Coronavirus Pandemic Update 45: Sharing Ventilators, More on Sleep, Immunity, & COVID-19 Prevention

Welcome to other

update

s from MedCram COVID-19 now for the first time in the US is topping the charts with 85,000 653 confirmed infections, a staggering total of 24,000 daily deaths. New cases in the United States continue to rise and if we look at the total cases in the United States, New York State tops that list by a huge amount. the epicenter of new cases right now and because supplies are tight, there is an article here in the New York Times talking about the shortage of mechanical

ventilators

. New York begins

sharing

ventilators

and this was approved by the governor to keep

coronavirus

patients breathing.

Hospitals are pioneering an untested method. You can see there a portable ventilator that ambulances use to transport patients who are connected to ventilators. They mentioned here that this is not the first time this has happened before they did it in Las Vegas when there was a mass shooting. In previous

update

s here at med cram we showed you dr. Babcock, the ER doctor, demonstrates that in a video on YouTube, also in the news and updated about six hours ago, there was a story on Fox from Prisma Health that says their innovative new ventilator adapter can actually treat up to four patients on a ventilator at a time.

There was another ER doctor named Sarah Ferris and her husband who is a software engineer developed this device called the Vesper as it turns out it's a 3D printed device and they're making it available so it can be printed at your local hospital as well as The US Food and Drug Administration has granted emergency use authorization for this type of ventilator and you can see a link below. Other hospitals that want to start using Vesper can receive free source code and printing specifications for the device today by signing up for Christmas. health website and you can see there, okay, so not so fast because there is a joint statement released by the American Respiratory Care Association along with other societies that are pretty impactful, like the Society of Critical Care Medicine.

They issued a joint statement basically saying no, we don't think it's a good idea. The reasons included here are quite numerous, including the fact that volumes could go to the

more

flexible lung segments and that it would be impossible to manage the positive end expiratory. pressure, among other things, and you can read some of the others and they also give references in this joint statement, so it will be interesting to see what happens because, as the New York Times pointed out, the other option is death, however, the AARC is saying that it could endanger both patients on the ventilator, I think no matter how you take it, it will be clear that there will be people caring for people on ventilators who are not used to caring for people on ventilators if you or If you know someone who is good at caring for someone who is on a ventilator, we wanted to offer this course as a refresher on mechanical ventilation.

Well, I wanted to continue our discussion on how to improve

immunity

. We talked earlier about the beneficial effects of an elevated body temperature. regarding killing infections in the virus and we'll move on to other things, but I wanted to reaffirm and underline the importance of rest and

sleep

in terms of activating the immune system, especially at a time like now where people are very Si worry that they are not getting enough

sleep

, it is important for us not to underestimate the benefits of sleep. Now we're just going to go over a little bit, but if you want to know

more

in detail, go back to update 17 on the corona virus that I've done it very briefly, this was a study that looked at the effect of sleep deprivation on the response to immunization.

The participants were sleep deprived and received a vaccine against the influenza virus and those who were sleep deprived had a much better immune response in terms. of antibodies to the vaccine and the conclusions reached by the author were that these results indicate that the response to the influenza vaccine is likely to be affected in people who suffer from chronic partial sleep restriction because adults who show responses deficient to vaccines and other antigenic challenges also experience higher rates of clinical disease, our findings support the concept that adequate amounts of sleep are needed to maintain resistance to an infectious challenge such as kovat 19:00.

This is the other study we looked at in Update 17 that looked at sleep habits. how long they slept and what their sleep efficiency was in terms of a 14-day basis and then they went ahead and dropped rhinovirus-filled droplets into the nasopharynx of these subjects and waited to see how many of them would develop common cold symptoms. And what they found was quite surprising: They found that those with an average sleep duration of less than 7 hours were not 10% more or 50% more or even a hundred percent more likely to develop the cold, but actually almost three times more likely to develop it. a cold and when they looked for confounding factors, these things could not be explained in terms of differences in virus-specific antibodies before the challenge, demographics, season of the year, body mass, socioeconomic status, psychological variables or health practices, so here we have at least four rhinovirus evidence that Poor sleep efficiency and shorter sleep duration in the preceding weeks and exposure were associated with lower resistance to the viral disease, but there are still more research that came to light last year and this is the focus of the dream that I want to analyze today, so the first thing to understand is that there is a cell that is infected with a virus and in this case it was an infected cell with CMV.

CMV stands for cytomegalovirus, it is a common virus that can cause chronic infection, here we have the nucleus and because this cell is infected with cytomegalovirus, it produces its normal proteins on the cell surface so that the immune system cells recognize it, but it also puts a small portion of that cytomegalovirus protein on the surface to let the immune cells know that it is an infected cell, so these regular proteins that are made in the cell are known as mhc1. It's not that important to understand, but that's the name of the protein. This here is a portion of the virus that lets the immune system know that it actually is.

In an infected cell there are other proteins that are also in the cell and these proteins help the immune cells attach to them so that they can make the appropriate determination of whether this cell should be destroyed or should survive and this protein is known as I cam . I see an M so far, so good, now let's bring in our immune cell, it's our cytotoxic T cell, it's responsible for moving around and making sure the cells aren't infected and taking care of the cells that are infected and these would be the cells that would be giving turning and getting rid of the cells infected with the corona virus so that they do not produce more virus to infect more cells and in fact if this can be done early in the course you would have a limited disease and it would not give rise to many cells.

