Melasma, also called ‘chloasma’ and ‘pregnancy mask’, is a common skin condition of adults in which brown or greyish patches of pigmentation (colour) develop, usually on the face. The name comes from melas, the Greek word for black, or cholas, from the word green-ish. It is more common in women,particularly during pregnancy (when up to 50% of women may be affected). Sometimes men may also be affected. Melasma is more common in people of colour and those who tan very quickly but can occur to anyone. Melasma usually becomes more noticeable in the summer and improves during the winter months. It is not an infection; therefore, it is not contagious, and it is not due to an allergy. It is not cancerous and will not develop into skin cancer. For more information about Acne click HERE. In this guide you will learn basics and current clinical treatment for melasma. What is the cause of Melasma? How it looks? What are the symptoms of Melasma? How to diagnose Melasma? Can it be cured? What are the current treatment strategies for Melasma? Melasma Causes The exact cause is not known, but it is thought to be because of pigmentproducing cells in the skin (melanocytes) producing too much pigment (melanin). Several factors can contribute to developing melasma, including pregnancy and using hormonal drugs such as birth control pills and hormonereplacement. Rarely, other medical problems that affect hormones (such as thyroid problems) may cause melasma, as well as some other medications, such as anti-epileptics. Exposure to ultraviolet (UV) light from the sun and the use of sun-beds or phototherapy can trigger melasma or make it worse. How Melasma Looks Melasma appears darker than the surrounding skin- affecting the cheeks, forehead, upper lip, nose and chin. It can also affect other areas of the body exposed to the sun, such as the forearms and neck. Areas of melasma are flat, not raised. Symptoms of Melasma Most patients are upset by the appearance of melasma, but it has no physical symptoms. Affected skin is not itchy or painful. Melasma appears in six locations or a combination of locations on your skin: Brachial: The melasma appears on your shoulders and upper arms. Centrofacial: The melasma appears on your forehead, cheeks, nose and upper lip. Lateral cheek pattern: The melasma appears on both cheeks. Malar: The melasma appears on your cheeks and nose. Mandibular: The melasma appears on the jawline. Neck: In people age 50 or older, melasma can appear on all sides of the neck. Your healthcare provider will decide for sure if you have melasma or another type of skin disorder. Diagnosis Melasma can sometimes be mistaken for another skin condition. To tell the difference between skin conditions, your healthcare provider may perform a biopsy, which is where a small piece of your skin is removed and examined. A biopsy is quick, safe procedure routinely performed during a normal visit to your healthcare provider’s office. Skin conditions commonly confused with melasma include: Actinic lichen planus and lichen planus. Drug-induced pigmentation. Guttate hypomelanosis. Hydroquinone-induced exogenous ochronosis. Lentigo (age spots). Nevus of Hori. Nevus of Ota. Postinflammatory pigmentation. If you have melasma, the results of the biopsy will typically reveal the following: Dendritic (branched) pigmented melanocytes. Melanin in the basal and suprabasal keratinocytes. Melanin in the dermis within melanophages. Solar elastosis and elastic fiber fragmentation. The severity of your melasma can be measured by using the Melasma Area and Severity Index (MASI). Your healthcare provider may administer the test. Can Melasma Be Cured? No, at present there is no cure for melasma, but there are several treatment options that may improve the appearance. If melasma occurs during pregnancy, it may go away a few months after delivery and treatment may not be necessary- though it may come back during another pregnancy. Hydroquinone and retinoid creams should be avoided in pregnancy as they could harm the foetus. Even if it is treated, melasma often returns after stopping the treatments. Current Treatment Strategies Melasma treatments fall into the following categories and can be used together: Avoiding known triggers, such as birth control pills and hormone therapy.• Avoiding the sun and using sun-blocking creams.• Lightening creams for Skin.• Procedures such as chemical peels, microneedling and laser therapy.• Camouflage of Skin. Sun protection Skin affected by melasma darkens more than the surrounding skin when exposed to light, so sun-avoidance and sun-protection are important (see the‘top sun safety tips’ below for more information).One of the most important things you can do to prevent melasma worsening is protecting yourself from UV radiation. This means avoiding the sun, wearing a wide-brimmed hat when you are outside and wearing broad-spectrum sun cream (SPF 30 or above, with a high UVA rating). The higher the SPF themore effective it will be. Avoid using sun-tanning beds. Protecting your skin from the sun will also help the below treatments be more effective. Skin lightening creams Hydroquinone is a medicine that prevents pigment cells in the skin from producing melanin and is commonly used to treat melasma. It may cause skin irritation, and they should only be used for a few weeks at a time to prevent over-lightening of the skin. Hydroquinone can only be prescribed by doctors and may occasionally cause the skin to become darker. Retinoid creams, usually used to treat acne, and some types of