lung injury Archives - Amazing Health Advances

Study Says Vitamin-Magnesium Combo May Reduce Severity of COVID-19 in Seniors

AHA Publisher — Tue, 09 Jun 2020 07:00:01 +0000

Dr. Liji Thomas, MD via News-Medical Net – The COVID-19 pandemic that began in late December 2019 has spread to over 188 countries and territories, causing over 6.5 million cases and 385,000 deaths. With no effective therapeutic COVID-19 drug or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in sight, researchers are exploring different strategies to limit its spread and mortality. A recent study published on the preprint server medRxiv* in May 2020 shows that a combination of the readily available and inexpensive vitamins D3, B12, and the mineral magnesium can reduce the progression of the disease to severe or fatal stages. Hyperinflammation in COVID-19 Disease The current thinking on the pathogenesis of the condition is that hyperinflammation plays a crucial role in patient outcomes. In other words, direct viral injury is not the only or even primary player in organ dysfunction related to COVID-19. Rather, it is the result of the organ toxicity caused by the unregulated release of pro-inflammatory cytokines like IL-6 and IL-8, in response to the immune induction by the virus. Immunomodulation is thus an attractive option in the treatment of COVID-19 and may prevent the progression of the patient to severe or critical illness. Various biologic molecules have been tried, such as the IL-6 blocker tocilizumab. The DMB Protocol The present study was an observational cohort study of a consecutive series of hospitalized COVID-19 patients aged 50 years and above, who were given a combination of the above micronutrients (DMB), comparing the rate of progression of disease in this group to another cohort of patients who were not given DMB. Vitamin D protects the respiratory epithelium structure and function. Magnesium promotes vitamin D functions, acting as a cofactor in multiple enzymes involved in vitamin D metabolism, while also having independent bronchodilator and vasodilator activity. Vitamin B12 improves the health of the gut bacteria, which in turn is vital for an active and effective immune system. All are safe and well-tolerated by patients. How Was the Study Done? The current study aimed at testing the effect of a short course of supplementation of DMB in COVID-19 patients who are not yet in the severe or critical phase of the illness. The aim was to find out if this could prevent poor patient outcomes. The study included all patients with COVID-19 who were at least 50 years old, admitted to Singapore General Hospital, between 15 January and 15 April 2020. All of them had a positive RT-PCR test. The study outcome was to assess how many progressed to need oxygen in any mode, or intensive care unit (ICU) admission. From 6 April 2020, all patients fitting these criteria were administered DMB and formed the study cohort. DMB consisted of one daily dose of vitamin D3 1000 IU, magnesium 150mg, and vitamin B12 500mcg for up to 14 days. It was stopped if the patient either recovered symptomatically and two successive PCR tests were negative, or if the patient deteriorated clinically. Most patients in the study arm received DMB on the first day of admission and had continued therapy for 5 days (median). The patients admitted in the same period but who did not receive DMB were the controls. The study arm comprised 17 patients while the control arm had 26 patients, both arms being similar concerning demographics, and clinical features. Did the DMB Improve the Clinical Course? The researchers found that only 3/17 patients in the study arm required supplemental oxygen, compared to 16/26 in the control group. In both groups, the requirement for oxygen also signaled a high risk for ICU, with 2/3 in the DMB group and 16/16 in the non-DMB group requiring ICU admission. Of the 3 patients in the DMB group who deteriorated, one needed oxygen supplementation after 3 days on DMB but remained stable on the ward. Of the 9 patients who received early DMB (in the first week of hospitalization), only one deteriorated, being among the 2, which required oxygen early (within 24 hours of starting DMB). These 2 are likely to have already gone downhill, judging from their rapid deterioration, and the DMB was probably too late to affect events either way. The analysis showed that the odds of requiring oxygen went up with age and the presence of other illnesses, but went down significantly with DMB treatment, even after adjusting for age, gender, and other illnesses. The odds would have been even more impressive if the two patients who received DMB late in their clinical course were excluded. Importantly, there were no adverse effects that could be traced to DMB. The Implications of the DMB Study Available data from around the world shows that up to a fifth of COVID-19 patients experience life-endangering complications. IL-6 blockers and anti-thrombotic agents may be little better than a Band-aid in this situation, addressing the late events and mostly ineffective. However, the current study sought to make use of pre-emptive immunoregulatory, safe, and well-tolerated agents to reduce the cytokine storm associated with terminal organ damage and death. The apparent success of this strategy could allow it to be adopted as a safe, easily administered, and early intervention in the primary care setting. It could also be equally effectively used to prevent symptomatic or severe disease among high-risk contact clusters traced during an outbreak. It is extremely cost-effective, making it suitable for low- and middle-income countries, even when vaccines or therapeutic drugs may be too costly to afford. Lastly, the use of DMB may be equally effective in other viral infections that also produce high levels of cytokines and thus cause injury independent of the direct tissue injury. The small sample size and absence of biologic assays to support the clinical improvement in the study cohort are limitations. However, the authors conclude, “It is a proof-of-principle effort with very promising results. Our findings would need to be further validated in a well-designed randomized study.” *Important Notice medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information. To read the original article click here.

