If you have been following the first few of our newsletters you are probably wondering what we are trying to accomplish.  We are a small group of experienced instructors that hail from several areas of the public service industry.  While we believe in embracing new technologies and applying empirical knowledge in every area of this industry, we come from over 100 years of combined experience.

We believe in paying attention to detail and that ‘good enough’ is not good enough.  We believe in doing it right the first time…every time.  We also believe in ‘giving back’. We arrive at this point with great passion for what we do.

Each month this newsletter passes along EMS related information that we acquire through several vetted channels. We figure you might have seen some of it before…but you might not have either.

We have also mapped a path forward.  When the pandemic forced us to curtail our live classes, we decided that we wanted to continue to be the ‘tip of the sword.’  If we were going to join the myriad of online CE providers, we would strive to have an edge.  We are beginning with EMS but will soon reach back for law enforcement and the fire service.

We are currently writing curricula to meet the needs of the average CE recipient and looking at ways to expand those offerings.  We have created several labs, and are developing others, that will allow participants to experience a truly blended process, wherein they have the same lab materials in front of them that the live instructor has.  Our EMS Upskilling Series is being developed to lift the skill and knowledge level of participants that want that challenge, whether they are new and want to expand their knowledge, or are a seasoned veteran that wants to ‘level up’ to changes in the industry.

We will also provide preparatory classes and CE support for several specialty certifications, as well as compliance level classes, such as the ‘Designated Infection Control Officer’ and classes for supervisors.  For participants in the Great State of Texas, we have developed a specific program that meets your hour requirements over each four-year certification period.

We also have a surprise up our sleeve!  We have a program under development that is being created by public servants for public servants and the focus is to NEVER TALK SHOP!  It will be a fun, informative, free program just for you.  We are in consultation with best selling writers; comedians; master class presenters; musicians; financial advisors; sports figures; motivational speakers, etc.  These people are either public servants, were previously public servants, or are providing these services specifically for YOU, from your perspective.  Our goal is to motivate and uplift you in a time when we all need it.  Over the next several months we will continue to make announcements about our progress with this program.

By Louis J. Ignarro

Inhale through your nose and exhale through your mouth. It’s not just something you do in yoga class – breathing this way actually provides a powerful medical benefit that can help the body fight viral infections.

The reason is that your nasal cavities produce the molecule nitric oxide, which chemists abbreviate NO, that increases blood flow through the lungs and boosts oxygen levels in the blood. Breathing in through the nose delivers NO directly into the lungs, where it helps fight coronavirus infection by blocking the replication of the coronavirus in the lungs. But many people who exercise or engage in yoga also receive the benefits of inhaling through the nose instead of the mouth. The higher oxygen saturation of the blood can make one feel more refreshed and provides greater endurance.

I am one of three pharmacologists who won the Nobel Prize in 1998 for discovering how nitric oxide is produced in the body and how it works.

The role of nitric oxide in the body

Nitric oxide is a widespread signaling molecule that triggers many different physiological effects. It is also used clinically as a gas to selectively dilate the pulmonary arteries in newborns with pulmonary hypertension. Unlike most signaling molecules, NO is a gas in its natural state.

NO is produced continuously by the 1 trillion cells that form the inner lining, or endothelium, of the 100,000 miles of arteries and veins in our bodies, especially the lungs. Endothelium-derived NO acts to relax the smooth muscle of the arteries to prevent high blood pressure and to promote blood flow to all organs. Another vital role of NO is to prevent blood clots in normal arteries.

In addition to relaxing vascular smooth muscle, NO also relaxes smooth muscle in the airways – trachea and bronchioles – making it easier to breathe. Another type of NO-mediated smooth muscle relaxation occurs in the erectile tissue (corpus cavernosum), which results in penile erection. In fact, NO is the principal mediator of penile erection and sexual arousal. This discovery led to the development and marketing of sildenafil, trade name Viagra, which works by enhancing the action of NO.

