Archive for the ‘Hormone Physician’ Category

The president has had a life-threatening, infectious disease for over a week, and he and his doctors havent been very transparent about the timeline and course of his affliction. In lieu of detailed disclosures, reporters have to piece together his condition based on the treatments hes been receiving.

Trump was started off on an experimental therapeutic an antibody cocktail and then advanced to another remdesivir. The other biomolecules coursing through Donald Trump's system (and this week's headlines) are corticosteroids, called dexamethasone.

You may have heard of cytokine storms, where the body's immune response to severe COVID-19 bombards healthy cells, making the illness worse. Trump has been given dexamethasone, an immuno-supressant that doctors prescribe to temper that effect. Unlike the other experimental treatments, dexamethasone is common and somewhat easy to access. However, it is rarely administered to a patient with a case as (self-)reportedly mild as Donald Trumps. In an interview with New York Magazine's Intelligencer, the co-author of a recent study testing dexamethasone elaborates:

That lack of evidence is concerning as Trump heads into a critical point in the course of his illness. COVID-19 is known for being a bit of a roller coaster, with intermittent fevers, mysterious symptoms, and rapid declines. Abraar Karan, a physician with experience treating patients with COVID-19, told Monique Brouillette at Scientific American that some people have turned corners and left the hospital, only to come back feeling much sicker, with even worse oxygen levels and possibly other harm to the bodys organs.

It is theoretically possible that the early steroid treatment may ward off a dangerous auto-inflammatory reaction. But beyond the inherent risks of immuno-supression, corticosteroids may also cause behavioral side effects in the President. Trump's cognitive and behavioral state has been a point of concern for years. Potent steroids such as dexamethasone are known to increase appetite, decrease restful sleep, and bring about heightened "maniacal" energy states.

As the nation enters the weekend, Speaker of the House Nancy Pelosi is rolling out a 25th amendment commission, Trump is boasting a miraculous recovery with a Fox News doctor, and the rest of us continue to wait and learn how biology will run its course. For better or worse, the side effects our president experiences may prove to have historical consequences. To my knowledge, roid rage has never been a factor in nuclear geopolitics.

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A tiny particle collider yields new evidence for a type of 'quasiparticles' called anyons - Massive Science

Beta blockers are often prescribed for high blood pressure, especially if the patient has suffered a heart attack. A new study shows they may not be as effective as once thought.

The study was done in Italy at the University of Bologna. According to researchers, it appears that these beta blockers may not be as effective in women patients as they are in men. Data indicated that women had a higher rate of heart failure than men when they had angina or a heart attack.

The study had 14,000 participants from 12 different countries in Europe. Each one had a diagnosis of high blood pressure, but none of them had a heart disease diagnosis. According to the research, women may have an almost five percent higher risk for having heart failure after a heart attack when taking beta blockers. For those who didnt take the medications, the rate of heart failure was about the same for both men and women.

Researchers dont know the cause for this possible difference. One theory is in the interaction between the beta blockers and hormone replacement therapy. It is obvious that more research focused on women is needed. According to doctors and scientists, research often leads to blanket statements that may not hold true for both men and women.

Women present differently with heart issues than men. They also have a unique physiology from men, which leads to the idea that they may react differently to the same medications as men. Other researchers say that beta blockers pose a risk for anyone, whether the patient is a man or woman.

Beta blockers do their work by blocking the transmission of the hormone epinephrine, which is better recognized as adrenaline. These medications slow down your heart rate as well as the force with which it beats. The result is that your blood pressure is also lowered.

The medications have a secondary job which is to open up the veins and arteries for better blood flow. Not all beta blockers work the same. Some focus on the heart rate while others also impact the blood flow. Some popular brand names of beta blockers include Sectral, Corgard, Zebeta, Toprol XL, Tenormin and Inderal.

Beta blockers arent usually the first line of defense against high blood pressure. Diuretics are often prescribed first. Beta blockers may be prescribed if other medications arent effective and with other drugs designed to lower blood pressure.

Doctors may prescribe these medications for angina, heart attacks, irregular heart rhythm, and migraines. They are often given with other medications.

Beta blockers arent usually recommended for people with asthma because it may trigger an attack. It is also not the first choice for people with diabetes because it can mask signs of low blood sugar.

Until more research is done, it is important to discuss medications like beta blockers with your physician and to tell them everything about your medical history to ensure it is the right choice for your health condition.

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Senate Bill May Give More Authority to the FDA for Drug Recall - Med News 365

Katie Byard| For the Akron Beacon Journal

Weve got big news about this little root beer stand that has persevered.

For this first time in its 67 years, the B&K Root Beer drive-in in Cuyahoga Falls, a neighborhood staple, will stay open all year. Previously each year since 1953 the stand closed in the fall.

Loyal customers who in years past have stocked up on pints and quarts of coney dog sauce for the winter are rejoicing.

Weve weathered the storm. Alot of these smaller businesses have not made it," through the COVID-19 pandemic, said Scott Reynolds, who, along with his wife, Christy, owns the old school place at 737 Munroe Falls Ave.

The Reynolds purchased the business in 2015, becoming independent operators of the B&K that years ago was part of the long disbanded B&K drive-in chain.

This has been our best year ever, Reynolds said, noting he wants to keep the momentum going. Weve been very fortunate with all our loyal customers and new ones that discovered the places coney (Spanish) dogs, kraut dogs, hamburgers that are made fresh upon ordering, soft-serve ice cream and more.

I can walk here if the weather gets too bad, said customer Larry Dean, 79, who became a regular about four months ago, after moving nearby to the stand, tucked in a neighborhood.

Last week, Dean, a retired warehouse and inventory manager, drove to the B&K to pick up lunch for himself and his wife. He got his regular order: one coney dog ($2.40), one kraut dog ($2.40), a hamburger ($2.80) and fries ($1.65 for a small order; $2.25 for a large).

