Medical equipment is still strewn around the house of Rick Lucas, 62, nearly two years after he came home from the hospital. He picks up a spirometer, a device that measures lung capacity, and takes a deep breath — though not as deep as he’d like.

Still, Lucas has come a long way for someone who spent more than three months on a ventilator because of covid-19.

“I’m almost normal now,” he said. “I was thrilled when I could walk to the mailbox. Now we’re walking all over town.”

Dozens of major medical centers have established specialized covid clinics around the country. A crowdsourced project counted more than 400. But there’s no standard protocol for treating long covid. And experts are casting a wide net for treatments, with few ready for formal clinical trials.

It’s not clear just how many people have suffered from symptoms of long covid. Estimates vary widely from study to study — often because the definition of long covid itself varies. But the more conservative estimates still count millions of people with this condition. For some, the lingering symptoms are worse than the initial bout of covid. Others, like Lucas, were on death’s door and experienced a roller-coaster recovery, much worse than expected, even after a long hospitalization.

Symptoms vary widely. Lucas had brain fog, fatigue, and depression. He’d start getting his energy back, then go try light yardwork and end up in the hospital with pneumonia.

It wasn’t clear which ailments stemmed from being on a ventilator so long and which signaled the mysterious condition called long covid.

“I was wanting to go to work four months after I got home,” Rick said over the laughter of his wife and primary caregiver, Cinde.

“I said, ‘You know what, just get up and go. You can’t drive. You can’t walk. But go in for an interview. Let’s see how that works,’” Cinde recalled.

Rick did start working earlier this year, taking short-term assignments in his old field as a nursing home administrator. But he’s still on partial disability.

Why has Rick mostly recovered while so many haven’t shaken the symptoms, even years later?

“There is absolutely nothing anywhere that’s clear about long covid,” said Dr. Steven Deeks, an infectious disease specialist at the University of California-San Francisco. “We have a guess at how frequently it happens. But right now, everyone’s in a data-free zone.”

Researchers like Deeks are trying to establish the condition’s underlying causes. Some of the theories include inflammation, autoimmunity, so-called microclots, and bits of the virus left in the body. Deeks said institutions need more money to create regional centers of excellence to bring together physicians from various specialties to treat patients and research therapies.

Patients say they are desperate and willing to try anything to feel normal again. And often they post personal anecdotes online.

“I’m following this stuff on social media, looking for a home run,” Deeks said.

The National Institutes of Health promises big advances soon through the RECOVER Initiative, involving thousands of patients and hundreds of researchers.

“Given the widespread and diverse impact the virus has on the human body, it is unlikely that there will be one cure, one treatment,” Dr. Gary Gibbons, director of the National Heart, Lung, and Blood Institute, told NPR. “It is important that we help find solutions for everyone. This is why there will be multiple clinical trials over the coming months.”

Meanwhile, tension is building in the medical community over what appears to be a grab-bag approach in treating long covid ahead of big clinical trials. Some clinicians hesitate to try therapies before they’re supported by research.

Dr. Kristin Englund, who oversees more than 2,000 long covid patients at the Cleveland Clinic, said a bunch of one-patient experiments could muddy the waters for research. She said she encouraged her team to stick with “evidence-based medicine.”

“I’d rather not be just kind of one-off trying things with people, because we really do need to get more data and evidence-based data,” she said. “We need to try to put things in some sort of a protocol moving forward.”

It’s not that she lacks urgency. Englund experienced her own long covid symptoms. She felt terrible for months after getting sick in 2020, “literally taking naps on the floor of my office in the afternoon,” she said.

More than anything, she said, these long covid clinics need to validate patients’ experiences with their illness and give them hope. She tries to stick with proven therapies.

For example, some patients with long covid develop POTS — a syndrome that causes them to get dizzy and their heart to race when they stand up. Englund knows how to treat those symptoms. With other patients, it’s not as straightforward. Her long covid clinic focuses on diet, sleep, meditation, and slowly increasing activity.

