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Old 02-06-2020, 11:25   #76
InTheBlack
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ORT FORMULA for oral rehydration

https://rehydrate.org/solutions/packaged.htm

Need to figure the weight of ordinary glucose (L-glucose) vs the anyhdrous specified. And verify dextrose (D-glucose) is equivalent wrt digestion.

2 COLUMN FORMATTING WILL NOT PASTE:

The New Reduced Osmolarity formula for the ORS packet recommended by WHO and UNICEF contains:

Reduced osmolarity ORS


grams
/litre


Reduced osmolarity ORS


mmol/
litre

Sodium chloride


2.6


Sodium


75

Glucose, anhydrous


13.5


Chloride


65

Potassium chloride


1.5


Glucose, anhydrous


75

Trisodium citrate, dihydrate


2.9


Potassium


20


Citrate


10
Total Weight 20.5

Total Osmolarity


245


The above ingredients are to be dissolved in one litre of clean water.

WHO said the new formula would reduce the severity of diarrhoea and vomiting, the number of hospitalisations, the need for costly intravenous fluid treatment and the length of illness. This formula also gives the packets a longer shelf life and is at least as effective in correcting acidosis and reducing stool volume as the old formula. Packets containing sodium bicarbonate are still safe and effective.
How do I make the solution?
SNIP

Last edited by InTheBlack; 02-06-2020 at 11:58.
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Old 02-06-2020, 16:21   #77
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DRUG INTERACTION CHECKER

Look up a drug, and scroll down to see an entry box for a drug to check against it. Also has a complete list below.

https://reference.medscape.com/drug/...astatin-342463

Interactions
Enter a drug name
and cimetidine
1 Interaction Found
Serious - Use Alternative

cimetidine + simvastatin

cimetidine will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
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Old 02-06-2020, 17:26   #78
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Quote:
Originally Posted by mugwump View Post
There is no disputing that this could be Taiwanese nationalists spreading disinformation. They’d have to be damn good hackers to get into Tencent, though, which has a reputation for airtight security. That said, anything is possible.
I’m with you on this. I honestly think it is in his best interest to paint a best-possible scenario for his “clients”. For all we know they are multinational, US-based companies with major interests in China. China’s actions defy the stats, in my non-expert opinion, indicating the situation is much worse than they want the world to believe. And, like you said, any leaks from citizens, who are risking death, must be taken seriously. And, we’ll find out in time what the real story is.
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Old 02-06-2020, 18:34   #79
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Quote:
Originally Posted by InTheBlack View Post
[
How do I make the solution?
SNIP
https://med.virginia.edu/ginutrition...ons-9-2018.pdf

Do some research on Dr. Robert K. Crane who won a Nobel prize for co-transport

Crane's discovery of cotransport led directly to the development of oral rehydration therapy.[6][7] This treatment counterbalances the loss of water and electrolytes caused by cholera via a glucose containing salt solution that accelerates water and electrolyte absorption. This is possible because cholera does not interfere with sodium-glucose cotransport.[8][9]

Oral rehydration therapy saves the lives of millions of cholera patients in underdeveloped countries since the 1980s.[10] In 1978, The Lancet wrote: "the discovery that sodium transport and glucose transport are coupled in the small intestine, so that glucose accelerates absorption of solute and water, was potentially the most important medical advance this century."[11]


After you read and understand all of this come back
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Old 02-07-2020, 03:16   #80
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Well this is interesting. Correspondence/New England Journal of Medicine - 17 Docs from Munich.

Supposedly the virus can be spread during the incubation period while no symptoms are present, but now it also appears (not certain) that someone who's contracted and recovered from the CoronaVirus can still shed the virus after they've convalesced and still be contagious to others.

[QUOTE]
".......the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery....."
/QUOTE]


Link:
https://www.nejm.org/doi/full/10.1056/NEJMc2001468


Edited to add:
If the hypothesis by those 17 Docs from Germany is true, this virus has the potential to get a little sporty worldwide. Let's hope it doesn't.