acid cream (such as azelaic acid, ascorbic acid and kojic acid) can help improve the appearance of melasma but can also cause skin irritation. Steroid creams can also be useful and are often mixed with the above chemicals to help preventskin irritation. Some skin-lightening creams contain a combination of two or three ingredients to make them more effective. Skin lightening creams must only be used when prescribed, and under medical supervision to reduce the risk of side effects. Drugs Drugs Phenolic Compounds Non-phenolic Compounds Combination FormulasHydroquinone Azeleic acid Kligman’s formula4-isopropylcatechol Retinoids Modified Kligman’s formula4-hidroxianisol L-ascorbic acid Triple creamKojic acid Thiocytic acidN-acetyl-glucosamine N-acetylcysteine4-methoxyphenol LicoriceN-acetyl-4-S-cysteminylphenol Corticosteroids4-n-butylresorcinolNiacinamideArbutine Skin Lightning Drugs Used in Melasma Procedures Chemical
Vitamins For A Healthy Life
The vitamins are certain organic compounds that are needed by the body for healthy life but that cannot be manufactured by the body. They mainly serve as catalysts for certain reactions in the body. The amounts of vitamins required are very small, perhaps hundredths of grams. Do you know that vitamins are mainly obtained from our foods? As a health professional, I know vitamins are needed for a healthy life. In this article, you are going to learn Classification of Vitamins Vitamin Sources RDA (Required Daily Allowance) Diseases that can occur due to Vitamin Deficiency Vitamin Toxicity Let us start with the vitamins classification. I know most of us do not really remember basic knowledge of vitamins. You may also be interesting in reading 05 Vitamins for good hair growth. Classification of Vitamins Based on solubility Vitamins are classified as either fat-soluble (lipid-soluble) or water-soluble. Vitamins A, D, E, and K are fat-soluble Vitamin C and B is water-soluble. All types of vitamins are needed for a healthy life. Water Soluble Vitamins 1. B Complex Vitamins Eight of the water-soluble vitamins are known as the vitamin B-complex group: thiamin (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), vitamin B6 (pyridoxine), folate (folic acid), vitamin B12, biotin, and pantothenic acid. The B vitamins are widely distributed in foods and their influence is felt in many parts of the body. They (vitamins) function as coenzymes that help the body obtain energy from food which is needed for a healthy life. The B vitamins are also important for normal appetite, good vision, and healthy skin, the nervous system, and red blood cell formation. A. Vitamin B1 (Thiamin) Thiamin, or vitamin B1, helps to release energy from foods, promotes normal appetite, and is important in maintaining proper nervous system function for a healthy life. Food Sources Sources include peas, liver, and legumes. Most commonly, thiamin is found in whole grains and fortified grain products such as cereal enriched products like bread, pasta, rice, The process of enrichment adds back nutrients that are lost when grains are processed. Among the nutrients added during the enrichment process are thiamin (B1), niacin (B3), riboflavin (B2), folate, and iron. RDA (Required Daily allowance) Males: 1.2 mg/day; Females: 1.1 mg/day Thiamin Deficiency Under-consumption of thiamin is rare due to the wide availability of enriched grain products. However, low-calorie diets, as well as diets high in refined and processed carbohydrates, may place one at risk for thiamin deficiency. Alcoholics are especially prone to thiamin deficiency because excess alcohol consumption often replaces food or meals. Symptoms of thiamin deficiency include mental confusion, muscle weakness, wasting, water retention (edema), impaired growth, and the disease known as beriberi. Thiamin deficiency is currently not a problem in the United States. Thiamin toxicity No problem with overconsumption is known for thiamin. B. Vitamin B12 (Riboflavin) Riboflavin, or vitamin B2, helps to release energy from foods, promotes good vision, and healthy skin. It also helps to convert the amino acid tryptophan (which makes up protein) into niacin. Food Sources Sources include liver, eggs, dark green vegetables, legumes, whole and enriched grain products, and milk. Ultraviolet light is known to destroy riboflavin, which is why most milk is packaged in opaque containers instead of clear. RDA (Required Daily Allowance) Males: 1.3 mg/day; Females: 1.1 mg/day Riboflavin Deficiency Under consumption of riboflavin is rare. However, it has been known to occur with alcoholism, malignancy, hyperthyroidism, and in the elderly. Symptoms of deficiency include cracks at the corners of the mouth, dermatitis on the nose and lips, light sensitivity, cataracts, and a sore, red tongue. Riboflavin toxicity No problems with overconsumption are known for riboflavin. C. Vitamin B3 (Niacin, Nicotinamide, Nicotinic Acid) Niacin, or vitamin B3, is involved in energy production, normal enzyme function, digestion, promoting normal appetite, healthy skin, and nerves. Food Sources Sources include liver, fish, poultry, meat, peanuts, whole, and enriched grain products. RDA (Required Daily Allowance) Males: 16 mg/day; Females: 14 mg/day Niacin Deficiency Niacin deficiency is known to occur with alcoholism, protein malnourishment, low-calorie diets, and diets high in refined carbohydrates. Pellagra is a disease state that occurs as a result of severe niacin deficiency. Symptoms include cramps, nausea, mental confusion, and skin problems. Niacin