Monday, May 04, 2020

The importance of performing Autopsies in COVID19 Deaths

https://consultqd.clevelandclinic.org/lessons-from-two-covid-19-autopsies/

The importance of performing Autopsies in COVID19 Deaths

If the main cause of death in COVID-19 is DIC and not Respiratory failure we will have to totally rethink the treatment plans.

Lessons from Two COVID-19 Autopsies

COVID-19 Autopsies, Oklahoma, USA

Lisa M Barton, MD, PhD, Eric J Duval, DO, Edana Stroberg, DO, Subha Ghosh, MD, Sanjay Mukhopadhyay, MD

American Journal of Clinical Pathology, aqaa062, https://doi.org/10.1093/ajcp/aqaa062

Published:

10 April 2020

Characteristics of patients who died positive for SARS-CoV-2 infection in Italy

English

The report on the characteristics of COVID-19 positive deceased patients in Italy is published on this page on Friday.

The report " Impact of the COVID-19 epidemic on the total mortality of the resident population in the first quarter of 2020 " is online (pdf 1.4 Mb) produced by ISS and ISTAT to provide an integrated reading of the epidemiological data of the spread of the COVID epidemic- 19 and of the total mortality data acquired and validated by ISTAT. This is the first time that Istat has disseminated this information referring to such a large number of municipalities. The large database, covering 86% of the population residing in Italy, allows to evaluate the effects of the impact of the spread of Covid-19 on the total mortality by gender and age in the initial period and the most rapid spread of the infection: March 2020.

Report on the characteristics of patients who died positive for SARS-CoV-2 infection in Italy

April 29, 2020 update

Weekly infographic “ Characteristics of patients who died positive from SARS-CoV-2 infection in Italy. Data as of April 29, 2020 "(pdf 132 kb)
report in English " Characteristics of COVID-19 patients dying in Italy Report based on available data on April 29th, 2020 " (pdf 182 kb)

Report index

1. Champion

The analysis is based on a sample of 25,452 patients who died and were positive for SARS-CoV-2 infection in Italy.

2. Demographic data

The mean age of the deceased and SARS-CoV-2 positive patients is 79 years (median 81, range 0-100, InterQuartile Range - IQR 73-87). There are 9684 women (38.0%). The median age of SARS-CoV-2 positive deceased patients is more than 15 years higher than that of patients who contracted the infection (median age: patients who died 81 years - patients with infection 62 years). The figure shows the number of deaths by age group. Women who died after contracting SARS-CoV-2 infection are older than men (median ages: women 84 - men 79).

3. Pre-existing pathologies

The graph presents the most common pre-existing chronic pathologies (diagnosed before contracting SARS-CoV-2 infection) in deceased patients. This figure was obtained from 2351 deceased for whom it was possible to analyze the medical records. The average number of pathologies observed in this population is 3.3 (median 3, Standard Deviation 1.9). Overall, 90 patients (3.8% of the sample) had 0 pathologies, 340 (14.5%) had 1 pathology, 504 (21.4%) had 2 pathologies and 1417 (60.3%) had 3 or more pathologies . Prior to hospitalization, 24% of patients who died positive for SARS-CoV-2 infection followed ACE inhibitor therapy and 16% treated with Sartani (angiotensin receptor blockers). In women (n = 764) the average number of pathologies observed is 3.4 (median 3, Standard Deviation 1.9); in men (n = 1587) the average number of pathologies observed is 3.2 (median 3, Standard Deviation 1.9).

4. Hospitalization diagnosis

In 92.5% of hospitalization diagnoses conditions (e.g. pneumonia, respiratory failure) or symptoms (e.g. fever, dyspnoea, cough) compatible with COVID-19 were mentioned. In 166 cases (7.5% of cases) the diagnosis of hospitalization was not related to the infection. In 17 cases, the diagnosis of hospitalization concerned exclusively neoplastic pathologies, in 68 cases cardiovascular pathologies (for example acute myocardial infarction, heart failure, stroke), in 23 cases gastrointestinal pathologies (for example cholecystitis, intestinal perforation, intestinal obstruction, cirrhosis), in 58 cases other pathologies.

