Editor's note: Find the newest COVID-19 news and guidance in Medscape's Coronavirus Resource Center(covid &plaquinil)

Editor's note: Find the newest COVID-19 news and guidance in Medscape's Coronavirus Resource Center

More than 140 scientists and physicians are challenging the validity of an influential study that found an association between prescribing the antimalarial drugs hydroxychloroquine and chloroquine for COVID-19 patients and increased in-hospital mortality. After the observational study's results were published within the Lancet on May 22, the earth Health Organization (WHO) temporarily suspended enrollment into an ongoing randomized clinical trial testing hydroxychloroquine for COVID-19

An letter to the observational study's authors and therefore the Lancet's editor-in-chief posted May 28 lists 10 concerns. The signatories, who identify themselves as "clinicians, medical researchers, statisticians, and ethicists from across the earth ," say the researchers didn't account sufficiently for factors which can have influenced their results, including disease severity, and lift concerns a few lack of ethics review and errors within the underlying database

They also charge that the study's authors are being unduly secretive about their data sources and methods, despite the very fact that The Lancet signed a pledge to support data sharing during the coronavirus pandemic

"This paper has had a really negative impact on clinical trials," said Watson , DPhil, a statistician at the Mahidol-Oxford medicine Research Unit in Thailand and thus the lead signatory on the letter . "A lot of selections [about hydroxychloroquine] are made on the thought of very poor evidence. This drug might be harmful, it might be beneficial, it could do absolutely nothing in the least , but we'd like a randomized trial," Watson said

The Lancet study is based on data from the medical services company Surgisphere about 96,032 hospital patients diagnosed with COVID-19 from December 20 to Pan American Day from every continent except Antarctica. Every patient was discharged by April 21, unless that they had died by then. the bulk of patients, 81,144, didn't receive antimalarial drugs. The remaining 14,888 patients began to receive the antimalarial drugs chloroquine or hydroxychloroquine within 48 hours of their positive diagnosis, either alone or with an antibiotic

After controlling for various factors including age, race, sex, and comorbidities like cardiovascular and lung disease, the authors found that patients on antimalarials were twice as likely to die within the hospital as patients who didn't receive them (18% mortality for patients who received hydroxy chloroquine, 16.4% for chloroquine, 9.3% for those that didn't receive an antimalarial). Patients who also received antibiotics experienced even higher mortality rates

"We were fairly reassured that, although the study was observational, the signals were robust and consistent across all regions of the earth in diverse populations, which we didn't see any muting of that signal, counting on region," lead author Mandeep R. Mehra, MD, MSc, the Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital in Boston, Massachusetts, previously told the heart.org | Medscape Cardiology about the results

Italy experienced the primary case of COVID-19

After Italy experienced the primary case of COVID-19 in late February 2020, the country soon became a worldwide hub for the virus. With over 233,000 deaths and 33,000 deaths thus far , the virus has been more deadly in Italy than in China. To slow the spread, the govt ordered everyone to remain in their homes. Now, infection rates are finally dropping

 And because the country begins to reopen it, some Italian doctors say the deadly virus is losing its power

 "In March and April, patients to ER were very ill. that they had acute respiratory distress syndrome and multi-organ failure. They needed immediate oxygen, ventilation, and within 2-3 days, we had patients who died," says Matteo Passetti. MD, Director of the Infectious Diseases Clinic at the San Martino Hospital in Genoa. "But now, during the past four to 5 weeks, it had been completely different. Patients are an equivalent age because patients before, even older patients, aren't as sick as patients who were only four to 6 weeks ago."

 In strong opposition to the statements of Bassetti and other doctors, Italian public health officials and thus the planet Health Organization have warned that there's no evidence to support these allegations. They urge health care providers and thus the general public continues to require the virus very seriously. Meanwhile, Bassetti says the clue is on the way

? is that the epidemic weakening

 "One of the golden rules of virology is that viruses that spread within society change and alter ," says Mark Cameron, Ph.D., professor of population and quantitative health at Case Western Reserve University's School of drugs 

 He says they are doing this to survive. an epidemic enough to kill all of its hosts will die as soon because the last infected person dies. The weakest sort of virus - an epidemic that doesn't make people completely sick - are often transmitted from person to person

 "The virus is curious about keeping it alive," says Cameron. "She must maintain high viral fitness and not kill her host - we. COVID-19 has already achieved this perfect balance