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New Study Links Vitamin C Therapy to Better Survival Rates After Sepsis

AHA Publisher — Sat, 21 Mar 2020 07:00:47 +0000

Virginia Commonwealth University via EurekAlert – Exploratory 3-year study finds that treating septic patients with intravenous vitamin C could lead to decreased mortality, quicker recovery. New research led by Virginia Commonwealth University and published in the October issue of the Journal of the American Medical Association suggests that patients with sepsis and septic lung injury could have a better chance of survival and recover more quickly when treated with vitamin C infusions. Up to 300,000 deaths reported each year Sepsis, a bodywide inflammation in response to infection, is a leading cause of death in U.S. hospitals, with up to 300,000 deaths reported each year, according to the National Institute of General Medical Sciences. Researchers discovered that intravenous vitamin C therapy reduced mortality in septic patients from 46% in the placebo group to almost 30% in the vitamin C group at day 28. “This therapy could potentially transform the way we care for sepsis patients. We may have found a lifesaving therapy,” said first author Alpha A. “Berry” Fowler III, M.D., a professor in the Division of Pulmonary Disease and Critical Care Medicine in the Department of Internal Medicine at the VCU School of Medicine. “While further research is needed, the results from our preliminary study are encouraging.” Designed to study the effect of vitamin C on organ failure, a common complication of sepsis that often leads to death, the CITRIS-ALI trial showed that patients receiving intravenous vitamin C spent significantly fewer days in the intensive care unit and in the hospital overall. “We conducted this phase II, proof-of-concept trial to explore if vitamin C is a more effective therapy for organ failure than the current standard of care for sepsis,” Fowler said. “We did not find evidence that vitamin C improves sepsis-related organ failure in this particular trial, but it significantly reduced how long patients were hospitalized.” On average, the vitamin C group spent three fewer days in the ICU (seven days compared to 10) at day 28 and a week less in the hospital overall (15 days versus 22) by day 60 than the placebo group. Sepsis is a major contributor to disability, death and health care costs Sepsis is a major contributor to disability, death and health care costs in the U.S. and worldwide. Patients with sepsis accounted for $23.7 billion in U.S. hospital costs in 2013 alone, according to the Agency for Healthcare Research and Quality. “Taking care of a septic patient in the ICU costs tens of thousands of dollars each day,” Fowler said. “Improving clinical outcomes for sepsis means significant cost savings for the U.S. health care industry.” A $3.2 million National Institutes of Health grant funded the clinical trial that involved 167 patients across seven enrollment sites, including the Cleveland Clinic, the Medical College of Wisconsin, the University of Kentucky and Emory University. It was the first randomized, double-blind, placebo-controlled multicenter trial related to vitamin C and its potential impact on sepsis and acute respiratory distress syndrome, a lung disease often associated with sepsis worldwide. The study was conducted from September 2014 to November 2017. “Imagine two fully loaded 747s crashing every day — that’s how many people die of sepsis every year in this country,” Fowler said. “The CITRIS-ALI trial could form the basis for a larger, more definitive trial.” To read the original article click here.

