Discussion - Covid-19 Thrombosis, myocarditis, vitamin levels etc.

[kiwibird]

Yesterday, 04:19 AM
April 24th, 2020, 04:38 PM
https://www.nbcnews.com/health/healt...clots-n1190491
Doctors report uptick in surprising coronavirus complication: dangerous blood clots

Blood clots are not usually associated with respiratory viruses.

https://www.thesun.co.uk/news/114620...lthy-patients/
Coronavirus causes blood clots and sudden strokes in young, healthy patients, doctors warn

Why are so many COVID-19 patients also seeing blood clots?

https://abcnews.go.com/Health/covid-...ry?id=70131612
Health experts have been confounded by this latest trend.

https://www.statnews.com/2020/04/16/...ronavirus-tpa/
Doctors treating the sickest Covid-19 patients have zeroed in on a new phenomenon: Some people have developed widespread blood clots, their lungs peppered with tiny blockages that prevent oxygen from pumping into the bloodstream and body.

A number of doctors are now trying to blast those clots with tPA, or tissue plasminogen activator, an antithrombotic drug typically reserved for treating strokes and heart attacks. Other doctors are eyeing the blood thinner heparin as a potential way to prevent clotting before it starts.

Without a rigorous study, though, it’s impossible to know the potential risks or benefits of tPA, blood thinners, or other drugs — or what makes a difference. Until more robust research gets underway, the body of evidence now is a handful of case reports and anecdotal observations on the use of drugs to combat clots.

https://flutrackers.com/forum/forum/...ratory-failure From Tetano's post:tiphat:

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4 comments

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  #225.1
  Supa commented
  April 25th, 2020, 07:55 PM
  Clots are probably added to by silent hypoxia from collapsed sacks and its a spiral down from there. https://www.sciencedaily.com/release...0802115657.htm
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  #225.2
  kiwibird commented
  April 26th, 2020, 04:22 PM
  Thank you Supa - food for thought.
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  #225.3
  kiwibird commented
  Today, 04:15 AM
  http://www.c-jcm.com/html/2020/1/20200201.htm Very interesting article on guidelines for nutrition for patients with coronavirus. From Chinese Journal of Clinical Medicine. Is it a chicken and egg thing here - with a problem with Protein S deficiency leading to thrombosis - and how is Protein S - Vitamin K dependent? Seems counterintuitive - but in the list of medicines and nutritional supplements in this article - they recommend vitamin k supplements!
  
  It has also been bugging me - almost every photo of patients in China have an IV attached - and yet in Italy in the quarantine areas there are lots of people on army cots who do not even seem to have a jug of water to hand. Also here (UK) if people are in self isolation because they are symptomatic they will certainly not be popping in their own IV. Is there clinical evidence from China showing the IV helped? For certain hydration and fluid intake is always important with Pneumonia. Did the Chinese practitioners add anything to the IV's? Has anyone else any input?
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  #225.4
  kiwibird commented
  Today, 04:17 AM
  I also never saw any compression socks on patients in Chinese hospitals - and yet very early on the Italian hospitals were using compression socks...

 

[kiwibird]

Nutritional supplements recommended by Clinical Nutrition Branch of Chinese Nutrition Society

Yesterday, 04:38 AM
http://www.c-jcm.com/html/2020/1/20200201.htm

Very interesting and thorough list of supplements and vitamins recommended for patients with varying conditions. Also tables with different recommendations for different ages, including babies and the elderly.

...

The new crown critically ill patients often significant systemic inflammation of the body in a high catabolic state [SUP][ . 1 - . 3 ][/SUP] . Due to the release of various stress-related hormones and pro-inflammatory cytokines and insufficient oxygen supply, its nutritional metabolic characteristics are mainly manifested as: (1) Decreased energy supply for glucose oxidation, increased glycolysis, enhanced gluconeogenesis, insulin resistance , Increased blood sugar; (2) increased protein breakdown, increased protein synthesis during the acute phase, decreased muscle protein synthesis, and altered amino acid profile: such as a decrease in the concentration of branched chain amino acids (BCAA); (3) increased fat mobilization and breakdown; (4) multiple Increased consumption of vitamins and trace elements. In this case, patients are prone to malnutrition, and the incidence of malnutrition is higher for patients with chronic underlying diseases.

