natural approaches to health & immunityandrew pekosz, virologist at johns hopkins university:...
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Natural Approaches to Health & Immunity
Dr. Robert G. Silverman DC, DACBN, MS, CNS, CCN, CSCS, CIISN, CKTP, CES, DCBCN, HKC, FAKTR
www.DrRobertSilverman.com
@drrobsilverman @drrobertsilverman@DrRobertSilverman
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You can’t control the virus, but you can control the host
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Factors that make us more likely to contract COVID-19• CVD• Diabetes• Obesity• Hypertension • Age • Chronic pulmonary disease • Chronic liver or kidney disease • Radiation therapy • Autoimmune conditions • Chronic neurological diseases
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Stats - comorbidities
• 71% of those hospitalized with COVID-19 in the U.S. and 78% of those in intensive care have underlying health conditions like:• Diabetes
• Chronic lung disease
• Heart disease
• 25% of those infected with COVID-19 may not show symptoms
CDC.gov. March 28, 2020
Dr. Robert Redfield, Dir. Of CDC. March 31, 2020
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Stats
• 60% of U.S. adults have at least 1 underlying health condition
• 399 patients with at least 1 additional disease had a 79% greater chance of requiring intensive care or respirator or both, or of dying
NYTimes. March 12, 2020
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Increased odds of severe COVID-19
• Patients age 50 plus – 2.5 times more likely to progress to severe case of COVID-19
• 53,000 patients Dec. 19 – Feb. 19
Increased odds of severe illness
Male 1.3 x
Smoking 2.5 x
Comorbidities 2-3 x
COPD 2.5-11 x
Kidney issues 2-16 x
NPR, March 22, 2020
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Stats
• China:• 3% of cases – 80 years or older
• 87% – 30-79 years
• 8% in their 20s
• 1% in their teens
• 0.9% – 9 years or younger
• Fatality rate:• 2.3%
• 14.8% – 80 years or older
• 1.3% – 50s
• 0.4% – 40s
• 0.2% – 10-39 years
• 58% of cases – male
• 2.8% – male
• 1.7% – female
JAMA. Published online February 24, 2020
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Potential effects of coronaviruses on the CV system
Conclusion: COVID-19 associated with high inflammatory burden that can induce vascular inflammation myocarditis and cardiac arrhythmia
Tao G, YongZhen F, Ming C, et al. JAMA Cardiol, Mar 27, 2020 online
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Stats
• Loss of smell or taste might be early sign of infection with the pandemic virus
• 30% of patients testing positive
• Many have loss of taste
The Scientist. May 24, 2020
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New Study on COVID-19 Estimates 5.1 Days for Incubation Period
Ann Intern Med. Published online March 10, 2020
Johns Hopkins. Published online March 9, 2020
97.5 percent of people develop symptoms of SARS-CoV-2 infection within 11.5 days of exposure
Median incubation period – 5.1 days
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Eye ocular abnormalities in COVID-19 patients
• 1/3 sample size had abnormalities involving the eye:
• Conjunctivitis
• Conjunctival hyperemia
• Chemosis
• Epiphora
• Increased secretions
Conclusion: Ocolar abnormalities frequently occurred in patients with more severe COVID-19
Wu P, Duan F, Luo C, et al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. Published online March 31, 2020
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The coronavirus isn’t alive. That’s why it’s so hard to kill.• Once inside a cell, a virus can make 10,000 copies of itself in hours
• Within a few days, infected person will carry hundreds o millions of viral particles in every teaspoon of blood
Andrew Pekosz, virologist at Johns Hopkins University:
“They break into your home, eat your food, use your furniture and have 10,000 babies. And then they leave the place trashed.”
The Washington Post, March 23, 2020
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Adjusted fatality infection rates by age group
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March 17, 2020
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Why does SARS-CoV-2 spread so easily?
https://www.medicalnewstoday.com/articles/why-does-sars-cov-2-spread-so-easily
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https://www.rndsystems.com/resources/articles/ace-2-sars-receptor-identified
ACE-2 is the host cell receptor
responsible for mediating infection by SARS-CoV-2, the novel coronavirus responsible for coronavirus disease 2019 (COVID-19). Treatment with anti-ACE-2 antibodies disrupts the interaction between virus and receptor.