 It could take generations to form enough genetic change to need an area to significantly weaken the coronavirus - both that cause COVID-19 and other forms that existed before it. Human coronavirus is understood to be very stable in its genetic makeup. Little or no change over time. the first tracing of SARS-CoV-2, the coronavirus that causes COVID-19, indicates that it behaves like its relatives, changing slowly and brilliantly over time

 This doesn't mean that the virus doesn't change at the very least. When researchers at Arizona State University analyzed coronavirus samples collected from nasal swabs, they found a private sample with a significant genetic difference from other samples

 But it's not known whether this particular difference to the virus results in more or less severe disease or a minimum of any difference in symptoms. To verify such a theory that needs further research. Scientists will work to align the varied genetic sequences of various nasal swabs with the patient's symptoms

 However, Cameron says, this single sample won't prevent other strains from continuing to spread and causing disease. Viral strains live independently of 1 another. For this reason, for instance , many flu strains circulate every season

 With many of us infected with SARS-CoV-2, a mutation during one sample is unlikely to change the course of the outbreak, Cameron says.

 Although researchers say it's unlikely that the virus has mutated enough to make major differences in how serious the disease is, this is often not all bad news. The virus creates a stable target for researchers who perform a vaccine. for instance , the flu changes so quickly that vaccine developers need an alternate injection per annum 

? The road guide

 Public health officials stress that there's no scientific evidence that the virus is now weaker. Until this evidence is found, health authorities warn that the general public cannot reduce its defenses against the spread of the virus. But Bassetti promises that evidence is coming. He cites ongoing studies within the cities of Milan and Brescia in northern Italy which will show that folks have fewer viral loads than before - a logo of less severe diseases - that have made genetic mutations within the virus less lethal

 one among the golden rules of virology is that viruses that circulate within society change and alter

 "We aren't here to mention that the virus has disappeared," says Basetti. "We are here to say that it's different." He attributes these differences to a possible set of things, including biological changes within the virus, and thus successful closure, social disorganization, mask use, and hand washing. Cameron adds that flattening the curve allows testing to catch up and provides medical assistance to those that need it directly

 In response to the WHO response to his allegations, Bassetti says, "The WHO doesn't care about the patients. they're sitting at a table in Geneva. These are the impressions of most doctors at rock bottom . we've admitted nearly 500 patients [COVID-19] during a hospital San Martino Since the start of the epidemic, I even have seen a big decrease within the severity of the disease

 Cameron, the work of health-care providers on the bottom , may are liable for this dramatic change

 "I would really like to put the credit for improving patient outcomes constantly in Italy at the feet of doctors and health care workers," he says. "It is testimony to their heroism that they broke the rear of this virus without the assistance of the virus itself, if any, we'll got to await virus sequence studies and clinical studies  to unravel the problem

The World Health Organization reveals the date of the second corona wave

The World Health Organization reveals the date of the second corona wave

 After fears in several countries that have decreased the incidence of coronavirus infection then rise again, the earth Health Organization has warned of a possible second wave of the epidemic, and has set a possible date

 according to the statements of the regional director of the organization in Europe, Hans Klug, the second wave of Corona is perhaps getting to be within the autumn, stressing the need to still follow the isolation measures during a deliberate manner

 "Although the second wave isn't inevitable, things today isn't better than it had been at the beginning of the year, within the absence of any treatment or vaccine for the disease," Klug said in comments reported by British newspaper "The Independent"

 He added that "it is possible" that the autumn semester will have a negative impact on the increase within the amount of cases infected with the Corona virus, with the same peak reached by seasonal flu cases at the highest of the year

 "It is possible that at the start of the autumn season and with the seasonal flu spreading, there will be a seasonal impact on the Corona virus. But we aren't yet sure that we'll witness a second wave," he said

 Cluj noted that following the principles of closure and preventive measures in societies contributed decisively to preventing the spread of infection, especially with the approaching summer when people are more inclined to gatherings

 The senior health official involved the "alarm" to sound, because the "Covid 19" epidemic remains during a lively stage in many countries, adding: "Many countries are still facing increased numbers of infections, like Northern Macedonia, Armenia, Azerbaijan and Uzbekistan

