Heart disease patients need to be extra vigilant during the coronavirus pandemic
This is because they are at increased risk of serious complications
There are, however, precautions they can take to keep themselves healthy and safe
The coronavirus pandemic and flu season pose a double risk for heart disease patients, so they need to be extra vigilant about their health, the American College of Cardiology (ACC) says.
“Heart disease patients bear a greater burden during the pandemic since they are having to navigate managing their heart health while also protecting themselves from Covid-19, as they are at increased risk of serious complications,” ACC President Dr Athena Poppas said.
Simple, easy-to-follow steps
“The ACC has worked with experts around the world to assess best treatment practices, and the consensus on how to protect heart disease patients comes down to several simple, easy-to-follow steps,” Poppas explained in an ACC news release:
Wear a mask, keep a safe distance from others and wash your hands.
Get a flu shot. Contact your health care provider or pharmacy today.
Keep your health care appointments and call if you notice something new or worse with your health. If you think that you may be having a heart attack or stroke, dial 911 immediately.
Keep a supply of your medicines handy. Let your care team know if you need help with your medications.
Stay active and stay calm. Regular exercise can help keep your heart healthy and manage stress.
“We hope that the near future will bring progress against Covid-19, but right now, these actions go a long way in keeping heart disease patients healthy and safe,” Poppas said.
A large data analysis shows how certain underlying health conditions can increase the Covid-19 death risk for infected patients
The research was done by a team from Penn State University
Individuals with these conditions should be prioritised for vaccination, once it becomes available
Underlying medical conditions have been known to put individuals at risk of severe Covid-19 illness and death, but there are certain medical conditions that can particularly put patients at an increased risk of death, researchers from Penn State College of Medicine have found.
According to their international study, cardiovascular disease, hypertension, diabetes, congestive heart failure, chronic kidney disease, strokes and cancer can increase a patient’s risk of dying from Covid-19, the disease caused by SARS-CoV-2.
The research team conducted a systematic review and meta-analysis of 25 international studies and analysed data from more than 65 000 patients.
“We took an all-inclusive, global approach for this study by examining 11 chronic conditions and including patients from four continents: Asia, Europe, North America and Africa,” Dr Paddy Ssentongo, a doctoral student in epidemiology at the College of Medicine and study co-author, said in a news release by Penn State University.
The studies were published between December 2019 and July 2020, and revealed which chronic conditions put hospitalised patients at risk of Covid-19 mortality.
Patients in these studies were on average 61 years old, the researchers wrote.
The following co-existing conditions that may pose a risk of severe Covid-19 disease and death among patients were explored: cardiovascular disease, diabetes, hypertension (high blood pressure), cancer, chronic kidney disease, chronic obstructive pulmonary disease, stroke, congestive heart failure, asthma, chronic liver disease, and HIV/Aids.
What they found
The researchers compared the data of hospitalised Covid-19 patients with pre-existing conditions to those without pre-existing conditions, and found the following:
Chronic kidney disease may triple the Covid-19 mortality risk in patients;
Cardiovascular disease, hypertension, and congestive heart failure may double a patient’s risk of dying from Covid-19;
Patients with diabetes and cancer are 1.5 times more likely to die from Covid-19.
Ssentongo also emphasised the need to be aware that, based on their findings, chronic conditions are not simply just common in patients with Covid-19, but that “their presence is a warning sign for a higher risk of death”.
“There is a high prevalence of cardiovascular disease and hypertension around the world and, in particular, the US. With the persistence of Covid-19 in the US, this connection becomes crucially important,” Ssentongo added.
From a local perspective, a 2017 study by Wits University revealed that South Africa has the highest prevalence of hypertension in southern Africa, as well as the highest number of people whose blood pressure remains uncontrolled, even while on treatment.
The Heart and Stroke Foundation also indicates that around one in 10 South Africans live with diabetes, but that roughly one in two of these individuals is unaware of having the condition as they haven’t been diagnosed.
Vaccination importance, once available
Ssentongo explained that, based on research, the Covid-19 virus may become seasonal and require annual vaccinations.
Once an approved and effective vaccine is available, high-risk individuals with these pre-existing conditions should receive vaccination priority to prevent high mortality rates.
According to the World Health Organisation (WHO), there are currently over 100 Covid-19 vaccine candidates under development. The organisation’s director-general, Tedros Adhanom Ghebreyesus, recently stated that a vaccine may be ready by year-end, News24 reported.
High-risk individuals: how to reduce your risk of infection
The risk of severe Covid-19 illness and death has been shown to increase steadily with age, irrespective of whether an individual has an underlying medical condition, although, as this recent study has shown, pre-existing conditions do increase one’s risk of severe illness and death.
