Robert Charles Powell, MD, PhD
AUTHOR / RESEARCHER / HISTORIAN / CLINICIAN
I try to be very thorough and very efficient, but
I do NOT do "quick" evaluations. My motto is to
"Do it right the first time!"
I also strongly believe that
"two heads are better than one" -- so
I try -- whenever possible -- to have
a nurse or a social worker or a mental health tech or a post-graduate medical/ psychiatric trainee with me for the initial evaluation of a patient --
even in the Emergency Room.
linguistic/ cognitive
dynamic psychiatry meets
neurologic/ nutritional/ endocrinologic
psychobiology
ability to form & use concepts soft neurologic signs
nutritional deficits premenstrual syndrome
>>
Yes, I’ve been writing all of the
“standard” psychiatric prescriptions
for decades.
I also do more than that.
I evaluate and try to address each patient’s
ability to form and use concepts – as well as
simple issues of a
soft neurologic, nutritional, and endocrinologic
nature that frequently
contribute to a patient's presenting problems.
<<
psychosomatic somatopsychic consultation-liaison
percepts concepts
Latest clinical release:
Listening Closely to Patients --
without Jumping to Conclusions
{essays on practicing psychiatry} [2021]
https://www.amazon.com/dp/1542835364/ref=sr_1_1?keywords=listening+closely+to+patients&qid=1627610561&s=books&sr=1-1&asin=B09BG1FYK9&revisionId=b94a9236&format=1&depth=2
Two observational studies:
PART ONE – Differentiation of Moods as a Reflection of
Ego Organization and Personality Style:
Listening Very, Very Closely as
Patients Answer Only Five Questions.
[neurotic/ normal,
borderline,
pre-psychotic/ psychotic]
As an integral part of every initial psychiatric
evaluation, this clinical approach quickly
elicits verbalized data on
a patient's ability -- or lack of ability --
to form and use concepts.
It also quickly provides data on what is
NOT schizophrenia and what is
NOT borderline personality disorder,
while quickly suggesting
probable neurotic conflicts and
likely neurologic/ endocrinologic issues.
PART TWO – Erroneous Psychiatric Self-Diagnosis:
Non-Psychiatric Patients
that Present at a Psychiatrist’s Office.
APPENDIX – Elucidation of Useful
Additional Clinical Data.
*****Ascertaining Soft Neurologic Signs.
[with a bibliography of
select medical abstracts
systematically collected since 2000]
*****Ascertaining Nutritional Deficits
(Iron Deficiency {especially in men},
Pyridoxine/ B6 Deficiency,
Zinc Deficiency, Vitamin D Deficiency,
Hypercalcemia, Magnesium Deficiency,
Cobalamin/ B12 Deficiency, Hypocalcemia).
[with extensive bibliographies of
select medical abstracts
systematically collected since 2010]
*****Ascertaining PreMenstrual Syndrome/ "PMS".
[with an extensive bibliography of
select medical abstracts
systematically collected since 2020]
*****Reconsidering the Relationships of
Parts One & Two.
psychosomatic somatopsychic consultation-liaison
percepts concepts
neurology endocrinology malnutrition
>>> The following groups of
very medical "psychiatric" patients now make up
over one-third of all patients evaluated & treated by me on
either an inpatient or an outpatient basis <<<
***** The "mixed"
"depression" [negativity] +
"anxiety" [tension]" group is by far
the most common -- correlating highly with
past head-injury -- including birth-injury.
***** Generally, the neurologic component is primary, with
an endocrinologic component appearing later & making
the situation worse. Being malnourished or drug-addicted
certainly does not help. Having additional psychiatric issues certainly does not help. Many of these patients do respond
quickly to treatment once the overall picture is grasped.
in the international classification of diseases/ ICD:
>>mood disorder due to
known physiologic condition, mixed
(mania + depression)
[neurologic &/ or endocrinologic]
>>anxiety disorder due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>mood disorder (major depression) due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>mood disorder (mania) due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>catatonia due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>psychosis due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>[non-psychotic] organic [auditory] hallucinosis due to
known physiologic condition
[neurologic &/ or endocrinologic]
“Listening Closely” is about trying to make
interesting and significant a lot of clinical
information that has been there all the time –
waiting to be gathered –but frequently
not perceived, conceptualized, and appreciated.