Americans are craving more comfort foods during the pandemic, food industry officials say, and the B&K offers familiar eats.

Familiar but upgraded Reynolds says.

Since taking over in 2015, Reynolds, 45, and his wife have kept the vintage vibe freshening up the familiar orange and brown paint while making changes.

The stand now serves one-third pound burgers (larger than before the Reynolds took over) that are formed with the hamburger press that Christy Reynolds grandmother used.

Buns are from Lakemore's Ideal Bakery.

They stand up to our burgers, Scott Reynoldssaid.

Hamburgers previously only offered on Tuesdays are now on the daily menu.

Also joining the daily menu is soft-serve ice cream. One flavor is offered each week.

I am happy to report I have added the B&K to my list of fave area burger places. I brought a couple of cheeseburgers home (including one with grilled onions) for my hubby and me to eat. The stands burgers are straightforward and filling. And, yes, I enjoyed the bun that melded nicely with the cheese and meat, but did hold up.

We also enjoyed a kraut dog (a hotdog topped with homemade sauerkraut that has a sweet flavor), a coneydog (topped with homemade coney sauce) and french fries.

Sides including french fries, tater tots, onion rings, mozzarella cheese sticks are now deep fried. Previously, they were cooked using an air method without grease. Reynolds said customers wanted that classic fried taste.

The stands side of sauerkraut balls isfrom Akron-based Ascot Foods, with roots in the formerBunny B Sauerkraut Balls & Ice Co.

It was rough for the first few years after the couple bought the stand in 2015, Reynolds said.

He noted the business finances were stretched with the purchase of new equipment, including new freezers and refrigerators.

We didnt really know what we were doing at first, he said.

Reynolds, a maintenance supervisor at the Ford Motor Co. plant in Brook Park, and his wife, Christy, a nurse, were looking for an investment when Christy spotted an advertisement saying the stand was for sale.

The idea of running a family business appealed to them. Their children Scott, a fireman;Brian; and Madison, a college student, all work at the stand.

Brians availability to work full-time at the stand now is helping to drive the decision to stay open all year.

The stand is one of three independently operated B&Ks in the area.

Initially the stands were part of the B&Kchain, which began in Michigan City, Ind., in the 1940s. B&Kstands for Bergerson & Kenefick.

Sheila Trombka, a part-time cook at the Cuyahoga Falls stand, is a daughter of Al and Cathy Emich, who acquired the stand in 1958 and sold it in 1996 toVic and Dixie Davis, who sold the stand to Scott and Christy Reynolds in 2015.

Trombka has worked at the stand for virtually her whole life. She learned to wash root beer mugs when she was 5 years old and when she was 9, she ran the register. By the time she was 11,she was a carhop. Now her sons, James, 22, and Jonathan, 18, work part-time there.

She showed us the ropes. We love her to death, Scott Reynolds said.

I came with the building, Trombka said.

About B&K in Cuyahoga Falls

Address: 737 Munroe Falls Ave.

Hours: 11 a.m. to 8:30 pm. Tuesday through Saturday - now, all year.

Phone: 330-922-3355

See the stands Facebook page for specials.

New downtown eatery

Evelyns Coffee & BnhMi has opened at11 E. Exchange St., inthe space behind the Goodwill blue boutique on Main Street in downtown Akron.

The space previously housed coffee shops, including Wholly Joe.

So what is a bnh mi?

Bnh mi is the Vietnamese word for bread, and also in this case refers to the popular Vietnamese baguette sandwich (think sub sandwich on crusty, light bread), typically featuring a meat and pickled vegetables.

French colonists introduced the baguette to Vietnam, but the Vietnamese have made the sandwich their own, creating many versions.

At Evelyns, I enjoyed a chicken bnh that included pickled carrots, cucumber and cilantro ($5.50). You can also get a beef or meatball bnhmi.

Eveylyns also offers kimbap, a Korean dishof seasoned rice with fish cakes, carrots, egg and spinach rolled in seaweed. Other offerings include smoothies, papaya salad and a Vietnamese salad made with shredded cabbage, chicken, carrots and onion. It comes with a sweet and tangy dressing.

The shop offers Vietnamese iced coffee (made with sweetened condensed milk), along with a variety of other coffee drinks.

Vinh Nguyen, a local physician, opened the place this summer, taking advantage of the Start Downtown program operated by the nonprofit Downtown Akron Partnership. The program provides six months of support, including rent subsidies, in the 42-bock Special Improvement District in downtown Akron.

Evelyns is open from 8 a.m. to 4 p.m. Monday through Friday and 9 a.m. to 4 p.m. Saturday.

Phone is 330-849-5080.

See Evelyns web page --https://www.evelynscoffee.comfor more information and to order online.

West Side Bakery's Apple Week

This week is Apple Week at the West Side Bakery in Akron, celebrating 25 years in business this year.

Barb Talevich, who owns the bakery with her husband, Steve, said she expects to go through some fiveor six bushels of Golden Delicious apples from Bauman Orchards in Rittman to make a variety of apple treats.

Available now: Apple cobbler, apple hand pies, caramel apples, apple cobbler tea bread, apple coffee cake, cinnamon apple cheesecake and apple-frangipane galette (an apple tart featuring an almond pastry cream).

Apple fritters will be available this Friday and Saturday.

Its the only time of the year these fried treats are available.

Talevich happily reported that the bakerys employment roster is now back up to more than 20 full- and part-time workers.

For a time during the ongoing pandemic, she and and her husband were the only workers, and the shop was only open on Saturdays.

The shop, at 2303 W. Market St., is now open from 8 a.m. to 5 p.m. Monday through Saturday pickup only. Phone is 330-836-4101.

ThaiSoul Fusion Grill relocates

ThaiSoul Fusion Grill has moved to 992 Kenmore Boulevard in Akrons Kenmore neighborhood.

Thats the space that previously housed Lil Bit Cafe, which closed earlier this year. It apparently was not able to withstand the negative financial impact of the ongoing pandemic.