If you are at higher risk, the Centers for Disease Control and Prevention (CDC) recommends taking the following measures:
Take everyday precautions to maintain physical distancing between yourself and others;
When you’re out in public, wash your hands as often as possible;
Limit close contact with people who are sick;
Avoid crowds;
Avoid non-essential air travel and cruise travel;
If you are experiencing a Covid-19 outbreak in your community, stay home as much as possible in order to reduce your risk of being exposed to the virus.
Although children tend to be more resilient to Covid-19, some children have developed a hyperinflammatory condition called multisystem inflammatory syndrome (MIS-C). This disease is dangerous and can even lead to death.
On 2 October 2020, the Centers for Disease Control and Prevention released a new report which suggests that a type of multisystem inflammatory syndrome can also affect some adults. This version is referred to as MIS-A.
According to the report, MIS-A is a severe illness that targets multiple organs and causes increased inflammation in the body.
As with children, the adults who presented with MIS-A either test positive for SARS-CoV-2, or they have antibodies, which means that they have been infected with the virus in the past.
The CDC received reports of at least 935 cases of children with MIS-C, including 19 fatalities – including teens and young adults.
Recently, a similar syndrome has been observed in adults, and the CDC refers to 27 cases from the United States and the United Kingdom.
A life support technique called ECMO has saved the lives of many critically ill Covid-19 patients, a new study shows.
The ECMO (extracorporeal membrane oxygenation) machine takes over the function of the lungs and heart. Blood is pumped from the body into equipment that adds oxygen to the blood before it’s returned to the body.
This technique has saved lives in previous epidemics of lung-damaging viruses, but small studies published early in the coronavirus pandemic questioned its effectiveness.
This international study included 1 035 Covid-19 patients at high risk of death because ventilators and other types of care couldn’t support their lungs.
After being placed on ECMO, the death rate among these patients was less than 40%, according to the study authors.
“These results from hospitals experienced in providing ECMO are similar to past reports of ECMO-supported patients, with other forms of acute respiratory distress syndrome or viral pneumonia,” said co-author Dr Ryan Barbaro, of the University of Michigan.
Zanele Ngcoko, also known as “Chef Zan” in Gugulethu, Cape Town, was diagnosed with Covid-19 in May after she had trouble breathing.
“I’d take five steps but it would feel like I’d taken like one hundred steps to get to the bathroom,” she told News24.
At the hospital, x-rays of her chest revealed that she had pneumonia in her lungs and she was sent to the Groote Schuur Hospital for a Covid-19 test.
“It felt like I was literally dying in that moment, you know, when they tell you because there are so many family friends that have passed on due to Covid,” she said.
She spent nine days recovering at an isolation facility set up at the Lagoon Beach Hotel and when she returned home, her employer, told her she would be retrenched. Ngcoko worked as a chef at a catering company.
She said she expected the news and because of this, came up with a back-up plan.
Boris Johnson’s scientific advisers want him to introduce “drastic” new lockdown measures after the number of coronavirus cases and hospitalizations surged in the UK.
“We are starting to get to a point where we really will have to take really critical action,” Professor John Edmunds, a member of the government’s scientific advisory group said on Tuesday.
“These local restrictions that have been put in place in much of the north of England really haven’t been very effective,” Edmunds told the BBC’s Newsnight programme.
“We need to take much more stringent measures, not just in the north of England, we need to do it countrywide, and bring the epidemic back under control.”
Edmunds said that the government should introduce further national restrictions to replace the patchwork of local measures currently in place across the UK.
the most stringent measures, including a ban on household mixing indoors, have been enforced across much of northern England where the rate of infection is highest. But they do not appear to have worked, with new daily cases in cities including Manchester, Liverpool, and Newcastle soaring in the past seven days.
The coronavirus outbreak at the White House is the worst to hit any major seat of government, an analysis by Business Insider has found.
The US is not alone in having the core of its central government stricken by Covid-19, nor is it the only country to have its national leader test positive.
But the number of senior US officials, along with their high level of seniority, makes the outbreak among the Trump Administration the worst so far.
Politico has counted 34 people who tested positive since President Donald Trump announced he had Covid-19 on October 1.
Many were guests at Amy Coney Barrett’s Supreme Court nomination ceremony, at which social distancing was not observed and almost nobody wore masks. The event is now being scrutinized as a possible “super-spreader” event, as Business Insider’s Aylin Woodward and Susie Neilson reported.
Among them are 16 senior figures in the Trump administration. They include First Lady Melania Trump, Press Secretary Kayleigh McEnany, Senior Adviser Steven Miller, and former Governor Chris Christie. And, of course, there is the president himself.