But other doctors are willing to throw all sorts of treatments at the wall to see what might stick.

At the Lucas house in Tennessee, the kitchen counter can barely contain the pill bottles of supplements and prescriptions. One is a drug for memory. “We discovered his memory was worse [after taking it],” Cinde said.

Other treatments, however, seemed to have helped. Cinde asked their doctor about her husband possibly taking testosterone to boost his energy, and, after doing research, the doctor agreed to give it a shot.

“People like myself are getting a little bit out over my skis, looking for things that I can try,” said Dr. Stephen Heyman, a pulmonologist who treats Rick Lucas at the long covid clinic at Ascension Saint Thomas in Nashville.

He’s trying medications seen as promising in treating addiction and combinations of drugs used for cholesterol and blood clots. And he has considered becoming a bit of a guinea pig himself.

Heyman has been up and down with his own long covid. At one point, he thought he was past the memory lapses and breathing trouble, then he caught the virus a second time and feels more fatigued than ever.

“I don’t think I can wait for somebody to tell me what I need to do,” he said. “I’m going to have to use my expertise to try and find out why I don’t feel well.”

This story is from a reporting partnership that includes WPLN, NPR, and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).

Jamaica's activities are being led by the Pan American Health Organization (PAHO), in conjunction with the Ministry of Industry, Investment and Commerce, Ministry of Agriculture and Fisheries, and the Ministry of Health and Wellness.

WAAW is a World Health Organization (WHO)-led global campaign that is celebrated annually to improve awareness and understanding of antimicrobial resistance and to encourage best practices among the public, as health stakeholders and policymakers all play a critical role in reducing the further emergence and spread of antimicrobial resistance (AMR).

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

According to the WHO, researchers estimated that AMR in bacteria caused an estimated 1.27 million deaths in 2019.

In an interview with JIS News, National PAHO Infection Prevention and Control (IPC)/AMR Consultant Dr Glendee Reynolds-Campbell explained that the main activity for WAAW will be a symposium which will be held under the WAAW theme. The event will take place on Thursday, November 24 beginning at 10:00 at the Regional Headquarters Building, The University of the West Indies.

The other activity for the week will be a webinar hosted by the Ministry of Agriculture and Fisheries, in collaboration with the Ministry of Industry, Investment and Commerce, on Wednesday, November 23.

Diabetes mellitus (DM) is a prevalent health issue in developing world. Lower urinary tract symptoms (LUTS), a hidden and enigmatic morbidity, are widespread in diabetic individuals. Patients with diabetes mellitus (DM) experience LUTS that has a complex pathogenesis. Importantly, LUTS is understood to lead to both mental and physical suffering.

Studies examining risk factors that might lead to LUTS or the prevalence of LUTS among DM patients have not been conducted in Palestine.

Therefore, given the frequency of LUTS and risk factors, the authors set out to investigate the LUTS problem among DM patients visiting primary health care facilities and to determine whether there may be a connection between LUTS and the quality of life of diabetics.

For this purpose, data from 378 diabetic individuals were gathered over a 6-month period, from May 2021 to October 2021, in primary healthcare facilities. Data were gathered using the Incontinence Impact Questionnaire-7 (IIQ-7), Urogenital Distress Inventory-6 (UDI-6), and demographic and clinical parameters. Included were all patients whose laboratory tests revealed they had DM. Patients having a confirmed diagnosis of a urogenital disorder, a background of urological surgery or recurring UTIs, or those suffering from a mental illness were disqualified. (29.9%) were in the age range of (58–67). Females made up 49%. A third of the cohort was obese, and 50% of the group was overweight. 81% had type 2 diabetes. Nearly all of them were receiving medical care. Both single-variate and multiple-variate analyses were conducted.

