Nasopharyngeal swabs are the most effective means of detecting COVID-19 infection, offering detection rates of 92 to 100 percent. That’s the conclusion of Cornell University (USA) researchers.

COVID test accuracy

The scientists obtained samples from patients; more specifically, they got four types of specimens:

• Nasopharyngeal swabs (the Q-tip-like collector goes deep into your nose)
• Anterior nares swabs (front of the nostril)
• Saliva
• Sublingual swabs(under the tongue)

The researchers obtained the samples from individuals with symptoms, individuals without symptoms, and subjects who had recovered from illness.

Covid detection rates by test type

Let’s look at the results by test type:

The nasopharyngeal samples had the best detection rate, from 92 to 100 percent. This high detection rate seems logical, as the COVID virus replicates in the uppermost portion of the nose.

Samples from the front of the nostril and saliva proved fairly good, too; about 92 to 96 percent effective for patients with symptoms. On the other hand, when patients had no symptoms, these approaches worked 75 to 92 percent of the time.

Under the tongue sampling proved suboptimal, with detection rates of only 40 to 60 percent for patients with symptoms and 25 to 42 percent for those without symptoms.

Overall, detection rates appeared highest for those with symptoms, ranging from 92 to 100 percent. The detection rate dropped to 75 to 96 percent for those without symptoms. Finally, once a patient no longer had symptoms, detection proved challenging.

I find nasopharyngeal swab tests — wherein the swab is sent far back inside the nostril — dreadful. But this approach is more effective at finding COVID-19 than are swabs put just inside the nose, swabs under the tongue, or saliva tests.

Fortunately, samples obtained from the front of the nose are reasonably accurate (and easier to perform). Study researcher Diego Diel offers this relevant observation:

“We were surprised at the short time in which infectious virus was detected. The data aligns with current US Centers for Disease Control guidelines and its decision to decrease patient isolation periods from an initial 14-day period to 10 and ultimately to five.”

Here’s a piece I wrote earlier on long COVID:

Long Covid: Could This Be Why?MICROCLOTS. COULD THEY EXPLAIN the mystery of why some who get a COVID19 infection suffer for long periods? Three…medium.com

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Just transplanting an animal’s organ into a human will not work. The person’s immune mechanisms will immediately reject the transplanted organ. So, what is to be done? The key is to genetically engineer the animal to produce organs that are less likely to be rejected. In the last 20 years, there’s been substantial progress on the research front to produce genetically modified pigs. Why pigs? Pig organs are about the same size as human organs but also share many physiologic similarities.

Recent technologies, including CRISPR, have allowed more possibilities to genetically engineer the pig’s genome. A few specific genes have been identified that are critical. Some were modified and some inactivated, called “knocked out.” It’s not just a matter of changing the pig’s genetics, but it’s also having a very specific anti-rejection drug combination. This includes the standard drugs used to prevent rejection of human organs and a specially designed monoclonal antibody against a part of the immune system called CD 40. This monoclonal antibody has been found to be essential and critical to the successful transplantation of a heart in the nonhuman primate model with animals maintained without rejection for upwards of 900 days.

In September 2021, a xenograft kidney from a genetically engineered pig was placed in a brain-dead patient still on life support. It was observed for 58 hours at the New York University Langone Hospital Center with the family’s permission to study for evidence of function and rejection. As a result, the surgical and research team, led by Dr. Robert Montgomery, himself a donor heart transplant recipient, were able to obtain critical information about the pig organ after transplantation. “Whole-body donation after death for the purpose of breakthrough studies represents a new pathway that allows an individual’s altruism to be realized after brain death declaration in circumstances in which their organs or tissues are not suitable for transplant.”

On Friday, January 7, Bartley Griffith, MD, Muhammad Mohiuddin, MD, and an extensive team of multi-specialties successfully implanted a genetically modified pig heart obtained from the Revivicor company. Revivicor created the genetically modified pig and hence the heart to the investigators’ specifications. This included modifying ten genes with three knocked out that lead to antibody development and one knocked out that controls the pig organs’ growth. The patient will also receive various anti-rejection drugs plus the monoclonal antibody aimed at CD40.

The patient, a 57-year-old man, was on life support and not eligible for a human donor organ. His projected lifespan was in days to weeks. He understood the risks of the procedure and that it was a first-time human experiment. But as he said before surgery, “It was either die or do this transplant. I want to live. I know it’s a shot in the dark, but it’s my last choice… I look forward to getting out of bed after I recover.”

The Food and Drug Administration (FDA,) having reviewed the research data, authorized the procedure “for compassionate use” on New Year’s Eve. As of Tuesday, January 12, the patient was doing well with no evidence of rejection. Only time will tell if he will make a full recovery and have his pig heart perform for many years.

Dr. Griffith is a cardiovascular surgeon with years of experience in transplanting human hearts and lungs. He has been working on xenotransplantation for over a decade. Dr. Mohiuddin joined with Dr. Griffith at the University of Maryland School of Medicine and Medical Center about five years ago to further pursue his research from the National Institutes of Health. He and colleagues developed the initial techniques to prevent rejection by gene modifications and anti-rejection drugs.

Together Griffith and Mohiuddin established the Xenotransplantation Center with Griffith as clinical director and Mohiuddin as scientific director. But, of course, there is a large team, not just the two of them. The Center investigators received a $15.7 million sponsored research grant to evaluate Revivicor genetically-modified pig hearts in further baboon studies. Last week’s surgery was the current culmination of those studies with a first in human heart xenotransplantation.

A new dawn has likely arrived for organ transplantation. But, of course, this was only the first patient. It remains to be seen how effective it will be in this man or how effective it will be in others treated with other genetically engineered pig organs like kidneys, pancreas, or lungs. But without question, it’s an exciting time with transplant-waiting individuals having a new potential on the horizon for returning to a reasonably normal life.

Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, former CEO of the University of Maryland Medical Center, and author of Longevity Decoded — The 7 Keys to Healthy Aging and his co-authored book with Dr. Harry Oken BOOM — Boost Our Own Metabolism

The post A Pig Heart Was Transplanted Into a Human a Few Days Ago Is This The Future of Organ Transplantation? appeared first on Medika Life.

Fortunately, age-adjusted death rates are falling globally. Death rates show a 17 percent decline from 1990 to 2016. Today we look at some advances in the management of advanced breast and melanoma cancers that have spread to distant sites of the body.

Breast cancer

Let’s be clear: When breast cancer has spread to distant organs (such as the bones, lung, liver, or brain), the disease is not currently curable. What has me excited this morning is a recent report about long-term survival for two subtypes of breast cancer. Let’s get right to the results:

Patients with two of the three major types of advanced breast cancer now have a median overall survival of at least 5 years, which is roughly a doubling of survival time over the past decade.

The two types of advanced breast cancer for which survival times have doubled over the past decade are HER2-positive (HER2+) breast cancer and ER-positive (ER+) breast cancer. HER2-positive means that the cancer cells have a particular protein sticking out like antennae.

Individuals with HER2-positive disease represent about 25 percent of patients with metastatic breast cancer and now commonly live as long as ten years. Doctors can use drugs that target the HER2 pathway that drives cell growth and division. The best-known of these is trastuzumab (Herceptin).

For those of you who would like to hear more about Herceptin, try this book:

Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast CancerAmazon.com: Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer eBook: Bazell, Robert

To see a film representation of the passionate and inspiring story of Dr. Dennis Slamon, the UCLA (USA) doctor who helped develop the breast cancer drug, Herceptin, try this:

Living ProofTop-rated Lifetime movie! Dr. Dennis Slamon has reached a breakthrough in his career. He has helped to develop a new…

Melanoma

You may have heard about the revolutionary cancer management tool known as immunotherapy.

A group of investigators from around the world reported the results of using a combination of two immunotherapy drugs for advanced melanoma. Following treatment with nivolumab and ipilimumab drugs yielded a more prolonged progression-free survival and overall survival than with only one immunotherapy drug.

Striking to me are the long-term outcomes:

At a minimum follow-up of five years, the median overall survival was more than five years (median not yet reached) in the group that received two immunotherapy drugs in combination. Over half of patients with cancer spread to distant sites were still alive at the five-year mark.

Chronic disease survivors. Former United States President Jimmy Carter presented with advanced melanoma — his disease had spread to his brain. You know the rest of the story: First, doctors bombarded his cancer in the brain with a highly focused, high-dose radiation therapy known as radiosurgery.

The high-dose radiation therapy damaged the cancer cells in the brain. These dying cells then released substances into the bloodstream, attracting the attention of immune cells.

Carter then received immunotherapy; more specifically, he got a drug known as pembrolizumab (Keytruda). Three months after immunotherapy, the then-91-year old discovered that his tumors were gone. The drug supported his immune system’s response and appears to have completely eliminated any residual cancer.

More than five years later, President Carter has no evidence of cancer remaining. If you want to learn more about immunotherapy, please go here:

What is Immunotherapy?As of October 2021, the U.S.www.cancerresearch.org

You will not be surprised to learn that the 2018 Nobel Prize in Physiology or Medicine was awarded jointly to two cancer immunotherapy researchers, James P. Allison, Ph.D. of The University of Texas MD Anderson Cancer Center, and Dr. Tasuku Honjo of Kyoto University in Japan.

The Nobel Prize committee honored Allison and Honjo for their work on uncovering ways to activate the immune system to attack cancer.

Thank you for joining me today in exploring the promise of targeted therapy and immunotherapy in the management of advanced cancer.

The post Making Advanced Cancer a Chronic Disease appeared first on Medika Life.

This article will examine all the most common symptoms in-depth and offer advice to those who are hesitant to seek out treatment.

What exactly is LCS and how do I know if I’ve got it?

The million-dollar question. With so many varying symptoms, ranging from leg pain and breathing difficulty to brain fog and depression, healthcare is still trying to get a proper feel for the after-effects of Covid in certain individuals. Here are a few key facts you should keep in mind.

• Long Haul Covid, PASC, LCS, or CCS is a very real thing. It is now a recognized and documented medical consequence of coronavirus infection in some people. The exact percentage of people who will suffer from LCS is still unknown. This report from the CDC offers a new perspective and actual figures, but it’s too early yet to call these figures definitive and the CDC’s goal in publishing these is to draw your doctor’s attention to the incidence of LCS as becoming more commonplace.
• A study published in December of 2020, entitled Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact (links to a PDF file ) is based on survey results from more than 3,700 self-described COVID “Long Haulers” in 56 countries. They show nearly half couldn’t work full time six months after unexpectedly developing prolonged symptoms of COVID-19. A small percentage of respondents, thankfully, seemed to have bounced back from brief bouts of Long COVID, though time will tell whether they have fully recovered.
• There is no clear age group or demographic more likely to suffer from LCS. Some evidence exists to suggest that if you have pre-existing lung/heart/other conditions, these may increase your risk for developing LCS but the jury is still out on this. What is clear is that no age group is exempt from developing LCS.
• Good news. You aren’t losing your mind. This is an important point to grasp for most who start experiencing symptoms. Brain fog, depression, cognitive impairment and even waking dream states can all be caused by LCS and can have a profound impact on your mental health and thought patterns. Not seeking out help will increase your levels of stress and simply contribute to the worsening of symptoms.
• Not all medical practitioners will recognize your symptoms as LCS. Ensure your care provider is up to speed on the signs and symptoms of the condition, but don’t step into the public trap of self-diagnosis. Keep an open mind and discuss ALL your symptoms openly with your health care provider.
• What makes this condition so difficult to diagnose with certainty is that you may tick a number of boxes and not actually have LCS. Your doctor is the only person properly qualified to properly assess your condition and we’d recommend examining LCS extensively as a potential cause of any new mental health symptoms you may be experiencing, particularly if you’ve recently had a brush with the coronavirus.
• You may even have had a mild Covid infection and not been aware of it or simply passed it off as mild flu or sniffles. To play it safe, if you’re exhibiting some of the symptoms below, go in and have yourself checked out properly. A test that looks for coronavirus antibodies can help identify an earlier infection if you’re uncertain you’ve had Covid or haven’t recently had a PCR test.

