1/ Ivermectin+doxycycline for COVID-19 symptoms: a randomized trial
journals.sagepub.com/doi/10.1177/03…
New study included to ivermectin/doxycycline bandwagon

Upfront, luks legit - reported outcomes, as expected favours IVM+DOX in reducing progression to serious disease

But lets dig in
2/ Patients included are mild-moderate

The title says - 'for treating Covid19 symptoms'

But primary outcome measure is clinical recovery

Secondary outcome is progression to mild/moderate/severe or death - mild or moderate is included, so ideally it should be severe/critical
3/ Primary measure should have been secondary and vice versa - but none of these fit the title.

Authors mention: We sought to enroll as many patients as possible in a short time. As a result, a priori power calculations were not performed - which means pre protocol sample size..
4/ ..was not calculated and study is possibly underpowered - this is a major flaw

To correct for this, authors did post-hoc (after study) sample/power estimation - for detecting 2 day difference in median 'recovery time' again - not clinical progression - this also weakens study
5/ Next look at patients included

Group assignment was not stratified according to disease severity, which means lesser severity patients could have been allocated to treatment category as inclusion is unclear

Clinical recovery is undefined

Moderate disease is included...
6/..
but authors excluded patients with hypoxia [oxygen saturation (SpO2) <90%] requiring supplemental oxygen

But moderate disease also includs oxygen requirement in hospital

Unsure if those requiring oxygen vs thos not requiring with moderate disease were allocated to placebo Image
7/
...becoz allocation according to severity was not clarified as per authors own statement

Now look at treatment offered

Paracetamol, antihistamines, cough suppressants, vitamins, oxygen therapy, low molecular weight heparin, antibiotics, remdesivir, other antiviral drugs!
8/
Which means, treatments received by the groups differed extremely between groups.

Hence a sub group analysis with respect to treatment heterogeinity was warranted which was not done in this study

Another major flaw
9/
So this study LIKE ALL other IVM studies - have inherent high risk of bias and if included in a pooled analysis would contribute to very low quality evidence.

Hence, no proper evidence for use of IVM+DOX in Covid19 can be conferred from this very inattentively done RCT.
10/
Main lesson to learn here is - RCT doesnt mean 'gold standard' - one shud have basic analytical prowess 2 understnd quality of trial:

Methodology
Inclusion/exclusion commitment
Power/sample size calculation
Ideal/solid (not vague) endpoints

#ivermectin isnt useful in Covid

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More from @drabbyphilips

24 May
1/
Liv 52 - A🧵

➡️ What is it?
➡️ Is it Ayurveda?
➡️What is it used (advertised) for?
➡️What is the evidence?
➡️Research and evaluation?
➡️Is it safe?
➡️Who prescribes it?
➡️Should/ can I use it?

#medtwitter #livertwitter #meded #Ayush #Ayurveda
2/
What is Liv 52?
It is a herbal drug manufactured by Himalaya India
Launched in 1955 😐
Named Liv (for liver)
52 (becoz 'researchers' got the 'correct' formulation coded '52' - at 52nd attempt)
docprime.com/liv-52-mddp
himalayaglobalholdings.com/innovation/liv…
Contains ALMOST 20 components...
3/
...making it multiherbal drug

Is Liv 52 Ayurvedic?

According to the principles that guide an Ayurvedic treatment,

Any classical Ayurvedic drug must act on atleast one of the 3 doshas - Vata/Pitta/Kapha - to 'align' it normally

Action of Liv 52 on doshas isnt mentioned...
Read 29 tweets
24 May
This is very enlightening tweet

Reveals Ayurvedic quackery infiltration through power of marketing, undertable pay, commissions to general physicians/specialists IN THE ABSENCE OF CLINICAL EVIDENCE

Most products mentioned are NOT classical, but proprietary AYUSH company drugs
It shows that there are black sheep in the family

It doesnt mean modern medicine is dependent on/or accepting Ayurveda, but that doctors are ready to shed their ethics/morale for money

It also means there are Ayush apologists trained in modern medicine who need to be weeded out
It also shows another imp aspect

That Ayurvedic practitioners, including @deepadoc finds credibility in the pseudoscience of Ayurveda when modern med doctors use it

They hav nothing to showcase credibility as they can only attract patients thru marketing/bad mouthing modern med
Read 4 tweets
23 May
1/
Ayurveda for prevention for Mucor (black fungus)
DONT follow this
Major issues

Firstly - only frequency, but no end point of use is given (for how long) - this is not made by a medical person

Secondly - there is no evidence that none of these herbal drugs prevent mucor
2/
Third - Samsamani vati is Giloy which is liver toxic - do not use and definitely not in the long term


No studies on Giloy exist demonstrating fungus preventive efficiency
3/
Nishamalaki vati has amla (gooseberry)/turmeric (haldi) both of which cant prevent fungus
Given as anti-diabetic medicines - no clinical evidence of anti-diabetes effect of both
Turmeric is toxic

Amla too
Read 4 tweets
22 May
1

Lets break down all your fallacies: short class

// Ayurveda is a science of life
Ayur+veda //

This is just literal translation.
A logical fallacy of Special Pleading

'Please, please, accept this pseudoscience as credible.'
No. Image
2

//Millions of ppl are get benefited by this traditional system of medicine//

This is speculation and a bias
Called Bandwagon Effect

You have been hearing it for so long and from many others, you think it is the truth

"Like strongly believing that aliens will come" Image
3

//You dint wrote hatred but ur every word expressing tht//

This is answering 'criticism' with 'criticism'
Called as Tu Quoque
It is a very important logical fallacy people make when they are loss for words or reason

Shows paucity in logical judgemental responses Image
Read 4 tweets
13 May
India's terrible and nonsense craze about health benefits of cow urine

What are claims?
Kills germs
Protects heart and brain
Protects organs in general
Detoxifies body
Using in eye will improve eye sight
Older the urine, better benefits (?like honey)
Avoid plastic container

1/
Is cow urine good antibiotic, antifungal or antiviral?
This review on antimicrobial function of cow urine is rich in studies conducted on cells and tissue cultures.
ncbi.nlm.nih.gov/pmc/articles/P…
They have reviewed extensively on in-vitro studies between diff types of cow breeds...

2/
...when urine from every cow is same.

Gujarati Geer cow doesnt produce urine quality different from Karnataka Amrit Mahal cow

But yes, there were studies comparing different breeds as per review which is inherently foolishness

Antimicrobial discovery follows a method...

3/
Read 12 tweets
13 May
This is irresponsible.

More so, this is a sales advertisement that claims health benefits, but has very little scientific evidence to recommend

This is a business tweet

Benefits of eucalyptus oil in humans 4 inhalational purpose is not scientifically proven

Let us discuss

1/
Eucalyptus oil is an essential oil.
Why is it called essential?
It is just falsely named so, to impress on the user.
They are absolutely not essential


2/
There are no humans studies done on eucalyptus oils - as inhalational agents or in other forms to showcase its health benefits.

Very low quality cell, tissue, human data as antibacterial and opiniated reviews on eucalyptus oils exist in literature

ncbi.nlm.nih.gov/pmc/articles/P…

3/
Read 7 tweets

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