"Listening Closely" is about finally grasping
what the patient has been saying --
or trying to say --
or trying to find the words to say --
all along.
Harley C. Shands, MD semiotic emotion affect
overthinking negativity low-dose anticonvulsant
hungry anxious depressed angry afraid
hunger anxiety depression anger fear
During late 2021, I spun off --
as handouts for clinical staff working with me --
six excerpts -- with key medical abstracts --
on several specific psychiatric issues:
“Vitamin D, Iron, &
Executive Functioning (including Attention)”
--- 7pp; 24 abstracts plus commentary.
“Vitamin D, Magnesium, Zinc, Iron &
Sleep or Insomnia”
--- 2pp; 7 abstracts plus commentary.
“Vitamin D, Iron, B2/ Riboflavin, B12/ Cobalamin &
Suicide”
--- 3pp; 10 abstracts; with important
comments re vitamins B2 & B12.
“Iron, Zinc, B6/ Pyridoxine &
Attention”
--- 4pp; 14 abstracts plus commentary.
"Vitamin B12/ Cobalamin & the
Enhancement of Social Comfort
--- 1p; 1 abstract plus commentary.
“Vitamin B12/ Cobalamin & the
Reduction of Wariness/ Defensiveness/
Hyperactivity”
--- 3pp; 7 abstracts plus commentary.
~~~~
BONUS sets of
key medical abstracts not in the book:
{ask for a copy of any of these sets}
“Vitamin C/ Ascorbic Acid & the
Reduction of Anxiety/ Depression + the
Enhancement of Vitality/ Intimacy”
--- 2pp; 7 abstracts plus commentary.
“NAC/ N-acetylcysteine (an antioxidant) & the
Reduction of Anxiety/ Obsession/
Hypomania/ Driven Behavior”
--- 3p; 7 abstracts.
“Vitamin B2/ Riboflavin & Impact on
Migraine/ Migraine Equivalents/ Cognition"
--- 3pp; 9 abstracts plus commentary.
“Zinc, Iron, T3 Thyroid & the
Reduction of Anger/ Aggression/ Impulsivity"
--- 4pp; 9 abstracts plus commentary.
“Vitamin D, Magnesium, Iron, B1/ Thiamine,
B6/ Pyridoxine, B12/ Cobalamin &
Pain"
--- 4pp; 11 abstracts plus commentary.
“Vitamin D, Magnesium, Iron,
B12/ Cobalamin, B1/ Thyamine, &
Fibromyalgia"
--- 4pp; 11 abstracts plus commentary.
“Vitamin D, B6/ Pyridoxine, N-acetylcysteine, &
Augmentation of the Treatment of
Schizophrenia, Schizoaffective Disorder &
Bipolar Disorder" [sparse but interesting data]
--- 2pp; 5 abstracts.
“B6/ Pyridoxine, Magnesium, Vitamin D, Iron,
Zinc, B12/ Cobalamin, B9/ Folate, &
Seizures [sparse but interesting data]
--- 4pp; 15 abstracts plus commentary.
Coming soon! a chapter on:
“Overthinking with a
Predominance of Negative Thoughts:
Transitioning Patients
Off of Benzodiazepines & Zolpidem.
An Observational Study of 30 Patients”
[contains a bibliography on the use of
low-dose anticonvulsants; plus much
focus on NON-prescription items that
have brain-soothing qualities]
Coming soon! a chapter on:
“Psychiatric Admissions related to
PreMenstrual Syndrome ('PMS') and,
Frequently, also related to
Soft Neurologic Signs ('Busy Brain').
An Observational Study of 35 Patients”
[to say that this is a complex chapter
would be an understatement;
contains a very extensive bibliography --
focusing on nutritional approaches]
[evaluation & simple treatment of bloating,
fatigue, insomnia, hair loss, cramps, migraine,
tenderness, excessive sweating, etc that may
relate to anxiety, depression, irritability, etc]
Coming soon!
The next anticipated clinical release:
Pentoxifylline & the Brain
100+ selected abstracts including many re the
treatment of reduced cerebral perfusion as seen in
autism spectrum disorder,
Alzheimer’s disorder, & schizophrenia.