So, about those symptoms. Pull up a chair, it’s a long and growing list and you can expect additional symptoms to be added to this list over the coming months and some to fall away as our understanding of the condition improves.

LCS Symptoms

In the 2020 study referenced above, the following was found among 3,762 respondents from 56 countries. We’ve used this report as the basis for this article as it encompasses the broadest set of symptoms we’ve seen described and contains more detail than other reports.

Prevalence of 205 symptoms in 10 organ systems was estimated in this cohort, with 66 symptoms traced over seven months. Respondents experienced symptoms in an average of 9.08 (95% confidence interval 9.04 to 9.13) organ systems. The most frequent symptoms reported after month 6 were: fatigue (77.7%, 74.9% to 80.3%), post-exertional malaise (72.2%, 69.3% to 75.0%), and cognitive dysfunction (55.4%, 52.4% to 58.8%). These three symptoms were also the three most commonly reported overall

To best describe the findings in this cohort we’ve dissected the graphs published in the report and reproduced them below, as per the reports license Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). We’ll start with the neuropsychiatric symptoms (brain and mood-related). Bars represent the percentage of respondents who experienced each symptom at any point in their illness and are divided into nine sub-categories. When all rows in a given panel use the same denominator, the first row, labeled “All,” indicates the percentage of respondents who experienced any symptoms in that category. Error bars are 95% confidence intervals. Base scale is prevalence (in percentage)

Nest, we’ll move on to the non-neuropsychiatric symptoms. In other words, everything to do with the rest of the body, but excluding the brain. Bars represent the percentage of respondents who experienced each symptom at any point in their illness. Symptoms are categorized by the affected organ systems. When all rows in a given panel use the same denominator, the first row, labeled “All,” indicates the percentage of respondents who experienced any symptoms in that category. Error bars are 95% confidence intervals.

As the lists of possible symptoms are lengthy, we’ve summarized them below and you can view prevalence for each in the linked report. To simplify finding your symptoms, we have again separated these as per the report and graphics above, neuropsychiatric symptoms are shown first followed by non-neuropsychiatric.

List of neuropsychiatric symptoms for LCS

Brain fog/Cognitive dysfunction and memory impairment symptoms

• poor attention or concentration (74.8%)
• difficulty thinking (64.9%)
• difficulty with executive functioning (planning, organizing, figuring out the sequence of actions, abstracting) (57.6%)
• difficulty problem-solving or decision-making (54.1%)
• slowed thoughts (49.1%)
• short-term memory loss (64.8%)
• long-term memory loss (36.12%)
• forgetting how to do routine tasks (12.0%)
• unable to make new long-term memories (7.3%)

Memory symptoms, cognitive dysfunction, and the impact of these on daily life were experienced at the same frequency across all age groups. Of those who experienced memory and/or cognitive dysfunction symptoms and had a brain MRI, 87% of the brain MRIs (n=345, of 397 who were tested) came back without abnormalities.

Speech and language symptoms

• problems with word retrieval (46.3%)
• difficulty communicating verbally (29.2%)
• difficulty reading/processing written text (24.8%)
• difficulty processing/understanding others. (23.8%)

Those who spoke two or more languages had changes to their non-primary language. Speech and language symptoms occurred in 13.0% of respondents in the first week, increasing to 40.1% experiencing these issues in month 4. 38.0%of respondents with symptoms for over 6 months reported speech and language symptoms in month 7.

Sensorimotor symptoms

• numbness
• coldness in a body part
• tingling/pins and needles
• electric zap
• facial paralysis
• facial pressure/numbness, and weakness

Tingling, prickling, and/or pins and needles were the most common at 49% of respondents. Refer to Supplemental Table S3 (shown below) for the most commonly affected anatomical locations.

Sleep-related symptoms

78.6% of respondents experienced difficulty with sleep. The table below lists each type of sleep symptom, as well as the percentage of respondents with that symptom who also listed it as pre-existing (before COVID-19 infection).

Headaches

Headaches were reported by 77.0% of participants, with the most common manifestations being ocular 40.9%, diffuse 35.0%, and temporal 34.0%. 24.0% of respondents reported headaches after thinking/mental exertion and 23.0% experienced migraines. Of those experiencing migraines, 56.4% did not list migraines as a pre-existing condition. 46% of all respondents reported headaches during week 1, 54% of respondents experiencing symptoms in month 4 reported headaches in month 4, and 50% of respondents experiencing symptoms in month 7/reported headaches in month 7.

Emotion and mood

• Anxiety (the most common psychological symptom reported at 57.9%)
• Irritability (51.0%)
• Depression (47.3%)
• Apathy (39.2%)
• Mood lability, assessed by “mood swings” and “difficulty controlling emotions (46%)
• Suicidality (11.6%)
• Mania and hypomania (2,6 AND 3.4% respectively)

Of those who reported anxiety, 61.4% had no anxiety disorder prior to COVID. Of those who reported depression, 55.0% had no depressive disorder prior to COVID.

Taste and smell

• Loss of smell ((35.9%)
• Loss of taste (33.7%)
• Altered sense of taste (25.1%)
• Phantom smells (i.e. olfactory hallucinations or phantosmia) (23.2%)
• Altered sense of smell (19.8%)

Phantom smells were accompanied by a write-in question asking for a description of the smells, in which the most common words were “smoke,” “burning,” “cigarette,” and “meat.” Changes to smell and taste were more likely to occur earlier in the illness course, with 33.2% occurring in week 1. 25.2% of respondents with symptoms for over 6 months experienced changes to taste and smell in month 7.