....

2.1.3 FatThe target amount of fat: It is recommended that the total fat supply ratio of diet and tube feeding nutrition reach 25% ~ 30% of the total energy [SUP][ 12 ][/SUP] . For critically ill patients with parenteral nutrition, due to changes in fat absorption and metabolism, intravenous injection of too high fat will lead to lipid overload and toxicity, leading to hypertriglyceridemia and abnormal liver function, while low plasma three Acylglycerol concentration levels are associated with improved survival [SUP][ 6 ][/SUP] . Therefore, it is recommended that the daily venous fat is 1 g / kg, at most not more than 1.5 g / kg, and the dose needs to be adjusted according to individual tolerance [SUP][ 6 ][/SUP] .

.....

2.1.5 Liquid volumeFollow the general principles of fluid therapy, that is, stabilize patients with 30 to 40 mL / kg per day. In critically ill patients, the minimum amount of fluid that meets the needs of major nutrients is within our means. For every 1 ? C increase in body temperature, supplement 3 ~ 5 mL / kg (calculated at 4 mL / kg) [SUP][ 8 ][/SUP] . Patients with critically ill neonates often have pulmonary edema, fluid accumulation, etc. While maintaining fluid balance, it is more necessary to prevent excessive fluid, especially intravenous infusion [SUP][ 8 ][/SUP] .

Table 3 Daily recommended amount of micronutrients for total parenteral nutrition
[TABLE="width: 439"]
[TR]
[TD="class: table_top_border, align: left"]Minerals and trace elements[/TD]
[TD="class: table_top_border, align: left"]Recommended amount[/TD]
[TD="class: table_top_border table_left_border2 table_right_border2"] [/TD]
[TD="class: table_top_border, align: left"]Vitamins[/TD]
[TD="class: table_top_border, align: center"]Recommended amount[/TD]
[/TR]
[TR]
[TD="class: table_top_border2, align: left"]Minerals[/TD]
[TD="class: table_top_border2, align: left"] [/TD]
[TD="class: table_top_border2 table_bottom_border table_left_border2 table_right_border2"] [/TD]
[TD="class: table_top_border2, align: left"]Vitamin B1[/TD]
[TD="class: table_top_border2, align: center"]6 mg[/TD]
[/TR]
[TR]
[TD="align: left"]Sodium / potassium[/TD]
[TD="align: left"]1 ~ 2 mmol / kg[/TD]
[TD="align: left"]Vitamin B2[/TD]
[TD="align: center"]3.6 mg[/TD]
[/TR]
[TR]
[TD="align: left"]calcium[/TD]
[TD="align: left"]10 ~ 15 mEq[/TD]
[TD="align: left"]Vitamin B3[/TD]
[TD="align: center"]40 mg[/TD]
[/TR]
[TR]
[TD="align: left"]magnesium[/TD]
[TD="align: left"]8 ~ 20 mEq[/TD]
[TD="align: left"]Folic acid[/TD]
[TD="align: center"]600 mcg[/TD]
[/TR]
[TR]
[TD="align: left"]phosphorus[/TD]
[TD="align: left"]20 ~ 40 mmol[/TD]
[TD="align: left"]Pantothenic acid[/TD]
[TD="align: center"]15 mg[/TD]
[/TR]
[TR]
[TD="align: left"] [/TD]
[TD="align: left"] [/TD]
[TD="align: left"]Vitamin B6[/TD]
[TD="align: center"]6 mg[/TD]
[/TR]
[TR]
[TD="align: left"]Trace elements[/TD]
[TD="align: left"] [/TD]
[TD="align: left"]Vitamin B12[/TD]
[TD="align: center"]5 mcg[/TD]
[/TR]
[TR]
[TD="align: left"]chromium[/TD]
[TD="align: left"]<1 mg[/TD]
[TD="align: left"]Biotin[/TD]
[TD="align: center"]60 mcg[/TD]
[/TR]
[TR]
[TD="align: left"]copper[/TD]
[TD="align: left"]0.3 ~ 0.5 mg[/TD]
[TD="align: left"]Vitamin C[/TD]
[TD="align: center"]200 mg[/TD]
[/TR]
[TR]
[TD="align: left"]manganese[/TD]
[TD="align: left"]55 mcg[/TD]
[TD="align: left"]Vitamin A[/TD]
[TD="align: center"]990 mcg[/TD]
[/TR]
[TR]
[TD="align: left"]selenium[/TD]
[TD="align: left"]60 ~ 100 mcg[/TD]
[TD="align: left"]Vitamin D[/TD]
[TD="align: center"]5 mcg[/TD]
[/TR]
[TR]
[TD="align: left"]Zinc[/TD]
[TD="align: left"]3 ~ 5 mg[/TD]
[TD="align: left"]Vitamin E[/TD]
[TD="align: center"]10 mg[/TD]
[/TR]
[TR]
[TD="class: table_bottom_border, align: left"] [/TD]
[TD="class: table_bottom_border, align: left"] [/TD]
[TD="class: table_bottom_border, align: left"]Vitamin K[/TD]
[TD="class: table_bottom_border, align: center"]150 mcg[/TD]
[/TR]
[/TABLE]