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Study looks at Lung Injury and Vaping THC and Vitamin E Acetate

AHA Publisher — Sun, 15 Mar 2020 07:00:39 +0000

Dr. Liji Thomas, MD via News-Medical Net – The US has witnessed a spate of patients presenting with acute lung injury associated with e-cigarettes or vaping product use. A new study published in the journal JAMA Internal Medicine shows the pattern of the outbreak in California where recreational cannabis use is legal and which has among the maximum cases of the strange illness. Vaping is the practice of using electronic or e-cigarettes, which has exploded into prominence among the younger generation in the US. The basic principle is the heating of the liquid within the device’s canister to produce an aerosol that is then inhaled. The fluids may contain one or more of a variety of ingredients, including nicotine, various cannabis constituents, flavorings, and other chemicals. The chief danger of vaping is the lack of regulation.From August 2019 to date, over 2,700 patients have been reported with e-cigarette, or vaping, associated lung injury (EVALI) in all the states of the US. The Study The investigators used data on 160 patients admitted in hospital with EVALI between August 7 and November 8, 2019. The patient data came from treating doctors who reported them to the local health department, which in turn transmitted the information to the California Department of Public Health. The data included epidemiologic and laboratory data on the patients, who underwent interviews based on a standard format. The questions assessed the types of vaping products used, how often they were used, and how the patients acquired them. The vaping products provided for investigation by some of the patients also underwent testing for active ingredients. The Results The investigators found that among 160 patients with EVALI of whom approximately 60% were male, with a median age of 27 years, about half received intensive care, and a little less than a third had to be put on mechanical ventilation. Four of them died in hospital. Of the 160 patients, 86 were subject to interview. Among this group, 83% said they vaped products containing tetrahydrocannabinol (THC), which is the psychoactive component of cannabis. 43% had vaped products containing cannabidiol (CBD), another principal constituent of the same plant. 47% had vaped products containing nicotine. Of the 87 products that showed only the presence of THC, over 90% were prefilled cartridges but only 48% of nicotine-only cartridges. Where did they get the products from? 75% of them had got their THC-containing vaping products from friends, unlicensed vendors, and other informal sources. 87 vaping products tested were obtained from only 24 of the 160 patients. The results showed that 56% had THC. 84% of this subset had vitamin E or vitamin E acetate, but none of the nicotine-containing subset. Flavorings were added to 56% and 76% of the THC- and nicotine-containing products, respectively. The median period from the last use of the vaping product to the onset of EVALI symptoms and hospital admission was 3 and 5 days, respectively. About 40% had smoked or were smoking conventional cigarettes as well. Common symptoms included cough, shortness of breath, and fever with chills, besides one or more gut symptoms. Laboratory criteria of intense inflammation were present. Implications The pattern of use of vaping product by type, as well as the clinical features of the patients, were broadly similar to the overall trends seen in other US states. It is noteworthy that though California permits the recreational use of cannabis by adults, most of the THC-containing products came from informal sources. The authors emphasize, “These findings underscore the importance for all clinicians, including outpatient health care providers, to consider EVALI in patients with a history of vaping who present with typical findings of infection, as well as monitor their clinical course and respiratory status closely for decompensation, in accordance with CDC guidance.” Secondly, more female than male patients seemed to require ICU admission, suggesting that females fare worse on exposure to tobacco smoke and other environmental toxins. Thirdly, depression, and anxiety are the most common illnesses found in patients with EVALI in California, which could indicate that such patients vape at higher rates or that such patients are at higher risk of EVALI. Again, vitamin E or vitamin E acetate proved to be present in most products containing THC. The study concludes, “The California Department of Public Health recommends that individuals refrain from using any vaping or e-cigarette products, particularly THC-containing products from informal sources, while this investigation is ongoing.” To read the original article click here.

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