Key results of the study:

• The UDI-6 scale had a median score of 5.50 (2.00-8.00) and the IIQ-7 scale had a median score of 5 (0.00-10.00).
• Residency (p = 0.038) and regular exercise (p = 0.001) were substantially and negatively associated with the UDI-6 score, according to multiple linear regression models, whereas female gender (p = 0.042), insulin use (p = 0.009), and the presence of comorbidities (p = 0.007) were strongly and positively linked with this score.
• Age and body mass index (BMI) were considerably and favorably correlated with the IIQ-7 score (p = 0.040 and p< 0.001, respectively).

"LUTS is linked to high BMI and inactivity, regardless of the presence or absence of DM. It is also obvious that losing weight and exercising regularly help treat urine incontinence and alleviate LUTS in females. As a result, weight loss and more physical activity not only aid the patient's DM control and prevent serious complications, but also aid the patient's LUTS," asserted Faris Abushamma, Department of Medicine and team.

The findings support the notion that LUTS directly impairs diabetic patients' quality of life. The need for interventions to be implemented at all healthcare levels to identify such issues at an early stage in order to prevent physical and emotional tiredness among DM patients is compellingly demonstrated by this novel concept in Palestine.

REFERENCE

Qasrawi, H., Tabouni, M., Almansour, S.W. et al. An evaluation of lower urinary tract symptoms in diabetic patients: a cross-sectional study. BMC Urol 22, 178 (2022). https://doi.org/10.1186/s12894-022-01133-1 

New Delhi : Through a recent notice, the Medical Counselling Committee (MCC) has released the reporting schedule for mop up round of NEET PG counselling.

Medical counselling committee had published provisional result of Mop Up Round NEET-PG 2022 Counselling on 19.11.2022 on MCC website, following which final Result is published on MCC website.

To view the final result, click here-- https://mcc.nic.in/WebinfoMedical/File/ViewFile?FileId=4761&LangId=P

All the allotted candidates are advised to strictly adhere the counselling schedule as mentioned below:

Allotment Letter for Mop Up Round is now available for Download and Reporting will start as per Notice.

Mop Up Round

Result

Reporting

19th November, 2022

20th November, 2022 to 24th November,

2022

(1-Day)

 (05-Days)

All candidates shall ensure that admission process by allotted college should be made through online reporting portal of intraMCC. Any admission take through offline mode will be treated null & void.

To view the official Notice,Click here :  https://medicaldialogues.in/pdf_upload/notice-for-reporting-of-mop-up-round-pg-counsellin-191557.pdf

MCC is conducting the counselling for the following Institutions/Universities:-

a) 50% All India Quota seats of all states including Union Territory of Jammu & Kashmir, this year onwards. (UT of J&K will also contribute their 50% broad speciality Medical/ Dental seats for the All India Quota counselling conducted by MCC of DGHS).b) 100% seats (All India Quota seats + Institutional Quota seats) of Central Universities (Aligarh Muslim University/ Banaras Hindu University/ University of Delhi/ Central Institutes as per eligibility conditions mentioned in Important Questions related to Scheme of Counselling duly uploaded on MCC website.c) 100% seats of Deemed Universities.d) 50% AIQ P.G seats of colleges under Employee State Insurance Corporation (wards of ESIC insured persons).e) All P.G seats of Armed Forces Medical Services Institutions(only Registration part).f) Central Institutes, VMMC & Safdarjung Hospital, ABVIMS & RML Hospital and ESIC Institute, PGIMSR, Basaidarapur(50% All India Quota seats and 50% seats of I.P University).

Building upon the Caribbean’s innovative and successful partnership between tourism and health, the Caribbean Public Health Agency (CARPHA) has launched the first CARICOM (Caribbean Community)-approved health safety and environmental sanitation (HSE) hospitality standards to improve health, safety, and environmental quality in the regional hospitality sector, funded by the Inter-American Development Bank (IDB).

The standards – which include Food Safety and Sanitation; Energy Management; Water Treatment and Management; Sewage Treatment and Management; Solid Waste Management; Integrated Pest Management; and Environmental Management Systems – were unveiled by CARPHA at the Magdalena Grand Beach and Golf Resort in Tobago on Monday, November 14, with the support of senior officials of the Tobago government, the Caribbean Tourism Organization (CTO), and the Caribbean Hotel and Tourism Association (CHTA).

