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Month: February 2022

Dear Dr. K;

Dear Dr. K;

Thank you for keeping an open dialogue with me about Covid vaccines.  As you know, I opted against vaccination.  However, over Christmas I caught Covid, but luckily it was a mild flu like illness.  So, I guess I should be OK from here on out. 

I’m glad your illness was mild, but I’m a little hesitant about predicting how things will play out in the future.  First of all, just as vaccination doesn’t provide iron-clad protection so too natural immunity via infection is not 100% effective in preventing re-infection.  Therefore, with the extended nature of the pandemic, following Covid avoidance precautions still makes sense. 

Another concern I have is the frequency of post-Covid sequelae especially neurologic ones.  By now, the general public is well aware of Covid illness’ predilection to impact the sense of taste/smell.  As it turns out, this is just the tip of the proverbial iceberg.  At this point in the pandemic, it seems that roughly 70% of infected individuals suffer some sort of extended neurological issue.  For many it’s the smell/taste scenario and for others protracted headaches.  Of much graver concern is research done by Oxford University on 45,000 people in the UK which showed loss of brain mass as measured by CT scanning.  The loss was primarily in the frontal and temporal lobes which subserve the senses of taste and smell but also cognition. 

In this regard, the Oxford scientists conducted performance tests on some of the Covid patients and found they were slower in processing information than non-infected counterparts.  Also, there was no correlation between the severity of the illness (hospitalized verses non-hospitalized) and the loss of brain matter. 

These facts set up a comparison with Alzheimer’s disease where a common symptom is loss of sense of smell along with frontal/temporal lobes pathology.  In fact, some neuro scientists posit that Alzheimer’s disease is caused by chronic inflammation in genetically susceptible individuals to a prior viral infection.  What isn’t known is the potential for brain mass recovery in these individuals.  Neuroplasticity allows marked recovery of the brain from many insults.  Perhaps this will still be true with “Covid brain”.  But for now, I think it’s still best to not catch the illness. 

Gut Microbiome and Prostate Cancer

Gut Microbiome and Prostate Cancer

A recent article published in Science looked at the effect of gut microbiome and prostate cancer.  Obesity alters the gut flora.  It has been known for some time that obese men are more prone to prostate cancer.  Now, it seems there is a cause and effect. 

A current treatment for prostate cancer is castration (to remove the driving force of testosterone) either chemical via anti-androgens or surgical.  This almost uniformly leads to a very good clinical response.  But in some patients this response is short lived because their gut flora alters to bacteria that can produce androgens (testosterone).  This switch phenomenon is more likely to occur with obesity.  Currently research is ongoing to find an antibiotic therapy to eliminate these mischievous microbes or a form of probiotic to displace them. 

While that research is being completed another approach is via self-reliance.  It is known that even modest weight reduction (10 to 15 pounds) has a favorable impact on the gut microbiome.  In addition, adding a probiotic and selecting foods to support the probiotic (pre-biotics) can reduce the bad gut flora. 

Ivermectin for Covid

Ivermectin for Covid

Ivermectin in an FDA approved drug for the treatment of intestinal strongyloidiasis (round worm) and onchocerciasis (filarial worm).  It is also used in veterinary medicine to treat parasites in pets and in livestock. 

Because of significant use of Ivermectin off label to either try and prevent or to try and treat Covid, scientists have scrutinized its potential.  Of interest in vitro (in a test tube) Ivermectin does inhibit replication of the virus.  Unfortunately, in vivo (in actual patients) multiple studies have confirmed that it fails to either prevent Covid or treat Covid.  Despite these scientific facts, thousands of Americans have taken Ivermectin for Covid.  These individuals obtain either veterinary Ivermectin or prescription Ivermectin. 

This wouldn’t be a problem if Ivermectin were a perfectly safe drug.  Unfortunately, that isn’t the case.  Oregon Health and Science University recently reported in the New England Journal of Medicine a plethora of cases of Ivermectin toxicity.  

The usual treatment of Strongyloides is 12 to 14 mg either one time or twice.  But some individuals using the drug for Covid are using much larger doses and for longer periods of time.  The University of Oregon has compiled a study of Ivermectin toxicity.  To date no one has died, but there have been many patients hospitalized and many requiring ICU care for their toxicity.  The majority of these individuals were using veterinary products without prescription guidance.  Some were taking as much as 100 to 125 mg a day.  The main toxic effects were gastrointestinal, cardio vascular or neurologic.  The neurologic side effects included generalized weakness, ataxia and seizures. 

As the Covid pandemic continues it is critical that good scientific inquiry and open-mindedness prevail.  But at this point in time good science indicates that Ivermectin is not helpful and can be harmful. 

Transplant Immunology

Transplant Immunology

Since the first kidney transplant in 1950 and the first heart transplant in 1967 the field of transplant immunology has grown by leaps and bounds.  As successful as transplant medicine has become, there is still a major problem:  not enough donors.  This has led many scientists to explore the field of

xenotransplantation, using non-human animals as a source for organs. 

Other than the circumstance of receiving an organ from an identical twin, human to human transplants require immunosuppressive therapy to prevent immune rejection from occurring.  As good as this therapy has become, long-term rejection still occurs. 

Current research, therefore, centers on two areas:  genetics and immunology.  The genetic aspect involves genetically engineering the donor animal.  Two already successful inroads to this end are producing chimeras and immune cloaking.  A chimera is a genetically modified animal that expresses human antigens.  Immune cloaking involves a process that “hides” the animal antigens from immune scrutiny.  These techniques have been proven to work in animal models allowing rat pancreas to be transplanted into a mouse.  So, the future of human health may lie with our porcine and bovine brethren. 

New Covid Strategies

New Covid Strategies

The FDA has recently approved (emergency use authorization) two oral antivirals and a monoclonal antibody for Covid. 

The antivirals are designed for out patient use in mild to moderate Covid-19.  Both have proven to be active against the original Corona virus and its new variants. 

Paxlovid uses two agents:  nirmatrelvir (a viral protease inhibitor) and ritonavir (a CYP3a inhibitor).  The treatment is for 5 days and can be used down to the age of 12. 

Lagevrio contains molnupiravir a nucleoside analog that can be used down to 18-year-olds but not in pregnant women.  Again, it is a 5-day treatment. 

The monoclonal therapy is Evusheld and it contains two long lasting (6 months) antibodies:  tixagevimab and cilgavimab.  It is not a vaccine but a prophylaxis for people who are immune compromised (whether or not they have also been vaccinated) and for patients who can not receive one of the existing vaccines. 

Many immunocompromised individuals have a poor response to the vaccines and Evusheld provides an additional method of protection.