Pentoxifylline (high dose, carefully used) appears to
enhance "social consideration"/ engagement via
“re-memory of heard words” (eg, of discussions).
&
Pentoxifylline, as a pro-circulation medication and
powerful anti-inflammation medication, also has
demonstrated antidepressant effects.
phosphodiesterase inhibitor
TNF-alpha production inhibitor IL-6 reducer
increasing circulation decreasing inflammation
pro-circulatory anti-inflammatory
stops "cytokine storm"
some anti-viral, anti-bacterial, anti-fungal effect
see also:
Ramzi A, Maya S, Balousha N, Amin M, * Powell RC *, Shiha MR. "Effects of the anti-inflammatory pentoxifylline on psychiatric and neuropsychiatric conditions: Exploring various off-label utilities with meta-analyses”. Inflammopharmacol, Jan 2025; https://pmc.ncbi.nlm.nih.gov/articles/PMC11799099/ [reviews extensive data on the use of pentoxifylline in severe major depressive disorder, vascular cognitive impairment, schizophrenia, & autism – with a favorable safety profile]
See below, under "Works." my booklet:
Pentoxifylline:
A Versatile Off-Patent Medication
Best Not Overlooked
Coming soon!
The next anticipated historical release:
"Anton T. Boisen’s 'Psychiatric Examination:
Content of Thought' (c.1925-31):
An Attempt to Grasp
the Meaning of Mental Disorder" [2nd ed]
schizophrenia psychosis social isolation
Previous latest release:
When Death Is NOT Theoretical:
The Readiness of the Music Group ‘Queen’ for
Living with Freddie Mercury’s Dying
[2nd edition, 2018]
grief grieving
confronting evil, negativity, & death
"Keep Yourself Alive!" grief bereavement "Nevermore!" "Dear Friends" "Teo Torriatte! (Let Us Cling Together!)" "All Dead, All Dead!" "Save Me!" "It's a Hard Life!" "Hammer to Fall!" "I Was Born to Love You!" "Love Me Like There's No Tomorrow!" "Made in Heaven!" "Time (Waits for No one!)" "One Year of Love!" "Who Wants to Live Forever!" "Friends Will Be Friends!" "Barcelona!" "How Can I Go On?" "Guide Me Home!" "The Show Must Go On!" "Headlong!" "These Are the Days of Our Lives!" "Mother Love!" "Don't Try Suicide!" "Keep Passing the Open Windows!"
I do NOT do "quick" evaluations. My motto is to
"Do it right the first time!"
I also strongly believe that
"two heads are better than one" -- so
I try -- whenever possible -- to have
a nurse or a social worker or a mental health tech or a post-graduate medical/ psychiatric trainee with me for the initial evaluation of a patient --
even in the Emergency Room.
linguistic/ cognitive
dynamic psychiatry meets
neurologic/ nutritional/ endocrinologic
psychobiology
ability to form & use concepts soft neurologic signs
nutritional deficits premenstrual syndrome
>>
Yes, I’ve been writing all of the
“standard” psychiatric prescriptions
for decades.
I also do more than that.
I evaluate and try to address each patient’s
ability to form and use concepts – as well as
simple issues of a
soft neurologic, nutritional, and endocrinologic
nature that frequently
contribute to a patient's presenting problems.
<<
psychosomatic somatopsychic consultation-liaison
percepts concepts
Latest clinical release:
Listening Closely to Patients --
without Jumping to Conclusions
{essays on practicing psychiatry} [2021]
https://www.amazon.com/dp/1542835364/ref=sr_1_1?keywords=listening+closely+to+patients&qid=1627610561&s=books&sr=1-1&asin=B09BG1FYK9&revisionId=b94a9236&format=1&depth=2
Two observational studies:
PART ONE – Differentiation of Moods as a Reflection of
Ego Organization and Personality Style:
Listening Very, Very Closely as
Patients Answer Only Five Questions.
[neurotic/ normal,
borderline,
pre-psychotic/ psychotic]
As an integral part of every initial psychiatric
evaluation, this clinical approach quickly
elicits verbalized data on
a patient's ability -- or lack of ability --
to form and use concepts.