HEALTH TIPS (as recommended by the NICD and WHO)
• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing
• Practise frequent hand-washing, especially after direct contact with ill people or their environment
• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus
• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.
Diabetes has been reported to be a risk factor for severe Covid-19, the disease caused by SARS-CoV-2. This is because high blood sugar levels can weaken the immune system, making it harder for diabetic people to fight off infections such as Covid-19.
During a Covid-19 special session at the online Annual Meeting of the European Association for the Study of Diabetes (EASD), a new review of the evidence on the devastating impact of Covid-19 on people who have diabetes was presented by Professor Juliana Chan from the Chinese University of Hong Kong and Prince of Wales Hospital, Sha Tin, Hong Kong, China, according to EurekAlert.
“Major risk factors for mortality include advanced age and chronic conditions, notably obesity, diabetes, hypertension, heart and kidney disease as well as social deprivation, minority ethnic groups and those with poor access to care,” said Chan, explaining that these common coexisting conditions highlight the complexity of Covid-19.
A recent report (from The Lancet Diabetes & Endocrinology), based on a UK population-based survey of more than 60 million people registered with the primary care system, showed that 0.4% had type 1 diabetes, and 4.6% had type 2 diabetes.
However, the report further highlighted that among the more than 24 000 Covid-19-related deaths, 30% occurred in diabetics.
After the researchers of the paper adjusted for several risk factors, including social deprivation, ethnicity and other chronic conditions, they found that people who had type 1 diabetes had an almost threefold (2.86) risk of death. In those who had type 2 diabetes, they found an almost two times (1.8) higher risk of death due to Covid-19, compared to those who did not have diabetes.
Chan also explained that the search term “Covid-19 and diabetes” yielded more than 1 800 publications in PubMed, a free full-text archive of biomedical and life sciences journal literature at the US National Institutes of Health’s National Library of Medicine.
When Covid-19 started to spread, experts were not sure about the outcomes for pregnant women and infants.
A previous study discussed on Health24 advised that mothers who contracted Covid-19 should continue to breastfeed their infants as the benefits of breastfeeding outweigh the risk of Covid-19.
Now, a new study from researchers at the University of California, San Francisco, suggests that even when babies are born to mothers infected with SARS-Cov-2, they do well in the six to eight weeks after birth, and that there are few adverse effects. This was the case even though there were more neonatal intensive care unit (NICU) admissions of mothers who had Covid-19 up to two weeks before delivery.
The study, a pre-publication accepted by Clinical Infectious Diseases, investigated 263 infants and found that adverse outcomes, whether they were preterm birth, NICU admission or prevalence of respiratory disease, did not differ between those born to mothers with the virus and those who tested negative.
In this research, 179 of the mothers tested positive for SARS-CoV-2 and 83 tested negative.
Out of the 263 infants, 44 were admitted to NICU, but not for pneumonia or lower respiratory infection.
South Africa has a high level of environmental burden of disease, with 16% of all deaths estimated to be related to the state of the environment, Health Minister Zweli Mkhize said on Tuesday, referring to a 2006 World Health Organisation (WHO) report.
“It is actually all linked, a healthier environment gives you a healthier population and everything has to be done to make sure that we keep improving the quality of our natural environment.
“The science of environmental health is based on the premise that the prevention is better than [the] cure as this profession is concerned, with the key environmental factors that are at the heart of the public health dynamics,” he explained during a webinar commemorating World Environmental Health Day.
During the virtual conference, Mkhize noted that the “fight for health for all will be won or lost in the public health space, therefore it is critical that as we pause to shine a spotlight on environmental health”.
He added: “The international federation for environmental health recognises the continuing threats of environmental risk factors to human health and the urgent need to adopt a preventative approach in improving the quality of the natural environment and reducing environmental disease impact on the earth, on the health of the population.”
President Cyril Ramaphosa said Africa needs financing of $100 billion for “fiscal space and liquidity” for the continent’s governments amid the economic fallout of the Covid-19 pandemic, which has been described as the worst shock to the global economy since World War II.
Ramaphosa addressed the UN’s high-level meeting on financing the 2030 Agenda for Sustainable Development in the era of Covid-19 and beyond on Tuesday via a video message.
UN Secretary-General António Guterres described breaching the millionth Covid-19 death as a “tragic milestone”.
“The economic and social consequences are as bad as we feared, and in some cases, worse. We are suffering the largest economic contraction since the Second World War,” he said.
“Unless we take action now, we face a global recession that could wipe out decades of development and put the 2030 Agenda for Sustainable Development completely out of reach.”