Hallucinations

The most common hallucination reported was olfactory hallucinations 23.2%, mentioned above. Visual hallucinations were reported by 10.4% of respondents, auditory hallucinations by 6.5%, and tactile hallucinations by 3.1%.

List of non-neuropsychiatric symptoms for LCS

Systemic

• Fatigue (98.3%)
• Weakness (44.5%
• Elevated temperature below 100.4F (58.2%)
• Fever above 100.4F (30.8%)

3.0% (113 respondents) experienced a continuous fever (>100.4F) for 3 or more months, and 15.0% (563 respondents) experienced an elevated temperature, continuously, for 3 or more months. Skin sensations of burning, itching, or tingling without a rash were reported by 47.8% of respondents.

Reproductive/Genitourinary/Endocrine

• Menstrual/period issues (36.1% of respondents with active menstrual cycle)
• Abnormally irregular periods (26.1%,)
• Abnormally heavy periods/clotting (19.7%)
• Post-menopausal bleeding/spotting among cis females over 49 (4.5%)
• Early menopause among cis females in their 40s (3.0%)
• Extreme thirst (35.8%)
• Bladder control (14.1%)

Sexual dysfunction occurred across genders, experienced by 14.6% of male respondents, 8.0% of female respondents, and 15.9% of nonbinary respondents. 10.9% of cis male participants and 3.2% of nonbinary participants reported pain in testicles.

Cardiovascular (heart and circulation)

• Heart palpitations (67.4%)
• Tachycardia (61.4%)
• Pain/burning in the chest (53.1%)
• Fainting (12.9%)

Cardiovascular symptoms were more common over the first 2 months than in later months. Even so, 40.1% of respondents with symptoms for over 6 months experienced heart palpitations, 33.7% experienced tachycardia, and 23.7% experienced pain/burning in the chest in month 7.

Postural Orthostatic Tachycardia Syndrome (POTS)

To screen for POTS, participants were asked whether they had the ability to measure their heart rate, if their heart rate changed based upon posture, and if standing resulted in an increase of over 30 BPM. Of the 2,308 patients who reported tachycardia, 72.8% (1680) reported being able to measure their heart rate. Of those, 52.4% (570) reported an increase in heart rate of at least 30 BPM on standing.

Musculoskeletal

• Chest tightness (74.8%)
• Muscle aches (69.1%)
• Joint pain (52.2%)

Musculoskeletal symptoms were common in this cohort, seen in 93.9%. In month 7, chest tightness affected 32.9% of month 7 respondents and muscle aches affected 43.7% of month 7 respondents

Immunologic and Autoimmune

• Heightened reaction to old allergies (12.1%)
• New allergies (9.3%)
• New or unexpected anaphylaxis reactions were notable at 4.1%

20.3% of respondents (n=765) reported experiencing changes in sensitivity to medications,

Reactivation and test results for latent disease

Since being infected with SARS-CoV-2, 2.8% of respondents reported experiencing shingles (varicella-zoster reactivation), 6.9% reported current/recent EBV infection, 1.7% reported current/recent Lyme infection, and 1.4% reported current/recent CMV infection. Detailed results are shown in the table below.

HEENT (Head, ears, eyes, nose, throat)

28 symptoms were defined as symptoms of the head, ears, eyes, nose, and throat (graphic above). All respondents experienced at least one HEENT symptom. A sore throat was the most prevalent symptom (59.5%) which was reported almost twice as often as the next most prevalent symptom, blurred vision (35.7%). Within this category, symptoms involving vision were as common as other organs. Notably, 1.0% of participants reported a total loss of vision (no data on the extension and duration of vision loss were collected).

Ear and hearing issues (including hearing loss), other eye issues, and tinnitus (ringing in the ears) became more common over the duration studied. Tinnitus, for example, increased from 11.5% of all respondents reporting it in week 1 to 26.2% of respondents with symptoms for over 6 months reporting it in month 7.

Pulmonary and Respiratory (lungs)

• Shortness of breath (77.4%)
• Dry cough at (66.2%)
• Breathing difficulty with normal oxygen levels (60.4%)
• Rattling of breath (17.0%)

Dry cough was reported by half of the respondents in week 1 (50.6%) and week 2 (50.0%) and decreased to 20.1% of respondents with symptoms for over 6 months in month 7. Shortness of breath and breathing difficulties with normal oxygen increased from week 1 to week 2 and had a relatively slow decline after month 2. Shortness of breath remained prevalent in 37.9% of respondents with symptoms in month 7.

Gastrointestinal (stomach)

• Diarrhea (59.7%)
• Loss of appetite (51.6%)
• Nausea (47.8%,)

Of respondents experiencing symptoms after month 6, 20.5% reported diarrhea and 13.7% reported a loss of appetite in month 7.

Dermatologic (skin)

• Itchy skin (31.2%)
• Skin rashes (27.8%)
• Petechiae (17.8%
• COVID toe (13.0%)

COVID toe, petechiae, and skin rashes were most likely to be reported in months 2 through 4 and decreased thereafter.

Post-exertional malaise

The survey asked participants whether they have experienced “worsening or relapse of symptoms after physical or mental activity during COVID-19 recovery”. Borrowing from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) terminology, this is referred to as postexertional malaise (PEM). 89.1% of participants reported experiencing either physical or mental PEM.

• Of the respondents who experience PEM triggered by physical exertion, 49.6% experience it the following day, 42.5% experience it the same day, and 28.7% experience PEM immediately after.
• Of the respondents who experience PEM triggered by mental exertion, 42.2% experience it the same day, and 31.4% experience it immediately after.

For some respondents the time PEM started varied. A high number of the respondents with PEM (68.3%) indicated that the PEM lasted for a few days. For physical exertion, the mean severity rating was 7.71, and for mental exertion, the mean severity rating was 5.47.

Recovery and long term prognosis for LCS

Now you know the possible effects of LCS the next question on everyone’s mind is an obvious one. Is this permanent or do people recover, and if they do, what sort of time frames are we looking at.