toxicity Consuming large doses of niacin supplements may cause flushed skin, rashes, or liver damage. Overconsumption of niacin is not a problem if it is obtained through food. D. Vitamin B6 (Pyridoxine, Pyridoxal, Pyridoxamine) Vitamin B6, otherwise known as pyridoxine, pyridoxal, or pyridoxamine, aids in protein metabolism and red blood cell formation. It is also involved in the body’s production of chemicals such as insulin and hemoglobin. Food Sources Sources include meats, whole grains and cereals, legumes, and green, leafy vegetables. RDA (Required Daily Allowance) The RDA for vitamin B6 is 1.3 mg/day for adult males and females through age fifty. Vitamin B6 Deficiency Deficiency symptoms include skin disorders, dermatitis, cracks at the corners of the mouth, anemia, kidney stones, and nausea. A vitamin B6 deficiency in infants can cause mental confusion. Vitamin B6 Toxicity Overconsumption is rare, but excess doses of vitamin B6 over time have been known to result in nerve damage. E. Folate: (Folic Acid, Folacin) Folate, also known as folic acid or folacin, aids in protein metabolism, promoting red blood cell formation, and lowering the risk for neural tube birth defects. It may also play a role in controlling homocysteine levels, thus reducing the risk for coronary heart disease. Food Sources Sources of folate include liver, kidney, dark green leafy vegetables, meats, fish, whole grains, fortified grains and cereals, legumes, and citrus fruits. Not all whole grain products are fortified with folate.. RDA (Required Daily Allowance) The RDA for folate is 400 mcg/day for adult males and females. Pregnancy will increase the RDA for folate to 600 mcg/day. Folate Deficiency Folate deficiency affects cell growth and protein production, which can lead to overall impaired growth. Deficiency symptoms also include anemia and diarrhea. A folate deficiency in women who are pregnant or of childbearing age
Treatment Strategies for COVID-19
Coronavirus disease (COVID-19) is a life-threatening disease caused by a deadly coronavirus. In this article, you will learn about the treatment strategies for COVID-19 Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Aged people and those with some serious diseases like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more prone to develop life-threatening illnesses. Most people recover at home after becoming ill with COVID-19. Following things you can do to feel better if you have the flu getting enough rest, staying well hydrated, and taking medications to relieve fever and pains — also help with COVID-19. COVID-19 Current Treatment Strategies The current methodology to treat COVID-19 involves using antiviral medications, anti-inflammatory medications, and immune system modulators, including remdesivir, glucocorticoids, and tocilizumab. Dexamethasone Many doctors around the world, including those in the UK & United States, have been treating very serious COVID-19 patients with corticosteroids since the start of the pandemic. The strategy behind this is to minimize a hyper-immune response (a cytokine storm) in COVID-19 patients. As we all know that in these cases, it is the immune system’s overworking that is denaturing the lungs and other organs, and too often leading to death. Some of the potent anti-inflammatory drugs include Dexamethasone and other corticosteroids (prednisone, methylprednisolone). These drugs are frequently available and inexpensive. According to the NIH COVID-19 treatment guidelines, the use of dexamethasone in certain people hospitalized with severe COVID-19 is highly recommended. These recommendations were based on results from the RECOVERY trial. In the recovery trial study, above 6,000 patients hospitalized with COVID-19 randomly received either standard treatment or dexamethasone. The result of the study showed that patients who required supplemental oxygen or ventilators and who received dexamethasone were less likely to die within 28 days than those who received standard care. The study confirms that Dexamethasone did not have a benefit in patients who did not need respiratory support. Remdesivir The FDA approved the antiviral drug Remdesivir in October 2020 to treat COVID-19. The drug can be used to treat adults and children ages 12 and older. Those who weigh at least 88 pounds, who have been hospitalizing for COVID-19. Clinical trials suggest that in these patients, remdesivir may modestly speed up recovery time. Baricitinib in combination with remdesivir In November 2020, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the use of baricitinib in combination with remdesivir. This drug allow administering in hospitalized adults and children 2 years and older who require respiratory support. However, there is not yet enough evidence to support the use of this therapy instead of dexamethasone with or without remdesivir. Anticoagulation drugs (“blood thinners”) Almost all people admitted to the hospital with COVID receive medications to help prevent blood clots. Doctors usually prescribe low-dose heparin or enoxaparin. However, some patients require full doses of anticoagulants. If they already have developed blood clots or have a high risk of doing so. Doctors always need to balance the risk of dangerous bleeding when prescribing full doses. Conclusion Treatment strategies for Covid-19 change as the various clinical studies results are publishing. I have covered the latest treatment strategies going on in the world. Please share your valuable comments below if you know any current strategies.