Epilepsy: definition, complications, and treatment

  Definition of

  Epilepsy is defined as the recurrence of sudden, excessive and / or simultaneous secretions in cerebral cortical neurons resulting in disturbance of consciousness, disturbance of sensation, movements, impaired mental function, or a combination of these signs.  Because of its sudden nature, seizures are called events of ictal, from Latin ictus meaning "multiplication".  The terms epilepsy, seizures and convulsions are not synonymous

 

  Epilepsy brain and normal brain

  Types of epileptic seizures

  There are three diagnoses a doctor may make when treating a patient with epileptic seizures

  Idiopathic - this means that there is no clear cause

  Cryptogenic - This means that the doctor thinks there is likely a cause, but he cannot determine it

  There are three descriptions of seizures, depending on which part of the brain the epilepsy started

  Partial seizure

  Partial seizure means that epilepsy activity occurred in only part of the patient's brain.  There are two types of partial seizures

  Simple partial seizure - the patient is conscious during the seizure.  In most cases, the patient also realizes his surroundings, although the seizure is in progress

  Complex partial seizure - poor patient awareness.  The patient will generally not remember the seizure, and if this happens, his memory will be vague

  Generalized seizure

  Generalized seizures occur when the brain hemispheres have epilepsy activity.  The patient lost consciousness while the seizure occurred

  Concussive spells (formerly known as major epileptic seizures) - these are probably the best general type of seizures.  They cause unconsciousness, body stiffness, and vibration

  Absentia seizures (formerly called small epileptic seizures) - they involve short lapses in consciousness as a person appears to stare into space.  Attack attacks often respond well to treatment

  Seizures - muscles become stiff.  May cause falls

  Atony epileptic seizures - loss of muscle control, causing the individual to suddenly drop

  Concussive seizures - associated with rhythmic and shaking movements

  General Secondary Nuba

  A general secondary seizure occurs when epilepsy activity begins as a partial seizure, and then spreads to the two hemispheres of the brain.  With this development, the patient loses consciousness

 Some causes of epilepsy

  In most cases, no cause of epilepsy can be found and is described as idiopathic.  However, there are a number of recognized factors that increase a person's risk of epilepsy.  These include

  Brain scarring or brain damage, for example due to birth injuries, accidents, physical assaults, and excessive use of alcohol / drugs

  Infections and fever, such as meningitis, rubella, encephalitis and AIDS

  Benign and malignant tumors

  Genetic factors, such as tuberous sclerosis

  Dementia and degenerative neurological disorders, for example Alzheimer's disease

  Stroke that can occur at any age

  Parasitic infections, for example malaria

  Developmental disorders - for example, autism or neurofibromatosis

  Genetics

 Risk factors

  Sometimes the risk factor can cause brain scarring or cause the brain to not grow or function properly.  Risk factors include

  Babies born young for their ages

  Children who have had seizures in the first month of life

  Babies born in abnormal areas of the brain

  Brain bleeding

  Abnormal blood vessels in the brain

  Serious brain injury or hypoxia in the brain

  Brain tumors

  Brain infections: abscess, meningitis, or encephalitis

  Stroke caused by clogged arteries

  Cerebral Palsy

  Cases of intellectual and developmental disability

  Seizures that occur within days after a head injury ("early post-traumatic seizures")

  A family history of epilepsy or seizures associated with fever

  Alzheimer's disease (late in disease)

  Autism spectrum disorder

  Unusually long (febrile) episodes

  Prolonged seizures or recurrent seizures called epilepsy

  Use of illegal drugs such as cocaine

  Mild head injuries, such as concussion with a very brief loss of consciousness, do not cause epilepsy.  But the effects of frequent mild head and epilepsy injuries are unknown

 Symptoms of epilepsy

  The main symptoms of epilepsy are frequent seizures.  In the event that one or more of the following symptoms exist, the individual should visit the doctor, especially if it recurs

  Spasms without temperature (without fever)

  Short bouts of blackout or muddled memory

  Intermittent fainting episodes, during which bowel or bladder control is lost, often followed by extreme fatigue

  For a short period, the person does not respond to instructions or questions

  A person becomes solid, suddenly, for no apparent reason

  The person suddenly falls for no apparent reason

  Sudden bouts of flash without apparent stimuli

  Sudden bouts of chewing, for no apparent reason

  For a short time, the person appears stunned and unable to communicate

  Repetitive movements that seem inappropriate

  The person becomes frightened without an apparent reason;  They may panic or become angry