Dr Joy St John, CARPHA’s Executive Director, who earlier this year signed an agreement with the CARICOM Regional Organisation for Standards and Quality (CROSQ) to further develop the standards, said these seven regional clean and green standards are a key component for providing assurance to travelers about company commitment to health and safety and towards avoiding or mitigating health threats to the Caribbean tourism product.

Each of the standards is equipped with an assessment checklist to easily guide the industry through a process of recognizing and achieving the standards. Upon completion, after verification by CARPHA, the company will be eligible to receive CARPHA’s Tourism Health Program (THP) Healthier, Safer Tourism Award.

“There is now a verifiable way of having the suite of standards act as a crucial tool for establishing the quality of Caribbean tourism,” Dr St John stated.

Health and tourism professionals throughout the Caribbean have placed a high priority on the well-being and health and safety of the industry’s employees and travelers. Through the intervention of a unique partnership with CTO and CHTA, established by CARPHA in 2014, the Caribbean was well positioned to respond strategically during the pandemic and now during its recovery.

In 2020 and 2021, CARPHA also trained 7,000 hospitality professionals in preventing and controlling COVID-19 in the tourism sector. This contributed to the Caribbean tourism product’s ability to rebound quickly after the end of the “lockdown” phase of the pandemic.

The standards are currently voluntary and certified properties that meet all seven standards will be eligible for a platinum distinction.

Dr Lisa Indar, CARPHA’s Director of the Surveillance Disease Prevention and Control Division – who recently facilitated THP stakeholder training in preparation for the Tobago carnival last month – was congratulated by senior officials for her leadership and commitment to the process of standards development since 2018.

Dr Faith B Yisrael, Deputy Chief Secretary and Secretary for Health, Wellness and Social Protection, Division of Health, Wellness and Social Protection, Tobago House of Assembly, congratulated CARPHA and its partners for developing the standards. She encouraged tourism stakeholders to utilize them and not leave them on shelves gathering dust: “If we pull together and if we actually follow these robust standards … we would all really truly survive whatever is to come next.”

Councillor Tashia Burris, Secretary for Tourism, Culture, Antiquities and Transportation, Division of Tourism, Culture, Antiquities and Transportation, Tobago House of Assembly, said the COVID-19 pandemic has shown that having robust policies, standards and regulations can help save lives and livelihoods.

Neil Walters, Acting CTO Secretary General, believes the standards are another incremental step towards ensuring the future of the region’s tourism sector: “I believe we are laying the foundation for a more sustainable, world-class, regional tourism sector as this very important sector moves forward in its recovery.”

Frank Comito, Special Advisor to CHTA, which has supported the health and safety awards program from its inception, noted that the standards can uplift the tourism industry’s continued commitment to the health and safety of its employees and visitors, “which can help us to deliver our promise to the world and there is no better place for mental, physical and spiritual well-being than in the Caribbean.” (PR)

The post CARPHA introduces new CARICOM-approved hospitality industry standards for the region appeared first on Barbados Today.

History has illustrated that since the 1970s rotaviral gastroenteritis has been a leading cause of diarrhoeal illnesses amongst young children globally — and in fact in the year 2003 Jamaica experienced 12 deaths of young children attributable to diarrhoea, with eight of the deaths occurring amongst children under three years old. Analysis of samples confirmed that most of the illnesses were linked to rotavirus.

As the name suggests, this type of gastroenteritis is caused by the rotavirus and results in the hospitalisation of approximately 55,000 children each year in the United States and the death of over 600,000 children worldwide. Like most other infectious illnesses, the cases reported are estimated to be a mere 10 per cent of the actual number of the illnesses that exist. Jamaica and other countries that experience similar temperatures and climate often see an increase in the illness during the cooler months of the year, and like many other viruses the rotavirus fares well in the environment and will cause an infection once it enters the body of an individual.