Well have more soon on ThaiSoul Fusion Grill, which, as its name suggests,offers Thai eats, as well as soul food.

Owners are Tawon and Patricia Burton. They most recently operated the eatery in Stark County, after running it out of space on Romig Roadnear the site of the former Rolling Acres Mall.

Phone is 330-937-8846. Online ordering is athttps://www.thaisoulfusiongrill.com.

The restaurant is only open for pickup at this time.

Wise Guys' clambake

Wise Guys Lounge & Grill in Akrons North Hill will offer a clambake from 3 to 9 p.m. Friday and Saturday.

Cost is $55 for clams, mussels, crab legs, potato, a half check, corn and clam chowder.

Add lobster for $10.

Guys, known for its wide selectionof wine, is at 1008 N. Main St. Phone is 330-922-3006.

Harvest Mart at Lock 3

Harvest Mart featuring food and non-edible items will debut at Lock 3 park off Main Street in downtown Akron on Saturday.

Itll run from 1 to 5 p.m. Saturday, and from 1 to 5 p.m. Oct. 24.

See the Harvest Mart at Lock 3 Facebook page for more information.

Akron'sJ Hudson, an experienced organizer of markets, is coordinating the event.

Hormone-free chicken, turkey, pork, lamb and beef, as well as pumpkins, gourds, apples, late-summer produce and more,will be available.

Cast your vote for favorite burger

You can vote for your favorite burger among two choices at Bob's Hamburg in Akron.

In its "Keeping Burgers Great 2020" election, you vote by buying the quarter pound burger with Swiss cheese and jalapenos or the burger with American cheese, ketchup, onions and mustard. A portion of each saleeach burger costs $6.35 will go to Akron Children's Hospital.

Voting continues through Nov 2. The winner will be revealed Election Day, Nov.3.

Bob's is at 1351 East Ave., near Interstate 76.

Last call at Louie's

As reported by Beacon Journal staff writer Alan Ashworth last week, Louie's Bar & Grille at 739 E. Glenwood Ave. in Akron's North Hill is closing this month. The 28-year-old Louie's, known for its burgers, cited COVID-19 restrictions in its decision to close.

Last day for customers is Saturday.

Thanks for the memories.

Send your local food news to Katie Byard at msakron@sbcglobal.net.

Read more from the original source:
Akron Dish: For first time, B&K drive-in staying open through winter in Cuyahoga Falls - Akron Beacon Journal

Monday, October 12, 2020

Dr. Michael Fine, Author

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Justice Brett Kavanaugh

The full audiobook can be downloaded here.

"Boys and girls like beer"

-- Brett Kavanaugh, Associate Justice, US Supreme Court

Every morning at 5 AM, three or four white minivans leave from a parking lot on Cowden Street in Central Falls, Rhode Island for factories all across southern New England. Each minivan is densely packed with 10 to 15 mostly undocumented immigrants who live two or three or five people to a room in the ramshackle wooden frame triple-deckers that are crammed into every available square foot in this old mill city. The people in the minivans are from all over the world - from Guatemala, Honduras and El Salvador, from Cape Verde, the Dominican Republic, Colombia; and Puerto Rico refugees from Hurricanes Maria and Dorian who cant find other jobs here. The vans are run by labor contractors who find and supply unskilled labor to the low-wage employers who need bodies for the hot, dirty, smelly and dangerous jobs no one else wants, in the factories, construction sites, meat-packing plants and fish-houses of Southern New England. The vans charge each worker $5 to $10 a day. The work pays minimum wage - $10.50 an hour in Rhode Island, $12.00 an hour in Massachusetts, $11.00 an hour in Connecticut. Theres lots of wage theft on these jobs sometimes workers only get paid for eight hours when they work 12 or 14, or get told the labor contractors havent been paid yet and then never get paid, or are paid piece work using a scale that means they earn $5 or $6 dollars an hour, when they were promised $20 an hour but youd have to produce at an impossible pace to generate that much income.

Yes, we drank beer. My friends and I. Boys and girls. Yes, we drank beer. I liked beer. Still like beer. We drank beer, said Judge Brett Kavanaugh during his testimony to the US Senate Judiciary Committee confirmation hearing.

This testimony provided a unique lens on American culture and mores. A preening conservative President, pandering to his base, chose an undistinguished juror to sit on the U.S. Supreme Court. The opposition party, powerless to stop Kavanaughs confirmation, used accusations about the nominees behavior in high school as the bulwark of their objections to his nomination.

By the time Judge Kavanaugh testified, the process of Supreme Court nomination and confirmation had already been defiled. The nomination to the Supreme Court of Judge Merrick Garland two years earlier had been blocked by the Senate Majority leader, just because he had the power to do that. This occurred just six years after a President had forced through health care insurance reform, because he had the power to do that. Health care insurance reform was unanimously opposed by a minority party, even though the reform itself was based on the ideas of that minority party, which objected only because it was in their perceived political interest to resist the reform, the hell with what the country wanted and needed.

Any pretense of government of, by and for the people, and of governing for the good of the nation had fallen by the wayside years ago. The U.S. Government has long been controlled by special interests, the consequence of the over-centralization of capital, itself a consequence of changes in banking and securities regulations that had been sought by the banking and securities industries themselves. The notion of a common good, of Americans as one people with liberty and justice for all was replaced by narcissism, consumer capitalism, and greed. Brett Kavanaugh is a shallow self-satisfied man - the pure product of a culture without compass or meaning. He now sits on our highest court, appointed for life. I worked hard, he said. I played basketball. I got into Yale and Yale Law School. I got ahead. And yes, I like beer.

These are the values we brought with us into a pandemic.

The nomination and confirmation of Brett Kavanaugh posed a simple question. In the words of another time - have we no sense of decency or responsibility to ourselves as a people?

The story of SARS-CoV-2 and of Covid-19 makes the answer to that question clear. We let loose a pandemic in the US that will cost at least 250,000 lives because we have lost our sense of dignity, our discipline, our courage and our pride.