  Strange changes in the senses, such as smell, touch and sound

  Children, arms, legs, or body tremors appear as a group of rapid jerking motion

 Complications of epilepsy

  If you fall during a seizure, you can injure your head or break a bone

  If you have epilepsy, you are likely to drown while swimming or bathing 15 to 19 times more than the rest of the population due to the possibility of a seizure while in the water

  Car accidents.  A seizure that causes either loss of consciousness or control can be dangerous if you are driving a car or operating other equipment

  Complications of pregnancy.  Seizures during pregnancy pose a risk to both the mother and the baby, and some antiepileptic drugs increase the risk of birth defects.  If you have epilepsy and are considering pregnancy, talk to your doctor while you plan to become pregnant

  Emotional health problems.  People with epilepsy are more likely to experience psychological problems, especially depression and anxiety, and in extreme cases, suicide.  Problems may be the result of difficulties in dealing with the condition itself as well as the side effects of the medications

  Sudden unexplained sudden death in epilepsy (SUDEP).  People with epilepsy also have a risk of sudden, unexplained death.  The cause is unknown, but some research shows it may be caused by heart or respiratory disease

  Diagnosis and testing of epilepsy

  The evaluation of epilepsy patients aims to determine the type and cause of seizures, because different types respond better to specific treatments.  The diagnosis is based on

  The patient's medical history, including any family history of seizures, associated medical conditions, and current medications

  A complete physical and neurological examination is examined - your muscle strength, reactions, eye sight, hearing, and the ability to discover different sensations are tested so that doctors can better understand the cause of your seizures

  EEG, which measures electrical impulses in the brain.  This is the only test that directly detects electrical activity in the brain, and seizures are determined by abnormal electrical activity in the brain.  During the EEG, electrodes (small metal discs) are attached to specific locations on your head.  The electrodes are connected to a monitor to record the electrical activity of the brain.  EEG is not only useful to confirm the diagnosis of epilepsy, but also to determine the type of epilepsy

  

  A routine EEG records about 20 minutes of brain waves (however, a routine EEG takes about 90 minutes).  Because 20 minutes is a short period of time, the results of routine EEG studies are often normal, even in people known to have epilepsy.  Therefore, it may be necessary to monitor EEG for long periods

  EEG video monitoring is a better diagnostic method.  During this type of observation, EEGs monitor brain activity and video cameras for body movements and behavior during a seizure.  Prolonged monitoring often requires the patient to spend time in a private facility for several days.  Prolonged EEG video monitoring is the only way to diagnose epilepsy.

  Brain imaging studies, such as those provided by magnetic resonance imaging (MRI).  This can determine the cause of the seizures, but the majority of epilepsy patients have a normal MRI

 Medication and treatment

  Drug treatment

  Several medications are available to treat epilepsy, and many have been launched recently.  Old and large medications used to treat epilepsy include

  Phenytoin (Dilantin)

  Phenobarbital

  Carbamazepine (Tegretol, Carbatrol)

  Primidone (Mesulin)

  Ethosuximide (Zarontin)

  Valproic acid (Depakote)

  Diazepam (Valium) and its derivatives

  Modern medications to treat epilepsy includ

  Felbamate (Felbatol)

  Gabapentin (Neurontin)

  Lamictal

  Oxcarbazepine (Trileptal)

  Topiramate (Topamax)

  Tiagabine (Gabitril)

  Levitiracetam (Kebra)

  Zonisamide (Zonegran)

  Other treatment options

  Epilepsy surgery is safe and effective, and is the preferred treatment when medications do not work.  (See the brochure on Epilepsy Surgery)

  The ketogenic diet is effective in treating certain types of epilepsy.  Specifically, it is effective in children with generalized epilepsy with severe symptoms with more than one type of seizure and brain damage.  However, diet requires careful planning and may be difficult to follow, so this is not possible in older children or adults.  The diet begins in the hospital, and when it succeeds, it is usually kept for 2 to 3 years.  A highly motivated family and a qualified dietician require

  Vagus nerve stimulation (VNS).  This treatment requires a simple implant, and is the size of a pacemaker.  It is placed under the skin in the upper left chest, like a pacemaker.  This treatment appears to be effective for seizures that do not respond well to medication alone