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The science of soap. Here’s how it kills the coronavirus
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Support your immune system
• Avoid certain foods: • GPS
• DNA
• Anti-inflammatory diet
• Detect or avoid food sensitivities
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Diet for immune resilience
Proper diet = enhanced immunity
vs.
Poor diet = impaired immunity
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Support your immune system
• Make clean-eating a priority:• Wild SMASH fish
• Plant-based diet
• Fruits and vegetables
• Grass-fed meats
• High fiber
• Nuts and seeds
• Chicken soup
• Snack - organic dark chocolate
• Herbals - ginger, turmeric
• Bone broth
• Appropriate fluid intake
• Organic coffee, tea
• Oils – EVOO, avocado, macadamia nut
• Mushrooms - shiitake, reishi, chaga, turkey tail, maitake, oyster, lion’s main
• Include nuts, avocado, olive oil in your diet• Oleic acid from these foods stimulate SIRT1 – the defense enzyme
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Support your immune system
• Consider a time-restrictive eating (intermittent fasting) - fast for 12-16 hours
• Get sufficient sleep - aim for 7-8 good quality hours
• EVRL Violet light - Erchonia
• Home exercise plan – work with a practitioner online
• Humidity – keep humidity up at home to maintain airway health and mucus
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Types of Fasting
Prolonged Fasting (PF)4 or more consecutive days
of fasting• Water Only Fast• Fasting Mimicking
Diet (FMD)
Time Restricted Eating/Feeding
(TRE/TRF)Daily pattern of eating
during a window of 8-12h
Intermittent Fasting (IF)1-3 days of fasting
usually non-consecutive, per week
S M T W T F S S M T W T F S
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Proof-of-concept in viral inactivation: virucidal efficacy of 405 nm light
Conclusion: Results provide first proof-of-concept demonstrating that the antimicrobial efficacy of 405 nm light can be extended to medically important virus
Rachael MT, Michelle M, John EC, et al. Food Environ Virol. 2017; 9(2): 159–167
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Nutrition support in the time of COVID-19
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Immune support supplements
• Vitamin C
• Zinc citrate
• Mixed mushroom complex
• Vitamin D3 with K2
• Probiotics
• Liposomal glutathione
• Beta-glucans
• Omega-3 fatty acid
• Elderberry
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The immunomodulatory actions of 1,25(OH)2D against respiratory viruses
Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients. 2015;7(6):4240–4270. Published 2015 May 29
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Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta analysis of individual participant data
Conclusions:
Vitamin D supplementation safe and protected against acute respiratory tract infection overall.
Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.
BMJ, Feb 15, 2017;356,i6583
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Vitamin D/VDR and microbiome in intestine and other putative organs
Curr Opin Clin Nutr Metab Care. 2018 Nov; 21(6): 471–74
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Probiotics
• 12-week study
• Participants had contracted a cold 4X in the past year
Conclusion: Consumption of probiotics significantly reduced incidence of upper respiratory infection and flu-like symptoms. They had increased sIgA in the gut
Hong Z, Chiajung Y, Zonglian J, et al. Synth Syst Biotechnol, June 2018;3(2):113-120. Published online 2018 March 12
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Spore probiotic
• Soil-base microorganisms
• Formed from spores
• Found in dirt and vegetation
• Bacillus species delivered as dormant spores
• Endospores encapsulate beneficial bacteria:• Making them stable
• High resistant to stomach acid
• Results in more usable probiotics to the SI
Cuentas, et al. Journal of Probiotics & Health, 2017;5:4Fouad MFE, Namita R, Rohini DG, et al. Front. Microbiol. Aug 10, 2017
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Spore probiotic (cont’d)
• Bacillus subtilis (ability to form spores):• Protects microbes from harsh conditions
• Shelf-stable
• Do not require refrigeration
• Resist gastric hydrochloric acid
• Pancreatic enzymes and bile
• Helps adhere to intestinal epithelium
• Propagates bacteria in the large intestine
Cuentas, et al. Journal of Probiotics & Health, 2017;5:4
Fouad MFE, Namita R, Rohini DG, et al. Front. Microbiol. Aug 10, 2017
Kovács, ÁT. Bacillus subtilis. Trends in Microbiology, 2019;27(8):724-25
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Beta glucans
• These compounds regulate the function of the innate immune system
• This part of your immune system is the first line of defense against viruses and bacteria
• Helps your white blood cells bind to and kill viruses and bacteria