Other types of cells in the body, including circulating white blood cells and tissue macrophages, produce nitric oxide for antimicrobial purposes. The NO in these cells reacts with other molecules, also produced by the same cells, to form antimicrobial agents to destroy invading microorganisms including bacteria, parasites and viruses. As you can see, NO is quite an amazing molecule.

Nitric oxide gas as an inhaled therapy

Since NO is a gas, it can be administered with the aid of specialized devices as a therapy to patients by inhalation. Inhaled NO is used to treat infants born with persistent pulmonary hypertension, a condition in which constricted pulmonary arteries limit blood flow and oxygen harvesting.

Inhaled NO dilates the constricted pulmonary arteries and increases blood flow in the lungs. As a result, the red blood cell hemoglobin can extract more lifesaving oxygen and move it into the general circulation. Inhaled NO has literally turned blue babies pink and allowed them to be cured and to go home with mom and dad. Before the advent of inhaled NO, most of these babies died.

Inhaled NO is currently in clinical trials for the treatment of patients with COVID-19. Researchers are hoping that three principal actions of NO may help fight covid: dilating the pulmonary arteries and increasing blood flow through the lungs, dilating the airways and increasing oxygen delivery to the lungs and blood, and directly killing and inhibiting the growth and spread of the coronavirus in the lungs.

How nitric oxide kills viruses

In an in vitro study done in 2004 during the last SARS outbreak, experimental compounds that release NO increased the survival rate of nucleus-containing mammalian cells infected with SARS-CoV. This suggested that NO had a direct antiviral effect. In this study, NO significantly inhibited the replication cycle of SARS-CoV by blocking production of viral proteins and its genetic material, RNA.

In a small clinical study in 2004, inhaled NO was effective against SARS-CoV in severely ill patients with pneumonia.

The SARS CoV, which caused the 2003/2004 outbreak, shares most of its genome with SARS CoV-2, the virus responsible for COVID-19. This suggests that inhaled NO therapy may be effective for treating patients with COVID-19. Indeed, several clinical trials of inhaled NO in patients with moderate to severe COVID-19, who require ventilators, are currently ongoing in several institutions. The hope is that inhaled NO will prove to be an effective therapy and lessen the need for ventilators and beds in the ICU.

The sinuses in the nasal cavity, but not the mouth, continuously produce NO. The NO produced in the nasal cavity is chemically identical to the NO that is used clinically by inhalation. So by inhaling through the nose, you are delivering NO directly into your lungs, where it increases both airflow and blood flow and keeps microorganisms and virus particles in check.

While anxiously awaiting the results of the clinical trials with inhaled NO, and the development of an effective vaccine against COVID-19, we should be on guard and practice breathing properly to maximize the inhalation of nitric oxide into our lungs. Remember to inhale through your nose; exhale through your mouth.

This article appeared in The Conversation, and is reprinted here under a creative commons license.  

Author

Louis J. Ignarro - Distinguished Professor Emeritus of Molecular & Medical Pharmacology, School of Medicine, University of California, Los Angeles

Herbs, including cilantro, have a long history of use as folk medicine anticonvulsants. Until now, many of the underlying mechanisms of how the herbs worked remained unknown. In a new study, researchers uncovered the molecular action that enables cilantro to effectively delay certain seizures common in epilepsy and other diseases.

The study, published in FASEB Journal, explains the molecular action of cilantro (Coriandrum sativum) as a highly potent KCNQ channel activator. This new understanding may lead to improvements in therapeutics and the development of more efficacious drugs.

"We discovered that cilantro, which has been used as a traditional anticonvulsant medicine, activates a class of potassium channels in the brain to reduce seizure activity," said Geoff Abbott, PhD, professor of physiology and biophysics at the UCI School of Medicine and principal investigator on the study. "Specifically, we found one component of cilantro, called dodecenal, binds to a specific part of the potassium channels to open them, reducing cellular excitability. This specific discovery is important as it may lead to more effective use of cilantro as an anticonvulsant, or to modifications of dodecenal to develop safer and more effective anticonvulsant drugs."

