Category Archives: Uncategorized

COVID-19: Aspirin Reduced Mortality, ICU Admissions, and Need for Mechanical Ventilation

…in hospitalized patients. The usual aspirin dose was 81 mg/day. Here’s the abstract from April 2021 in Anesthesia & Analgesia.

BACKGROUND: 

Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality.

METHODS: 

A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions.

anesthesiologist medical doctor working with anesthesia patent
Intubation in preparation for mechanical ventilation

RESULTS: 

Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users.

CONCLUSIONS: 

Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.


At the start of the pandemic, many physicians were avoiding use of nonsteroidal anti-inflammatory drugs like aspirin. I don’t remember why.

This was a small study, so results are not as reliable as a 2000-patient experiment. But low-dose ASA is well-tolerated and cheap.

Steve Parker, M.D.

9/11: An Alternative History You’ve Never Heard Of

Israeli flag

From Ron Unz, who is smarter than you and me:

The widespread doubts about the reality of the official story provided by our government and almost universally promoted by our media has severely diminished popular faith in the credibility of those two crucial institutions, with consequences that are still very apparent in today’s highest profile issues.

Over the years, diligent researchers and courageous journalists have largely demolished the original narrative of those events, and have made a strong, perhaps even overwhelming case that the Israeli Mossad together with its American collaborators played the central role. My own reconstruction, substantially relying upon such accumulated evidence, came to such conclusions, and I am therefore republishing it….

I recommend that you RTWT.

Before it’s disappeared by TPTB.

Steve Parker, M.D.

Cancel Culture: LinkedIn Cancelled Me

Boo hoo waah. They “restricted” my account and wouldn’t even take the time to tell me why. LinkedIn wants a photo of a government-issued ID before they’ll communicate with me. Ef that.

Steve Parker, M.D.

Update Sept 18, 2021:

From Yahoo!News: “Rep. Jim Banks, chairman of the conservative Republican Study Committee in Congress, sent a letter Friday to Microsoft-owned LinkedIn, criticizing them for bowing down to the Chinese government by blocking the profiles of Americans who refer to the Asian superpower in a critical fashion.”

Surely my little blog isn’t on China’s rardar screen. I don’t recall posting or saying anything critical of the CCP. But if I want to, I will.

Happy National Avocado Day!

Allison Carter, Communication Manager at Trees.com, informs me that today (July 31, 2021) is National Avocado Day. In my childhood days growing up in Oklahoma and Texas, I don’t recall eating avocados at all. I’m not sure if that’s a reflection on my parents, or if avocados weren’t readily and cheaply available then. I love them now. This graphic is from Allison:

Avocado infographic

Celebrity Culture Promotes Consumerism

h/t Fanatic Cook

Mediterranean Diet Lowers Parkinson’s Disease Risk for Women

  • santorini, greece

Investigators studied a female Swedish population.

Women who adhere closely to a Mediterranean diet in their 30s and 40s have a lower risk of Parkinson’s disease later in life, particularly once they reach their mid-60s, a large population-based Swedish study found.The study, “Mediterranean Dietary Pattern at Middle Age and Risk of Parkinson’s Disease: A Swedish Cohort Study,” was published in the journal Movement Disorders.Diet is increasingly recognized for its potential influence on a person’s risk of several diseases. With Parkinson’s, for instance, studies have suggested that dairy products could be a risk factor for its development.

Source: Holding to Mediterranean Diet Lowers Parkinson’s Risk for Women, Study Finds

Steve Parker, M.D.

Another Reason to Avoid Chronic Proton Pump Inhibitor Use: Higher Risk of Diabetes

prilosec, proton pump inhibitor
Neither the cited study nor I implicate Prilosec in particular

Regular use of proton-pump inhibitors (PPIs) increases patients’ risk of developing type 2 diabetes mellitus (T2DM) by 24%, an observational study published in Gut has suggested.

Source: Regular use of PPIs linked with increased risk of type 2 diabetes, study suggests | News | Pharmaceutical Journal

Proton pump inhibitors are widely used in the U.S. to treat esophageal reflux, ulcers, and dyspepsia. They are among the most widely prescribed drugs. You can also get them over-the-counter. Brand names include Protonix, Prilosec, and Nexium.

The study at hand defined “regular use” as at least twice per week. The study was an epidemiological one observing participants for 10-12 years. The more years of regular use, the greater risk of diabetes developing. Nearly all participants were White, so results may not apply to other ethnicities.

Note that this study doesn’t prove that PPIs cause diabetes. They just found a statistical linkage. As you know, correlation does not equal causation. We don’t know how PPIs could cause T2 diabetes. From the article:

According to the study, the possible mechanism for the association could be related to gut microbiota, as previous studies have shown that PPI use is associated with reduced diversity of gut microbiome and consistent changes in the microbiota phenotype.

If your physician recommends you take a PPI chronically, ask about alternatives.

Steve Parker, M.D.

“Thank You” to My Supporters!

I published my first book in 2007 to extend my healing reach beyond the confines of the clinic and hospital room. I’m certain my writing has improved the health of many folks I’ll never know about, and that means more to me than any financial success I’ve had with the books.

In 2020, my net profit from writing was $937.08, which is admittedly pitiful. The prior year profit was $5,802.48. Pandemic effect, maybe? To lower my expenses in 2021, I’ll look into a private PO box instead of US Postal Service ($168/year), drop Amazon Prime ($129/year), and negotiate lower fees with Network Solutions.

I am blessed to have a hospitalist job that pays well. COVID-19 has caused major economic hardship for many of you, including unemployment.

My primary means of advertising has been blogging. Cross-posting on Facebook, Twitter, and LinkedIn has done almost nothing for book sales. A few years ago I could give my hospital patients a business card with links to my books, but my employer insisted I stop.

If you care to support my writing, buy a book. If not for yourself, then for someone you care about.

Steve Parker, M.D.

PS: Guesstimating my combined federal and state taxes being 40%, I have $562.25 left after paying taxes. And don’t forget sales tax on many things I might buy.

front cover of Conquer Diabetes and Prediabetes

Click to purchase at Amazon.com. E-book also available at Smashwords.com.

front cover of paleobetic diet

Click to purchase at Amazon.com. E-book also available at Smashwords. com.

Determination of Brain Death by Neurologic Criteria

Wish I were here

This is for my personal use. Not for my typical readers. From the World Brain Death Project:

Abstract

Importance

There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries.

Objective

To formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel.

Process

Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery.

Evidence Synthesis Based on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed.

Recommendations

Prior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability.

Conclusions and Relevance

This report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries.

Source: Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project | Critical Care Medicine | JAMA | JAMA Network

COVID-19: Do Lock-Downs Work?

artist's rendition of coronavirus
Artist’s rendition of Coronavirus

If you’re looking for evidence that stay-at-home orders and business closures don’t help control COVID-19, here it is:

In summary, we fail to find strong evidence supporting a role for more restrictive non-pharmacological interventions in the control of COVID in early 2020. We do not question the role of all public health interventions, or of coordinated communications about the epidemic, but we fail to find an additional benefit of stay-at-home orders and business closures.

– John P.A. Ioannidis, et al.