Being infected causes a lot of T cells to try to fight and cause that cytokine storm. Well, there are a couple of proteins on these T cells, so this is a T cell and it's a cytotoxic T cell, non-toxic to your pet, cytotoxic to the cell that's infected. These are actually your friends, so there is a receptor on the T cell that sees that little virus particle and understands that CEL needs to be destroyed and that is called the T cell receptor or TCR, the TCR also activates right next to it. and I'll show this here in green that is activating the beta integral.

This interaction between the beta integrins and the I cams allows for a very strong coupling that allows these cells to bind very, very tightly to these infected cells and that allows these T cells to secrete cytokines that will shut down and kill the cell before it produces more. viruses, so it is very important that beta integrins and eye chambers can bind normally; beta integrins are not activated and will not bind to these eye chambers, otherwise your immune system would begin to destroy your own body so they would shut down, but there are certain situations where they need to be activated and if they do not activate, your immune system will not work very well.

In this case, it is the TCR that activates these beta integrins and allows this to occur. The purpose of this article was to see if there are things that can affect this activation of beta integrins and sure enough, they discovered that there is a receptor called the G alpha receptor and this receptor is coupled to what is known as a G protein and it is coupled to an enzyme known as dental 8-cyclase. There are a lot of moving parts to this receptor, but I'm going to simplify it and show you that essentially you need ATP, which is abundant in the cell, and you convert it to something called cyclic MP, and it turns out that a cyclic MP turns off the TCR's ability to activate beta integrase. , so the question is what actually stimulates this G alpha receptor. a number of things that can activate this, one of them is epinephrine, typically dopamine, histamine, serotonin, and what about all of these things that can really stimulate this receptor here, they're all pretty elevated when you're awake, so You can see that it is possible that epinephrine dopamine histamine serotonin could stimulate this receptor that would eventually convert ATP to cyclic AMP II which would then inhibit TC Ara's ability to have the beta integrand buy with I cam and cause this T cell to destroy with cytokines this cell infected.

So is it possible? that sleep could prevent epinephrine, dopamine, histamine and serotonin from binding to this receptor and allow beta integral and I cam to bind closely so that the immune response is more robust and therefore now the title becomes a little more understandable. GA-coupled receptor signaling. and sleep regulate the activation of human antigen-specific T cell integrins and this was published last year in the Journal of experimental medicine. They also infected them with Epstein-barr virus, so we have data on both, so here we can see the data for the CMV-specific cytotoxic cd8 T cells, they looked at isoproterenol, which affects the epinephrine receptor, which also affects to the receptor and to norepinephrine, and here on the and adenosine in the cell cultures of the VV or Epstein-Barr virus that were infected.

As the concentration of the same substances we talked about increases, you can see that the ocular chambers go down, so it is one thing to say that these specific substances cause them to go down, but the question is whether sleep is actually beneficial in ensuring that cells can bind to their targets. and take them out and that's what they tried to show here in human patients. What we see here again is the same thing on the y axis that we're looking at. Binding cam but we have two types of patients in this scenario we have the ones that are filled with black circles and these were the ones that slept at night and were awake during the day unlike these open circles that are white in the middle where they are awake during the night and also awake during the day and So you can see the effects here in the CMV infected cells on the left and in the EBV infected cells on the right during the night, which is shaded here and here also at least a two in the morning and here at six. at two in the morning there was a statistically significant increase in I cam fixation in these patients who were sleeping at two in the morning versus being awake at two in the morning and I just wanted to point out those of you who work shifts , as long as they work at night and go home and sleep with the lights off and no light coming in through the windows and do this every day on the weekend, they can also get the same thing. benefit from sleeping even when the sun rises and then they decided to observe the different types of differentiation of these cytotoxic T cells, they observed those that were in the early stages of their life, intermediate in cellular life and late in cellular life. cell life and what they found was that this effect seemed to be stronger in the early phase of cell life even though it didn't have many of these G receptors that we talked about, which could suggest that it is the early cells that are are amplifying against the infection in question that is more influenced by the effect of sleep versus wakefulness, so the authors' conclusions are as follows: We show here that several G alpha-coupled receptor cd8 T cells are the ones that are killing here While sleeping regulates integrand activationby suppressing G alpha-coupled receptor signaling, given the importance of integrand activation for immunological synapse formation, our data suggest a critical role for conditions such as sleep that are characterized by low G alpha-coupled receptor ligands. level in Boost T cell responses and I will tell you that it is those T cell responses that are very important in your immune system.

Get rid of cells infected by the corona virus. So you can imagine the current scenario and it doesn't require much drawing. here to modify this image for the current situation of kovat 19 sleeping is important and you don't have to go to the store to buy it and you don't have to wait for a pharmacist to dispense it, it's something we can do. put down your iPads put down your phones and go to sleep and wake up with a better immune system for those of you who have a hard time sleeping if you have insomnia we have a free course on Meg cram comm on how to deal with insomnia so check that out thanks for joining us