Antiviral Drugs A Quick Review
Antiviral drugs are prescription medicines (pills, liquid, an inhaled powder, or an intravenous solution) that fight against flu viruses in your body. Antiviral drugs are not sold over-the-counter. You can only get them if you have a prescription from a health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections. If you get sick with flu, antiviral drugs are a treatment option. Check with your doctor promptly if you are at high risk of serious flu complications and you develop flu symptoms. Flu signs and symptoms can include feeling feverish or having a fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Your doctor may prescribe antiviral drugs to treat your flu illness. Benefits of Antiviral Drugs Antiviral treatment works best when started soon after flu illness begins. When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen fever and flu symptoms, and shorten the time you are sick by about one day. They also may reduce the risk of complications such as ear infections in children, respiratory complications requiring antibiotics, and hospitalization in adults. For people at high risk of serious flu complications, early treatment with an antiviral drug can mean having milder illness instead of more severe illness that might require a hospital stay. For adults hospitalized with flu illness, some studies have reported that early antiviral treatment can reduce their risk of death. Classification of Antiviral Drugs Drug Mechanism of Action Therapeutic Uses Key Notes Neuraminidase Inhibitors Oseltamivir Zanamivir -Prevent the release of new virions and their spread from cell to cell -Given prior to exposure they prevent infection -Given24-48 hours after onset of infection, they effect intensity and duration of symptoms -Type A and B influenza viruses -Orthomyxoviruses need neuraminidase for life cycle of the virus -Sialic acid analogs -Do not interfere with response immune response to influenza A vaccine -Zanamivir should be avoided in pts with severe reactive asthma or COPD Amantadine Rimantadine -Block the viral membrane matrix protein (M2) which is required for the fusion of viral membrane with cell membrane Preventing formation of endosome Interferes with viral uncoating -70 to 90% effective in preventing infection if tx begun at time of or prior to exposure to infection -Given w/in first 48 hours, they reduce duration and severity of systemic symptoms -Influenza A viruses -Amantadine: Parkinson’s disease -Do not impair the response of influenza A vaccine -Amantadine may accumulate to toxic levels in pts with renal failure -Cautious use in pregnant and nursing mothers (embryotoxic and teratogenic) -Cross-resistance occurs between the two drugs Ribavirin -Converted to 5’-phosphate derivative forming ribavirin-triphosphate Inhibits guanosine triphosphate formation Prevents viral mRNA capping, blocking RNA-dependent RNA polymerase -Infants and young children: severe RSV infections -Chronic hepatitis C (w/ IFN) -Reduces mortality and viremia of Lassa fever -Guanosine analogs -Contraindicated in pregnancy due Interferon -Interfere with ability of viruses to infect cells -Induce host cell enzymes that inhibit viral RNA translation Degradation of viral mRNA and tRNA -IFN-α-2b: hepatitis B, C -Condylomata acuminate -Hairy cell leukemia -Kaposi’s sarcoma-IFN-β: MS -Interferes with metabolism of THEOPHYLLINE -Potentiates the bone marrow suppression caused by other agents Lamivudine -Inhibitor of both HBV DNA polymerase and HIV reverse transcriptase -Must be phosphorylated by host cell enzymes to active form (triphosphate) -HBV -HIV -Cytosine analog -Chronic treatment reduces hepatic inflammation -Dose reductions required in moderate renal insufficiency Adefovir dipivoxil -Phosphorylated to adefovir diphosphate Incorporated into viral DNA Termination of further DNA synthesis and prevents viral replication -Causes decreased viral load and improved liver function -Nucleotide analog -Cautious use in pts with existing renal disease Entecavir -Intracellular phosphorylation to triphosphate Competes for viral reverse transcriptase -LAMIVUDINE-resistant HBV -Guanosine analog -Improves liver scarring and inflammation -Drugs that have renal toxicity should be avoided Telbivudine -Phosphorylated intracellularly to triphosphate Competes with endogenous thymidine triphosphate for incorporation into DNA Terminates further elongation of DNA -HBV -Thymidine analog -Dose should be adjusted in renal failure -Can be combined with LAMIVUDINE Acyclovir -Monophosphorylated in cell by thby thymidine kinase -Acyclovir triphosphate: competes with deoxyguanosine triphosphate as a substrate for viral DNA polymerase Incorporates into viral DNA Premature DNA-chain termination -HSV 1 and 2 -Varicella-Zoster virus -EBV -DOC: HSV encephalitis -Prophylactic to sero+ pts before BM or heart transplant Accumulates in pts with renal failure -Valacyclovir: hydrolyzed to Acyclovir -Resistance occurs due to altered or deficient to thymidine kinase and DNA polymerase -Cross-resistance to other cyclovirs occurs Cidofovir -Inhibits viral DNA synthesis -CMV-induced retinitis in pts w/ AIDS -Nucleotide analog -Eliminates the permanent venous access used for GANCICLOVIR therapy -CI in pts with renal impairment or taking nephrotoxic drugs -PROBENECID can be given to reduce risk of nephrotoxicity Fomivirsen -Directed against CMV mRNA -CMV retinitis -Antisense oligonucleotide -Should be used 2-4 weeks after CIDOFOVIR to reduce toxicity Foscarnet -Reversibly inhibits viral DNA and RNA polymerases Interferes with viral DNA and RNA synthesis -CMV retinitis in immunocompromised pts -ACYCLOVIR-resistant HSV and Herpes Zoster infections -Phosphonoformate Ganciclovir -Activated through conversion to nucleotide triphosphate Nucleotide competitively inhibits viral DNA polymerase -CMV retinitis in immunocompromised pts -CMV prophylaxis in transplant pts -Analog of ACYCLOVIR -Accumulates in pts with renal failure-Valganciclovir: rapid hydrolysis in intestine and liver Peniciclovir -Triphosphate inhibits HSV DNA polymerase -Pain and healing are shortened -HSV 1 and 2 -Varicella Zoster -Acyclic guanosine nucleoside Famciclovir -Prodrug metabolized to active PENCICLOVIR -Acute herpes zoster -In animals: increased mammary adenocarcinomas and testicular toxicity Vidarabine (ara-A) -Converted in cells to ara-ATP Inhibit viral DNA synthesis -Tx of immunocompromised pts with herpetic and vaccinial keratitis -HSV kerato- conjunctivitis -Adenosine analog Trifluridine -Converted to triphosphate Competitively inhibits incorporation of thymidine triphosphate into viral DNA Defective DNA -Irreversible inhibitor of viral thymidine HSV 1 and 2 -Vaccina virus -DOC: HSV keratoconjunctivitis and recurrent epithelial keratitis -Fluorinated pyrimidine nucleoside analog NRTIs Zidovudine Stavudine Didanosine Tenofovir Lamivudine Emtricitabine Zalcitabine Abacavir -After entering a cell, they are phosphorylated to corresponding