Almost all the deaths from Covid-19 were preventable. Any fingers to be pointed must be pointed directly at us at ourselves, our culture and our politics. No one did this to us. We did this to ourselves.

Sometime in September or October of 2019, a bat, a pangolin or some other wild animal in China coughed, sneezed, or cried out, perhaps in pain from being caught or slaughtered, or just breathed near a human being. Out of that animal came a virus or more likely a thousand or more viral particles from the family of viruses called Coronavirus - that hung in the air for a moment. Then a human being nearby inhaled. The virus entered the nasal passages and perhaps the lungs of that person, an event likely happens millions or even billions of times a day.

The transfer of viral particles from animals and other human beings is a common, even trivial, event in the human experience. Those particles are always in the air we breathe and they are what our nasal passages, our lungs, our respiratory secretions and our immune systems work to protect us against almost always effectively. Most of the billions of viral particles we inhale or introduce into the body by touching eyes, nose or mouth have no significant impact on the health of individuals. Many viral particles that infect other species plant viruses, insect viruses, frog and toad viruses and bird viruses - have cellular architecture that is slightly different from the cellular architecture of human cells, so most of those viruses are unable to attach to human cells or cause infection. Most of those viral particles are quickly destroyed by the immune system. Most are just dust.

But the virus that entered a human body in the fall of 2019 was different. That virus, which likely evolved in another mammal, had a mechanism that allowed it to attach to specific proteins in certain human cells, cells that line the nose, are present in the lungs and heart and in small numbers in the gastrointestinal system, proteins that are called ACE2 receptors. ACE2 receptors are the proteins that allow the attachment of a hormone called angiotensin converting enzyme, a hormone that helps regulate blood pressure, among other functions.

The virus attached to human cells. It entered those cells and inserted itself into the genetic material of those cells, which is what viruses do. The virus then caused those cells to make copies of itself. Those copies destroyed the cell and were released into the bloodstream where they found and attached themselves to the ACE2 receptors of other cells and entered those cells and their genetic material. Those cells began making still more copies of the virus billions and billions of copies.

That human being had become infected. And then that human began to cough, or sneeze, or breathe or speak, so that the virus entered the air and infected other people nearby. And those people coughed and sneezed and infected other people. The newly infected people infected others, over and over again, until at least sixteen million people who have been tested and counted, as I am writing this, but very likely many more than that likely a hundred to two hundred million people - people who have had the virus but havent been tested or counted have become infected. Which is not many, really, when you consider that none of us has seen this virus before so have no immunity to it. And that there are seven billion of us. Likely all seven billion human beings are susceptible to this new virus and will become infected with it before long since none of us were immune to it in the fall of 2019.

Seven billion humans. 200 million people is about three percent of seven billion, so many more people will become infected before this pandemic is over.

I thought Id sit out the Coronavirus outbreak in the US as an observer. Im a fiction writer turned doctor turned fiction writer again. I worked as a family physician and then started doing public health in my late fifties. I was Director of the Rhode Island Department of Health 2011-2015 a period that included the Ebola epidemic of 2014-2015. Along the way Ive had the privilege of knowing three CDC directors, three Surgeons General (one of whom I helped train to be a state health officer, in 2015) and about 100 city and state health directors, a number of whom are close and dear personal friends with whom I talk frequently. I know CDC and its culture. Many friends and colleagues work there. And I also know government and how it works at the federal, state and city levels. Or doesnt.

When reports began to come out of China of hospitals overwhelmed, of a doctor who had been silenced and then died of the disease, of health workers getting sick and dying in large numbers, of people dying in the streets of Wuhan, I was writing in the morning, and working in the afternoons seeing patients two half days a week, and trying to develop new programs to reduce cost and improve access to health services in Central Falls, Rhode Island, the smallest, poorest and most densely populated city in the state. I consulted a little with the mayors of Central Falls and Pawtucket, Rhode Island, a neighboring city, but had turned my attention to writing fiction, an old first love. I worried a little about this new virus but I assumed that the Chinese CDC and WHO would get in front of it and get it stopped before it spread too far.

I didnt expect to find myself in the middle of one of the worst outbreaks of Coronavirus in the nation.

I also didnt expect the public health apparatus of the world and nation to so dismally fail. Or that the failure would reveal again what my 2018 book Health Care Revolt was written to reveal originally that we have a medical services market, a pharmaceutical products market and a health care insurance market but that we dont have a health-care system in the United States, a system that provides the same set of essential services to all Americans. Our medical, pharmaceutical and health care insurance markets are focused on profit, as markets should be, and not public health. These markets, and the profit focus of American society, have produced a culture in which the rich get richer and the poor are kicked to the side of the road.

Again. The poor get kicked to the side of the road. We have decades of data showing how the market focus of American health care has made our population sicker and poorer, worsened income inequality in the US and has disadvantaged the poor and people of color. You would have thought wed learned something from all our studies, and used what we learned to do a better job with Covid-19. Instead, we failed again, and failed so profoundly that we locked up our society for at least a year, and perhaps for as long as half a generation.

Still, because of my role with a community health center and with the two cities, I paid close attention to the stories and the data coming out of China in late 2019 and by January of 2020 was able to brief the mayors and my colleagues about what we were learning: This new Coronavirus is in the family of viruses that cause the common cold. This one likely evolved in bats and crossed over to human beings in the fall of 2019 in Wuhan China. It was related to the coronaviruses that cause SARS and MERS but this virus appeared to be harder to contain. In most people this new Coronavirus causes mild disease runny nose, fever, cough, loss of taste and smell, and sometimes nausea, vomiting, and diarrhea. But the new Coronavirus spreads quickly and can cause a very serious lung infection in some people, something called Adult Respiratory Distress Syndrome, which is much worse than a simple pneumonia and can be fatal in about one-third of the people who get significantly ill. The case fatality rate - the ratio of the number of people who get the disease to the number of people who die of it - was reported to be 3 percent, so that of a hundred people who would get the disease likely three would die, which made this Coronavirus 30 times more lethal than influenza but 20 times less lethal than Ebola, a virus that kills 50-75 percent of the people who get it.