5. Symptoms

The graph shows the symptoms most commonly observed prior to hospitalization in patients who died positive for SARS-CoV-2 infection. Dyspnoea fever and cough are the most common symptoms. Less frequent are diarrhea and hemoptysis. 6.0% of people had no symptoms at the time of hospitalization.

6. Complications

Respiratory failure was the most commonly observed complication in this sample (97.1% of cases), followed by acute kidney injury (23.3%), superinfection (12.6%) and acute myocardial injury (10.9 %).

7. Therapies

Antibiotic therapy has been commonly used during hospitalization (85% of cases), less used antiviral therapy (57%), more rarely steroid therapy (37%). The common use of antibiotic therapy can be explained by the presence of superinfections or is compatible with the beginning of empirical therapy in patients with pneumonia, pending laboratory confirmation of COVID-19. In 486 cases (21.0%) all three therapies were used. Tocilizumab was administered to 4.4% of patients who died positive for SARS-CoV-2 infection.

8. Times

The figure shows the median times (in days) that pass from the onset of symptoms to death (10 days), from the onset of symptoms to hospitalization (5 days) and from hospitalization to death (5 days). The time from hospitalization to death is 3 days longer in those who have been transferred to intensive care than those who have not been transferred (8 days versus 5 days).

9. Deaths in patients under 50 years of age

As of April 29, 284 of the 25,452 (1.1%) positive SARS-CoV-2 patients who died under the age of 50 years. In particular, 59 of these were less than 40 years old (39 men and 20 women aged between 0 and 39). Of 9 patients under the age of 40 years, no clinical information is available, the other 40 had serious pre-existing diseases (cardiovascular, renal, psychiatric, diabetes, obesity) and 10 had no diagnosed significant diseases.

Based on the indications issued by the Ministry of Health in the Circular published on 25 February 2020 (protocol 0005889-25 / 02/2020), the certification of death due to COVID-19 must be accompanied by the opinion of the Istituto Superiore di Sanità (ISS ). For this reason, a working group was created to study the causes of death of deceased patients who tested positive for SARS-CoV-2 infection.

The analysis is based on the data contained in the ISTAT medical records and death cards containing the causes of death of these patients. Data collection takes place via the web platform http://covid-19.iss.it , already used by national, epidemiological and virological surveillance of COVID-19 cases in Italy (coordinated by the ISS and activated by the Ministerial Circular of 22 January 2020, n.1997).

For information, you can send an e-mail to the e-mail address decessicovid-19@iss.it or contact dr. Graziano Onder (Director of the Department of Cardiovascular, Endocrine Metabolic and Aging, ISS) at the telephone number: 06/49904231.

Useful resources

Circular 0005889-25 / 02/2020 (pdf 200 kb) published by the Ministry of Health on February 25, 2020
the EpiCentro page dedicated to national , epidemiological and virological surveillance of COVID-19 cases in Italy

HOME
HOAX
"COVID 19, HE IS NOT THE KILLER: THE WRONG DIAGNOSIS THAT HAS BROUGHT THE WORLD TO ITS KNEES"

"Covid 19, he is not the killer: the wrong diagnosis that has brought the world to its knees"

by Luca Mastinu | April 27, 2020

We had already talked about it on April 11, but in an article published on April 21 the CityweekNapoli website re-launched the news of the "wrong diagnosis" on COVID-19. "He is not the killer" , the authors write, and refer to the alleged cardiologist of Pavia who would have discovered that the cause of the deaths of this historical context would not be attributable to respiratory problems, but to cardiovascular complications .

A news born on WhatsApp, shared on Facebook and then taken up by the clickbait sites

The name is not mentioned for this cardiologist, but in a highly shared post on Facebook we find all the general information. We present below the text of the post compulsively shared, which also has a certain precedent on WhatsApp:

CORONAVIRUS DEATH
Published by Prof.
S ***** G ********
Pavia cardiologist :
People go to resuscitation for generalized venous thromboembolism , especially pulmonary.
If this were the case, resuscitations and intubations are of no use because first of all you have to dissolve, indeed prevent these thromboembolisms. If you ventilate a lung where blood does not reach, it is not needed! In fact, 9 out of 10 die. Because the problem is cardiovascular, not respiratory ! It is venous microthrombosis, not pneumonia that determines fatality!
And why are thrombi formed? Because inflammation, as per school text, induces thrombosis through a complex but well-known pathophysiological mechanism.
Then? What scientific literature, especially Chinese, said until mid-March was that anti-inflammatories should not be used. Now in Italy anti-inflammatories and antibiotics are used (as in the influences) and the number of inpatients collapses.
Many deaths, even 40 years old, had a history of high fever for 10-15 days that was not treated properly. Here the inflammation destroyed everything and prepared the ground for the formation of thrombi. Because the main problem is not the virus, but the immune reaction that destroys the cells where the virus enters. In fact, our COVID departments have never entered patients with rheumatoid arthritis! Because I'm on cortisone therapy.
This is the main reason why hospitalizations in Italy are decreasing and it is becoming a curable disease at home.
By taking care of her well at home, you avoid not only hospitalization, but also the thrombotic risk.
It was not easy to understand it because the signs of microembolism have faded, even at the echocardium.
But this we have compared the data of the first 50 patients between those who breathe badly and those who do not and the situation has appeared very clear.
For me it could go back to normal life and reopen business. Quarantine street.
Not now. But time to publish this data. The vaccine can come slowly.
In America and other states that follow scientific literature calling for NOT to use anti-inflammatories is a disaster! Worse than in Italy.
And let's talk about old and cheap drugs. "
The colleague's testimony appears to be confirmed by the protocols of some other hospitals:
al Sacco give Clexane to everyone, with predictive D-dimer: the higher it is, the less the patient will respond.
at San Gerardo of Monza Clexane and cortisone
at Sant'Orsola in Bologna Clexane to all + protocol shared with family doctors who prescribe Plaquenil rain on all pcs. monosymptomatic at home
Intact with a clarification on anti-inflammatories:
COX 2 production increased in viral target tissues from patients with active viral infection and cox2 deletion has been shown to reduce mortality, while cox1 deletion is associated with worsening infection
So anti-inflammatory drugs like Brufen, naproxen, aspirin that inhibit cox1 as well as Cox 2 should not be used,
While celecoxib a selective Cox 2 inhibitor seems to give good results, we still have to wait for the outcome of studies, however this analysis highlights the need to use a high dose low molecular weight heparin in the most advanced stages of the disease ... (Clexane 8,000 IU / day)
testimony of an anatomo-pathologist: just think that the "Pope Giovanni XXIII" of Bergamo performed 50 autopsies and the "Sacco" of Milan 20 (the Italian one is the highest case record in the world, the Chinese have made only 3 and "Minimally invasive"). Everything that comes out seems to fully confirm the above information.
In a nutshell, it appears that the exit is determined by a DIC (for non-doctors, Disseminated Intravascular Coagulation) triggered by the virus. So interstitial pneumonia would have nothing to do with it, it would have been only a diagnostic mistake : we doubled the number of resuscitation places, with exorbitant costs, probably unnecessarily.
In hindsight, I have to rethink all those Chest Rxs we commented about a month ago: those images that were interpreted as interstitial pneumonia could actually be completely consistent with a DIC.
It will be interesting now (once all this new information has been confirmed) to check whether there will be a "political will" to receive it from the institutions .
It could mean leaving this mess in four and four times, taking away a lot of broken parts (masks, tracking apps , queues at shops, etc. etc.).
Unfortunately I have some doubts about it ..

It is well known and logical that an expert who is sure of what he says would not seek fame on social networks but would contact the institutions to ensure that his actions and words are not in vain attempts, because a discovery cannot be reduced to sharing on social networks by users who have no scientific knowledge.

The denial of the person concerned

Above all, our experience in fact-checking teaches us that a word attributed to a person and shared compulsively requires verification with the person directly concerned. For this reason, in the verification phases of our previous article published on 11 April 2020, we had contacted the cardiologist mentioned in the viral letter. The person concerned had told us that he was not a cardiologist and above all that he had never written those words .

To know the full text of the denial letter, please read our previous article at this address . Moreover, the same content had been contested by Roberto Burioni on MedicalFacts on the same April 11 : "A stupidity of immense proportions" , and moreover the same doctor we had contacted had strongly contested the words reported in the viral content .

A weeks-old hoax that, however, does not stop finding blood "thanks" to its publication on new sources that create clickbait titles. Talking about "wrong diagnosis" on the basis of a viral content denied by the same doctor to whom it is attributed means falling back into the temptations of a hoax .

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"Why did the US (NIH) in 2014 give $598,500, to the Wuhan Lab in China?

"Why did the US (NIH) in 2017 give $3.7m to the Wuhan Lab in China? Such grants were prohibited in 2014. Did Pres. Obama grant an exception?"

this was tweeted by

Rudy W. Giuliani

Read the fact check by politifact

why did he tweet this info which was false? just to blame the Obama administration?

May be this idiot did not know such grants were still on and were stopped only in MAY 2020

The Trump administration has pulled funding for a group of scientists studying coronaviruses in bats and the risk of their spillover into humans -- the very kind of infection that started the COVID-19 pandemic -- according to EcoHealth Alliance, the New York-based nonprofit organization conducting the research.

The cancellation of the grant after more than a decade of work in this field seems to be tied to EcoHealth Alliance's partnership with the Wuhan Institute of Virology, the biomedical lab at the heart of conspiracy theories that the Chinese government created or unleashed the virus or the unproven thesis that the outbreak started with an accident because of faulty safety standards in the lab.

Either way, the group expressed regret at the decision by the National Institutes of Health to terminate funding, saying its work has helped in "designing vaccines and drugs to protect us from COVID-19 and other coronavirus threats" and pointing out the Wuhan Institute's participation had been approved by the NIH for years, including just last year under President Donald Trump.

@RudyGiuliani

US, Canada have funded Chinese lab eyed as likely source of coronavirus outbreak

APRIL 16, 2020 BY TYLER OLSON

Get all the latest news on coronavirus and more delivered daily to your inbox. Sign up here.

Both the United States and Canada have sent money to the Wuhan Institute of Virology, the Chinese lab that multiple sources tell Fox News is suspected of being the likely source of the coronavirus pandemic — with the Canadian funding coming as recently as last month.

Fox News reported Wednesday that, according to sources, there is increasing confidence the novel coronavirus likely escaped from the Wuhan laboratory, where it was being studied, with a worker spreading it to the larger population.

CORONAVIRUS: WHAT TO KNOW

In a news release from early March, the Canadian Institutes of Health Research announced millions in funding to research and develop tools such as vaccines and tests to combat the coronavirus. One project that got $828,046 from the agency was aimed at developing a rapid coronavirus test “using isothermal amplification and CRISPR technology.” Among the organizations on the project was the Wuhan Institute of Virology.

“The collaborative research is conducted by a multi-disciplinary team of virologists, chemists, infectious disease specialists, front-line practitioners, and public health researchers from the University of Alberta, Canadian Food Inspection Agency, and Wuhan Institute of Virology (China),” a backgrounder detailing where the Canadian government’s grant money was going reads. “Our team members in Wuhan who currently perform the standard diagnostic tests will lead this effort.”

Sunday, April 26, 2020

Iboga and Ibogaine in the Context of Psychedelic Commercialization

Expanding Ancestral Knowledge Beyond the Sale of Molecules: Iboga and Ibogaine in the Context of Psychedelic Commercialization

Written by Ricard Faura, Ph.D, Andrea Langlois, and José Carlos Bouso, Ph.D.

MAPS Bulletin Spring 2020: Vol. 30, No. 1

Download this article.

From Gabon to all corners of the globe, practices with iboga and ibogaine are rapidly expanding. With this expansion, several important considerations arise, particularly around what happens when two seemingly disparate worlds collide: the world of traditional healing systems and the Western world that is hopeful for solutions to the problems of addiction and social and spiritual dislocation. Like all liminal spaces, this encounter is not always comfortable. ICEERS (the International Center for Ethnobotanical Education, Research and Service) has been working within this space for over a decade and we propose that it is full of opportunity—the opportunity to move beyond seeing traditional psychoactive plant medicines as molecules commodities and towards a sophisticated engagement with bio-cultural knowledge systems in service to a true revolution in mental health care.