It also quickly provides data on what is
NOT schizophrenia and what is
NOT borderline personality disorder,
while quickly suggesting
probable neurotic conflicts and
likely neurologic/ endocrinologic issues.
PART TWO – Erroneous Psychiatric Self-Diagnosis:
Non-Psychiatric Patients
that Present at a Psychiatrist’s Office.
APPENDIX – Elucidation of Useful
Additional Clinical Data.
*****Ascertaining Soft Neurologic Signs.
[with a bibliography of
select medical abstracts
systematically collected since 2000]
*****Ascertaining Nutritional Deficits
(Iron Deficiency {especially in men},
Pyridoxine/ B6 Deficiency,
Zinc Deficiency, Vitamin D Deficiency,
Hypercalcemia, Magnesium Deficiency,
Cobalamin/ B12 Deficiency, Hypocalcemia).
[with extensive bibliographies of
select medical abstracts
systematically collected since 2010]
*****Ascertaining PreMenstrual Syndrome/ "PMS".
[with an extensive bibliography of
select medical abstracts
systematically collected since 2020]
*****Reconsidering the Relationships of
Parts One & Two.
psychosomatic somatopsychic consultation-liaison
percepts concepts
neurology endocrinology malnutrition
>>> The following groups of
very medical "psychiatric" patients now make up
over one-third of all patients evaluated & treated by me on
either an inpatient or an outpatient basis <<<
***** The "mixed"
"depression" [negativity] +
"anxiety" [tension]" group is by far
the most common -- correlating highly with
past head-injury -- including birth-injury.
***** Generally, the neurologic component is primary, with
an endocrinologic component appearing later & making
the situation worse. Being malnourished or drug-addicted
certainly does not help. Having additional psychiatric issues certainly does not help. Many of these patients do respond
quickly to treatment once the overall picture is grasped.
in the international classification of diseases/ ICD:
>>mood disorder due to
known physiologic condition, mixed
(mania + depression)
[neurologic &/ or endocrinologic]
>>anxiety disorder due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>mood disorder (major depression) due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>mood disorder (mania) due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>catatonia due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>psychosis due to
known physiologic condition
[neurologic &/ or endocrinologic]
>>[non-psychotic] organic [auditory] hallucinosis due to
known physiologic condition
[neurologic &/ or endocrinologic]
“Listening Closely” is about trying to make
interesting and significant a lot of clinical
information that has been there all the time –
waiting to be gathered –but frequently
not perceived, conceptualized, and appreciated.
"Listening Closely" is about finally grasping
what the patient has been saying --
or trying to say --
or trying to find the words to say --
all along.
Harley C. Shands, MD semiotic emotion affect
overthinking negativity low-dose anticonvulsant
hungry anxious depressed angry afraid
hunger anxiety depression anger fear
During late 2021, I spun off --
as handouts for clinical staff working with me --
six excerpts -- with key medical abstracts --
on several specific psychiatric issues:
“Vitamin D, Iron, &
Executive Functioning (including Attention)”
--- 7pp; 24 abstracts plus commentary.
“Vitamin D, Magnesium, Zinc, Iron &
Sleep or Insomnia”
--- 2pp; 7 abstracts plus commentary.
“Vitamin D, Iron, B2/ Riboflavin, B12/ Cobalamin &
Suicide”
--- 3pp; 10 abstracts; with important
comments re vitamins B2 & B12.
“Iron, Zinc, B6/ Pyridoxine &
Attention”
--- 4pp; 14 abstracts plus commentary.
"Vitamin B12/ Cobalamin & the
Enhancement of Social Comfort
--- 1p; 1 abstract plus commentary.
“Vitamin B12/ Cobalamin & the
Reduction of Wariness/ Defensiveness/
Hyperactivity”
--- 3pp; 7 abstracts plus commentary.
~~~~
BONUS sets of
key medical abstracts not in the book:
{ask for a copy of any of these sets}
“Vitamin C/ Ascorbic Acid & the
Reduction of Anxiety/ Depression + the
Enhancement of Vitality/ Intimacy”
--- 2pp; 7 abstracts plus commentary.