He said: “The economic and social consequences are as bad as we feared, and in some cases, worse. We are suffering the largest economic contraction since the Second World War.”
Up to 100 million additional doses of any eventual Covid-19 vaccines will be secured for delivery to poorer countries in 2021, health groups announced on Tuesday, as the virus showed no sign of receding after claiming more than one million lives around the world.
The announcement doubles the number of doses already secured from the Serum Institute of India by the Gavi vaccine alliance and the Bill & Melinda Gates Foundation, following an initial agreement in August.
The public-private health partnership stressed that the eventual total is “potentially several times” greater, and said the price would be capped at $3 per dose.
“No country, rich or poor, should be left at the back of the queue when it comes to Covid-19 vaccines; this collaboration brings us another step closer to achieving this goal,” Gavi chief Seth Berkley said in a statement.
As nine vaccine candidates are in last-stage trials, the World Health Organization is stepping up efforts to provide faster and cheaper testing to poorer countries.
The WHO said on Monday that around 120 million rapid tests for Covid-19 will be made available to low- and middle-income countries at $5 each under a $600 million scheme – as long as funding can be secured.
In April, children represented just 2.2% of coronavirus cases in the US. By mid-September, that proportion had risen “dramatically” to reach 10%, according to data released today by the American Academy of Paediatrics and the Children’s Hospital Association.
It’s unlikely the rise is due to increased testing since CDC data shows children have consistently made up 5% to 7% of all tests administered since April, the organisations report.
While 10% is still lower than the percentage of children in the population (about 20%), and children with Covid-19 tend to fare better than adults, AAP President Dr. Sally Goza said in a press release “the rising numbers concern us greatly, as the children’s cases reflect the increasing virus spread in our communities”.
For the study, which will be published in the December issue of Paediatrics but was pre-published online today, researchers looked at five months of reported Covid-19 cases using data from U.S. public health department websites.
In addition to finding that the cumulative total paediatric Covid-19 cases has grown from 2.2% to 10% since the beginning of the pandemic, they found the percentage has been rising on a week-to-week basis.
For instance, less than 3% of cases reported the week ending April 23 were paediatric, but in the eight weeks prior to September 10, that percentage ranged from 12%to 15.9% per week.
HEALTH TIPS (as recommended by the NICD and WHO)
• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing
• Practise frequent hand-washing, especially after direct contact with ill people or their environment
• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus
• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.
As masks are becoming mandatory all over the world, authorities have asked people to use homemade cloth masks instead of single-use surgical and N95 masks that are needed by medical staff.
Face coverings from all materials and shapes are being used. And while all face coverings offer a measure of protection against large and small respiratory droplets, a team of researchers from the University of Cincinnati wanted to examine the efficacy of different household fabrics.
The study, which was recently published in the journal PLOS ONE, wanted to determine what practices would be most effective in practice. The researchers examined cotton, polyester and silk by their resistance to the penetration of small and aerosolised water drops.
They also investigated the breathability of the fabrics, and how they would fare if they were washed repeatedly. In the laboratory, they used the materials as an overlaying barrier for respirators, as well as face coverings. The team then looked at the penetration and absorption of droplets – and observed that silk faired the best, both as a barrier and in terms of breathability.
“Cotton traps moisture like a sponge. But silk is breathable. It’s thinner than cotton and dries really fast,” said Patrick Guerra, an assistant professor of biology at UC’s College of Arts and Sciences.
It’s not only the fact that silk is dense and breathable that made the researchers take note.
Silk contains elements of copper from silk moths, which could contribute to fighting bacteria and viruses. Studies have shown that copper can kill bacteria and has antiviral properties.
Death and disease have been one of the hallmarks of 2020, and Covid-19’s global impact will be felt for years, maybe even decades to come.
In one of the many ways it has changed our lives, it might also have shifted the trajectory of human life expectancy around the world according to research published in PLOS ONE.
In real life, as of 22 September 2020, there have almost been one million global deaths in total as a result of Covid-19, with the US in the lead followed by Brazil, India, Mexico and the UK.
South Africa has had almost 16 000 deaths, although global totals are expected to be higher due to limited testing and reporting, unknown factors surrounding asymptomatic spread, and the fact that countries have different methods and criteria for counting Covid-19 deaths.
“Previous epidemics such as the 1918 influenza pandemic and the 2014 Ebola virus outbreak resulted in a drop in life expectancy at birth of as many as 11.8 years and 1.6–5.6 years in the USA and Liberia, respectively,” explain the researchers.
“In severely affected countries, an unprecedented surge in mortality from Covid-19 may result in significant years of life lost.” This is especially true when you think of the number of other life-threatening diseases that have taken a backseat in the pandemic, and might contribute to the decline in life expectancy.