Research gone wrong is what this appears to be, IMHO. It is interesting that 2 of the scientists who researched and engineered a similar virulent Virus at UNC in 2014/2015 were, and are now; doing similar research at the Wuhan Institute of Virology, in Wuhan, China. Coincidence?
https://www.nature.com/articles/nm.3985

Last edited by T-Rock; 02-07-2020 at 21:27. Reason: Edited because it was too wordy and was half asleep after a shift. Lol
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Old 02-07-2020, 08:52   #81
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Originally Posted by T-Rock View Post
...now it also appears (not certain) that someone who's contracted and recovered from the CoronaVirus can still shed the virus after they've convalesced and still be contagious to others.
That's not exactly what it says. They don't know if the virus is still active. And since these patients all had very short & mild cases, maybe this is a very weak strain.
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Old 02-09-2020, 04:20   #82
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Retraction of paper re German infection

But the retraction only addresses that patient zero actually did have symptoms during the time she was in contact with the subsequent patient.

It does NOT retract that the samples from the recovered patient (not patient zero) still had high viral loads. Unless I am completely misunderstanding that part of the data. Someone please check me on that aspect.

https://www.sciencemag.org/news/2020...et_cid=3198419


EDIT:
https://www.sciencemag.org/news/2020...et_cid=3198419

THIS DATED 5FEB20
snip
So far it has been difficult to get a handle on this question. Some data from China seem to support asymptomatic transmission, but none are clear-cut. A widely reported 30 January letter in The New England Journal of Medicine described the case of a Chinese businesswoman who touched off a cluster of four cases in Germany before she became sick herself. But 4 days later, it became clear the researchers had not contacted the woman, who had flown back to China, before the paper was published. In a later phone interview, she said she had experienced some symptoms while in Germany.

In follow-up results announced in a 4 February press release, the researchers noted that some patients they studied shed virus even though their symptoms were mild. That’s almost as bad as asymptomatic transmission, says virologist Christian Drosten of the Charité University Hospital in Berlin: Patients with mild symptoms are unlikely to seek medical care and may not even stay home, giving the virus ample opportunities to spread far and wide.

Last edited by InTheBlack; 02-09-2020 at 23:07.
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Old 02-09-2020, 20:15   #83
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I read an article on Gateway Pundit that said that a recorded case of Coronavirus was treated successfully using a still-experimental anti-viral drug called Remdesivir.

The following is a quote from a comment to the article:
"Remdesivir metabolizes into its active form GS-441524. GS-441524 is an adenosine nucleotide analog that confuses viral RNA polymerase and evades proofreading by viral exonuclease (ExoN)goog, causing a decrease in viral RNA production. It is unknown whether it terminates RNA chains or causes mutations in them."
-----------------
Basically, Remdesivir wrecks the capacity of some viruses to replicate themselves. This is a good thing, because infectious viruses must make huge numbers of copies of themselves to succeed.

Are there any virologists here who can verify this information?

GP article:
https://www.thegatewaypundit.com/202...n-hours-video/
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Old 02-09-2020, 23:09   #84
InTheBlack
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Correction to my statement --
Retraction of paper re German infection

It does ** NOT **
retract that the samples from the recovered patient (not patient zero) still had high viral loads. Unless I am completely misunderstanding that part of the data. Someone please check me on that aspect
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Old 02-09-2020, 23:11   #85
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Originally Posted by Stobey View Post
I read an article on Gateway Pundit that said that a recorded case of Coronavirus was treated successfully using a still-experimental anti-viral drug called Remdesivir.
Yesterday I read an article saying that the US company which created it filed a patent for it, to treat coronavirii in general, in China, in 2016. They were working with some Chinese partners.

But in January, two days before the Wuhan virus was publicized, several Chinese labs - including a military lab - filed a patent for it SPECIFICALLY to treat the Wuhan coronavirus.

EDIT - here is the story:
https://sanfrancisco.cbslocal.com/20...lead-sciences/

Last edited by InTheBlack; 02-09-2020 at 23:19.
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Old 02-09-2020, 23:29   #86
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Hell of a test run for an antidote, by the very same people who created the killer virus and then, lets save the world.

Last edited by Penn; 03-13-2020 at 07:42.
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Old 02-10-2020, 00:03   #87
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What is the course of this illness?

