs from Dr Monica Vasudev)

 Evidence on spironolactone safety, COVID-19 reassuring for acne patients

Concerns have been raised about potential risks with the use of spironolactone for acne during the COVID-19 pandemic on social media; however, spironolactone and other androgen blockers might actually protect against the virus, suggests a report published in the Journal of the American Academy of Dermatology.

The virus needs androgens to infect cells, and uses androgen-dependent transmembrane protease serine 2 to prime viral protein spikes to anchor onto ACE2 receptors. In the absence of this step, the virus is not able to enter the cells. Androgens are the only known activator in humans, so androgen blockers like spironolactone could possibly short-circuit the process, state lead author Carlos Wambier, MD, PhD, of the department of dermatology at Brown University, Providence, R.I (J Am Acad Dermatol. 2020 Apr 10. doi: 10.1016/j.jaad.2020.04.032).

The lack of androgens could possibly explain why mortality is so rare among children and why fatalities among men are higher than among women. At least one study is currently ongoing to see if spironolactone is beneficial: 100 mg twice a day for 5 days is being pitted against placebo in Turkey among people hospitalized with acute respiratory distress. The study will evaluate the effect of spironolactone on oxygenation.

Buy a pulse oximeter

1. Some COVID-19 patients have dangerously low levels of oxygen, but appear completely comfortable. This is being called “silent hypoxia.”
2. COVID-19 patients can monitor their oxygen levels at home with a pulse oximeter.
3. A normal oxygen level measured using a pulse oximeter is around 97%, unless there are other underlying health problems like COPD. Start to worry when this level drops below 90% as this can potentially affect the amount of oxygen reaching the brain and other vital organs. People may experience confusion and lethargy at low levels. Levels below 80% are considered dangerous and increase the risk of organ damage.
4. When parts of the lung are damaged, blood vessels constrict to push blood to areas of the lung that are not damaged, keeping up the oxygen levels. With COVID-19, this response may not be working. As a result, blood flow continues even to areas with damaged lung, where oxygen can’t reach the blood stream.
5. There’s also a new finding of microthrombi or tiny blood clots that can block oxygen flow into the blood vessels in the lungs which may result in drop in oxygen levels.
6. Checking oxygen levels at home is beneficial mostly for those who have diagnosed COVID-19 or symptoms that suggest infection. Monitoring your oxygen levels can provide reassurance as symptoms of shortness of breath recede during the course of the illness. If you notice your levels dropping, it can help you know when to reach out to your doctor for help.
7. Besides the risk of device malfunction, wearing dark nail polish, false nails, and having cold hands can give false readings, and the readings can change a little depending on your position as well. So, it’s important to track the trend in your levels, not to react to a single reading.
8. If your oxygen levels drop, contact your doctor for advice.
9. Many people are being given oxygen through nasal tubes or facemasks and are also being placed in “prone positioning.” This means you are put on your stomach or side to help open up air sacs at the bottom and back of your lungs in order to to allow for more oxygen exchange into the blood stream.
10. While taking care of yourself at home with COVID-19, it is important to monitor your symptoms. If you choose to use a pulse oximeter, do not solely rely on it to measure your condition. Closely monitor all your symptoms and contact your doctor if you experience worsening symptoms like weakness, confusion, chest pain, shortness of breath, irrespective of your oxygen levels.

Learn to strengthen your lungs

Learn to sleep prone or on the side

Belly breathing. Sit with one hand on your chest and the other on your belly. Take a deep breath in through your nose and feel your belly move out. Then breathe out through pursed lips as if whistling. Feel your belly move back in. Repeat this a few times slowly. This has the added bonus of relieving stress because it is relaxing.

Incentive spirometer. This is a device used by people after surgery or after a lung illness like pneumonia to take deep breaths that expand the lungs. It has a mouthpiece with tubing that connects with an air chamber that has an indicator inside it. As you inhale, the indicator rises to a goal marked on the spirometer and lets you know you’ve achieved the appropriate deep breath.

European Doctors Warn Rare Kids Syndrome May Have Virus Tie

Doctors in Britain, Italy, and Spain have been cautioned to look out for a rare inflammatory condition in children that is possibly associated with the new coronavirus. This is a multi-system inflammatory state that requires intensive care with features of toxic shock syndrome or Kawasaki disease. School-age children have been reported to be suffering from an unusual picture of abdominal pain, accompanied by gastrointestinal symptoms that could lead to shock, low blood pressure and heart problems within hours’ time.

Diabetes risk

The risk for death from COVID-19 is up to 50% higher in people with diabetes than those without. Evidence also suggests that the risks associated with COVID-19 are greater with suboptimal glycemic control, and the virus seems to be linked with an increased risk for diabetic ketoacidosis and new-onset diabetes.

COVID-19 is not ARDS

PEEP be set to zero, inspiratory time to 1.4 seconds, pCO₂ to less than 35 mmHg, and tidal volume be increased to at least 800 mL. The regimen runs in direct contrast with widely held ventilation strategies and current guidance on COVID-19 treatment. [Medscape]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA