The answer seems to be a clear “NO”
Older age and being male is bad… associated with significantly worse clinical outcomes.
Covid19 and blood types does it matter??
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Covid19 vaccination programs in Healthcare workers
Vaccination against the Covid19 virus in HC workers has shown clear lovering of incidence already 2 weeks after the first vaccination.
1. In a hospital in Texas infections occurred in 2.5% of nonvacc 1.8% in partially vacc and 0.05 in fully vacc. employees.
2. Of 28.000 receiving 2 doses only 0.05 tested positive over 8 days after the second vacc.
3. In Israel infections began to drop after 2 weeks from 1. vacc. This reduction occurred even though the B.1.1.7 variant was around. A very important issue.
Allergic reactions to Covid vaccines
CDC report on anaphylaxis (serious allergic reaction) when two vaccines were given:
Pfizer-Biontech 2 million first doses: adverse reactions 0,2%.
21 cases of anaphylaxis occurred, 90% in women, median age 40. Onset within 13 minutes and 71% within 15 min. 14% within 30 min and 14% after 30 min. No deaths.
Moderna vaccine had 10 cases of anaphylaxis among 4 mill receiving first dose. Mostly within 15 min.
Other allergic reactions were similar in the two groups.
Reference: Journal Watch march 2021
Oxygen treatment in acutely ill patients
Medical directives keep changing and this new rec. which is discussed in BMJ is certainly one which causes raised eyebrows…
New guidelines recommend that acutely ill patients requiring supplemental oxygen therapy
maintain peripheral capillary oxygen saturation levels (SpO2) of 96% or less (strong recommendation).
Higher levels have been linked to elevated mortality risk.
The guidelines, written by an expert panel and published in The BMJ, note that the ideal upper limit may be closer to 94%.
Among the recommendations for patients with acute stroke or myocardial infarction:
• The panel suggests not starting oxygen when SpO2 is between 90% and 92%, as it may not be beneficial (weak recommendation).
• Supplemental oxygen shouldn’t be started at or above 93% saturation (strong recommendation).
• The panel writes that there are “probably no benefits to initiating oxygen therapy when SpO2 is >92%, and it may cause harm.”
Low back and radicular pain: is treatment futile?
“New guidelines, several meta-analyses and a few new studies show that neither medication nor nonpharmacologic approaches confer much benefit” (JWatch.org jan 2018)
A few studies have been done on Gabapentin and Pregabalin for back pain with radicular pain and not been found to have any effect. One study with Pregabalin titrated to 600mg and continued for 8 weeks was ineffective. It had the same effect as “sugar” pills.
Six studies of gabapentin versus placebo or pregabalin against another analgesic in pat. with LBP (about 500 pat) showed no clinically meaningful benefits and substantial side effects.
Diazepam as extra medication in 114 pat. w LBP who were given naproxen did not improve pain or function at 1 week.
NSAIDS (ex. naproxen, ibuprofen) have also been in the storm of questioning their effect and shown to have only modest effect in LBP w/wo radicular pain. One would need to treat 6 patients for 1 to have benefit.
Nonpharmacological treatments:
1. intradiscal steroids in pat. w MRI evidence of vertebral endplate inflammation: after 1 mo some improvement, after 3 mo worse, after 12 mo no difference.
2. Radiofrequency denervation for pat. w pain from facet joints, SI joints or intervert discs showed no incremental benefit when added to typical exercise therapy.
3. Spinal manipulation a meta analysis of 26 randomised trials for acute LBP showed statistically significant but modest benefit að 6 weeks with a high frequency of moderate side effects.
So: drugs dont work, injections and denervations dont work, manipulation seems to help a little bit but you pay a considerable sum of money and waste time doing repeated manipulations.
It may be considered a relief that you dont need to take any medication, you dont need to go to the doctor, physiotherapist or chiropractor, you just wait for a few weeks knowing that there is sound reason to expect spontaneous recovery.
If the back pain is chronic, which indeed is a very common condition; medication with pain medication is not advisable as the risk of addiction is considerable and the effect is small according to research.
Note: these are not to be considered guidelines for every back pain situation!
Spring is near and so follow pollen allergies
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Guidelines from 2017 joint task force of Practice Parameters
“for initial treatment in adolescents and adults age over 12 monotherapy with an intranasal steroid is preferred: combining it with an oral antihistamine confers no additional benefit”
For moderate to severe allergic rhinitis, adding an intranasal antihistamine to an intranasal steroid can be beneficial.
An intranasal corticosteroid if used regularly is the most effective treatment for all allergic rhinitis symptoms
Oral therapy for new onset DM2 with high blood sugar
High blood sugar and oral treatment
When diagnosed with high blood sugar without ketoacidosis or hyperosmolar symptoms treatment with high dose oral medication may work and lessen the need for insulin therapy.
In an article in J. Clin Endocriology from jan 2016 100 persons with high blood sugar were put on 2 regimens of peroral drugs:
1. Glipizide 10mg extended release tablet.
2. 5mg Saxagliptin and 2000 mg of metformin.
Median fasting blood sugar was 19 mmol/L and A1C 11%
All patients rec. general info and were followed up in a diabetic center.
Nearly all pat. got better values and median fasting was 7.2 mmol/L and A1C 7%
Frequency of hypoglycemia was higher in the glipizide group but in neither were there serious sequelae or sugar under 2.8.
Steroids for acute disc prolaps
Design, Setting, and Participants Randomized, double-blind, placebo-controlled clinical trial conducted from 2008 to 2013 in a large integrated health care delivery system in Northern California. Adults (n=269) with radicular pain for 3 months or less, an Oswestry Disability Index (ODI) score of 30 or higher (range, 0-100; higher scores indicate greater dysfunction), and a herniated disk confirmed by magnetic resonance imaging were eligible.
results: Pain did not change significantly, working ability was slightly better. Hardly benefit in giving steroids orally for acute disc prolaps.