Background

Tabernanthe iboga, or simply Iboga, is a shrub from the Apocynaceae family native to Central Africa and its root bark is considered a spiritual sacrament among the Bwiti who use it in initiatory and healing rituals. Iboga was used for centuries among Bantou communities of Gabon and was likely practiced among Pygmies in earlier times. Importantly, in its original context, iboga is considered a spiritual and community “binding” tool.

iboga plant

Iboga plant in Ebieng, Ogooue-Ivindo province, Gabon, 2019

Ibogaine, an alkaloid found in Tabernanthe iboga, is being extracted for use in therapeutic and psychospiritual contexts outside of Africa. As with other psychoactive plants and fungi, such as psilocybin, these molecules are being extracted both literally and metaphorically from their original biocultural ecosystems and developed as products for the international pharmaceutical market. This phenomenon presents a clash between traditional stewardship of complex social systems and the commercialization of molecules disconnected from traditional wisdom. As with the growing interest in psychedelic pharmacology, the production and marketing of iboga and ibogaine is generally embedded within the biomedical approach that prevails in the scientific and commercial models of the Global North.

Sustainability, a Growing Concern

As with other psychoactive plants, the legal context for iboga and ibogaine internationally adds complexity. It is currently illegal in 10 countries (the U.S. and nine European countries, namely, Belgium, Denmark, France, Hungary, Ireland, Italy, Norway, Switzerland, and Sweden); there are three countries where it is regulated (Australia, Israel, and Canada); and three more countries where it is legal as a prescription pharmaceutical substance, under “compassionate use,” or extended access (New Zealand, South Africa, and Brazil).The most concerning issue arising from an unregulated market for both iboga and ibogaine (typically extracted from Tabernanthe iboga) is that of plant sustainability. In a recent engagement project led by ICEERS (iceers.org/ibogareport), respondents reported that iboga in the wild is on the brink of being endangered, primarily due to improper harvesting and poaching. The Union for Conservation of Nature’s Red List of Threatened Species has listed Tabernanthe iboga as a plant of concern, however not as endangered. Further, in February 2019, the Gabonese government halted all exports, stating concerns for the sustainability of the plant.

Iboga plant nursery, Woleu-Ntem province, Gabon, 2019

A recent promising development is that there are community associations are starting to cultivate iboga for sale within a regulated international market, however they are still awaiting export permits from the Government of Gabon. One such project has been initiated by the community association Ebyeng-Edzuameniene (A2E, located in a community forest in the province of Ogooue-Ivindo near Makokou) that is receiving support from the organization Blessings of the Forest.

However, despite these measures, international black-market sales are putting pressure on the plant and its ecosystems as well as on the indigenous communities who are having increasing difficulties accessing root bark. Participants in our initiative also warned about the poor reliability of many vendors, who may in fact be distributing impure products with low levels of (or no) alkaloid content, fake iboga, or iboga that has been adulterated.

Ancestral Wisdom As a Cure for Extractivist Mindsets

The opioid epidemic in North America has increased the interest in ibogaine by media and investors. Currently, ibogaine therapy is inaccessible due to cost and there is inconsistency in the quality of treatments available, resulting in risks for patients. In the West, addiction is seen through the lens of disease, overlooking its social and cultural roots. Ibogaine is presented as the “magic pill” cure for addiction, seeking to “fix” the person without regard for the illness located within social systems. Extracting ibogaine from iboga and the traditional wisdom that has held it for generations results in a significant loss, as does the extraction of ibogaine from iboga without regard for reciprocity with the peoples and ecosystems at the source. Commercialization and medicalization of psychedelics rarely take an ecosystems-based approach.

In Gabonese Bwiti traditions, rituals are enacted with the intention of creating harmony. When someone is struggling (i.e., is unwell or disconnected), the community seeks to re-integrate them. In this world view, no problem is strictly individual but rather is connected to the community in the broadest sense (which includes the natural and spirit worlds). Therefore, the community does not marginalize the community member but rather supports healing through complex collective rituals. Iboga is not at the center, but rather is part of the whole.

