December 16, 2020

Background: Throughout the COVID-19 pandemic, numerous therapeutic agents have been repurposed and applied empirically and within clinical trials. Prophylactic medications for COVID-19 could have a huge benefit, but studies to date haven’t panned out. Initially many therapeutic medications were used late in illness, and one of the criticisms of these negative studies was that the drugs were applied too late in the disease and therefore did not show any benefit. There were also numerous studies showing associations of benefit, but subsequent randomized clinical trials have failed to prove effectiveness in reducing mortality (i.e. Remdesivir, hydroxychloroquine, lopinavir/ritonavir, convalescent plasma, monoclonal antibody therapy). Ivermectin is an interesting medication that had fallen off my radar until recently.  It is an anti-parasitic medication, with potential anti-viral, and anti-inflammatory properties against SARS-CoV-2 and COVID-19. In this post we will review some of the current evidence in using Ivermectin as a prophylactic and therapeutic agent in COVID-19.

December 14, 2020

Background: In the US out-of-hospital cardiac arrest (OHCA) has an estimated survival rate of <10% overall, but slightly better survival rates with shockable rhythms of approximately 30% [2]. A small proportion of these patients will have refractory VF/VT OHCA not treatable by standard ACLS guidelines.  One possible modality for these patients is extracorporeal membrane oxygenation (ECMO, followed by immediate coronary angiography and percutaneous coronary intervention (PCI).  How would this ECMO-facilitated resuscitation strategy fair when applied in a US metropolitan community?

December 10, 2020

Background: Acute migraine headaches are a common presentation to emergency departments.  Treatment can be challenging: multiple medications are often required and allergies can limit options. Oral timolol maleate is approved by the FDA for migraine prophylaxis but is not typically effective once the migraine has started.  There are some case reports of topical timolol in the treatment of acute migraine headaches [2][3] and a research letter [4] describing the use of timolol eyedrops in the treatment of acute migraine headaches. The research letter was a randomized trial of 10 patients that was not masked and therefore no definitive conclusions could be made.

December 5, 2020

Background: Despite limited high-quality evidence, many institutions are currently using convalescent plasma therapy (CPT) in the treatment of COVID-19.  The majority of the evidence for CPT comes from observational studies lacking placebo arms (US Expanded Access Program). Convalescent plasma therapy isn’t a novel treatment modality and has been used in the treatment of other infectious diseases (SARS, MERS, H1N1, Ebola, etc…) with mixed results. The theory behind CPT is it can supplement the patient’s immune response by administering plasma rich in antibodies from someone previously infected who has recovered.  Thus far the US Expanded Access Program, showed that giving convalescent plasma earlier (i.e. ≤3 days) and with higher titers (>18.45 S/Co) was associated with improved mortality in COVID-19 (This data cannot show causality as there was no randomization and no control arm) [3].

December 4, 2020

Background: Throughout the COVID19 pandemic, massive efforts have been invested on the research of effective therapeutics.  Much of the research looks at repurposing older treatments (i.e. antimalarial drugs, antiviral agents, interleukin blockers and convalescent plasma therapy).  There have been no large randomized, controlled trials of targeted treatments specific to SARS-CoV-2. LY-CoV555 is an anti-spike protein neutralizing monoclonal antibody that binds with high affinity to the receptor-binding domain of SARS-CoV-2. Its role in treatment of COVID19 is unclear.