Eventually wed learn the case fatality rate is more likely 0.4 percent or less, or about four times that of seasonal influenza. Even so thats a scary number, because every human being, in theory is susceptible to the Coronavirus, which means all of us could get sick at about the same time. In theory, a city of 100,000 might have 10,000 people in the hospital in the span of a few weeks, about ten times the usual number. And 3000, we thought then, would likely die. By comparison, about 5 percent of us are susceptible to seasonal flu each year. Even so, it kills 30,000 to 60,000 Americans every year. This means in that city of 100,000 people, likely 5000 people get the flu, and 500 people are hospitalized for it, and 5 die.

See the rest here:
What Was That? Coronavirus, Chaos and Democracy By Michael Fine PART 1 - GoLocalProv

Thanks to our ongoing global battle with the pandemic it looks like many nations will face some sort of covid-19 lockdown for the next six months a least. And given that for many of us it feels like restrictions had no sooner been lifted than they were reimposed, the result can be hard to bear psychologically, even if (thankfully) were unaffected physically.

However, help is at hand if you want to handle lockdown with the resolve, resilience and inventiveness of a ninja, take a look at these 7 ways to adapt to Covid-19 lockdown life.

You can literally learn to be a ninja online by watching free Ninja Learning Network training videos however please be careful not to injure yourself and seek advice from a physician before starting any strenuous fitness regime.

Been meaning to try that healthy vegetarian or vegan diet for some time? With so much plant-based food available online, theres never been a better time to switch your waistline will also thank you for it!

Creating some calm headspace for yourself is more important than ever during lockdown. If you dont want to adhere to Buddhist meditation practices, mindfulness is an effective secular version youll find on apps like Calm.

Always had a penchant for writing but never had the time to write down your thoughts? Writing a daily journal can be very therapeutic and your finished draft might turn into an autobiography or novel. Your lockdown diary could become a classic like Hagakure, still read hundreds of years after it was penned who knows?

Forget informal MOOCs where you put in the effort to study but dont get a recognised qualification in return take an online degree with ARU Distance Learning in a subject like digital marketing or psychology and you could be on your way to an exciting new career.

Being stuck indoors with family need not mean that youre at each others throats in fact it can be the ideal opportunity to build bridges and spend some quality time together. Spend a little less time on your phone or tablet and a little more time bonding over activities like cooking, crafts and simply chatting, then youll feel closer than ever to your loved ones.

Participating in a regular virtual pub quiz can be a great way of exercising those little grey cells and catching up with friends over a few convivial drinks. If youre struggling for ideas on how to get started, take a look at the amazing Jays Virtual Pub Quiz, which has taken the online world by storm this year!

Follow these seven ways to adapt to covid-19 lockdown life like a ninja and youll navigate the next few months like the most nimble shinobi you can thank us later!

Share youre lockdown tips in the comments section we would love to hear them.

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7 Ways To Adapt To the Covid-19 Lockdown Life Like A Ninja - Chiang Rai Times

Are you stressed, anxious, or depressed? Do you have trouble sleeping? Do you have skin and hair problems? The answer to all those queries can be CBD.

Cannabidiol, widely known as CBD, comes from cannabis plants and is one of the two prevalent compounds popular within the medical community. The other one, known as Tetrahydrocannabinol or THC, is responsible for the feeling high and the euphoric experience people experience.

Cannabis plants have two subspecies known as Cannabis Indica and Cannabis Sativa. Marijuana and hemp are both varieties of the Cannabis Sativa species, and CBD can be derived from both of them. Usually, hemp plants have been selectively bred and used industrially to remove THC almost completely. Marijuana, however, contains 30% of THC.

The breeding of hemp plants and CBD manufacturing has been legalized for medicinal reasons as long as it contains no more than 0.3% of THC per dry weight. CBD derived from marijuana is also legally manufactured but usually requires a doctors prescription to be sold.

CBD derived from both marijuana and hemp plants is used to treat many medical issues such as nausea (from chemotherapy), stress, anxiety, pain management, and treating muscle spasms that can be brought on due to multiple sclerosis, etc. It works on the neurotransmitters and regulates the nerve cells in our brains and tells them to calm down. This year, with the coronavirus pandemic going around, many people are stressed and have a heightened anxiety level than before for staying at home for too long or from losing jobs. It brings a feeling of relaxation to the patients who suffer from these issues and helps them sleep and relax. Another use of this compound is it is excellent in reducing acne and improves skin and hair conditions.

Products containing CBD are everywhere now, in hair products, skin products, capsules, oil, pet products, etc. It was also included in some food items as additives until the FDA banned it in 2019.

However, for ingesting, there are different methods that you can use that would best suit your needs. You can try inhaling, vaping, taking capsules orally, or ingesting oil drops. You can even choose what type of flavor or aroma you prefer.

The most effective relaxant that promotes the wellness of health is CBD-containing oil supplements. If you are new to using this, you can start with a low dosage and increase it as you see fit. Labels stating CBD oil have a significant amount of CBD not to be confused by hemp oil, which doesnt contain any CBD. You can buy CBD oil UK and notice how it boosts your mood and relaxes you.

Its simple. These oils come with an ml dropper and labeled instructions on how much dosage should be taken. It is usually recommended to start low, about 5mg, and then making your way up. Drop 5mg of oil under your tongue and keep it that way for around 60 90 seconds and then swallow. This way, you can retain the full potency of the product. Another thing to remember is that CBD oil drops can be taken after every six to eight hours. Ideally, you should use cannabinoids in consistent doses.

