Dear all,
In the current pandemic without any effective approach, should biological plausibility and mechanistic approaches exceptionally have larger space to be attempted in clinical practice? Perhaps yes.
The publication of preprint becomes particular relevant for a collective building of ideas to overcome Covid-19, once publications have some barriers and may delay some potential solutions. In this peculiar moment, will researches have to analyze whether the data from a pre-print is relevant and reliable for utilization? Perhaps. In this context, preprints are possibly the most important part of the recently released community.
However, given the broad field that the topic "Covid-19" encompasses, since it covers from therapeutical approaches to political solutions, preprints and forums should perhaps be divided into sub-topics, including: 1. Novel potential risk factors; 2. Potential beneficial therapeutics; 3. Targets in Covid-19; 4. Effectiveness of preventive approaches; 5. Health politics behind the pandemic; 6. Previously unidentified clinical and biochemical manifestations; and others. I do not think there is nothing irrelevant at all. However, featuring papers according to their potential relevance is an effective effort to provide readers the most useful pieces of papers to read and help them build up hypotheses.
With regards to the paper I authored (attached in the community and also in my profile), considering the urgency of the current pandemic, the massive amount of deaths, and the indisputable correlation with hypertension, likely linked to the use of ACE2i/ARB, perhaps the publication of a short communications /correspondence proposing the hypothesis of switching to spironolactone could be helpful for refractory severe patients without other options (particularly because hydroxychloroquine and chloroquine will not be promptly and sufficiently available, and because these drugs have contraindications and potential severe harms). From an ethical perspective, since spironolactone is an old and largely safe drug, and in the absence of other options, I do not see any concern.
In case this piece of information is used to switch the antihypertensive therapy on critical refractory patients with Covid-19, Its successfulness could be reported, regardless of the response. In this regard, an additional topic of "successful experiences" may call attention in case different centers are equally successful implementing a certain therapeutic, which the concordant observation may strengthen hypothesis to be further tested. I am not a big fan of this approach, but in this particular moment it seems more than necessary.
And of course there will be some further retractions, but the risk of having papers being published should be reweighed for the disclosure of the maximum amount of information, and as I previously said, researchers and clinicians should adopt a more active role when reading these papers - and the same is applicable for preprints.
Sorry for writing too much - just wanted to expose some ideas that I haven't found at or at least not spread out there.
Flavio Cadegiani
Concerning the medical humanities and evolutionary biology, it is essential to understand Covid19 in terms of social anthropology. Medical reductionism will not be able to solve this global health issue alone.
Article Acquired Long QT Syndrome: A Review of the Literature
This review discusses the points I outline below.
A note of caution.
Several medications that have been recommended for the treatment of Covid-19 based on mechanistic probability are associated with prolongation of the QTc interval and therefore torsade de pointes and sudden cardiac death.
The evidence of the potential benefit of chloroquine and hydroxychloroquine in the treatment of Covid-19 is increasing.
Other medications which may be used in this cohort include the macrolide antibiotics (e.g. azithromycin). These can also prolong the QTc interval. Administering several medications that may prolong the QT interval is associated with a high risk of complications.
Article Acquired Long QT Syndrome: A Review of the Literature
In medicine risks and benefits must be balanced. Safety netting is important whenever there is a great potential benefit but also a very significant risk. In that context QTc intervals, renal and liver function must be monitored closely in patients treated with chloroquine and or macrolides. They should probably not be started if the baseline QTc is more than 450 ms. It should probably be stopped if the QTc increases 25% above baseline. It should definitely be stopped if QTc is above 500 ms. This is an evolving situation and recommendations may change as the potential risks and benefits become clearer.
Beta-blockade is used in the treatment of congenital and acquired long QT syndrome, so may be beneficial in this setting.
Concerning the medical humanities and evolutionary biology, it is essential to understand Covid19 in terms of social anthropology. Medical reductionism will not be able to solve this global health issue alone.
It might be worth trying to understand Covid 19 as manifesting separate effects according to cultural conditions rather than just one single entity. Its effects on Europe appear different to elsewhere and should it manifest in Africa again the effects will be different and be conditioned by cultural forms. Also the virus' affects on different cultures will change it produces further strategies as the virus visits again.
The déconfinement will be a great challenge for most governments. Acceptability will be a major source of discussion...
- Badges
- Science topic
- Similar topics
- Papers