“NAC/ N-acetylcysteine (an antioxidant) & the
Reduction of Anxiety/ Obsession/
Hypomania/ Driven Behavior”
--- 3p; 7 abstracts.
“Vitamin B2/ Riboflavin & Impact on
Migraine/ Migraine Equivalents/ Cognition"
--- 3pp; 9 abstracts plus commentary.
“Zinc, Iron, T3 Thyroid & the
Reduction of Anger/ Aggression/ Impulsivity"
--- 4pp; 9 abstracts plus commentary.
“Vitamin D, Magnesium, Iron, B1/ Thiamine,
B6/ Pyridoxine, B12/ Cobalamin &
Pain"
--- 4pp; 11 abstracts plus commentary.
“Vitamin D, Magnesium, Iron,
B12/ Cobalamin, B1/ Thyamine, &
Fibromyalgia"
--- 4pp; 11 abstracts plus commentary.
“Vitamin D, B6/ Pyridoxine, N-acetylcysteine, &
Augmentation of the Treatment of
Schizophrenia, Schizoaffective Disorder &
Bipolar Disorder" [sparse but interesting data]
--- 2pp; 5 abstracts.
“B6/ Pyridoxine, Magnesium, Vitamin D, Iron,
Zinc, B12/ Cobalamin, B9/ Folate, &
Seizures [sparse but interesting data]
--- 4pp; 15 abstracts plus commentary.
Coming soon! a chapter on:
“Overthinking with a
Predominance of Negative Thoughts:
Transitioning Patients
Off of Benzodiazepines & Zolpidem.
An Observational Study of 30 Patients”
[contains a bibliography on the use of
low-dose anticonvulsants; plus much
focus on NON-prescription items that
have brain-soothing qualities]
Coming soon! a chapter on:
“Psychiatric Admissions related to
PreMenstrual Syndrome ('PMS') and,
Frequently, also related to
Soft Neurologic Signs ('Busy Brain').
An Observational Study of 35 Patients”
[to say that this is a complex chapter
would be an understatement;
contains a very extensive bibliography --
focusing on nutritional approaches]
[evaluation & simple treatment of bloating,
fatigue, insomnia, hair loss, cramps, migraine,
tenderness, excessive sweating, etc that may
relate to anxiety, depression, irritability, etc]
Coming soon!
The next anticipated clinical release:
Pentoxifylline & the Brain
100+ selected abstracts including many re the
treatment of reduced cerebral perfusion as seen in
autism spectrum disorder,
Alzheimer’s disorder, & schizophrenia.
Pentoxifylline (high dose, carefully used) appears to
enhance "social consideration"/ engagement via
“re-memory of heard words” (eg, of discussions).
&
Pentoxifylline, as a pro-circulation medication and
powerful anti-inflammation medication, also has
demonstrated antidepressant effects.
phosphodiesterase inhibitor
TNF-alpha production inhibitor IL-6 reducer
increasing circulation decreasing inflammation
pro-circulatory anti-inflammatory
stops "cytokine storm"
some anti-viral, anti-bacterial, anti-fungal effect
see also:
Ramzi A, Maya S, Balousha N, Amin M, * Powell RC *, Shiha MR. "Effects of the anti-inflammatory pentoxifylline on psychiatric and neuropsychiatric conditions: Exploring various off-label utilities with meta-analyses”. Inflammopharmacol, Jan 2025; https://pmc.ncbi.nlm.nih.gov/articles/PMC11799099/ [reviews extensive data on the use of pentoxifylline in severe major depressive disorder, vascular cognitive impairment, schizophrenia, & autism – with a favorable safety profile]
See below, under "Works." my booklet:
Pentoxifylline:
A Versatile Off-Patent Medication
Best Not Overlooked
Coming soon!