Unfortunately, figuring out by how much the current pandemic will shorten our lives isn’t easy. While it disproportionately affects older sections of the population, people of all ages are affected.
Health Minister Zweli Mkhize has effectively disbanded government’s chief scientific advisory committee on Covid-19.
News24 has seen a letter sent to members of the Ministerial Advisory Committee on Covid-19 on Friday, dated 21 September, in which Mkhize expressed his “gratitude and appreciation” for the commitment and dedication of members.
“Your contribution has led to the containment of Covid-19 pandemic in South Africa and the reduction of mortality of the citizens of South Africa. The new members of the MAC will assume duty soon,” the letter reads.
The committee is chaired by Professor Salim Abdool Karim and was established early during the outbreak of Covid-19 in April to advise Mkhize.
Karim’s status as chairperson is unclear.
While it appears the entire 50-member MAC has been affected, at the time of writing News24 had confirmed that 14 members of the MAC had received letters, including South Africa’s Covid-19 vaccine trial leading researcher Professor Shabir Madhi, and CEO of the South African Medical Research Council Professor Glenda Gray.
The Gauteng provincial command council has noted a decline in new Covid-19 infections, but warned that the risk of transmitting the virus is still high as restrictions have been eased.
The country moved to Level 1 lockdown from Sunday at midnight.
“There has been a gradual but steady decline in [the] number of new infections and hospitalisations.
“Government and social partners continue to work hard to improve the capacity of the health care system to cope with the demand for hospital care now and post Covid-19,” the command council said in an update on Friday.
Despite this progress, residents of South Africa’s economic hub were reminded that the fight against the virus is far from over and the risk of transmission following the easing of restrictions still remains high.
The command council said: “There is still no vaccine, the only way we can contain the spread of Covid-19 is through non-pharmaceutical interventions. We all have to play our part to protect ourselves and those around us.”
France and the UK recorded their highest daily Covid-19 cases since the global outbreak began, and the EU warned that some of its countries now have worse outbreaks than they had in March.
Stella Kyriakides, the EU’s health commissioner Stella Kyriakides warned on Thursday that in “some member states, the situation is now even worse than during the peak in March.”
Taken together, the developments point to the feared second wave of the pandemic having arrived in Europe.
There are differences from the first wave in spring. While infections have increased, the number of deaths has not risen so sharply.
Also, the ability of officials to test and keep track of the number of infections has increased, meaning that the daily figures are now a better reflection of how the virus is spreading.
In the first wave, testing systems were only able to capture a small portion of those infected.
British grocery chains Tesco and Morrisons have started rationing essential items over fears that stricter lockdown measures will send shoppers into a panic.
Supermarkets limited sales of certain goods earlier in the pandemic, and Morrisons became the first major grocer to reintroduce these measures when it said on Thursday that customers could only buy three of certain products. These included pasta, soup, hand wash, and hand sanitiser, as well as multipacks of toilet paper and kitchen roll.
One checkout worker at Morrisons who wished to remain anonymous said customers had been stocking up on canned food and toilet roll. They described their store was “worse than a bad Christmas, it was horrible.”
Tesco imposed its own three-item limits on Friday morning for flour, dried pasta, toilet rolls, baby wipes, and anti-bacterial wipes, the grocer confirmed to Business Insider. The limit extends to a small number of products online, such as rice and canned vegetables, it added.
Prime Minister Boris Johnson announced stricter lockdown measures on Tuesday, including a 10 p.m. curfew for pubs and restaurants, and extending the use of face masks. Officer workers were also told to work from home wherever possible.
Social media users began posting images of empty shelves on Monday, when rumours of the stricter measures began to emerge, and toilet paper sales rose 23% in the week to Tuesday, The Guardian reported.
HEALTH TIPS (as recommended by the NICD and WHO)
• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing
• Practise frequent hand-washing, especially after direct contact with ill people or their environment
• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus
• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.
Not all women have the same level of pain during childbirth
A study found that some women had higher pain tolerance for heat, cold and mechanical pressure
These women had a higher-than-expected occurrence of a rare variant of the gene KCNG4
A genetic variant that acts as a natural pain reliever may explain why some women don’t require pain relief during childbirth, researchers say.
The level of pain and discomfort experienced during childbirth varies widely, so researchers at the University of Cambridge in England decided to investigate why some women have less pain during labour and delivery.
“It is unusual for women to not request gas and air, or epidural for pain relief during labour, particularly when delivering for the first time,” said co-lead author Dr Michael Lee, a consultant in pain medicine in the Division of Anaesthesia.