2.2.3 Enteral nutrition (EN)EN contraindications: comprising shock uncontrolled, uncontrolled acidosis and hypoxemia, upper gastrointestinal bleeding, intestinal ischemia, obstruction, abdominal compartment syndrome and distant-feeding path high output fistula [SUP][ 6 , 19 ][/SUP] . In addition, when hemodynamic instability or gastric retention is greater than 500 mL / 6 h, EN should be suspended [SUP][ 5 ][/SUP] .
Indications for EN: enteral nutrition can maintain the integrity of the intestinal barrier and function [SUP][ 19 ][/SUP] , prevent gastrointestinal complications in patients with mechanical ventilation [SUP][ 13 , 19 ][/SUP] , and promote intestinal immune function [SUP][ 13 , 20 ][/SUP] . So, who can not eat by mouth and no contraindications EN new crown critically ill patients, should be preferred EN, EN given early in the ~ 48 H 24- [SUP][ 5 - 6 , 19 , 21 ][/SUP] . For patients receiving extracorporeal membrane oxygenation (ECMO), early EN is also recommended [SUP][ 22 ][/SUP] .
Nourishing feeding of EN: Nourishing feeding (usually defined as 10-20 mL / h or 10-20 kcal / h) can prevent intestinal mucosa atrophy and maintain intestinal integrity [SUP][ 13 ][/SUP] . Therefore, it is recommended that in the case of critically ill patients with new crowns, EN cannot be increased due to gastrointestinal intolerance or other reasons. If the situation permits, it is recommended not to stop EN completely, and try to maintain nourishing EN feeding to keep the intestinal mucosa intact.

 

[Emily]

https://twitter.com/SlythSeeker/status/1255157609927045120

JFC you guys, my daughter, who is not yet 30 years old, had a stroke last night due to having contracted covid-19. PLEASE stay inside if you can. This is no joke. I think she's going to pull through but this is terrifying. She's been sick with it for weeks. She just had a baby...
8:31 AM ? Apr 28, 2020

relying to@SlythSeeker
and@PhoenixWytch
So sorry!! Was she on any medications? I'm hearing there are certain meds that make Covid worse people need to avoid

Malfoy
@SlythSeeker
9h
She's always been a little sickly, born with under developed kidneys, but she stopped taking medication for that a long time ago. I have no idea if she's taking anything now. I'll have to ask her.