These are both difficult questions, particularly as we are still only getting to grips with the condition and we don’t have a long enough frame of reference yet to answer the question definitively. Obviously, the degree to which your organs have been affected, pre-existing conditions, and the type of symptoms you exhibit all play a role. Let’s look again at the cohort from the report above.

Relapses: triggers & experience

Patients with Long COVID can experience relapsing-remitting symptoms. A minimum of 85.9% of respondents reported experiencing relapses. Respondents characterized their relapses as occurring in an irregular pattern (52.8%) and in response to a specific trigger (52.4%). The most common triggers of relapses, or of general worsening of symptoms, that respondents reported were

• Physical activity (70.7%)
• Stress (58.9%)
• Exercise (54.39%)
• Mental activity (46.2%
• More than a third of menstruating participants experienced relapses during (34.3%) or before menstruation (35.2%).

Heat and alcohol were other triggers of relapse. Triggers that were written in by respondents included food with sugar and high histamines (reported by 70 respondents); lack of sleep or rest (64 respondents); cold air (39 respondents); overworking or schoolwork (28 respondents); smoke, pollution, and chemical odors (24 respondents).

Approximately half (51.7%) of respondents indicated that their symptoms have slowly improved over time, while 8.9% indicated that their symptoms have gradually worsened and 10.8% have had symptoms rapidly worsen over time.

Remaining symptoms after 6 months

Only 164 out of 3762 participants (4.4%) experienced a temporary break in symptoms. The remaining participants reported symptoms continuously, until symptom resolution or up to taking the survey. A total of 2454 (65.2%) respondents were experiencing symptoms for at least 6 months. For this population, the top remaining symptoms after 6 months were primarily a combination of systemic and neurological symptoms. Over 50% experienced the following symptoms:

• Fatigue (80.0%)
• Post-exertional malaise (73.3%)
• Cognitive dysfunction (58.4%)
• Sensorimotor symptoms (55.7%)
• Headaches (53.6%)
• Memory issues (51.0%)

In addition, between 30%-50% of respondents were experiencing the following symptoms after 6 months of symptoms:

• insomnia
• heart palpitations
• muscle aches
• shortness of breath
• dizziness and balance issues
• sleep and language issues
• joint pain
• tachycardia
• other sleep issues.

How is LCS affected by pre-existing conditions?

Again, let’s examine the data from the cohort. Most patients (83%) reported at least one pre-existing condition. The most commonly reported pre-existing conditions were;

• Seasonal allergies (36.3%)
• Environmental allergies (24.1%)
• Migraines (18.7%)
• Asthma (17.1%)

Other conditions of note include acid reflux (12.2%), irritable bowel syndrome (12.9%), vitamin D deficiency (11.8%), obesity (10.7%), hypertension (9.1%), hyperlipidemia (7.4%), and myalgic encephalomyelitis / chronic fatigue syndrome (2.5%).

In the United States, the prevalence of asthma in the general population is 7.7%. While this cohort is not representative of the U.S. population, the prevalence of asthma (17.07%) should be noted.

Making it personal, the voices of respondents

We’ve added these, not to concern you, but to allow you a deeper understanding of the extent to which LCS can affect your life and if you’re experiencing these symptoms, to assure you, you not losing your mind. We strongly urge you to seek help from a trusted medical practitioner who is knowledgeable in the field of LCS.

On Cognitive Dysfunction and Memory Loss

“mother has started to help me take the medications I’m on because I can’t remember if I’ve taken them immediately after having the bottle in my hand”

“was trying to fill out a mortgage application form and couldn’t remember our rent. I put £3750 a month. My partner said, no it’s £1375. So I put £13750. My partner said no, so I tried several more times — I was just guessing numbers”

“sitting on the toilet to pee and had to stop for a second to think if I was really there and not about to pee myself or the bed”

“don’t remember what I did in March or April up until the last week of April. I had almost nothing on my schedule. I don’t know what I did”

“put food on the gas stove and walked away for over an hour, only noticing when they were smoking/burning”

“forget how to do normal routines like running a meeting at work”

“felt lost driving and had to stop and find my position in a GPS to be able to drive back home. It’s a route I have done hundreds of times”

“have trouble comprehending new ideas”

“can’t hold multiple trains of thought […] If I tell myself I have to water my plants, I must do it before another thought comes into my mind because otherwise, I will forget”

“can’t follow plots in movies or tv shows, have to write everything down, have to remember to look at notes”

“had to terminate many phone calls because I could no longer comprehend the speakers nor communicate clearly with them”

“used to do the New York Times crossword puzzle every single day and I can’t even manage the mini ones now”

“can’t focus on reading complex texts, and it makes me feel very tired to do that”

“Found that I had become dyslexic — and knew it was happening at the time, could not remember how to spell words — also found I was missing words from sentences and sometimes writing things that did not make sense”

Should I see a psychiatrist or psychologist first?

Medika’s advice on this is no. Your first port of call should be a doctor qualified to recognize the symptoms of LCS. The right provider can assist you with an appropriate treatment strategy without necessarily resorting to psychotropic drugs and antidepressants which can have serious long-term implications for your mental health.

First, explore the probable diagnosis of LCS with a qualified medical practitioner, particularly if you’re experiencing a number of the symptoms listed above.

If you would like to share your personal experiences of LCS, we encourage you to use the form below and we’ll add your voice to the conversation.

The post The Complete A to Z of Long Haul Covid Symptoms. What you Need to Know appeared first on Medika Life.

The pandemic proved new therapeutics and vaccines are able to navigate through the bureaucratic quagmire when there is the public will to make it happen. New antivirals therapies, monoclonal antibodies, and mRNA vaccines are now saving lives. 

These success stories are outliers. In reality, pharmaceutical and medical device innovations move through the system at a snail’s pace. 