Researchers screened cilantro leaf metabolites, revealing that one -- the long-chain fatty aldehyde (E)-2-dodecenal -- activates multiple potassium channels including the predominant neuronal isoform and the predominant cardiac isoform, which are responsible for regulating electrical activity in the brain and heart. This metabolite was also found to recapitulate the anticonvulsant action of cilantro, delaying certain chemically-induced seizures. The results provide a molecular basis for the therapeutic actions of cilantro and indicate that this ubiquitous culinary herb is surprisingly influential upon clinically important potassium channels.

"In addition to the anticonvulsant properties, cilantro also has reported anti-cancer, anti-inflammatory, anti-fungal, antibacterial, cardioprotective, gastric health and analgesic effects," said Abbott. "And, the best part is it tastes good!"

People in many cultures around the globe use cilantro for remedy and cooking use, but let’s face it, cilantro is better with a generous serving of good Ol’ Tex-Mex wrapped around it!

Editors Note:  Throw 2 cups of cilantro, 1/2 cup olive oil, 2 tablespoons of white vinegar, 1 garlic clove, salt, and red pepper flakes in a blender.  (Or sub in jalapeno for the red pepper and lime juice for some of the vinegar.)  Add a little water if you need it.  Blend for one minute...and put it on everything!  That's Texas delicious!

Journal Reference: Rían W. Manville, Geoffrey W. Abbott. Cilantro leaf harbors a potent potassium channel–activating anticonvulsant. The FASEB Journal, 2019; fj.201900485R DOI: 10.1096/fj.201900485R

FDA Approves Breast Cancer Treatment That Can Be Administered At Home By Health Care Professional

For Immediate Release - June 29, 2020

Today, the U.S. Food and Drug Administration approved Phesgo—a combination of pertuzumab, trastuzumab and hyaluronidase–zzxf—for subqutaneous injection to treat adult patients with HER2-positive breast cancer that has spread to other parts of the body, and for treatment of adult patients with early HER2-positive breast cancer. Patients should be selected based on an FDA-approved companion diagnostic test.

HER2-positive breast cancer, which makes up approximately one-fifth of breast cancers, has too much of a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. Pertuzumab and trastuzumab bind to sites on HER2 and disrupt signaling to stop cancer cell growth. Phesgo is initially used in combination with chemotherapy and could continue to be administered at home by a qualified health care professional once the chemotherapy regimen is finished.

“Currently, most patients with HER2-positive breast cancer receive trastuzumab and pertuzumab at infusion centers. With a new administration route, Phesgo offers an out-patient option for patients to receive trastuzumab and pertuzumab,” said Richard Pazdur, M.D., director of the FDA’s Oncology Center of Excellence and acting director of the Office of Oncologic Diseases in the FDA’s Center for Drug Evaluation and Research. “As part of the FDA’s ongoing commitment to address the novel coronavirus pandemic, we continue to keep a strong focus on patients with cancer who constitute a vulnerable population at risk of contracting the disease. At this critical time, we continue to expedite oncology product development. This application was approved about four months ahead of the FDA goal date.”

Phesgo contains a fixed-dose combination of pertuzumab and trastuzumab with hyaluronidase for injection under the skin. The therapeutic components in Phesgo are the same as those in FDA-approved intravenous (IV) pertuzumab and IV trastuzumab.

The FDA’s approval was based on the results of a non-inferiority study in patients with HER2-positive early breast cancer, which demonstrated Phesgo had comparable efficacy and safety as IV pertuzumab and IV trastuzumab, except for administration-related reactions, which were higher with Phesgo due to the subcutaneous route of administration.

Prescribing information for Phesgo includes a boxed warning to advise health care professionals and patients about the risk of potential heart failure, fetal harm and lung toxicity. Health care professionals should use similar monitoring parameters as those used with IV pertuzumab and IV trastuzumab.

Fireworks photo credit:  Free photo 908302 © Scott Patterson - Dreamstime.com

Passion Led Us Here photo credit: Photo by Ian Schneider on Unsplash

Man breathing photo credit: © elijah-hiett--unsplash

Cilantro photo credit:  Tomasz Olszewski - Unsplash

Pig photo credit:  Amber Kipp - Unsplash