Hence, beyond the intrinsic value that any molecular compound present in sacred plants have, this holistic approach places the experience within a broader social and spiritual context. The result is the integration of everyone into the community, which is perhaps the greatest contribution of these generations-old approaches. This holistic view is absent in the dominant biomedical approach to the commercialization of “promising new products” within psychedelic pharmacology.

Bwiti ceremony in Gabon. This is a Nzame Fang, which is a syncretic Bwiti-Christian rite, conducted the Ebieng community, in the Ogooue-Ivindo province, close to Makokou, Gabon, 2019

The World Health Organization’s Global Mental Health (GMH) approach posits that people have the right to access evidence and human rights-based care. GMH advocates suggest that traditional practices based on community-perspectives are important in addressing growing mental illness epidemics. Yet current application of this framework seeks to apply models from the Global North to the Global South—models for mental healthcare such as the wide application of pharmaceuticals that haven’t proved effective, perhaps because mental health is conceived as an individual problem originating in a person’s brain.

The lack of evidence for the effectiveness of iboga and ibogaine in supporting healing has presented a tremendous barrier for how this medicine can be incorporated into models for mental health and addictions treatments. ICEERS is involved in two of the first ibogaine clinical trials (one for alcoholism and one for methadone dependency), research that provides an opportunity to explore how to situate clinical evidence within a larger framework that incorporates perspectives on community health.

Traditional practices work from a community perspective, so rather than exporting ineffective therapies, an optimal future for Global Mental Health could incorporate the wisdom from traditional healers, community-based models, and clinical research. This type of approach could also serve to shift the commodity-based approach and inform a new standard of reciprocity within business models, wherein those at the source also benefit and sustainability for the plants is ensured.

In closing, rather than narrowly focusing on molecules found in traditionally-used plants, a true revolution in mental health care may be possible if we expand our vision—looking beyond the molecules and even the plants themselves and seeing the interconnected social and cultural elements of traditional knowledge and nature and their potential for supporting individual, community, and planetary healing.

liana

Ricard Faura holds a Ph.D. in social psychology and a Master’s Degree in social anthropology. He is an international project developer and evaluator, and an associate professor at the Open University of Catalonia (UOC). He is currently the Coordinator of the Iboga/ine Community Engagement Initiative for the International Centre for Ethnobotanical Education, Research, and Service (ICEERS), where he’s been engaging with many African and International perspectives and voices to create a powerful opportunity for influencing how iboga and ibogaine are globalizing, bridging perspectives and strengthening intercultural connections between local, African stakeholders and the global iboga/ine community.

kat

Andrea Langlois is the director of engagement at the International Centre for Ethnobotanical Education, Research, and Service (ICEERS). Andrea is passionate about dialogue, social movements, community engagement, Indigenous rights, Amazonian conservation, and plant medicine. She holds a Master’s Degree in Media Studies from Concordia University in Montreal and a BA in Women’s Studies from the University of Victoria. Prior to joining ICEERS, Andrea worked for over a decade in the harm reduction, drug policy, and HIV/AIDS sector. She is co-lead of the Iboga/ine Community Engagement Initiative at ICEERS.

kat

Jose Carlos Bouso is a psychologist and has a PhD in Pharmacology. He has been the Scientific Director at International Centre for Ethnobotanical Education, Research, and Service (ICEERS) since 2012, where he oversees research on ayahuasca, ibogaine and cannabis. He is the co-Principal Investigator of the first clinical trial assessing the safety and efficacy of ibogaine in the treatment of methadone dependence. His main area of research now is studying the role of traditional medicines involving psychoactive plants through the lens of Global Mental Health.

March madness

Tens of thousands of students flocked to South Florida and other warm-weather destinations for their spring break, ignoring calls from officials to help “flatten the curve” by practicing social distancing and staying at home.

Florida Gov. Ron DeSantis refused to shut down the state’s beaches last week, despite warnings from public health officials that there’s a unique risk of the coronavirus spreading in Florida, where 27 percent of the population is over the age of 60, and several people have already died. Florida’s state parks, including beaches, finally closed on Monday.