“When we tested these women, it was clear their pain threshold was generally much higher than it was for other women,” he said in a university news release.
A rare genetic variant
Lee and his colleagues assessed women who didn’t request any pain relief during an uncomplicated vaginal delivery of their first baby. To test their pain threshold, researchers applied heat and pressure to their arms and had them plunge their hands into icy water.
Compared to a control group of women who required pain relief when giving birth, women in the test group had higher pain tolerance for heat, cold and mechanical pressure.
No differences were found in the groups’ emotional and thinking abilities, suggesting a difference in their ability to detect pain.
Genetic tests on both groups of women found that those in the test group had a higher-than-expected occurrence of a rare variant of the gene KCNG4. About one in 100 women have this variant.
This variant limits the ability of nerve cells to send pain signals to the brain, according to authors of the study published on 21 July in the journal Cell Reports.
New drugs to manage pain
“The genetic variant that we found in women who feel less pain during childbirth leads to a ‘defect’ in the formation of the switch on the nerve cells. In fact, this defect acts like a natural epidural,” said study senior co-author Ewan St John Smith, a group leader in the Department of Pharmacology.
“It means it takes a much greater signal – in other words, stronger contractions during labour – to switch it on. This makes it less likely that pain signals can reach the brain,” Smith said in the release.
Researchers said they hoped the discovery would lead to development of new drugs to manage pain.
“This approach of studying individuals who show unexpected extremes of pain experience also may find wider application in other contexts, helping us understand how we experience pain and develop new drugs to treat it,” said study senior co-author Dr David Menon, head of the Division of Anaesthesia.
Genitourinary syndrome of menopause includes vaginal dryness, painful sex and painful urination
This affects most postmenopausal women
It’s best to try over-the-counter products first as prescription medicines can be costly
Hot flashes and night sweats are well-known side effects of menopause, but the end of a woman’s periods can also lead to other uncomfortable changes.
Vaginal dryness, painful sex and painful urination are common symptoms of genitourinary syndrome of menopause, or GSM. Estimates vary, but most research suggests that a majority of postmenopausal women are affected. It can significantly impair health, sexual function and quality of life.
But women experiencing these symptoms may not know why they’re happening or that treatments are available. In recent years, new therapies have been approved, and the North American Menopause Society (NAMS) has now published new treatment recommendations after reviewing those therapies.
Best to ‘start simple’
Deciding which to use starts by “knowing what you’re treating,” said Dr Anne Ford, an obstetrician-gynaecologist at Duke University Medical Center in Durham, North Carolina.
When counselling her patients, Ford recommends “starting simple, and then getting more complex”, which dovetails with the NAMS guidelines.
NAMS recommends over-the-counter products like moisturisers and lubricants first. If these options don’t help, prescription therapies can deliver oestrogen or other hormones directly to the vagina in the form of creams, rings, tablets and inserts.
Oral oestrogen therapy can be considered if vaginal symptoms are accompanied by debilitating side effects, such as hot flashes and insomnia. Still, the potential health risks associated with hormone therapy make it a backup option, NAMS says.
GSM used to be called vulvovaginal atrophy, to describe when tissues outside and inside the vagina become thinner, drier and less flexible due to less oestrogen. The new moniker GSM “acknowledges that the symptoms were more than just vaginal and that they really included urinary symptoms”, said Dr Stephanie Faubion, medical director for NAMS.
Pain during sex
Adding the word menopause served to help women who didn’t recognise that these symptoms were related, she added.
While pain during sex is a common complaint, Faubion said the idea that the condition only affects sex is a misconception.
“We’re talking about this not just in the context of sex, but in the context of women being comfortable,” Faubion said. For example, wiping with toilet paper or wearing jeans can bring pain.
Ford explained that when NAMS recommends starting with “simple” treatments, it is referring to over-the-counter moisturisers and lubricants. If the discomfort is mostly external, moisturisers can be applied to the vulva. “Moisturisers aren’t really made for sex. They’re made for if people have discomfort in their day-to-day life due to the dryness,” she noted.
Prescription treatments expensive
For women who are experiencing pain during sex, over-the-counter lubricants can provide relief, Ford added.
Prescription treatments can be costly and may not be covered by insurance, which is why women are urged to try over-the-counter remedies first.
But sometimes these products don’t do enough. The symptoms of dryness and pain are side effects of the vaginal tissues thinning and losing elasticity, and only hormonal therapies can treat the problem itself.
“If we get to the point where I think a prescription-based product is indicated, then I talk to the patient about their preferences and go over all the different kinds of products that are available,” Ford said. “There are creams, rings, vaginal inserts and suppositories, and there’s now a tablet – the ospemifene tablet.”