A product must pass through a lengthy FDA approval process to verify safety and efficacy. Despite FDA approval, a new medical device still can not get into the hands of surgeons. New technologies run into a brick wall as they fight for acceptance as an approved product by third-party payers. 

Insurance companies hide behind the word “investigational” to justify the denial of care. An FDA-approved medical device has little value to doctors and patients if none of the third-party payers pay for its use. 

Every insurance company must accept and authorize a new medication or medical device into their approved formulary before it is considered a covered benefit. Even after CMS approval, each managed care Medicare and Medicaid plan also submit new products to this lengthy process.

Medical practices spend countless hours jumping through pre-authorization hoops and appealing denied claims. 

We invest this time and energy to get our patients the most effective options, but patient care does not have to be so hard. Patients want doctors to spend time in the exam room, not writing insurance appeal letters. 

Finn Partners manager of global health, Gil Bashe, summarizes the barriers stifling medical device innovation in his article “Investigational” Is Payer Code for “Coverage Denied”. 

It is time for insurance companies to tear down the walls, stop playing games and help doctors provide the best care to their patients. 

The post Nonsensical Processes Prevent Patient Access to New and Safe Treatments appeared first on Medika Life.

• Pain, which may radiate down an arm (for cervical spine) or around the chest (for thoracic spine)
• Weakness
• Numbness of the extremities

To diagnose and treat these symptoms, your doctor may use nerve root injections.

Purpose of diagnostic nerve root injections: 

If your physician can’t determine the specific cause of your pain using diagnostic imaging, such as an MRI or CT scan, temporarily numbing the suspicious spinal nerve root may help to identify the source of the pain.

Purpose of therapeutic nerve root injections: 

Injection of a steroid along the nerve root may be used as a treatment to help reduce irritation and swelling, thereby relieving pain. The steroid usually starts to work two days to two weeks after the injection. The pain relief varies for each individual, from no relief to long-term pain relief.

Types of nerve root injections

Selective Nerve Root Block (SNRB): This is a diagnostic-only procedure. It tests to see if a specific nerve is causing pain by blocking it with a strong anesthetic. No steroid is used. The anesthetic may cause temporary numbness, tingling, and/or mild weakness in the affected leg. These symptoms and any pain relief only last until the anesthetic wears off.

Nerve Root Injection (NRI): This is a diagnostic and therapeutic injection. Both a strong anesthetic and steroid are used and injected around the nerve and into the epidural space.

Transforaminal Epidural Steroid Injection (TFESI): This is primarily a therapeutic procedure aimed at relieving pain when the physician knows which nerve is affected. A lighter anesthetic and steroid are injected around the nerve and epidural space.

Overview of the nerve root injection procedure

Here’s what to expect during a cervical or thoracic nerve root injection procedure:

• If your pain is in your cervical spine, you will lie face up; if your pain is in your upper back, you will lie face down.
• The injection area is cleaned and numbed before the injection.
• Using fluoroscopic (X-ray) guidance, your physician will determine the appropriate path for the needle.
• Your doctor will insert a thin needle to a point immediately behind the nerve root.
• Next, your doctor will inject a small amount of contrast dye to make sure that the medication will flow exactly where intended.
• Then, your physician will inject a small amount of anesthetic, steroid, or a combination of both, depending on the procedure’s purpose.
• During the injection, you may feel a sensation of pressure in the neck or arm. This typically disappears in a few moments.
• After the procedure, you’ll spend 20 to 30 minutes in the recovery area.

Preparing for the nerve root injection

• While the procedure may take less than 15 minutes, you should allow for at least one hour at the procedure center.
• You need to arrange for a driver to be present and take you to and from the medical facility. If you do not have a driver with you, we may have to reschedule your procedure.
• For diagnostic injections, you should have some pain at the time of the procedure or be able to reproduce it consistently with certain activities or positions. If you are typically pain-free after taking pain medication, please do not take these medications for four to six hours before an injection.
• If you are taking prescription blood thinners such as Coumadin (warfarin), Ticlid (ticlopidine), or Plavix (clopidogrel bisulfate), please inform your docot. These medicines will need to be stopped before the procedure, but only after you receive permission from the doctor who is prescribing these medicines.
• If you develop a fever, night sweats, or an active infection before your procedure, your procedure will need to be rescheduled.

Possible side effects of the steroid

Side effects of steroid injections are usually minimal and go away within one to three days after the procedure. Possible side effects of the steroid include:

• Facial flushing
• Fluid retention
• Insomnia
• Low-grade fever (less than 100° F)
• For women, temporary changes to your menstrual cycle
• Headache
• For people with diabetes, temporary elevation of blood sugar levels

After the injection

• Follow the specific instructions given to you by the health care providers
• Plan to rest for the remainder of the day. You may resume light activity that is comfortable for you, but do not overexert yourself the first day.
• You may be sore from the needle placement for one to two days. If a local anesthetic was injected, you may feel a numbing sensation in your arm for a few hours until the anesthetic wears off.
• For discomfort, apply ice packs to the puncture site for 15 minutes several times a day.
• Do not soak in a tub for 24 hours after the procedure. You may take showers.
• Report any signs of infection or other unusual symptoms to your doctor, including:
  • Redness and warmth at the injection site
  • Increasing pain
  • Swelling or drainage at the injection site
  • Chills, night sweats, or fever that reaches above 100° F

• If you develop a headache:
  • Stay quiet with your head and body flat
  • Drink plenty of fluids
  • Take Tylenol (acetaminophen) or your prescribed pain medication
  • If your headache lasts more than 12 hours or is noticeably worse when you stand up, it may be an indication of a spinal leak and you should notify your doctor. This is very rare and usually gets better without treatment.
• Keep a record of your pain and symptoms after the injection and report your results as instructed by your doctor’s patient care coordinator.