Side effects due to ingesting CBD have not been reported yet, or they are so mild that it was not directly attributed to cannabidiol. The ones reported were mild dry mouth and thirst, although they are not proven to be caused by CBD.

With the arrival of a pandemic and lockdown situation, most people have become anxious, depressed, and stressed financially and mentally. Some opt to take marijuana or other drugs and leave their problems behind, but the compound itself is so addictive that people keep asking for more. So when they finally decide to quit, they go through severe withdrawal issues. CBD has been known to help patients like these and manage mental health issues such as psychosis.

If you have skincare issues such as eczema and psoriasis, then using CBD topical products has been known to reduce oil production and eradicate acne. It contains anti-inflammatory agents that help in clearing out the skin.

CBD also helps with back pain or injury that involves inflammation; however, more studies are yet to be conducted.

As for stress-related issues, CBD has proven to relax the nerve cells and signals the body to take it slow. It acts as a mood regulator and reduces anxiety, hence re-balancing a persons mental and emotional health.

CBD therapy has also been shown to help health-care workers in this pandemic by providing relief to their neck or back pains and aid in restoring their sleep. It also helped many people who had panic attacks and were suffering from depression and the insomniacs affected due to the ongoing lockdown situation.

CBD reacts differently in men and women, where the latter is usually sensitive to the chemical compounds effects due to their hormone, estrogen. Women can develop a tolerance level within their bodies, so they must take a break now and then. A break from CBD will ensure their endocannabinoid system resets and help them adjust better to the product.

Despite CBD showing promising results, it is always good to consult your physician before making CBD a part of your life. It is particularly crucial to consult your doctor if you are taking other medications for your health issues such as antidepressants, which may have a side effect if combined with CBD.

CBD, with its therapeutic benefits, taken in appropriate amounts can lead to a better and healthier lifestyle, mentally, emotionally, and physically. However, a relationship with this compound requires you to put in a bit of work and make your life easier in this lockdown situation.

Read this article:
How Effective is CBD for your Health - Oregon Cannabis Connection

Hormones are natural substances made by our glands in our body and the network of glands that make hormones is termed as endocrine systems. These hormones are carried through bloodstream and act as a messenger between one part to another part of our body. Hormone therapy is one of the major modalities of medical treatment for cancers which involves manipulation of the endocrine systems through exogenous administration of steroid hormones or drugs inhibiting or interrupting activities of specific hormones. Surgical removal of certain endocrine organs for instance oophorectomy can also be employed as a part of hormone therapy. In hormone therapy physician generally start with hormone receptor test that let caregivers to measure amount of cancer proteins or hormone receptors within a cancer tissue. By estimating the amount of hormones such as estrogen or progesterone the test either can be positive or negative. A positive test indicates growth of cancer cells with the help of hormones. In such cases physician divert the hormone therapy by blocking the interaction of hormones with the hormone receptor. Alternatively, in case of negative hormone receptor test which signifies null effect of hormones in growth and development of cancer cells other effective treatments can be rendered to cure cancer.

Read Report Overview - https://www.transparencymarketresearch.com/cancer-hormone-therapy-market.html

A hormone therapy can be rendered either before or after a primary treatment. In case it is rendered before the primary treatment it is medically termed as neoadjuvant treatment which kills. Neoadjuvant treatments help to kill cancer cells and contribute to the effectiveness of the primary therapy. If hormone therapy is given after the primary cancer treatment, it is called adjuvant treatment. Adjuvant therapy is given to improve the chance of a cure. Now a day hormone therapy is widely used in treating breast and prostate cancer. In breast cancer the female hormone estrogen are primarily responsible for stimulating the growth and development of breast cancer cell in majority of cases. Recently in 2014, aromatase inhibitors such as Arimidex and Femara have been approved for treating breast cancers through hormone therapy. Apart from these FDA approved Zoladex Lupron can also be used in curing breast cancers through hormone therapy. In case of prostate cancer a variety of medications can be used as hormone therapy. Male hormones, such as testosterone, stimulate prostate cancer to grow. Hormone therapy is given to help stop hormone production and to block the activity of the male hormones. Some of the antiandrogens used as inhibitors of prostate cancer cell growth encompass flutamide, enzalutamide, bicalutamide, and nilutamide among others. some of the other cancers to which hormone therapy is gaining acceptance now a day include womb cancer, kidney cancer, ovarian cancer among others.

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Major drivers to global cancer hormone therapy include rising incidences of cancer across globe. Statistically according to WHO cancer accounts for 8.2 million deaths in 2012 and it is estimated that annual cancer cases is expected to rise from 14 million in 2012 to 22 million by 2022. Rising awareness among physician and patients towards alternative cancer therapy processes such as target therapy, immunotherapy or hormone therapy is likely to uplift the market in forthcoming years. Side-effects associated with hormone therapy are major restraints to growth and acceptance of therapy. Some of the common side-effects associated with hormone therapy for cancer include nausea, vaginal spotting, irregular menstrual periods, skin rashes, loss of appetite, vaginal dryness, impotence and male breast enlargement among others.

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Prominent companies operating the global cancer hormone therapy market include AstraZeneca plc, Novartis International AG, Merck & co., QuatRx Pharmaceuticals and Pfizer, Inc. among others.

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Cancer Hormone Therapy Market: Rising incidences of cancer across globe is a major driving - BioSpace

The leader of the free world is now fighting his own battle with a virus that's laid global siege. A concoction of some experimental treatments is helping him do it.

On Monday evening, after spending three nights undergoing treatment for COVID-19 at Walter Reed National Military Medical Center, President Donald Trump returned home to the White House.

Standing on the balcony, Trump removed his mask and gave a double thumbs up to the crowd.

Minutes later, in a produced video released via tweet, Trump claimed his victory over the virus.

"I didn't feel so good," Trump said to camera. "Two days ago I felt great, like better than I have in a long time... better than 20 years ago."

"Now I'm better -- and maybe I'm immune! I don't know. But don't let it dominate your lives. Get out there. Be careful. We have the best medicines in the world, and they're all happened, very shortly, and they're all getting approved."