 

[Emily]

One of our members mentioned the local hypoxia issue - sorry, can't remember who or find the post. If PIC is early stage with DIC late stage, I'm confused about media reports stating that stroke is an early symptom. The stroke in the young woman above sounds like late stage as you would expect.
Anyway this article makes a case for the risk of subclinical cardiovascular disease. The first case in the Seattle area was a young man whose only health problem was high cholesterol, I think. He was quite ill until receiving Remdesivir.

https://flutrackers.com/forum/forum...e-with-disseminated-intravascular-coagulation
"Lack of Evidence for Coronavirus Myocarditis or Coronary Vasculitis
Myocarditis may occur after severe respiratory viral pneumonia and is comparatively
rare but well documented especially in younger females following influenza infection
(Table 2). Understandably, raised cardiac enzymes in COVID-19 have been taken to
potentially represent myocarditis or virally associated coronary system vasculitis.
Experimental and clinical studies suggested that direct cardiomyocyte infection by
coronavirus family and interactions with ACE2 receptor may underscore the
cardiovascular complications(25) but most evidence points away from cardiac
involvement(26, 27). The ACE2 receptor is also expressed on endothelial cells (EC)
and in situ hybridisation study suggested pulmonary endothelial infection (28). Other
studies showed a complete absence or very low level EC potential infection(26, 27).
Moreover, another study in SARS patients, suggested a close link between
pneumocytes infection and pro-inflammatory cytokine expression in the same
cells(29), but this was not reported for endothelium. Recent publications indicate that
COVID-19 RNA was undetectable in the blood in one study and in only 15% of cases
in a second study, again arguing for a very pneumocyte centric and adjacent tissue
pathology rather than systemic viral infection (30, 31) (Figure 2)."

"Laboratory Pointers towards early Pulmonary Intravascular Coagulopathy"

"Extensive Pulmonary Inflammation and thrombosis in COVID-19 Pathology"
"Importantly, EC disruption, TF expression and coagulation cascade activation will all
be progressively exacerbated by development of local hypoxia (35), establishing a
deleterious positive feedback thrombo-inflammatory loop within the small vessels of
the lungs with thrombosis and haemorrhage (Figure 3)."

 

[kiwibird]

https://bbs.guahao.com/topic/IPyJk119232269379600385 Article dated March 02, 2020. Warning of cold symptoms, sore throats, skin infections etc. to be aware of chest pain symptoms (and get them checked out) - especially in young people and children. (Probably because you wouldn't normally think of heart problems in a healthy young person with a cold).

 

[kiwibird]

From Emily's post https://flutrackers.com/forum/forum/...ew-perspective and multiple insightful posts by Gert including https://flutrackers.com/forum/forum/...d-and-latitude there seems to be a solid relationship between the balance of Vitamins in the severity of patients with Covid-19. One study I cannot immediately find looks at the balance between Vitamin D and Vitamin A and the severity of influenza.
There are more cases being reported of symptoms showing skin lesions etc. I am looking for studies showing the level of Vitamin A Carotenoids in blood as many of the exhibitions of Covid show symptoms that could be related to an excess. Even some of the Kawasaki disease symptoms could be attributed to this. The reason I have been prompted to look into this is the fact that one of the most bizarre symptoms of this coronavirus is the loss of the sense of smell - which is also related to a Vitamin A deficiency. The fact that pregnant women and children appear to have been proportionally lightly affected - both traditionally more likely to be suffering from Vitamin A deficiency - and obese patients - who may have a higher betacarotene circulating level... well worth discussing and looking for studies...