Common Antidote & Drug-Related Side Effects
Antidote An antidote is a drug, chelating substance, or a chemical that counteracts (neutralizes) the effects of another drug or a poison. There are dozens of different antidotes; however, some may only counteract one particular drug, whereas others (such as charcoal) may help reduce the toxicity of numerous drugs. Most antidotes are not 100% effective, and fatalities may still occur even when an antidote has been given. Some examples of antidotes include: Toxicity Antidote Arsenic Dimercaprol Benzodiazepines Flumazenil Acetaminophen N-acetylcysteine Heparin Protamine Sulfate Warfarin Vitamin K or Fresh-frozen plasma Tissue Plasminogen Activator Aminocaproic acid Methotrexate Leucovarin (Folinic acid) Sodium Nitroprusside Sodium Thiosulfate β-blockers Glucagon Carbon Monoxide 100% Oxygen Opioid Naloxone, Naltrexone Methanol Ethanol Organophosphates Atropine, PAM Iron Desferoxamine Cyclophosphamide Mesna Lead D-penicillamine Common Antidotes of Poisoning Drug Related Side Effects Side effects, also known as adverse events, are unwanted or unexpected events or reactions to a drug. Side effects can vary from minor problems like a runny nose to life-threatening events, such as an increased risk of a heart attack. Several things can affect who does and does not have a side effect when taking a drug – age, gender, allergies, how the body absorbs the drug, other drugs, vitamins and dietary supplements that you may be taking. Common side effects include upset stomach, dry mouth, and drowsiness. A side effect is considered serious if the result is: death; life-threatening; hospitalization; disability or permanent damage; or exposure prior to conception or during pregnancy caused birth defect. Side effects can happen when you start taking a new drug, dietary supplement, or vitamin/mineral stop taking a drug that you’ve been on for a while, or when you increase or decrease the amount of a drug that you take. Side Effect Causative Drugs Pulmonary Fibrosis BleomycinAmiodaroneBusulfan Pseudomembranous Colitis ClindamycinAmpicillinAmoxicillin Tendonitis Fluoroquinolones Interstitial Nephritis NSAIDsMethicillin Cholestatic Jaundice Macrolides Coronary Vasospasm CocaineSumatriptan Gout Thiazides Disulfiram-like reactions ChlorpropamideMetronidazoleCefoxitinCefamandole Atropine-like reactions TCAs Cough ACE Inhibitors Aplastic Anemia CarbamazepineChloramphenicolGold compounds EPS Antipsychotics Fatal Hepatotoxicity HalothaneValproic acidThiazolidinedionesAcetaminophen Gray Baby Syndrome Chloramphenicol Gynecomastia CimetidineSpironolactoneAlcohol Hand Foot Syndrome 5-FU Hemolytic anemia w/ G6PD deficiency PrimaquineDapsoneSulfa drugsNitrofurantoinChloramphenicol Hot Flashes NiacinTamoxifen Postural Hypotension α-Blockers Myelosuppression Alkylating cancer drugs SLE-like reactions ProcainamideHydralazineMethyldopa Red Man Syndrome Vancomycin Optic Neuritis Ethambutol Ototoxicity AminoglycosidesLoop diuretics Pancreatitis Didanosine Adrenal Insufficiency Steroid-withdrawal Thrombocytopenia HeparinRifampin Rebound Hypertension Clonidine-withdrawalα-Methyldopa Severe HTN w/ Tyramine MAO inhibitors Agranulocytosis Clozapine Cinchonism Quinidine Antidotes and Drugs Related To Famous Side Effects
18 Myth About Coronavirus Busted By WHO
As the coronavirus continues to make the news, a host of untruths has surrounded the topic. In this special article, I address some of these myth and conspiracies busted by WHO. A novel coronavirus is a new strain of coronavirus that has not been previously identified in humans. Coronaviruses (CoV) are a large family of viruses transmitting between animals and people that cause illness ranging from the common cold to more severe diseases such as the Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). To read in detail about coronavirus see the article Coronavirus Must Know information for Pharmacist Myth 01: You can catch COVID-19, no matter how sunny or hot the weather is Countries with hot weather have reported cases of COVID-19. To protect yourself, make sure you clean your hands frequently and thoroughly and avoid touching your eyes, mouth, and nose. Exposing yourself to the sun or to temperatures higher than 25 degrees DOES NOT prevent the coronavirus disease (COVID-19). Myth 02: Catching the new coronavirus DOES NOT mean you will have it for life. Most of the people who catch COVID-19 can recover and eliminate the virus from their bodies. If you catch the disease, make sure you treat your symptoms. If you have cough, fever, and difficulty breathing, seek medical care early – but call your health facility by telephone first. Most patients recover thanks to supportive care. Myth 03: Being able to hold your breath for 10 seconds or more without coughing or feeling discomfort DOES NOT mean you are free from the coronavirus disease (COVID-19) or any other lung disease. The most common symptoms of COVID-19 are dry cough, tiredness, and fever. Some people may develop more severe forms of the disease, such as pneumonia. The best way to confirm if you have the virus-producing COVID-19 disease is with a laboratory test. You cannot confirm it with this breathing exercise, which can even be dangerous. Myth 04: Drinking alcohol does not protect you against COVID-19 Frequent or excessive alcohol consumption can increase your risk of health problems. Myth 05: COVID-19 virus can not be transmitted in areas with hot and humid climates From the evidence