Case report for first US case, which is the one that got the experimental REMDESIVIR.


online:
https://www.nejm.org/doi/full/10.105...=featured_home

Downloadable:
https://sci-hub.tw/10.1056/NEJMoa2001191

ITEMS WHICH SEEM NOTABLE TO ME:

Went to clinic on Jan 19th, stated as Illness Day 4.
So Illness Day 1 would be Jan 15.
Hospital Day 1 was Jan 20 so would be Illness Day 5.

On Illness Day 7, his stool & nose showed the virus but serum negative.

The pneumonia developed between illness day 7 (negative x-ray) and 9 (positive x-ray) and his pulse oxygen saturation had dropped to 90%.

On Illness Day 10 he was started on oxygen via cannula.

They started heavy pneumonia antibiotics on illness day 10 but discontinued on illness day 11 when tests showed it was not staph etc.

On illness Day 10 another X-ray showed atypical pneumonia.

They started the REMDESIVIR on illness Day 11.

Improved on Illness Day 12 - taken off oxygen, his own saturation was 94-96%, rales gone, "His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea. "


>
initial mild symptoms at presentation with progression to pneumonia on day 9 of illness.

presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever.

body temperature of 37.2°C, blood pressure of 134/87 mm Hg, pulse of 110 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 96% while the patient was breathing ambient air. Lung auscultation revealed rhonchi, and chest radiography was performed, which was reported as showing no abnormalities (Figure 1).

TESTS FOR STANDARD VIRII NEGATIVE
A rapid nucleic acid amplification test (NAAT) for influenza A and B was negative. A nasopharyngeal swab specimen was obtained and sent for detection of viral respiratory pathogens by NAAT; this was reported back within 48 hours as negative for all pathogens tested, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and four common coronavirus strains known to cause illness in humans (HKU1, NL63, 229E, and OC43).

Given the patient’s travel history, the local and state health departments were immediately notified.

BECAUSE HE HAD BEEN IN CHINA THEY CONTACTED CDC & WUHAN VIRUS TESTS THE NEXT DAY WERE POSITIVE. SO ADMITTED HIM FOR OBSERVATION & ISOLATION. SEEMS LIKE HE REMAINED UN-ISOLATED FOR THAT DAY, UNTIL THE TESTS CAME BACK.

On admission, the patient reported persistent dry cough and a 2-day history of nausea and vomiting; he reported that he had no shortness of breath or chest pain. Vital signs were within normal ranges.

On physical examination, the patient was found to have dry mucous membranes. The remainder of the examination was generally unremarkable. After admission, the patient received supportive care, including 2 liters of normal saline and ondansetron for nausea.

On days 2 through 5 of hospitalization (days 6 through 9 of illness), the patient’s vital signs remained largely stable, apart from the development of intermittent fevers accompanied by periods of tachycardia (Figure 2). The patient continued to report a nonproductive cough and appeared fatigued.

On the afternoon of hospital day 2 [ILLNESS DAY 6], the patient passed a loose bowel movement and reported abdominal discomfort. A second episode of loose stool was reported overnight;

The stool and both respiratory specimens later tested positive by rRT-PCR for 2019-nCoV, whereas the SERUM remained negative.

Treatment during this time was largely supportive. For symptom management, the patient received, as needed, antipyretic therapy consisting of 650 mg of acetaminophen every 4 hours and 600 mg of ibuprofen every 6 hours. He also received 600 mg of guaifenesin for his continued cough and approximately 6 liters of normal saline over the first 6 days of hospitalization.

The nature of the patient isolation unit permitted only point-of-care laboratory testing initially; complete blood counts and serum chemical studies were available starting on hospital day 3. Laboratory results on hospital days 3 and 5 (illness days 7 and 9) reflected leukopenia, mild thrombocytopenia, and elevated levels of creatine kinase (Table 1).

In addition, there were alterations in hepatic function measures: levels of alkaline phosphatase (68 U per liter), alanine aminotransferase (105 U per liter), aspartate aminotransferase (77 U per liter), and lactate dehydrogenase (465 U per liter) were all elevated on day 5 of hospitalization.