A selection of articles - mainly to keep in one place for reference..

https://books.google.co.uk/books?id=...20a%22&f=false- marked page 40

https://apps.who.int/iris/bitstream/...3_eng.pdf?ua=1

Additionally, other micronutrient deficiencies can depress serum retinol values (3). Zinc, in particular, is required for the synthesis of retinol-binding protein (6). Zinc deficiency thus reduces the amount of retinol that can circulate, causing a functional vitamin A deficiency.. ???

https://link.springer.com/article/10...431-014-2346-y

stevens johnson syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301467/

https://vitamindwiki.com/tiki-index....80%93+May+2015

https://link.springer.com/article/10...431-014-2346-y

https://www.dailymail.co.uk/news/art...ronavirus.html

https://en.wikipedia.org/wiki/Hypervitaminosis_A

non insulin dependant diabetics https://www.ncbi.nlm.nih.gov/pubmed/9314640

sheep https://www.sciencedirect.com/scienc...22030279832439

https://www.mayoclinic.org/diseases-...s/syc-20355936
Some potential genetic markers - or perhaps a high green leaf diet??

https://www.sciencedirect.com/scienc...03986115000843

Of ∼600 carotenoids in nature, ∼50 are present in the human diet, but only six are ubiquitous in human serum, namely β-carotene (BC),1 α-carotene, β-cryptoxanthin, lycopene, lutein, and zeaxanthin [1].
The main known function of carotenoids in humans is to serve as precursors of vitamin A related retinoids such as retinol, retinal and retinoic acid that play important roles in the visual cycle and in gene regulation linked to many developmental and physiologic processes

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312803/

 

[kiwibird]

It was Supa. Hattip

 

[kiwibird]

https://emedicine.medscape.com/article/205582-overview Vitamin K deficiency - can lead to a protein s deficiency (Thanks Supa for the post Emily referenced above)

 

[kiwibird]

https://www.medrxiv.org/content/10.1....17.20155846v1

from https://twitter.com/MaxCRoser/status...50906018852867

Seems to me that the vegetables driving a higher mortality rate - have high levels of Vitamin A (and nitrates).

 

[Emily]

ETA: I just noticed the whole study was available and the vegetable consumption data was at the country level, not individual. My comments were assuming the data was individual, (though I wondered how they got it.)

The way I understand the paper, only lettuce was statistically associated with increased mortality. The only two vegetables that were statistically associated with decreased mortality were head cabbage and cucumber.

Of all the variables considered, including confounders, only head cabbage and cucumber reached statistical significance with the COVID-19 death rate per country. For each g/day increase in the average national consumption of some of the vegetables (head cabbage and cucumber), the mortality risk for COVID-19 decreased by a factor of 11, down to 13.6 %. Lettuce consumption increased COVID-19 mortality.

I don’t know what to make of the results. Lettuce has many varieties; some pale and some richly green so I would think there could be a lifestyle association here. I posted about a vegan with really good eating habits, lots of time spent outdoors hiking, but she couldn’t shake COVID for months. A naturopath tested her and found her extremely deficient in zinc and vitamin A. (True vitamin A - the retinol form the body can use.) She quickly got her health back by supplementing the zinc and taking high dose vitamin C. (Hadn’t even gotten around to the vitamin A)

It’s important to note that vegetables have only pro-vitamin A, (like beta-carotene), not the form your body ultimately uses. That form, A1, or retinol can only be found in animal products. Your body needs to convert the pro-A’s from vegetables into the active A form. About 45% of the human population can’t make the conversion: https://www.healthline.com/nutrition/foods-high-in-vitamin-a

Daily vitamin tablets used to have real vitamin A in them but few do now since retinol has a narrow safety margin for pregnant women. Most multi-formulas now just have beta-carotene.

It could be that lettuce is consumed more by vegans and cabbage is consumed more by animal product eaters. Along the same lines, I’ve suspected that the studies that show an increased risk for cancer for higher consumption of beta-carotene could be picking up an association between high beta-carotene and low vitamin A.

The protection from cucumbers is something I can’t even guess about. But this is just one pre-print study. I wouldn’t worry about eating any vegetables because of it. If I were concerned or not feeling well, I might measure levels of true vitamin A, vitamin D and zinc via blood testing, though, just to see if my own diet and lifestyle is keeping me nourished as an individual.