Oestrogen delivered vaginally provides sufficient hormone to relieve symptoms and is preferred over more aggressive oestrogen treatment when the symptoms are centralised in the vaginal area, according to the NAMS recommendations.
Vaginal oestrogen products are typically low-dose. Some, such as the DHEA vaginal insert, are not specifically oestrogen-based, but work by increasing certain hormone levels.
Systemic hormone therapy
“If the patient really has pain on the inside of the vagina, then anything that you put in the vagina will help that – whether it’s the ring, the cream or the inserts – all of that stuff will probably help the internal discomfort,” Ford said.
The oral drug, ospemifene (Osphena, Senshio), is approved to treat vaginal dryness and painful sex. Due to potential health risks, including endometrial cancer, all other systemic oestrogen therapies are only recommended if additional menopause-related symptoms are present.
“If I had somebody who came in and said that they weren’t sleeping because they were having 20 hot flashes at night, they were irritable, their depression was getting worse, and it was so horrible that they just couldn’t live like this – and they had vaginal pain – that’s somebody who would try systemic hormone therapy,” Ford said.
Energy-based devices, including lasers, may one day be added to the treatment arsenal. Lasers are thought to work by inducing collagen production, thereby thickening the skin.
But, Faubion said, “While initial results are really promising, we still await the longer-term studies to make sure that these are safe and effective for women over the long haul.”
The new NAMS position statement was published online in the September issue of Menopause: The Journal of The North American Menopause Society.
Not all eczema treatments can be given to young children
In a study, a topical probiotic against eczema was tested on children, with good results
This fits in with evidence that eczema involves an imbalance in the skin’s microbiome
Applying a type of “good” bacteria to the skin may relieve children of the itch and discomfort of eczema, a new, small study suggests.
Eczema is a chronic inflammatory condition that causes dry, itchy skin and scaly rashes. It usually starts in early childhood, and commonly occurs along with allergies like hay fever and asthma, according to the American Academy of Allergy, Asthma and Immunology.
There are numerous treatments for eczema, both topical and oral, but not all can be given to young kids.
“So, there’s a big need for safe and effective treatments for young children,” said study author Dr Ian Myles. He is a researcher and staff clinician with the US National Institute of Allergy and Infectious Diseases.
Imbalance in microbiome
For the study, his team tested a topical probiotic against eczema in 20 children as young as three years of age. Over four months, 17 of the 20 saw their rashes and itchiness fade by more than 50%.
The children were also able to cut down on topical corticosteroids, a standard treatment for eczema – but one that can cause side effects like thinning of the skin and stretch marks.
The probiotic therapy is a spray solution containing live Roseomonas mucosa bacteria. Those microbes are normally present on the skin, and past research has found that R. mucosa from people with healthy skin can treat eczema in lab mice.
In contrast, samples of the bacteria from people with eczema either had no effect, or made the skin condition worse.
It all fits with evidence that eczema involves an imbalance in the skin’s microbiome. That refers to the vast array of bacteria and other microbes that naturally dwell on the skin and help maintain its health.
Staph infections
The skin, Myles explained, has to repair itself from daily wear-and-tear, and the microbiome assists in that. He said R. mucosa appears to produce oils that aid the skin’s repair capacity.
The treatment also reduced staph bacteria on the children’s skin, and those microbes can worsen eczema symptoms.
Dr John Browning, a paediatric dermatologist, said, “I think this is a really interesting study.” Browning was not involved in the research.
He said people with eczema often get staph infections and need antibiotic treatment. It’s possible R. mucosa could be an alternative, according to Browning, who is based at Children’s Hospital of San Antonio and Texas Dermatology and Laser Specialists.
The findings, published online on 9 September in the journal Science Translational Medicine, are based on 20 children and teenagers who were given the probiotic therapy for four months. They (or their parents) applied the spray solution twice a week for three months, and then every other day for the final month.
Lasting benefits
On average, Myles said, the kids’ itchiness and rash improved by 60% to 75%, with no significant side effects.
And there were signs it could have lasting benefits. Eight months after the therapy was stopped, the good bacteria were still colonising the children’s skin – indicating R. mucosa had “moved in,” Myles explained.
That, he said, suggests the therapy could be one time only. It would still be possible, though, that whatever caused the bacterial imbalance in the skin could do it again.
Myles said a broader goal is to figure out what those factors are – with diet, soaps and antibiotics being among the suspects.
Browning is part of another trial testing R. mucosa for treating eczema. But he does not think it is the only bacterium that matters.
Further development
“There could be a lot of variability patient to patient in whether this approach would be helpful,” Browning said.
Myles agreed, noting that not all study patients responded to the probiotic.