Potential risks of nerve root injections

The risks of nerve root injections are minimal and are similar to any procedure involving a needle placement. These include, but are not limited to:

• Allergic reaction to the anesthetic or contrast dye. 
• Infection
• Needle injury to a blood vessel, which may bleed
• Irritation of the injected area, which could cause temporary worsening pain
• Inability to place the needle at the desired target, resulting in inability to complete the injection

The post Therapeutic Cervical or Thoracic Nerve Root Block appeared first on Medika Life.

What is staging?

Staging helps describe where a cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors often use diagnostic tests to determine a cancer’s stage. Staging may not be complete until all of these tests are finished. Knowing the stage of the cancer helps the doctor to:

• Plan treatment, including the type of surgery and/or whether chemotherapy or radiation therapy are needed
• Predict the chance that the cancer will come back after the original treatment
• Predict the chance of recovery
• Talk about the diagnosis in a clear, common language with the entire health care team
• Determine how well the treatment worked
• Compare how well new treatments work among large groups of people with the same diagnosis

Understanding the TNM staging system doctors use

For most types of cancer, doctors most frequently use the TNM system of the American Joint Committee on Cancer (AJCC) to describe a cancer’s stage. Doctors answer the following questions based on the results from diagnostic tests, imaging scans, and surgery to remove or get a sample of the tumor.

• Tumor, T – How large is the primary tumor and where is it located?
• Node, N – Has the tumor spread to the lymph nodes? If so, where and how many nodes are affected?
• Metastisis, M – Has the cancer spread to other parts of the body? If so, where and how much?
• Are there any biomarkers or tumor markers linked to the cancer that may make it more or less likely to spread?

TNM descriptions

These are the general descriptions of the TNM staging system. Keep in mind that the specific definitions for each category are different for each type of cancer that is staged using this system.

• Tumor (T). The letter “T” plus a number (0 to 4) describes the size and location of the tumor, including how much the tumor has grown into nearby tissues. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil. A larger tumor or a tumor that has grown more deeply into the surrounding tissue receives a higher number. For some types of cancer, lowercase letters, such as “a,” “b,” or “m” (for multiple), are added to the “T” category to provide more detail.
• Node (N). The letter “N” plus a number (0 to 3) stands for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near where the cancer started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Most often, the more lymph nodes with cancer, the larger the number assigned. However, for some tumors, the location of the lymph nodes with cancer may determine the “N” category.
• Metastasis (M). The letter “M” indicates whether the cancer has spread to other parts of the body, called distant metastasis. If the cancer has not spread, it is labeled M0. If the cancer has spread, it is considered M1.

In addition to the TNM categories, other factors may be included in the stage depending on the specific type of cancer. These may include tumor markers or bio-markers, grade, and tumor genetics.

Cancer Stage Grouping

Doctors will combine the T, N, M results and other factors specific to the type of cancer to determine the stage for each person. Most types of cancer have four stages: stages I (1) to IV (4). Some cancers also have a stage 0 (zero).

• Stage 0. This stage describes cancer in situ, which means “in place.” Stage 0 cancers are still located in the place they started and have not spread to nearby tissues. This stage of cancer is often highly curable, usually by removing the entire tumor with surgery.
• Stage I. This stage is usually a small cancer or tumor that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.
• Stage II and Stage III. In general, these 2 stages indicate larger cancers or tumors that have grown more deeply into nearby tissue. They may have also spread to lymph nodes but not to other parts of the body.
• Stage IV. This stage means that the cancer has spread to other organs or parts of the body. It may also be called advanced or metastatic cancer.

Restaging a cancer

The stage of a cancer does not change over time. If the cancer comes back or spreads to another part of the body, the more recent information about the size and spread of the cancer is added to the original stage.

Sometimes, a doctor might “restage” a cancer to determine how well a treatment is working or to get more information about a cancer that has come back after treatment. This process uses the same staging system described above. Usually some of the same tests that were done when the cancer was first diagnosed will be repeated.

After this, the doctor may assign the cancer a new stage. The doctor then adds a lowercase “r” before the new stage to show that it is different from that of the first diagnosis. However, this is not common.

Other staging systems

The TNM system is mainly used to describe cancers that form solid tumors, such as breast, colon, and lung cancers. However, doctors use other staging systems to classify other types of cancer, such as:

• Central nervous system tumors (brain tumors). Because cancerous brain tumors do not normally spread outside the brain and spinal cord, only the “T” description of the TNM system applies. Currently, no single staging system exists for central nervous system tumors.
• Childhood cancers. The AJCC does not include childhood cancers in its staging system. Doctors stage most childhood cancers separately according to other staging systems that are often specific to the type of cancer.
• Cancers of the blood. The TNM system does not describe leukemia, lymphoma, or multiple myeloma since they usually do not form solid tumors. Each blood cancer has a unique staging system.

Further Reading and Patient Care

The post Staging Cancer using TNM appeared first on Medika Life.

Why has your doctor requested this procedure?

Doctors use upper GI endoscopy to help diagnose and treat symptoms and conditions that affect the esophagus, stomach, and upper intestine or duodenum.

Upper GI endoscopy can help find the cause of unexplained symptoms, such as

• persistent heartburn
• bleeding
• nausea and vomiting
• pain
• problems swallowing
• unexplained weight loss

Upper GI endoscopy can be used to identify many different diseases:

• gastroesophageal reflux disease
• ulcers
• cancer
• inflammation, or swelling
• precancerous abnormalities such as Barrett’s esophagus
• celiac disease
• strictures or narrowing of the esophagus
• blockages

Upper GI endoscopy can check for damage after a person eats or drinks harmful chemicals.

During upper GI endoscopy, a doctor obtains biopsies by passing an instrument through the endoscope to obtain a small piece of tissue for testing. Biopsies are needed to diagnose conditions such as

• cancer
• celiac disease
• gastritis

Doctors also use upper GI endoscopy to

• treat conditions such as bleeding from ulcers, esophageal varices, or other conditions
• dilate or open up strictures with a small balloon passed through the endoscope
• remove objects, including food, that may be stuck in the upper GI tract
• remove polyps or other growths
• place feeding tubes or drainage tubes

Doctors are also starting to use upper GI endoscopy to perform weight loss procedures for some people with obesity.