Akramiene D, Kondrotas A, et al. Medicina (Kaunas), 2007;43(8):597-606
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Elderberry
• Contains several functional bioactive compounds:
• Flavonoids
• Phenolic acids
• Phenolic compounds are potent modulators of the immune response – inflammation
• Shown to reduce production:
• IL-16
• IL-6
• TNF-ɑ
• ROS
Putra WE, Rifa’i M. Adv Pharm Bull, 2019 Oct;9(4):619-623
Tiralongo E, Wee SS, Lea RA. Nutrients, 2016 Mar 24;8(4):182
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Imagery of a cytokine storm
Jennifer RT, Marcus JK, Cameron PS, et al. Microbiol Mol Rev. 2012 Mar;76(1):16-32
Cytokines – dangerous double-edged sword exploited by coronavirus
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Mediators of the cytokine storm and the associated phenotypes with infection outcome
Jennifer RT, Marcus JK, Cameron PS, et al. Microbiol Mol Rev. 2012 Mar;76(1):16-32
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Role of ion fluxes in NLRP3 inflammasome activation
Yang, Y., Wang, H., Kouadir, M. et al. Recent advances in the mechanisms of NLRP3 inflammasome activation and its inhibitors. Cell Death Dis, 2019;10:128
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Rebecca CC, Caroline LH, Kate S. Cell Research, Oct. 3, 2018. https://doi.org/10.1038/s41422-018-0093-8
LPS-induced Mitochondrial DNA contributes to NLRP3 inflammasome
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Modulate the cytokine storm
• Melatonin
• Ascorbic acid (vitamin C)
• Pro-resolving mediators
• Ginger
• Quercetin
• Nitrate oxide
• Curcumin
• Low-level laser
• Stinging nettle
• PEA
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Acute respiratory distress syndrome (ARDS)Acute lung injury (ALI)• Accumulation of neutrophils in lungs an increased production of:
• inflammatory cytokines
• chemokines
• ARDS/ALI – dependent upon activation of inflammasome
• ARDS/ALI – from cytokine storm + NLRP3 inflammasome
• Inflammasome – part of our innate immune system IL-1β and IL-18
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Main melatonin functions
Silvestri, M., Rossi, G.A. Melatonin: its possible role in the management of viral infections-a brief review. Ital J Pediatr, 3 Oct 2013;39:61
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Melatonin in experimental Respiratory Syncytial Virus infection
Silvestri, M., Rossi, G.A. Melatonin: its possible role in the management of viral infections-a brief review. Ital J Pediatr, 3 Oct 2013;39:61
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R. Zhang, X. Wang, L. Ni, et al. COVID-19: Melatonin as a potential adjuvant treatment, Life Science, 23 Mar 2020 online
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New York hospitals utilizing vitamin C
• COVID-19 intensive care patients immediately receiving 1500 mgs intravenously and re-administer exact amounts 3-4 times/day
“The patients who received vitamin C did significantly better than those who did not get vitamin C. It helps a tremendous amount, but it is not highlighted because it's not a sexy drug. “
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Pro-resolving mediators (SPMs)
Conclusion:
• Exogeneous administration of precursors/SPMs decreased proinflammatory cytokine and chemokine expression
• SPMs reductions may drive O3-induced pulmonary inflammation
B. Kilbury-Bas, S. W Reece, M. J Crouch, et al. SPM regulate ozone-induced pulmonary and systemic inflammation. Toxicol Sci. June 2018;163(2):466-477
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Adapted from Serhan, CN. FASEB J. 2017;31(4):1273-1288
Induction of 15-LOX promotes
LM class switching
Lipid mediators involved in inflammation initiationLipid mediators involved in inflammation resolution
Inflammation InitiationProtective Response
LIPID MEDIATOR BIOSYNTHESIS
Inflammation ResolutionReturn to homeostasis
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Induction of 15-LOX promotes LM class switching
IMPACT OF NSAIDS/COX-2 INHIBITORS ON LIPID MEDIATOR BIOSYNTHESIS
Lipid mediators involved in inflammation initiationLipid mediators involved in inflammation resolution
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Curcumin suppression of cytokine release/storm
Results:
• Curcumin block cytokine release, most importantly the key proinflammatory cytokines, IL-1 , IL-6 and TNF-a
• Suppression of cytokine release by curcumin correlates with clinical improvement models of disease conditions where a cytokine storm plays a significant role in mortality
Peter PS, Lawrence H. In Vivo, Jan-Feb 2015;29(1):1-4
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Vitamin D deficiency contributes directly to ARDS
Conclusions:
Vitamin D deficiency common in people who develop ARDS. This deficiency appears to contribute to development of the condition. Approaches to correct vitamin D deficiency in patients at risk of ARDS should be developed.