It’s unclear when the R. mucosa therapy could become commercially available. The US National Institutes of Health has licensed it to a private company, Forte Biosciences, to further develop.
Myles said the company worked to freeze-dry the probiotic so it can be reconstituted with water, then sprayed on. That will make it shelf-stable.
“We anticipate this being something you can pick up at the pharmacy,” he said.
A study has provided further evidence of a link between smoking and bleeding in the brain
External factors, such as smoking, have a much greater influence on the condition than genetics
Not smoking, or quitting if you’ve already started, is, therefore, an essential component of primary prevention
Smokers have a significantly raised risk of dying from a bleeding stroke, a new study warns.
For the study, researchers analysed data from over 16 000 same-sex twin pairs in Finland. The twins were born before 1958 and followed for about 42 years (between 1976 and 2018).
During the follow-up, there were 120 deaths from subarachnoid haemorrhage (SAH). This is a type of bleeding stroke that occurs under the membrane that covers the brain. The median age at death was about 61.
Further evidence
Compared to nonsmokers, the risk of fatal bleeding in the brain was three times higher among heavy and moderate smokers, and 2.8 times higher among light smokers.
The findings were published on 17 September in the journal Stroke.
“Our study provides further evidence about the link between smoking and bleeding in the brain,” co-author Ilari Rautalin said in a journal news release. Rautalin is a sixth-year medical and PhD student at the University of Helsinki in Finland.
Unlike previous research, this study found that high blood pressure, lower levels of physical activity and being female weren’t significant factors in the risk of a fatal brain bleed.
The paper didn’t have data on nonfatal cases. And the researchers couldn’t assess the impact of previous smoking on these brain bleeds, because former smokers and never smokers were combined in the nonsmoking category.
Essential component of primary prevention
Still, “this long-term study in twins helps to confirm the link between subarachnoid haemorrhage and smoking,” said Dr Rose Marie Robertson, deputy chief science and medical officer of the American Heart Association (AHA).
“Not smoking, or quitting if you’ve already started, is an essential component of primary prevention,” added Robertson, co-director of the AHA Tobacco Center for Regulatory Science. She was not involved in the study.
A previous study of nearly 80 000 twins in Denmark, Finland and Sweden suggested that external risk factors, such as smoking, have a much greater influence on subarachnoid haemorrhage than genetics.
In the US, only those from minority groups and with chronic health problems tend to die
Health services need to focus on removing systemic barriers that contribute to healthcare disparities
Only a tiny fraction of children and young adults who have contracted Covid-19 have died from their infection, a new government report shows.
Just 121 people younger than 21 have died from Covid-19 through the end of July, out of nearly 392 000 confirmed or probable cases, said researchers led by Dr Danae Bixler from the US Centers for Disease Control and Prevention.
The deaths of young Americans generally fall along the lines of risk that have applied to all people since the start of the pandemic.
Underlying conditions play a major role
Kids are more likely to die from Covid-19 as they enter young adulthood if they suffer from chronic health problems, and if they are part of a minority group, the results revealed.
“The study illustrates that in the relatively rare instance of death in someone less than 21 years of age, underlying conditions play a major role,” said Dr Amesh Adalja, who reviewed the findings. He’s a senior scholar with the Johns Hopkins Center for Health Security in Baltimore. “This fact underscores the need for those with underlying conditions, irrespective of age, to take Covid-19 seriously and to consider these individuals high-risk.”
Reports of Covid-19 infection among young people have steadily increased during the pandemic, peaking in July, the last month included in this study.
But Covid-19 deaths tended to hover around 30 per month for young people between May and July, the study showed.
More than 40% of Covid deaths among young people occurred in those aged 18 to 20, and nearly 20% in teens aged 14 to 17, the report found.
Three out of four kids who died from Covid were suffering from at least one underlying medical condition, the researchers found.
Hispanic youth most at risk
The most common chronic conditions associated with Covid death were chronic lung disease (28%), obesity (27%), neurological or developmental disorders (21.5%), cardiovascular disease (18%), cancer (14%) and diabetes (9%).
Hispanic youth were most at risk, representing nearly 45% of all Covid-related deaths among children. Black children represented another 29% of deaths, and whites 14%.
“In light of these new findings, we need to continue to focus on interventions to address such health disparities as the pandemic continues, especially in rural and underserved communities,” said Dr Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.
“Removing systemic barriers that contribute to such healthcare disparities is even more important. A focus on providing adequate housing and food to those most at risk can be instrumental in this respect,” said Glatter, who wasn’t part of the report.
The new study was published on 15 September in the CDC’s Morbidity and Mortality Weekly Report.