The next anticipated historical release:
"Anton T. Boisen’s 'Psychiatric Examination:
Content of Thought' (c.1925-31):
An Attempt to Grasp
the Meaning of Mental Disorder" [2nd ed]
schizophrenia psychosis social isolation
Previous latest release:
When Death Is NOT Theoretical:
The Readiness of the Music Group ‘Queen’ for
Living with Freddie Mercury’s Dying
[2nd edition, 2018]
grief grieving
confronting evil, negativity, & death
"Keep Yourself Alive!" grief bereavement "Nevermore!" "Dear Friends" "Teo Torriatte! (Let Us Cling Together!)" "All Dead, All Dead!" "Save Me!" "It's a Hard Life!" "Hammer to Fall!" "I Was Born to Love You!" "Love Me Like There's No Tomorrow!" "Made in Heaven!" "Time (Waits for No one!)" "One Year of Love!" "Who Wants to Live Forever!" "Friends Will Be Friends!" "Barcelona!" "How Can I Go On?" "Guide Me Home!" "The Show Must Go On!" "Headlong!" "These Are the Days of Our Lives!" "Mother Love!" "Don't Try Suicide!" "Keep Passing the Open Windows!"
Most considerations of Queen and its musical catalogue have been by journalists, but Dr. Powell approaches these questions as an historian and clinician, analyzing fifty-some songs and mobilizing extensive amounts of data to support his conclusions. — excerpt from description of When Death is NOT Theoretical, Amazon
2nd ed -- with an Addendum & now an Index --
40% longer than 1st ed
grief grieving heroic way of death
anticipatory & participatory grief
facing death head-on living while dying
a typology of death (four distinct varieties)
focus on the increasingly more common
"death from a disease with a somewhat known,
non-immediate time course"
2nd ed -- with an Addendum & now an Index --
40% longer than 1st ed
grief grieving heroic way of death
anticipatory & participatory grief
facing death head-on living while dying
a typology of death (four distinct varieties)
focus on the increasingly more common
"death from a disease with a somewhat known,
non-immediate time course"
Freddie Mercury -- Brian May -- Roger Taylor -- John Deacon
-- "Bohemian Rhapsody" --
-- "Bohemian Rhapsody" --
**COVID-19**
See below, under "Works." my booklet:
Pentoxifylline:
A Versatile Off-Patent Medication
Best Not Overlooked
Some Published Medical Thoughts about
COVID-19 & Pentoxifylline
(a phosphodiesterase 4 inhibitor )
(a production inhibitor of
TNF-alpha, IL-6, & IL-2R --
all of which inflammatory cytokines are
higher in COVID-19 infection)
*****
[Many recent investigators appear to be
relatively inexperienced in using pentoxifylline --
in that they do not seem to understand that
pentoxifylline does not work immediately.
It is NOT a TNF-alpha "blocker," for example, but is
a TNF-alpha "production inhibitor" --
working at the RNA level.
The time to begin prescribing
pentoxifylline (with food & fluid) for a patient is
NOT upon an admission to hospital, but, rather,
several weeks before such admission might be needed.]
Important New Article -- February 2022:
Feret W, Nalewajska M, Wojczyński Ł, Witkiewicz W, Kłos P, Dziedziejko V, Pawlik A. “Pentoxifylline as a Potential Adjuvant Therapy for COVID-19: Impeding the Burden of the Cytokine Storm [and of Fibrotic Clots].” J Clin Med. 2021 Nov 15;10(22):5305; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8617922/ ;
“… Pentoxifylline (PTX) is a drug that exhibits broad-spectrum anti-inflammatory and immunomodulatory effects through mechanisms involving the adenosine A2A receptor (A2AR), in parallel with rheological effects. Previous studies have shown that PTX has anti-inflammatory effects and, therefore, may be beneficial in countering the cytokine storm caused by COVID-19. This drug has also been shown to reduce lung fibrosis in patients with COVID-19, as well as to prevent thromboembolic events. Therefore, PTX may exert potential benefits in treating the symptoms of SARS-CoV-2 as well as its complications.” [bolding added]
[in early 2022, the role of fibrin clots in COVID-19 deaths became more appreciated]
Brubaker LS, Saini A, Nguyen TC, Martinez-Vargas M, Lam FW, Yao Q, Loor MM, Rosengart TK, Cruz MA. “Aberrant Fibrin Clot Structure Visualized Ex Vivo in Critically Ill Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.” Crit Care Med. 2022 Feb 15; https://pubmed.ncbi.nlm.nih.gov/35170535/ ; “… Blood was collected from 36 patients including 26 ICU patients with COVID-19 and 10 ICU patients with sepsis but without COVID-19 at a median of 11 days after ICU admission (interquartile range, 3-16). The cohorts were similar in age, gender, body mass index, comorbidities, Sequential Organ Failure Assessment (SOFA) score, and mortality. More patients with COVID-19 (100% vs 70% ...) required anticoagulation. Ex vivo fibrin clots formed from patients with COVID-19 appeared to be denser and to have smaller pores than those from patients with sepsis but without COVID-19 …. We found aberrant fibrin clot structure and function in critically ill patients with COVID-19. These findings may contribute to the poor outcomes observed in COVID-19 patients with widespread fibrin deposition.” bolding added]
Hendry BM, Stafford N, Arnold AD, et al. “Hypothesis: Pentoxifylline is a Potential Cytokine Modulator Therapeutic in COVID-19 Patients.” Pharmacol Res Perspect. 2020 Aug;8(4):e00631; https://pubmed.ncbi.nlm.nih.gov/32715661/ .