Dancer RCA, Dhruv P, Sian L, et al. Thorax, 2015;70:617-24
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Stinging nettle
• Reduces inflammatory cytokine release and reduces inflammatory biomarkers like:
• TNF-a
• IL-1
• IL-6
• hs-CRP
Johnston TA, Sohn J, Inman WD, et al. Phytomedicine, 2013 Jan 15;20(2):143-7
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Palmitoylethanolamide (PEA)Pronounced: Pal mit oyl ethanol amide
• PEA – a bioactive lipid that plays a key role in endocannabinoid system (ECS) responsible for promoting balanced systems, including the central nervous system and the peripheral nervous system
• ECS helps promote relaxation and healthy nerve function
• PEA – produced naturally in every cell of the body in biological response to inflammatory markers
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WELL RESEARCHED-underappreciated molecule
• With over 350 peer reviewed papers
• Nobel Prize all devoted to PEA and its many indications
• Significantly favorable outcome in 5 of 6 DBPC trials looking at acute respiratory disease/influenza
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MULTIPLE MECHANISMS
• Multiple mechanisms associated with PEA:
• Anti-inflammatory: inhibition of TNF-alpha & NFKb
• Immune support: mast cell stabilization and supporting the endocannabinoid system. In influenza – thought that PEA works by attenuating the potentially deadly cytokine storm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771453/
This Photo by Unknown Author is licensed under CC BY
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Fecal/oral transmission
• Fecal/oral transmission may be part of COVID-19 clinical picture
• Significant portion of Coronavirus patients experienced diarrhea, nausea, vomiting, and/or abdominal discomfort before onset of respiratory symptoms
• Researchers found – RNA and proteins from SARS-CoV-2 (viral cause of COVID-19) are shed in feces early in infection and persist after respiratory symptoms abate
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online
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Fecal/oral transmission (cont’d)
• Mild GI discomfort – diarrhea: 10% of people have GI symptoms
• GI manifestations consistent with distributor of ACE2 receptors which serve as entry points for SARS-CoV-2
• Receptors – most abundant in cell membranes of lung AT2 cells as well as in enterocytes in the ileum and colon
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online
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GI track – possible route of viral transmission
• 53.4% of patients had SARS-CoV-2 RNA in stool
• 23% of patients tested positive in stool despite testing negative for the virus in respiratory samples
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online
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GI track – possible route of viral transmission (cont’d)
• The small but growing body of clinical evidence indicates digestive system may serve as an alternative route of SARS-CoV-2 infection
• In addition to respiratory track, they stressed adding that clinicians should be careful to promptly identify the patients with initial GI symptoms
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online
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THYROIDHashimoto’s diseaseThyroid hormone levels
MUSCULOSKELETALSYSTEMArthritis/Joint painSoft-tissue injuryCytokines, MMPS
BODYCOMPOSITIONObesity
LPS
INSULINBlood sugar problemsInsulin resistancePre-diabetes/diabetes
LIVERLiver dysfunctionToxins/chemical overload
GI TRACTFood sensitivitiesLeaky gut syndromeYeast/FungusDysbiosis ( Good bacteria)
BRAINSatietyInflammatoryNeurodegeneration
Dr. Rob’sGUT MATRIX
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THE GUT IS NOT VEGAS.What happens in the gut,
doesn’t stay in The Gut
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Zhu X, Han Y, Du J, et al. OncoTarget. 2017 May 10;8(32):53829-53838
GUT-LUNG CONNECTION
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Gut-lung communication
Mathieu E, Escribano-Vazquez U, Descamps D, et al. Frontiers in Physiology, 2018;9:1168
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Schematic representation to depict assimilation of dietary nutrients by gut microbiome and their impact on distal organs
Anand S, Mande SS. Frontiers in Microbiology, 2018;9:2147
GUT LUNGS BRAIN
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Pulmonary microbiome in health and critical illness
Samiran M, Dusan H. Yale J Biol Med, 2018 Jun; 91(2): 143–149
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Bidirectional Gut-Lung Axis
Anand S, Mande SS. Frontiers in Microbiology, 2018;9:2147
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Inter-kingdom and inter-compartment crosstalks within the gut–lung axis
Enaud R, Prevel R, Ciarlo E, et al. Frontiers in Cellular and Infection Microbiology, 2020;10:9
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THE
Reset diet/lifestyle/mindset
Remove unwanted pathogens
Replace needed digestive enzymes and stomach acid
Regenerate damaged intestinal mucosa
Re-inoculate with quality pre and probiotics
Reintroduce certain foods removed in step 2
Retain your health and GI integrity
7(R) ACTION PLAN
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Covid-19 Assay
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Current Laboratory Diagnostic Methods
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Why we test for IgG and IgM?
