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      No evidence supports the use of ether and chloroform inhalation for treating COVID-19

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          Abstract

          Dear Editor, SARS-CoV-2 has been spreading rapidly across the world as well as the number of fake news on social media regarding harmful or non-harmful treatments which are ineffective for treating COVID-19. In Brazil, the first case of COVID-19 was confirmed on February 26, 2020 and until March 20, 2020 at least 970 cases and seven deaths have been reported. The fear and uncertainty have led people to consume and share mistrust and misinformation on the Internet. Since the first confirmed case in Brazil, fake news about the effectiveness of an ether and chloroform blend known as “lança perfume” or “loló” were spread on social media. Nowadays, the ecosystem of big data has provided valuable information about online health-related behaviour and new patterns among population groups using social media data. Google Trends may act as an efficient real time surveillance system by monitoring hit searches of specific health issues leading to reliable and meaningful indicators to track health information demand and supply trends (1). We used Google Trends to assess recent search activity (from February 25 to March 20, 2020) on the novel coronavirus in Brazil and the popularity of related search terms. Related searches for coronavirus revealed a high level of interest (a breakout over 5000%) on the information about the use of an ether and chloroform blend in treating COVID-19, especially in the North and Northeast regions which are recognized as the poorest regions in the country. The use of Internet as a source of health information has increased over the years, but reporting incomplete aspects of scientific studies, misinterpreting the findings and highlighting unusual claims have become common practice. Unfortunately, fake news and misinformation on social media can lead people to make harmful health decisions. It is important to check health information related to COVID-19 from reliable news sources and expert guidance from health authorities and international health organizations, rather than from shared stories in social media. Journalists and health-care professionals should cooperate with an effective communication to enhance healthy attitudes towards the pandemic (2). Although the epidemic use of the ether and chloroform as a recreational drug in Brazil has been generally neglected in the world literature of public health (3) and quantitative data of human fatality after acute inhalation exposure to this drug combination are not available, there is evidence from human and animal studies that chloroform may lead to hepatic, renal and cardiovascular injury (4-6). Furthermore, there is no evidence supporting claims that ether and chloroform inhalation is useful in the treatment of COVID-19. Authorities should reinforce the need to seek information from government agencies and national and international health organizations. Disclaimer. Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/PAJPH or the Pan American Health Organization (PAHO).

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          2019-nCoV, fake news, and racism

          The novel coronavirus (2019-nCoV) outbreak has had a significant impact on global health. As a neighbour country to China, Japan has been heavily affected by the spread of 2019-nCoV. As of Feb 10, 2020, 161 people (including 135 passengers and crew members on a cruise ship quarantined in Yokohama, Japan) have been confirmed to have the 2019-nCoV infection in Japan—the second largest number followed by mainland China.1, 2 The emergence of misinformation and racism against patients and Chinese visitors are also reaching critical levels. On Jan 29, 2020, one Japanese social media outlet uploaded the news story Will the Tokyo 2020 Olympics be suspended?, 3 citing an article in Süddeutsche Zeitung. 4 However, the original article just referred to ongoing communication between the International Olympic Committee and WHO, and there was no reference to the possibility of suspending the Olympic Games in Tokyo in 2020. In addition, the excess demand for surgical masks among the general public is a serious concern. Many people rushed to the pharmacy to purchase them, which has lowered provision for medical facilities including emergency and critical care centres. 5 Furthermore, fake news has led to xenophobia towards patients and Chinese visitors. On Jan 24, 2020, misinformation that “Chinese passengers from Wuhan with fever slipped through the quarantine at Kansai International Airport” was disseminated through multiple social media channels. 6 Although Kansai International Airport promptly denied the fact, discrimination against Chinese people has become widespread in Japan. #ChineseDon'tComeToJapan is trending on Twitter, and Chinese visitors have been tagged as dirty, insensitive, and even bioterrorists. 7 The magnitude of the 2019-nCoV outbreak remains unclear. Estimating the reproduction number and capturing the transmission dynamics are crucial to considering effective countermeasures. Considering that asymptomatic cases in Japan were detected among those who flew back from Wuhan by a Japanese chartered plane, 1 the risk of infection during the pre-symptomatic period needs to be investigated. The mass media must also take responsibility for providing correct information and creating comprehension among citizens. Journalists have an important role in health communication and should acknowledge that their strong but inaccurate and misleading headlines agitate members of the public, cause fear, impinge on public communication, and diminish countermeasures for the outbreak. Health-care professionals should cooperate with the mass media and help differentiate what is known and unknown. Effective communication will not only contribute to lessening the risk for inappropriate behaviour, such as unnecessary visits to health-care facilities, but also help eliminate fake news and discrimination against patients and Chinese visitors.
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            A Google Trends-based approach for monitoring NSSI

            Non-suicidal self-injury (NSSI) is an intentional, direct, and socially unacceptable behavior resulting in the destruction of one’s own body tissues with no intention of dying or committing suicide, even though it is associated with a higher risk of attempted, planned, or just considered suicide. In this preliminary report, we introduce the concept of “NSSI 2.0”; that is to say, the study of the Internet usage by subjects with NSSI, and we introduce a Google Trends-based approach for monitoring NSSI, called NSSI infodemiology and infoveillance. Despite some limitations, Google Trends has already proven to be reliable for infectious diseases monitoring, and here we extend its application and potentiality in the field of suicidology. Ad hoc web portals and surveys could be designed in light of the reported results for helping people with NSSI.
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              Mechanisms involved in cardiac sensitization by volatile anesthetics: general applicability to halogenated hydrocarbons?

              An increased sensitivity of the heart to catecholamines or cardiac sensitization is a recognized risk during acute human exposure to halogenated hydrocarbons used as solvents, foam-blowing or fire-extinguishing agents, refrigerants, and aerosol propellants. Although cardiac sensitization to such "industrial" halocarbons can result in serious arrhythmia and death, research into its mechanistic basis has been limited, whereas the literature on volatile anesthetics (e.g., halothane, chloroform) is comparably extensive. A review of the literature on halocarbons and related volatile anesthetics was conducted. The available experimental evidence suggests that volatile anesthetics at physiologically relevant concentrations interact predominantly with the main repolarizing cardiac potassium channels hERG and I(Ks), as well as with calcium and sodium channels at slightly higher concentrations. On the level of the heart, inhibition of these ion channels is prone to alter both action potential shape (triangulation) and electrical impulse conduction, which may facilitate arrhythmogenesis by volatile anesthetics per se and is potentiated by catecholamines. Action potential triangulation by regionally heterogeneous inhibition of calcium and potassium channels will facilitate catecholamine-induced afterdepolarizations, triggered activity, and enhanced automaticity. Inhibition of cardiac sodium channels will reduce conduction velocity and alter refractory period; this is potentiated by catecholamines and promotes reentry arrhythmias. Other cardiac and/or neuronal mechanisms might also contribute to arrhythmogenesis. The few scattered in vitro data available for halocarbons (e.g., FC-12, halon 1301, trichloroethylene) suggest inhibition of cardiac sodium (conduction), calcium and potassium channels (triangulation), extraneuronal catecholamine reuptake, and various neuronal ion channels. Therefore, it is hypothesized that halocarbons promote cardiac sensitization by similar mechanisms as volatile anesthetics. Experimental approaches for further investigation of these sensitization mechanisms by selected halocarbons are suggested.
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                Author and article information

                Journal
                Rev Panam Salud Publica
                Rev. Panam. Salud Publica
                rpsp
                Revista Panamericana de Salud Pública
                Organización Panamericana de la Salud
                1020-4989
                1680-5348
                24 March 2020
                2020
                : 44
                : e41
                Affiliations
                [1] normalizedFederal University of Sergipe orgnameFederal University of Sergipe São Cristóvão Brazil originalFederal University of Sergipe São Cristóvão, Brazil
                [2] normalizedUniversidade Federal de Alagoas orgnameUniversidade Federal de Alagoas Arapiraca Brazil originalUniversidade Federal de Alagoas, Arapiraca. Brazil
                Author notes
                saqmartins@hotmail.com

                Conflicts of interest.

                None.

                Article
                RPSP.2020.41
                10.26633/RPSP.2020.41
                7137810
                88e4c064-a856-467c-a156-da1ae7377519

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article’s original URL.

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