so far, the COVID-19 virus can be transmitted in ALL AREAS, including areas with hot and humid weather. Regardless of climate, adopt protective measures if you live in, or travel to an area reporting COVID-19. The best way to protect yourself against COVID-19 is by frequently cleaning your hands. By doing this you eliminate viruses that may be on your hands and avoid infection that could occur by then touching your eyes, mouth, and nose. Myth 06: Cold weather and snow CAN kill the new coronavirus. There is no reason to believe that cold weather can kill the new coronavirus or other diseases. The normal human body temperature remains around 36.5°C to 37°C, regardless of the external temperature or weather. The most effective way to protect yourself against the new coronavirus is by frequently cleaning your hands with alcohol-based hand rub or washing them with soap and water. Myth 07: Taking a hot bath to prevent the new coronavirus disease Taking a hot bath will not prevent you from catching COVID-19. Your normal body temperature remains around 36.5°C to 37°C, regardless of the temperature of your bath or shower. Actually, taking a hot bath with extremely hot water can be harmful, as it can burn you. The best way to protect yourself against COVID-19 is by frequently cleaning your hands. By doing this you eliminate viruses that may be on your hands and avoid infection that could occur by then touching your eyes, mouth, and nose. 08: The new coronavirus CAN be transmitted through mosquito bites. To date there has been no information nor evidence to suggest that the new coronavirus could be transmitted by mosquitoes. The new coronavirus is a respiratory virus which spreads primarily through droplets generated when an infected person coughs or sneezes, or through droplets of saliva or discharge from the nose. To protect yourself, clean your hands frequently with an alcohol-based hand rub or wash them with soap and water. Also, avoid close contact with anyone who is coughing and sneezing. 09: Hand dryers effective in killing the new coronavirus No. Hand dryers are not effective in killing the 2019-nCoV. To protect yourself against the new coronavirus, you should frequently clean your hands with an alcohol-based hand rub or wash them with soap and water. Once your hands are cleaned, you should dry them thoroughly by using paper towels or a warm air dryer. 10: Ultraviolet disinfection lamp kills the new coronavirus UV lamps should not be used to sterilize hands or other areas of skin as UV radiation can cause skin irritation. 11: Thermal scanners are effective in detecting people infected with the new coronavirus Thermal scanners are effective in detecting people who have developed a fever (i.e. have a higher than normal body temperature) because of infection with the new coronavirus. However, they cannot detect people who are infected but are not yet sick with a fever. This is because it takes between 2 and 10 days before people who are infected become sick and develop a fever. 12: Spraying alcohol or chlorine all over your body kill the new coronavirus No. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body. Spraying such substances can be harmful to clothes or mucous membranes (i.e. eyes, mouth). Be aware that both alcohol and chlorine can be useful to disinfect surfaces, but they need to be used under appropriate recommendations. 13: Vaccines against pneumonia protect you against the new coronavirus No. Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus. The virus is so new and different that it needs its own vaccine. Researchers are trying to develop a vaccine against 2019-nCoV, and WHO is supporting their efforts. Although these vaccines are
Laboratory Testing Guide For (COVID-19)
This article provides interim guidance to laboratories and stakeholders involved in COVID-19 virus laboratory testing of patients. Laboratory Testing Guiding Principles The decision to test should be based on clinical and epidemiological factors and linked to an assessment of the likelihood of infection. PCR testing of asymptomatic or mildly symptomatic contacts can be considered in theassessment of individuals who have had contact with a COVID-19 case. Screening protocols should be adapted to the local situation. Rapid collection and testing of appropriate specimens from patients meeting the suspected case definition for COVID-19 is a priority for clinical management and outbreak control and should be guided by a laboratory expert. Suspected cases should be screened for the virus with nucleic acidamplification tests (NAAT), such as RT-PCR. If case management requires, patients should be tested for other respiratory pathogens using routine laboratory procedures, as recommended in local management guidelines for community-acquired pneumonia. Additional testing in the laboratory should not delay testing for COVID-19. As co-infections can occur, all patients that meet the suspected case definition should be tested for COVID-19 virus regardless of whether another respiratory pathogen is found. In an early study in Wuhan, the mean incubation period for COVID-19 was 5.2 days among 425 cases, though it varies widely between individuals. Virus shedding patterns are not yet well understood and further investigations are needed to better understand the timing, compartmentalization, and quantity of viral shedding to inform optimal specimen collection. Although respiratory samples have the greatestyield, the virus can be detected in other specimens, including stool and blood. Local guidelines on informed consent should be followed for specimen collection, testing, and potentially future research. Specimen Collection and Shipment Safety procedures during specimen collection Ensure that adequate standard operating procedures (SOPs) are in use and that staff is trained for appropriate specimen collection, storage, packaging, and transport. All specimens collected for laboratory investigations should be regarded as potentially infectious. Ensure that health care workers who collect specimens adhere rigorously to infection prevention and control guidelines. Specimens to be collected At a minimum, respiratory material should be collected: upper respiratory specimens: nasopharyngeal and oropharyngeal swab or wash in ambulatory patients and/or lower respiratory specimens: sputum (if produced) and/or endotracheal aspirate or bronchoalveolar lavage in patients with more severe respiratory disease. (Note high risk of aerosolization; adhere strictly to infection prevention and control procedures). Additional clinical specimens may be collected as COVID-19 virus has been detected in blood and stool, as had the coronaviruses responsible for SARS and MERS. The duration and frequency of shedding of the COVID-19 virus in stool and potentially in urine is unknown. In the case of patients who are deceased, consider autopsy material including lung tissue. In surviving patients, paired serum (acute and convalescent) can be useful to retrospectively define cases as serological assays become available. Packaging And Shipment Of Clinical Specimens Specimens for virus detection should reach the laboratory as soon as possible after collection. Correct handling of specimens during the transportation is essential. Specimens that can be delivered promptly to the laboratory can be stored and shipped at 2-8°C. When there is likely to be a delay in specimens reaching the laboratory, the use of the viral transport medium is strongly recommended. Specimens may be frozen to – 20°C or ideally -70°C and shipped on dry ice if furtherdelays are expected (see Table 2). It is important to avoid repeated freezing and thawing of specimens. Transport of specimens within national borders should comply with applicable national regulations. International transport of potentially COVID-19 virus-containing samples should follow the UN Model Regulations, and any other applicable regulations depending on the mode of transport being used. Ensure Good Communication With the Laboratory And Provide NeededIinformation. Alerting the laboratory before sending specimens (COVID-19) encourages proper and timely processing of samples and timely reporting after testing. Specimens should be correctly labeled and accompanied by a diagnostic request form. Laboratory testing for COVID-19 virus Laboratories undertaking to test for COVID-19 virus should adhere strictly to appropriate biosafety practices. Nucleic Acid Amplification Tests (NAAT) For COVID-19 Virus. Routine laboratory confirmation testing of cases of COVID-19 is based on the detection of unique sequences of virus RNA by NAAT such as real-time reverse-transcription polymerase chain reaction (rRT-PCR) with confirmation by nucleic acid sequencing when necessary. The viral genes targeted so far include the N, E, S and RdRP genes. Examples of protocols used may be found here. RNA extraction should be done in a biosafety cabinet in a BSL-2 or equivalent facility. Heat treatment of samples before RNA extraction is not recommended. Laboratory Confirmation Of Cases By NAAT In Areas With No Known COVID-19 Virus Circulation. To consider a case as laboratory-confirmed by NAAT in an area with no COVID-19 virus circulation, one of the following conditions need to be met: A positive NAAT result for at least two different targets on the COVID-19 virus genome, of which at least one target is preferably specific for COVID-1 virus using a validated assay (as at present no other SARS-like coronaviruses are circulating in the human population it can be debated whether it must be COVID-19 or SARS-like coronavirus specific);OR One positive NAAT result for the presence of beta coronavirus, and COVID-19 virus further identified by sequencing partial or whole genome ofthe virus as long as the sequence target is larger or different from the amplicon probed in the NAAT assay used. When there are discordant results, the patient should be resampled and, if appropriate, sequencing of the virus from the original specimen or of an amplicon generated from an appropriate NAAT assay, different from the NAAT assay initially used, should be obtained to provide a reliable testresult. Laboratories are urged to seek confirmation of any surprising results in an international reference laboratory. Laboratory-Confirmed Case By NAAT In Areas With Established COVID-19 Virus Circulation. In areas where COVID-19 virus is widely spread a simpler algorithm might be adopted in which, for example, screening by rRT-PCR of a single discriminatory target is considered sufficient. One or more
WHO Recommended Hand Sanitizer Formulation
This Guide to Local Production of WHO-recommended Hand Sanitizer Formulations is separated into two discrete but interrelated sections: This guide will help in preventing the spread of Coronavirus pandemic across the globe by using WHO recommended hand sanitizer Part A provides a practical guide for use at the pharmacy bench during the actual preparation of the formulation (Hand Sanitizer). Part B summarizes some essential background technical information and is taken from the WHO Guidelines on Hand Hygiene in Health Care (2009). PART A: GUIDE TO LOCAL PRODUCTION OF HAND SANITIZER Part A is intended to guide a local producer in the actual preparation of the formulation (Hand Sanitizer). Materials required (small volume production) REAGENTS FOR FORMULATION 1: REAGENTS FOR FORMULATION 2: Ethanol 96% • Hydrogen peroxide 3% • Glycerol 98% • Sterile distilled or boiled cold water • Isopropyl alcohol 99.8% • Hydrogen peroxide 3% • Glycerol 98% • Sterile distilled or boiled cold water • 1-liter glass or plastic bottles with screw-threaded stoppers, or • 10-liter plastic tanks (preferably in polypropylene or high density polyethylene, translucent so as to see the liquid level) • Stainless steel tanks with a capacity of 80–100 liters (for mixing without overflowing) • Wooden, plastic or metal paddles for mixing • Measuring cylinders and measuring jugs • Plastic or metal funnel • 100 ml plastic bottles with leak-proof tops • 500 ml glass or plastic bottles with screw tops • An alcoholometer: the temperature scale is at the bottom and the ethanol concentration (percentage v/v) at the top METHOD: 1-LITRE PREPARATIONS These can be prepared in 1-liter glass or plastic bottles with screw-threaded stoppers. Recommended amounts of products: FORMULATION 1 FORMULATION 2 • Ethanol 96%: 833.3 ml • Hydrogen peroxide 3%: 41.7 ml • Glycerol 98%: 14.5 