What happens during the procedure?

A doctor performs an upper GI endoscopy in a hospital or an outpatient center. Before the procedure, you will likely get a sedative or a medicine to help you stay relaxed and comfortable during the procedure. The sedative will be given to you through an intravenous (IV) needle in your arm. In some cases, the procedure can be done without getting a sedative. You may also be given a liquid medicine to gargle or a spray to numb your throat and help prevent you from gagging during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible.

You’ll be asked to lie on your side on an exam table. The doctor will carefully pass the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope will send a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During the upper GI endoscopy, the doctor may

• take small samples of tissue, cells, or fluid in your upper GI tract for testing.
• stop any bleeding.
• perform other procedures, such as opening up strictures.

The procedure is quick and usually takes between 15 and 30 minutes. The endoscope does not interfere with your breathing, and many people fall asleep during the procedure.

What do you need to do?

You should talk with your doctor about your medical history, including medical conditions and symptoms you have, allergies, and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

• aspirin or medicines that contain aspirin
• arthritis medicines 
• blood thinners
• blood pressure medicines
• diabetes medicines
• nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen 

You can take most medicines as usual, but you may need to adjust or stop some medicines for a short time before your upper GI endoscopy. Your doctor will tell you about any necessary changes to your medicines before the procedure.

Arrange for a ride home

For safety reasons, you can’t drive for 24 hours after the procedure, as the sedatives used during the procedure need time to wear off. You will need to make plans for getting a ride home after the procedure.

Do not eat or drink before the procedure

To see your upper GI tract clearly, your doctor will most likely ask you not to eat or drink up to 8 hours before the procedure.

Are there risks to the procedure?

Upper GI endoscopy is considered a safe procedure. The risks of complications from an upper GI endoscopy are low, but may include

• bleeding from the site where the doctor took the tissue samples or removed a polyp
• perforation in the lining of your upper GI tract
• an abnormal reaction to the sedative, including breathing or heart problems

Bleeding caused by the procedure often is minor and stops without treatment. Serious complications such as perforation are uncommon. Your doctor may need to perform surgery to treat some complications. Your doctor can also treat an abnormal reaction to a sedative with medicines or IV fluids during or after the procedure.

• chest pain
• problems breathing
• problems swallowing or throat pain that gets worse
• vomiting—particularly if your vomit is bloody or looks like coffee grounds
• pain in your abdomen that gets worse
• bloody or black, tar-colored stool
• fever

The post Upper Gastrointestinal (GI) Endoscopy appeared first on Medika Life.

Your bile ducts are tubes that carry bile from your liver to your gallbladder and duodenum. Your pancreatic ducts are tubes that carry pancreatic juice from your pancreas to your duodenum. Small pancreatic ducts empty into the main pancreatic duct. Your common bile duct and main pancreatic duct join before emptying into your duodenum.

Why has your doctor requested this test?

Doctors use ERCP to treat problems of the bile and pancreatic ducts. Doctors also use ERCP to diagnose problems of the bile and pancreatic ducts if they expect to treat problems during the procedure. For diagnosis alone, doctors may use noninvasive tests—tests that do not physically enter the body—instead of ERCP.

Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of

• gallstones that form in your gallbladder and become stuck in your common bile duct
• infection
• acute pancreatitis
• chronic pancreatitis
• trauma or surgical complications in your bile or pancreatic ducts
• pancreatic pseudocysts 
• tumors or cancers of the bile ducts 
• tumors or cancers of the pancreas 

What happens during the procedure?

Doctors who have specialized training in ERCP perform this procedure at a hospital or an outpatient center. An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. A health care professional will give you a liquid anesthetic to gargle or will spray anesthetic on the back of your throat. The anesthetic numbs your throat and helps prevent gagging during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible. In some cases, you may receive general anesthesia.

You’ll be asked to lie on an examination table. The doctor will carefully feed the endoscope down your esophagus, through your stomach, and into your duodenum. A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During ERCP, the doctor

• locates the opening where the bile and pancreatic ducts empty into the duodenum
• slides a thin, flexible tube called a catheter through the endoscope and into the ducts
• injects a special dye, also called contrast medium, into the ducts through the catheter to make the ducts more visible on x-rays
• uses a type of x-ray imaging, called fluoroscopy, to examine the ducts and look for narrowed areas or blockages

The doctor may pass tiny tools through the endoscope to

• open blocked or narrowed ducts.
• break up or remove stones.
• perform a biopsy or remove tumors in the ducts.
• insert stents—tiny tubes that a doctor leaves in narrowed ducts to hold them open. A doctor may also insert temporary stents to stop bile leaks that can occur after gallbladder surgery.

The procedure usually takes between 1 and 2 hours.

What do you need to do?

You should talk with your doctor about any allergies and medical conditions you have and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

• arthritis medicines 
• aspirin or medicines that contain aspirin
• blood thinners 
• blood pressure medicines 
• diabetes medicines
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

Your doctor may ask you to temporarily stop taking medicines that affect blood clotting or interact with sedatives. You typically receive sedatives during ERCP to help you relax and stay comfortable.

Tell your doctor if you are, or may be, pregnant. If you are pregnant and need ERCP to treat a problem, the doctor performing the procedure may make changes to protect the fetus from x-rays. Research has found that ERCP is generally safe during pregnancy.

Arrange for a ride home

For safety reasons, you can’t drive for 24 hours after ERCP, as the sedatives or anesthesia used during the procedure needs time to wear off. You will need to make plans for getting a ride home after ERCP.

Don’t eat, drink, smoke, or chew gum

To see your upper GI tract clearly, you doctor will most likely ask you not to eat, drink, smoke, or chew gum during the 8 hours before ERCP.

The post Endoscopic Retrograde Cholangiopancreatography (ERCP) appeared first on Medika Life.