Common signs and symptoms of rotaviral gastroenteritis

The rotavirus causes inflammation of the stomach and intestines; hence most patients will experience diarrhoea, fever, and vomiting. Severe dehydration is also likely to occur in those who are within the susceptible population such as young children, especially those under five years old.

Causes and risk factors

There are five main strains of rotavirus that are responsible for over 90 per cent of rotavirus infections in humans. Importantly, the illness is transmitted via the faecal-oral route, hence the reason most cases occur amongst young children, especially those of day-care age. Globally, outbreaks of this illness have also occurred in the adult population, especially amongst those who are immunocompromised and exist in settings where there are poor hand hygiene and sanitation practices. Secondary transmission or person-to-person spread has always been a major route through which the illness is spread. Close contact of ill individuals therefore stands as a major factor in the contraction and spread of the illness.

In early childhood settings, such as day-care centres, common sources of infection that lead to the spread of this illness are toys and other inanimate objects that are shared. Generally, touching a surface that has been contaminated with the rotavirus and touching the mouth area can result in the infection.

Methods of prevention and control

In order to break the transmission of the illness and curtail its spread, the source of the infection must be targeted. A rotaviral vaccine is available, and when administered to children the chances of a child contracting the illness are greatly reduced. However, other measures of prevention and control are necessary.

Due to the fact that the virus can live for several hours on the hands, and for longer on hard surfaces, proper and frequent hand washing and adhering to good sanitation practices should be exercised as these strategies can reduce the spread of the illnesses by more than fifty per cent.

Hand hygiene policies should therefore be promoted and adhered to in public spaces, especially where populations of young children and other susceptible groups exist. Before eating and after using the restrooms are important intervals to which attention must be paid in relation to the washing of hands with soap (antibacterial liquid soap) and water. People who would have come in contact with ill individuals and their caregivers are encouraged to wash the hands as often as necessary; inclusive of times such as after the changing and handling of soiled diapers.

In early childhood settings, dwellings, and other areas where the susceptible population exist, proper cleaning and disinfection of surfaces such as handrails, sleeping mattress, eating utensils and toys are recommended. When disinfection is being carried out in these areas the following solutions have proven useful in deactivating the virus on surfaces:

• Chlorine bleach solution — half cup of regular household bleach in three quarters of a gallon of water, or the use of a 10 per cent iodine solution. One should take into consideration that whichever solution is used, it should be left on the surface for at least 10 minutes

• 70 per cent isopropyl alcohol left on the surface for 30 seconds

• Feeding bottles, eating utensils and toys should be washed and then sanitised in a solution made from two teaspoons of regular household bleach to one gallon of water. The items should be soaked in the bleach solution for at least two minutes then be allowed to air dry.

Other methods of prevention

• Use only safely treated water for drinking, preparing foods, and other purposes such as hand washing.

• Properly wash and sanitise raw fruits and vegetables before consumption.

• Minimise contact with ill people until at least two days have passed after the last episode of diarrhoea and vomiting.

• After each episode of diarrhoea or vomiting, clean toilet bowls and pipe taps thoroughly with disinfecting solutions.

• Do not share the toys, towels and eating utensils of those who have the infection with other members of the household.

• Ill people should not enter a swimming pool for the first two weeks after their last episode of diarrhoea.

Treatment

Rotaviral gastroenteritis can be severe and should be treated with great keenness and proficiency. Sick individuals should:

• Seek medical attention early.

• Consume enough fluids to prevent dehydration.

• Use a recommended electrolyte replacement such as Pedialyte.

• Take fever-reducing medication such as acetaminophen. (This should be done according to guidelines given by a medical professional; aspirin is not recommended).

• Follow up with a health-care provider as necessary.

• Eat smaller and more frequently instead of consuming larger meals.

The benefits of prevention

It might seem difficult to always quantify the financial cost associated with the outbreak of this illness, nevertheless, the current outbreak in Jamaica as well the global mortality and morbidity rates associated with this disease concretise the fact that there are benefits to be derived if attention is paid towards efforts and strategies that can prevent this illness, and ultimately protect the vulnerable population.