Dalamaga M, Karampela I, Mantzoros CS. “Commentary: Phosphodiesterase 4 Inhibitors as Potential Adjunct Treatment Targeting the Cytokine Storm in COVID-19.” Metabolism. 2020 Aug;109:154282; https://pubmed.ncbi.nlm.nih.gov/32497535/ .
Giorgi M, Cardarelli S, Ragusa F, et al. “Phosphodiesterase Inhibitors: Could They Be Beneficial for the Treatment of COVID-19?”. Int J Mol Sci. 2020 Jul;21(15):5338; https://pubmed.ncbi.nlm.nih.gov/32727145/ .
González-Pacheco H, Amezcua-Guerra LM, Sandoval J, Arias-Mendoza “A Potential Usefulness of Pentoxifylline, a Non-Specific Phosphodiesterase Inhibitor with Anti-Inflammatory, Anti-Thrombotic, Antioxidant, and Anti-Fibrogenic Properties, in the Treatment of SARS-CoV-2.” Eur Rev Med Pharmacol Sci. 2020 Jul;24(13):7494-7496; https://pubmed.ncbi.nlm.nih.gov/32706089/ .
Kanthi Y, Knight JS, Zuo Y, Pinsky DJ. “New (re)Purpose for an Old Drug: Purinergic Modulation May Extinguish the COVID-19 Thromboinflammatory Firestorm.” JCI Insight. 2020 Jul;5(14):140971; https://pubmed.ncbi.nlm.nih.gov/32530438/ .
Bridgewood C, Damiani G, Sharif K, et al. “Rationale for Evaluating PDE4 Inhibition for Mitigating against Severe Inflammation in COVID-19 Pneumonia and Beyond.” Isr Med Assoc J. 2020 Jun;22(6):335-339; https://pubmed.ncbi.nlm.nih.gov/32558435/ .
cytokine storm - TNF-alpha - IL-6 - IL-2R -
corona virus - anti-inflammation - pro-circulation
See below, under "Works." my booklet:
Pentoxifylline:
A Versatile Off-Patent Medication
Best Not Overlooked
Some Published Medical Thoughts about
COVID-19 & Pentoxifylline
(a phosphodiesterase 4 inhibitor )
(a production inhibitor of
TNF-alpha, IL-6, & IL-2R --
all of which inflammatory cytokines are
higher in COVID-19 infection)
*****
[Many recent investigators appear to be
relatively inexperienced in using pentoxifylline --
in that they do not seem to understand that
pentoxifylline does not work immediately.
It is NOT a TNF-alpha "blocker," for example, but is
a TNF-alpha "production inhibitor" --
working at the RNA level.
The time to begin prescribing
pentoxifylline (with food & fluid) for a patient is
NOT upon an admission to hospital, but, rather,
several weeks before such admission might be needed.]