ml • Isopropyl alcohol 99.8%: 751.5 ml • Hydrogen peroxide 3%: 41.7 ml • Glycerol 98%: 14.5 ml Step by step preparation: The alcohol for the formula to be used is poured into the large bottle or tank up to the graduated mark. Hydrogen peroxide is added using the measuring cylinder. Glycerol is added using a measuring cylinder. As glycerol is very viscous and sticks to the wall of the measuring cylinder, it should be rinsed with some sterile distilled or cold boiled water and then emptied into the bottle/tank. The bottle/tank is then topped up to the 1-liter mark with sterile distilled or cold boiled water. The lid or the screw cap is placed on the tank/bottle as soon as possible after preparation, in order to prevent evaporation. Immediately divide up the solution into its final containers (e.g. 500 or 100 ml plastic bottles), and place the bottles in quarantine for 72 hours before use. This allows time for any spores present in the alcohol or the new/re-used bottles to be destroyed. Final Products FORMULATION 1 FORMULATION 2 Final concentrations: • Ethanol 80% (v/v), • Glycerol 1.45% (v/v), • Hydrogen peroxide 0.125% (v/v) Final concentrations: • Isopropyl alcohol 75% (v/v), • Glycerol 1.45% (v/v), • Hydrogen peroxide 0.125% (v/v) Quality Control Pre-production analysis should be made every time an analysis certificate is not available to guarantee the titration of alcohol (i.e. local production). Verify the alcohol concentration with the alcoholmeter and make the necessary adjustments in volume in the preparation formulation to obtain the final recommended concentration. Post-production analysis is mandatory if either ethanol or an isopropanol solution is used. Use the alcoholmeter to control the alcohol concentration of the final use solution. The accepted limits should be fixed to ± 5% of the target concentration (75%–85% for ethanol). The alcoholmeter is for use with ethanol; if used to control an isopropanol solution, a 75% solution will show 77% (± 1%) on the scale at 25°C Efficacy It is the consensus opinion of a WHO expert group that WHO recommended hand rub formulations can be used both for hygienic hand antisepsis and for presurgical hand preparation. Hygienic Hand Rub The microbicidal activity of the two WHO-recommended formulations was tested by WHO reference laboratories according to EN standards (EN 1500). Their activity was found to be equivalent to the reference substance (isopropanol 60% v/v) for hygienic hand antisepsis.
Guide On Preventing the Spread of (COVID-19)
Coronaviruses are a large family of viruses, some causing illness in people and others that circulate among animals, including camels, cats, and bats. Rarely, animal coronaviruses can infect people exposed to infected animals, and then spread among people, as has been seen with MERS-CoV and SARS-CoV, and likely now with SARS-CoV-2, the virus that causes COVID-19. This interim guidance may help prevent this virus from spreading among people in their homes and in other residential communities. This interim guidance is intended for: People with confirmed or suspected COVID-19 People with confirmed COVID-19 Household members, intimate partners, and caregivers in a nonhealthcare setting Prevention Steps for (COVID-19) People with confirmed or suspected COVID-19 People with confirmed COVID-19 Stay home except to get medical care People who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis. Separate yourself from other people and animals in your home People: As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available. Animals: You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the virus. When possible, have another member of your household care for your animals while you are sick. If you are sick with COVID-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with pets and wear a facemask. See also Coronavirus: Must-Know Information For Pharmacists Call ahead before visiting your doctor If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed. Wear a facemask You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not stay in the same room with you, or they should wear a facemask if they enter your room. Cover your coughs and sneezes Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can. Immediately wash your hands with soap and water for at least 20 seconds or, if soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol. Clean your hands often Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water are the best options if hands are visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands. Avoid sharing personal household items You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water. Clean all “high-touch” surfaces every day High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during the use of the product. Monitor your symptoms Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19. Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed. Ask your healthcare provider to call the local or state health department. Persons who are placed under active monitoring or facilitated self-monitoring should follow instructions provided by their local health department or occupational health professionals, as appropriate. If you have a medical emergency and need to call 911, notify the dispatch personnel that you have, or are being evaluated for COVID-19. If possible, put on a facemask before emergency medical services arrive. Discontinuing home isolation Patients with confirmed COVID-19 should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low. The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments. Prevention Steps for (COVID-19) Household members, intimate partners, and caregivers in a nonhealthcare setting Household members, intimate partners, and caregivers in a nonhealthcare setting may have close contact with a person with symptomatic, laboratory-confirmed COVID-19 or a person under investigation. Close contacts should monitor their health; they should call their healthcare provider right away if they develop symptoms suggestive of COVID-19 Close contacts should also follow these recommendations: Make sure that you understand and can help the patient follow their healthcare provider’s instructions for the medication(s) and