Trump has been recovering under close watch from a team of physicians administering world-class care and special access to therapeutics. Monday, his personal physician, Dr. Sean Conley, told reporters Trump "has continued to improve" over the past 24 hours, having "met or exceeded all standard hospital discharge criteria."

There is not enough evidence to confirm when, or if, some level of immunity to COVID-19 occurs, and how long it might last. Experts say right now, the president is likely still contagious. The Centers for Disease Control and Prevention says COVID-19 patients should stay isolated for at least 10 days after the start of their symptoms or after receiving a positive test. Trump's doctors said Monday he "may not entirely be out of the woods yet," but they are using what they have called a "multi-pronged approach" in his treatment, which will continue as he recuperates at home.

Trump's diagnosis early Friday morning plunged a nation already in chaos into further crisis, uncertainty and fear for his well-being of urgent concern amid a pandemic that has now claimed the lives of more than 210,000 Americans.

Over the weekend, Trump assured the public he was feeling "much better" since being given a sundry mix of medication, some of it experimental, which he called "miracles coming down from God."

A car with US President Trump drives past supporters in a motorcade outside of Walter Reed Medical Center in Bethesda, Maryland on October 4, 2020.

The full picture of what treatments Trump has received thus far is still evolving, as still-outstanding questions in the public interest are met with more fulsome, forthright detail. Monday, his medical team told reporters they continue to treat him with the intravenous antiviral Remdisivir, and have continued with the steroid Dexamethasone.

Of the combination of medicines and supplements now being deployed to help him recoup, many are not yet definitively known to beat the novel coronavirus, but are thought to help mediate the virus' symptoms and severity in the body. There is, as of now, no drug "approved" by the FDA for COVID-19 treatment, though some have been given emergency authorization.

Some experts have raised questions about the uniquely robust drug regimen now being administered to the president. Dr. Lew Kaplan, president of the Society of Critical Care Medicine and a surgeon at the University of Pennsylvania, said these types of "non-standard processes" can " invite error." This exact combination of medications has not been tested together yet in large-scale studies.

NIH treatment panel guidelines member Dr. Mitchell Levy assured that there is no "miracle" drug yet available.

"If you look at our guidelines, we just don't think there's enough evidence to recommend one way or the other," Levy, chief of pulmonary critical care at Warren Alpert Medical School of Brown University, told ABC News. "So little is proven. It's like the Wild West, and he's the president of the United States, and so you feel like: 'I want to do anything I can to prevent the disease from progressing.' That often drives us to do things outside of the normal standard. And that is never a good idea. There's a standard of care for a reason. With COVID-19, part of the problem is, we're never really sure what the standard of care is."

Other experts are more optimistic

"All of these treatments shift the odds in your favor," Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, told ABC News. "None of them is a magic wand that suddenly makes you feel better," he added, explaining that Trump's treatment plan was made respecting the parameters of available science.

The president's doctors have said he is taking at least eight medicines and supplements. The timeline of Trump's illness remains murky; however, here's what we know about what the president is taking -- and when he started taking it.

Remdesivir

Before Trump was to check out of Walter Reed and head back to the White House Monday evening, his physicians told reporters they planned to administer the fourth dose of the antiviral drug Remdesivir. He has been receiving Remdesivir intravenous infusions since Friday, within 24 hours of revealing his diagnosis. Initially developed for Ebola treatment, it has solid evidence supporting its use in COVID-19 patients, according to the National Institutes of Health, and based on that promising potential, the FDA has issued emergency authorization for its use. Typically given to patients with severe infection, it works by hindering the virus' replication in the body.

Once Trump settles back at the residence, his doctors say, they've made arrangements for the fifth and final dose of his treatment course, Tuesday evening.

In this undated image from video provided by Regeneron Pharmaceuticals on Friday, Oct. 2, 2020, vials are inspected at the company's facilities in New York state, for efforts on an experimental coronavirus antibody drug. Antibodies are proteins the body makes when an infection occurs; they attach to a virus and help the immune system eliminate it.

Regeneron monoclonal antibody "cocktail"

Trump is taking a cocktail of two synthetic, pharmaceutical versions of what occurs naturally in the body to fight off infection. A mix of monoclonal antibodies, this one made by biotech company Regeneron, is thought to be promising, though still in its experimental phase. Late last month, Regeneron published positive, yet preliminary data for its cocktail treatment showing it improved symptoms in patients without severe disease.

While it is not yet FDA-authorized, Trump has been granted access to it under "compassionate use," enabling him to get it outside of a clinical trial. A Regeneron spokesperson confirmed to ABC News that Trump's medical staff reached out to them for permission to use their monoclonal cocktail, and it was cleared with the FDA.

Dexamethasone

Trump's personal physician told reporters Monday afternoon that they continue to treat the president with the steroid Dexamethasone, in response to temporary drops in his oxygen levels.

A corticosteroid used for its anti-inflammatory effects, Dexamethasone has solid evidence supporting its use in COVID-19 patients, according to the National Institutes of Health. In severe cases it's thought steroids can fight the haywire inflammation caused by the virus; however in milder cases, one trial found "no benefit (and the possibility of harm) among patients who did not require oxygen."

When pressed by reporters Monday afternoon, Conley, Trump's personal physician admitted that the president had, in fact, been given supplemental oxygen twice since falling ill. Previously, Conley had said he was not sure if Trump had received it a second time, and would have to check with the nursing staff.

Regarding those two times Trump received supplemental oxygen, Conley said, "it wasn't required."

Schaffner told ABC News that though the press and public have not seen the president's chest X-rays or CAT scans, prescribing the steroid is "a borderline indication within the physicians' prerogative."

Whatever was on those CAT scans, Schaffner said, along with his oxygen levels, seems "undoubtedly what targeted physicians' decision to add dexamethasone," in hopes that it would moderate his immune system response's "collateral damage."

