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Rajeev Jayadevan Profile picture
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30 May, 7 tweets, 4 min read
From Doctors, to Doctors.
25 Practical Tips for Doctors Treating COVID-19.

These pearls are based on the collective experience of several doctors who have been meeting every Tuesday 8 PM @ IMA Cochin, ever since the pandemic started.

These are PDF screenshots. Links on thread. ImageImageImageImage
Link to e-Book on palliative care in COVID-19 (see tip No. 24 in the series above) Thanks @palliumindia @mrraj47 @palliumchair

It is very important to keep our patients comfortable-even when they are critically ill; and also to reduce work of breathing.

palliumindia.org/wp-content/upl…
Link to FOGSI statement to start vaccinating pregnant women in India, see tip no.15 in the series above

fogsi.org/wp-content/upl…
Link to mucormycosis experience in India, pre-pandemic era. See tip no. 11 in the series above

10-20% cases are related to trauma and burns. We need to see if COVID-19 patients are inadvertently damaging their mucosal surfaces by trying to 'self-treat'.

pubmed.ncbi.nlm.nih.gov/30901907/
Link to WHO position on Remdesivir, see tip no. 13 in the series above

Remdesivir does not prolong survival.

apps.who.int/iris/bitstream…
ICMR study of nosocomial infections in the setting of COVID-19. Preventive measures and early recognition of these are important to ensure survival.

See tip no. 6 in the series above

dovepress.com/secondary-infe…
The importance of normal healthy bacteria in maintaining the immunity of our mucosal surfaces - not only in the gut, but also in the respiratory tract.

Irrational use of antibiotics do more harm than good. See tip no. 5 in the series above

pnas.org/content/108/13…

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More from @RajeevJayadevan

Rajeev Jayadevan Profile picture
31 May
Immunity against COVID-19 can be long-lasting.

Rare study that demonstrates long-lived plasma cells (that make antibodies) in the bone marrow of those who recovered from COVID-19, after 7-11 months.

From Washington University, St Louis.

Thread:

1/13
nature.com/articles/s4158…
2/13

-This study looked the body's ability to generate antibodies long-term.

-We know that S-specific antibody levels in blood drop for about 4 months, & then level off.

-That however does not mean we 'lost' the ability to make antibodies.

-Let us look @ some basics first.
3/13

-During infection, B cells pick up the antigens of the virus and present them on Class II MHC to CD4 T cells in the germinal centres in lymph node or spleen. This activates B cells, generating memory cells and plasmablasts. Some of these mature into long-lived plasma cells.
Read 13 tweets
Rajeev Jayadevan Profile picture
31 May
Only 7 out of 28,184 healthcare workers who received both doses tested positive >2 weeks after 2nd dose (0.0046%).

One of the authors Dr Torriani stated in a video that such people had milder symptoms than the unvaccinated. | NEJM

1/2
nejm.org/doi/full/10.10…
This study involved 36,659 HCW who had easy access to testing, was done during a surge and involved relatively younger people.

Of these, 28,184 completed 2nd dose by the time of publication, of these, 14,990 were 2 weeks past 2nd dose.

See research letter attached above.

2/2
We must also remember that the age profile of this cohort is young; their baseline risk of developing severe disease is relatively low. The key point in this study is that they had some level of mandatory testing, which means lower chance of missing infections.

3/3
Read 4 tweets
Rajeev Jayadevan Profile picture
30 May
Surge in Vietnam 🇻🇳 coincides with the discovery of B.1.617.2 with an additional mutation: Y144 deletion which had been seen in various settings (B.1.1.7 variant, and also in immunosuppressed patients who harboured longer SARS-CoV-2 virus infections)

1/3
e.vnexpress.net/news/news/viet…
Multiple mutations occurred while the SARS-CoV-2 virus lived for a long time in a immunocompromised B-cell-depleted patient. Such studies provide a rare opportunity to follow viral adaptive evolution. The Y144 deletion was first spotted ~a year ago.

2/3
medrxiv.org/content/10.110…
Paper describing the mutations in B.1.1.7

3/3
virological.org/t/preliminary-…
Read 4 tweets
Rajeev Jayadevan Profile picture
25 May
The rise of variants in India, 2021. Monthly genomic analysis of multiple districts in Kerala.

Over 5 months, the B.1.617 has had a steep growth, now standing tall at ~60% of genomes.

B.1.1.7 rose quickly in February, but is slowly being replaced by B.1.617.

Thread 👇
1/15
I have manually modified the graphs to accommodate the latest numbers to put them all in one picture. The bar on the right end shows a high prevalence of variants (approx %).

The bars on the left (each representing one month of 2021) are smaller.

2/15
In the beginning of 2021, there were very few variants; the bars are almost flat. Then came the rise of B.1.1.7 (UK), and the B.1.617(India) in April.

But now the “India variant” B.1.617 is fast-replacing all other viruses in circulation, accounting for ~60% of genomes.

3/15
Read 21 tweets
Rajeev Jayadevan Profile picture
23 May
Steam inhalation can have serious side effects both on skin and in our respiratory tract. See thread.
Apart from perceived symptomatic relief in cough, it has no scientific benefit in COVID-19.
A boy suffered burns from steam inhalation @
Hyderabad.
1/5
 thehindu.com/news/cities/Hy…
Every year, an average of 3 people are hospitalized in Burn Centres in Netherlands for burns resulting from a popular home-remedy: steam inhalation. Most victims were children; needing skin grafting more than adults. See thread for a report from India.
2/5
 ncbi.nlm.nih.gov/pmc/articles/P…
This report from Ireland is again about children suffering severe burns as a result of steam inhalation as a home remedy. See thread.
3/n
 ncbi.nlm.nih.gov/pmc/articles/P…
Read 7 tweets
Rajeev Jayadevan Profile picture
23 May
The first series on “Black Fungus” mucormycosis courtesy Prof. VP Pandey Indore. 210 patients.

Antibiotics had been used in 100% patients, steroids NOT used in 14%, 21% were NOT diabetic, 36% were @ home, oxygen only by 52%, Zinc status not checked.

See thread for details. 1/n
Immensely grateful to Prof. VP Pandey HOD Medicine at MGMMC Indore for analysing this series of 210 mucormycosis patients.

Clearly there are factors beyond steroid use & diabetes here.

The obvious question is, what other forms of treatment did these patients receive? 👇

2/8
3 potential offenders that must be looked for in studies:

1. Concurrent antibiotic use: not indicated in viral infections like COVID-19.

Azithromycin, Doxycycline , even carbapenems are seen on prescriptions. Antibiotics are known to increase risk of fungal infections. 👇

3/8
Read 10 tweets

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