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Result Interpretation
• IgM Positive: Presence of 2 purple bands (T and C) within IgM result window indicates positive for 2019-nCoV IgM antibody
• IgG Positive: Presence of 2 purple bands (T and C) within IgG result window indicates positive for 2019-nCoV IgG antibody
• Negative: Only 1 purple band appearing at control line (C) indicates negative result
• Invalid: If control line (C) fails to appear, no matter whether the T line is visible or not, the test is invalid. Insufficient specimen volume or incorrect procedural techniques are the most likely reasons.
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Clinical Data
1) Clinical trial of this product based on the clear diagnosis/ exclusion criteria of the disease identified in the “Novel Coronavirus Pneumonia Diagnosis and Treatment Program”
2) Clinical research conducted in 5 institutions and the total cases were 447
3) Using this kit:a) 110 cases out of 126 clinically confirmed cases are positive, with
the sensitivity of 87.3% b) 62 cases of clinically excluded cases are totally negative with the
specificity of 100%
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How to get a C-19 kit
• Serum test is available now via : https://kbmodiagnostics.com/
• Turnaround time is 24-48 hours from arriving at the Lab
• Home-draw offered
Use Code: COVID19/DrRob
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Keep an eye out…
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Learn more about functional medicine by subscribing to FMU clinical cases studies
www.ClinicalRounds.com
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“Take care of your body, it’s the
only place you have to live”.
Jim Rohn
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/DrRobertSilverman @DrRobSilverman @DrRobertSilverman
www.DrRobertSilverman.com
facebook.com/groups/mastermindlasergroup
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Principle
The kit detects 2019-nCoV IgM and IgG antibodies by immuno- capture method. The nitrocellulose membrane is coated by mouse-anti human monoclonal IgM antibodies, mouse-anti human monoclonal IgG antibodies, and goat-anti-mouse IgG antibodies. The recombinant 2019-nCoV antigen and mouse IgG antibodies are labeled with colloidal gold as a tracer. The antibodies will bind to colloidal gold-coated 2019-nCoV antigens to form compounds, which are further captured by pre-coated mouse-anti human IgM antibodies to form new compounds, and generate purple line (T). The binding of colloidal gold-labeled mouse IgG antibodies with goat-anti-mouse IgG antibodies will present purple line, which is used as the control line(C).
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2m tests run in Wuhan to date…
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We Offer at Home Phlebotomy Services
• We have over 6000 carefully selected phlebotomists in or database. We cover almost every city in the United States.
The prices for mobile phlebotomy services
• Single draw: $100.00
• Multiple draws; $100.00 for first and $50.00 for each additional at same location
• Hourly draws (3 hour minimum) $100.00 per hr
PLEASE CONTACT the link below to schedule
https://shop.evexiadiagnostics.com/ provide:
Patient Name and address and availability and phone number for the patient
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Lungs should be considered an ecosystem with its own microbiota
Mathieu E, Escribano-Vazquez U, Descamps D, et al. Frontiers in Physiology, 2018;9:1168
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Conceptual model of the study
Negi S, Pahari S, Bashir H, Agrewala JN. Frontiers in Immunology, 2019;10:1142