Important New Article -- February 2022:
Feret W, Nalewajska M, Wojczyński Ł, Witkiewicz W, Kłos P, Dziedziejko V, Pawlik A. “Pentoxifylline as a Potential Adjuvant Therapy for COVID-19: Impeding the Burden of the Cytokine Storm [and of Fibrotic Clots].” J Clin Med. 2021 Nov 15;10(22):5305; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8617922/ ;
“… Pentoxifylline (PTX) is a drug that exhibits broad-spectrum anti-inflammatory and immunomodulatory effects through mechanisms involving the adenosine A2A receptor (A2AR), in parallel with rheological effects. Previous studies have shown that PTX has anti-inflammatory effects and, therefore, may be beneficial in countering the cytokine storm caused by COVID-19. This drug has also been shown to reduce lung fibrosis in patients with COVID-19, as well as to prevent thromboembolic events. Therefore, PTX may exert potential benefits in treating the symptoms of SARS-CoV-2 as well as its complications.” [bolding added]
[in early 2022, the role of fibrin clots in COVID-19 deaths became more appreciated]
Brubaker LS, Saini A, Nguyen TC, Martinez-Vargas M, Lam FW, Yao Q, Loor MM, Rosengart TK, Cruz MA. “Aberrant Fibrin Clot Structure Visualized Ex Vivo in Critically Ill Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.” Crit Care Med. 2022 Feb 15; https://pubmed.ncbi.nlm.nih.gov/35170535/ ; “… Blood was collected from 36 patients including 26 ICU patients with COVID-19 and 10 ICU patients with sepsis but without COVID-19 at a median of 11 days after ICU admission (interquartile range, 3-16). The cohorts were similar in age, gender, body mass index, comorbidities, Sequential Organ Failure Assessment (SOFA) score, and mortality. More patients with COVID-19 (100% vs 70% ...) required anticoagulation. Ex vivo fibrin clots formed from patients with COVID-19 appeared to be denser and to have smaller pores than those from patients with sepsis but without COVID-19 …. We found aberrant fibrin clot structure and function in critically ill patients with COVID-19. These findings may contribute to the poor outcomes observed in COVID-19 patients with widespread fibrin deposition.” bolding added]
Hendry BM, Stafford N, Arnold AD, et al. “Hypothesis: Pentoxifylline is a Potential Cytokine Modulator Therapeutic in COVID-19 Patients.” Pharmacol Res Perspect. 2020 Aug;8(4):e00631; https://pubmed.ncbi.nlm.nih.gov/32715661/ .
Dalamaga M, Karampela I, Mantzoros CS. “Commentary: Phosphodiesterase 4 Inhibitors as Potential Adjunct Treatment Targeting the Cytokine Storm in COVID-19.” Metabolism. 2020 Aug;109:154282; https://pubmed.ncbi.nlm.nih.gov/32497535/ .
Giorgi M, Cardarelli S, Ragusa F, et al. “Phosphodiesterase Inhibitors: Could They Be Beneficial for the Treatment of COVID-19?”. Int J Mol Sci. 2020 Jul;21(15):5338; https://pubmed.ncbi.nlm.nih.gov/32727145/ .
González-Pacheco H, Amezcua-Guerra LM, Sandoval J, Arias-Mendoza “A Potential Usefulness of Pentoxifylline, a Non-Specific Phosphodiesterase Inhibitor with Anti-Inflammatory, Anti-Thrombotic, Antioxidant, and Anti-Fibrogenic Properties, in the Treatment of SARS-CoV-2.” Eur Rev Med Pharmacol Sci. 2020 Jul;24(13):7494-7496; https://pubmed.ncbi.nlm.nih.gov/32706089/ .
Kanthi Y, Knight JS, Zuo Y, Pinsky DJ. “New (re)Purpose for an Old Drug: Purinergic Modulation May Extinguish the COVID-19 Thromboinflammatory Firestorm.” JCI Insight. 2020 Jul;5(14):140971; https://pubmed.ncbi.nlm.nih.gov/32530438/ .
Bridgewood C, Damiani G, Sharif K, et al. “Rationale for Evaluating PDE4 Inhibition for Mitigating against Severe Inflammation in COVID-19 Pneumonia and Beyond.” Isr Med Assoc J. 2020 Jun;22(6):335-339; https://pubmed.ncbi.nlm.nih.gov/32558435/ .
cytokine storm - TNF-alpha - IL-6 - IL-2R -
corona virus - anti-inflammation - pro-circulation