Vaccination has undoubtedly proven to be the most effective method of preventing the rotaviral infection amongst young children. However, because children are not the only ones affected by this illness the benefits of hand washing coupled with environmental sanitation must be embraced and promoted, not just in the times of an outbreak but instead in a proactive way. More stringent policies that support and mandate adequate installation and proper use of hand washing facilities in educational institutions and in other places where the vulnerable populations exist, and specially designed training in hygiene and sanitation geared towards educating stakeholders such as caregivers will serve well in reducing future incidence of rotaviral or other infections of a similar nature in Jamaica.

Karlene Atkinson is a public health specialist and lecturer at the School of Public Health, University of Technology Jamaica. She can be contacted by email:karleneatkinson77@gmail.com

Yoga
has been tried and tested for many generations and is a beneficial practice that has stood the test of time. I highly recommend it. There is something for everyone. When you're not sure about what your body can manage, you can check in with your family doctor.

I had been going to Afya, a yoga studio, on and off — "mostly off", as Sonita reminded me. To be fair, I hadn't been in Jamaica half the time. Fast forward to now, and Afya's new location places them literally five minutes from my clinical practice at 11 Cunningham Avenue. So, I can stop using traffic and 'a little off my path' as excuses. And if I had excuses about the schedule, well, now there are so many options during weekdays and weekends, both in studio and online.

Dropping in on their new 'lunchtime' classes on Tuesdays and Wednesdays at 12 noon is really refreshing, and helps me feel relaxed, recentred and re-energised, a feeling that takes me through the rest of the week. One Thursday afternoon, I had opted to join the 6:00 pm class with Tina doing kundalini (con-da-leeny) yoga. I had arrived at the studio very early, and had time for a light vegetarian meal and beet juice from a vegetarian store at nearby Seymour Park, and nearly two hours to digest it while I read a book ahead of the session. An interesting thing happened.

Kundalini

I had had an early start to the day (to beat traffic), and it had become a little intense with writing reports and doing updates with the team at work. Sonita, Tina and I engaged in a little chitchat just prior to the session, discussing the various types of yoga — from ashtanga to kundalini to yin and restorative forms, as well as vinyasa flow. I was not familiar with kundalini prior to then, but it quickly became clear that breathing technique was a very important aspect of it. Initially, we spent time breathing through one nostril at a time, while keeping the other one closed with the thumb, and alternating. A quarter way into my hour-long session, I started to feel a burst of energy. Except that it was not quite the right time for my creative juices to be kicking in, with my thinking of articles to write and how I was going to get creative in the kitchen when I got home. Even new work projects popped into my head. I realised I was drifting, and with the help of the calming voice of my instructor, Tina, I brought my attention back to my breathing, listening to and feeling the long breaths enter and leave my body. The power of this kind of deep breathing is why I have recommended yoga and deep breathing exercises to my patients, from those with anxiety to those with lost lung function from long COVID. The lungs are stretchy, but with our usual day-to-day breathing, we don't really use up all that capacity, and deep breathing helps us to deliver more air to our lungs and therefore more oxygen to our blood stream that then gets to the cells or building blocks of our bodies. Oxygen is important for releasing energy and making that energy available to our bodies.

Easy breezy

One of my favourite things about going to Afya for yoga is the smartphone application or app called Momoyoga. I created an account with my e-mail address and can see all the sessions, the types of yoga, and the respective instructors available. I can select a single session or a batch of sessions with a discounted rate, which I can pay at the studio or by online bank transfer. I get a confirmation e-mail when I book, and I can use the Momoyoga app to track how many sessions I have left from the package I purchased.

Dr Yohann White is director and workplace wellness consultant at Para Caribe Consulting. He can be reached at
yohann.white@caribewellness.com
or @ParaCaribeJa on social media.

The United States Agency for International Development (USAID) supported the […]

PAHO develops roadmap to curb spread of meningitis in the Americas by 2030

Cristina Mitchell

18 Nov 2022