Given the patient’s recurrent fevers, blood cultures were obtained on day 4; these have shown no growth to date.

A chest radiograph taken on hospital day 3 (ILLNESS DAY 7) was reported as showing no evidence of infiltrates or abnormalities (Figure 3).

However, a second chest radiograph from the night of hospital day 5 [ILLNESS DAY 9] showed evidence of PNEUMONIA in the lower lobe of the left lung (Figure 4).

These radiographic findings coincided with a change in respiratory status starting on the evening of hospital day 5 [ILLNESS DAY 9], when the patient’s oxygen saturation values as measured by pulse oximetry dropped to as low as 90% while he was breathing ambient air.

On HOSPITAL day 6 [ILLNESS DAY 10], the patient was started on supplemental oxygen, delivered by nasal cannula at 2 liters per minute.

Given the changing clinical presentation and concern about hospital-acquired pneumonia, treatment with vancomycin (a 1750-mg loading dose followed by 1 g administered intravenously every 8 hours) and cefepime (administered intravenously every 8 hours) was initiated.

On hospital day 6 (illness day 10), a fourth chest radiograph showed basilar streaky opacities in both lungs, a finding consistent with atypical pneumonia (Figure 5), and rales were noted in both lungs on auscultation.


STARTED WITH EXPERIMENTAL REMDESIVIR ON HOSPITAL DAY 7 (ILLNESS DAY 11)
Given the radiographic findings, the decision to administer oxygen supplementation, the patient’s ongoing fevers, the persistent positive 2019-nCoV RNA at multiple sites, and published reports of the development of severe pneumonia3,4 at a period consistent with the development of radiographic pneumonia in this patient, clinicians pursued compassionate use of an investigational antiviral therapy. Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development10,11) was initiated on the evening of day 7, and no adverse events were observed in association with the infusion.

Vancomycin was discontinued on the evening of day 7 [ILLNESS DAY 11], and cefepime was discontinued on the following day, after serial negative procalcitonin levels and negative nasal PCR testing for methicillin-resistant Staphylococcus aureus.

On hospital day 8 [ILLNESS DAY 12], the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present. His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea.

As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the exception of his cough, which is decreasing in severity.
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Old 02-10-2020, 00:09   #88
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Anti nausea drug for disaster med kit?

The patient below seems not to have had severe fluid loss. But they did give him an anti-nausea drug. What OTC and "reasonably safe" prescription drugs might one put into their kit for nausea?

My philosophy is to have stuff in my disaster kit that I don't know how to use, because I can probably find someone who does know how to use it.
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Old 02-10-2020, 00:24   #89
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This coming weekend (Feb 8/9) will be interesting. When this first started three epidemiological curves of infection rates were predicted from SARS/MERS experience showing optimistic, expected, and worst-case plots of the growth of total cases. Basically, they predicted scenarios when the total number of infections would peak and then flatten and decline. The virus has blown past the optimistic and expected peaks. The pessimistic number should be achieved Thurs/Fri. If we hear of flat numbers this weekend that would be sublime---the disease will taper off in China and contagion pressure will ease. If not, we're looking at pandemic, most likely. Even then, we probably need to wait til the end of of the month to understand what's going to happen here in NA.
So the graph HAS flattened...
https://gisanddata.maps.arcgis.com/a...23467b48e9ecf6

if you hover over the little graph, an X will appear & click on that for full page. Click again to collapse it.
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Old 02-10-2020, 08:44   #90
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Quote:
Originally Posted by InTheBlack View Post
The patient below seems not to have had severe fluid loss. But they did give him an anti-nausea drug. What OTC and "reasonably safe" prescription drugs might one put into their kit for nausea?

My philosophy is to have stuff in my disaster kit that I don't know how to use, because I can probably find someone who does know how to use it.
Not a lot of good OTC meds for nausea - diphenhydramine (benadryl) can be used, but it has sedating effects. Pepto-Bismol and similar compounds may help some.

Best safe antiemeitc by prescription in my book is ondansetron (zofran) - and I treat a lot of nausea in my profession.
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