Famotidine

Famotidine, more commonly known by its brand-name Pepcid, is an FDA-approved for heartburn, not COVID-19. Some early, observational studies showed improved survival amongst hospitalized COVID-19 patients. Still, experts caution that observational studies are no substitute for high-quality, randomized trials designed to demonstrate a treatment's true effectiveness. A trial for an intravenous infusion of famotidine is still ongoing.

Zinc

This is not the first time Trump has said he is taking Zinc. In mid-May, Trump told reporters he had been taking both Zinc and Hydroxychloroquine as a "preventative" measure. On Friday, as his doctors listed off the treatments he would now receive for his infection, Zinc again appeared on the list. As an over-the-counter supplement, Zinc is subject to less regulatory oversight. Its virus-fighting properties have shown mixed results in prior studies. Schaffner described Zinc, along with Vitamin D, as "adjunctive therapies, the benefits of which are not known."

"There is some data that Zinc is helpful if you have the common cold," he said. "But not COVID."

Vitamin D

Trump's doctor announced the president is also taking a vitamin D supplement. Studies show an association between vitamin D deficiency and a greater risk of and dying from COVID-19. However, most people get enough vitamin D from their diet. At this point, studies have not demonstrated that taking a vitamin D supplement can help fend off COVID-19 related illness, although there is an ongoing, randomized trial that may offer clarity.

Melatonin

Melatonin is a naturally-occurring hormone with antioxidant, anti-inflammatory properties also helping regulate circadian rhythms. Some researchers have suggested that the supplement might help compliment other COVID-19 treatments. At this point, research showing that this supplement helps COVID-19 patients is limited, but there is at least one small, randomized study ongoing in the U.S.

Aspirin

Available over the counter, aspirin have been taken internationally as concomitant treatment for COVID-19 -- in response to the strange prevalence of clotting and pulmonary embolism doctors have seen crop up in some patients. Aspirin may also help reduce low grade fevers. Saturday, the president's medical team said he no longer had a fever, after less than a day's time. On Monday afternoon, his medical team told reporters Trump "has not been on any fever reducing medications for over 72 hours," but declined to elaborate.

For people for people who don't have increased cardiovascular risks or COVID-19, daily aspirin use is no longer recommended as a way to reduce the risk of heart attacks, because the risks are now believed to outweigh the benefits.

Before taking any medication, people should always check with their doctor, as every patient's situation is different.

This report was featured in the Monday, Oct. 5, 2020, episode of "Start Here," ABC News' daily news podcast.

"Start Here" offers a straightforward look at the day's top stories in 20 minutes. Listen for free every weekday on Apple Podcasts, Google Podcasts, Spotify, the ABC News app or wherever you get your podcasts.

ABC News' Eric Strauss and Ben Gittleson contributed to this report.

Read more from the original source:
All the president's medicine: How doctors are treating Donald Trump - ABC News

O'FALLON October is National Breast Cancer Awareness Month, a time to reaffirm our commitment to fighting breast cancer and to remind ourselves and others the importance of prevention and early detection.

Breast cancer can develop in women of every age, race, and ethnic group. According to the American Cancer Society, more than 200,000 women will be diagnosed with invasive breast cancer this year, and approximately 40,000 women will die. Breast cancer in men is not as common, but it does happen, affecting about 2,000 American men each year. Fortunately, the death rate for those diagnosed with breast cancer has decreased significantly due to early detection.

Breast cancer is the second leading cause of cancer death in women in America, but its also one of the most treatable when detected early, said Jacqueline Owens, MHA, BS, RDMS, director of radiology at St. Elizabeths. Each woman should take time out of her busy schedule to take care of herself and get essential screenings.

HSHS St. Elizabeths Hospital encourages women to take charge of their breast health by following these important breast cancer prevention tips:

Self-check. Starting at age 20, women should do a monthly self-breast exam. Visit http://www.nationalbreastcancer.org/breast-self-exam for more information.See your physician regularly. Women ages 20-40 should have a breast exam by a physician or nurse practitioner every three years, and annually thereafter. If you are high risk because of family or personal history, then you should see a physician every six months starting at age 25. Get a Mammogram. Mammograms should be done every one to two years for women age 40 or older and begin at age 30 if you are at high risk.Know your family history. Women who have a first-degree relative or other close relatives who have had breast cancer may be at increased risk of developing these cancers. When determining your risk due to a family history, it is important to look at the number of women and/or men in your family who have been diagnosed and the age at which they were diagnosed. Talk to your physician about your family history and discuss what you should be doing for prevention and screening.Breastfeed. Women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer later in life.Develop healthy habits. Eat low-fat foods and lots of fruits and vegetables. Stay close to the weight your doctor says is right for you and exercise regularly. An increased physical activity, even when begun later in life, reduces overall breast-cancer risk by about 10 percent to 30 percent. Limit alcohol intake to no more than one drink a day and refrain from tobacco use.If you are diagnosed with breast cancer, your physician will likely recommend a combination of treatments depending on the type of cancer, the stage of the cancer and your overall health. Common ways of treating breast cancer include surgery, radiation therapy, chemotherapy, hormone therapy and immunotherapy.

To schedule your mammogram at any of St. Elizabeths three, convenient imaging locations, call 618-222-4639 or use our easy, online scheduling tool through MyChart (https://www.hshs.org/StElizabeths/MyChart) to make an appointment. You can also learn more about the womens health services offered at HSHS St. Elizabeths Hospital at http://www.steliz.org.

To learn more about breast cancer prevention, visit https://www.cancer.org/breastcancer.

Text @RB to 618-202-4618 to sign up for Text Alerts from RiverBender!

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Honoring National Breast Cancer Awareness Month: Tips to Take Charge of Your Breast Health - RiverBender.com

Breast cancer data reported during the 2020 European Society Medical Oncology (ESMO) Virtual Congress revealed major advances in the treatment paradigm. The agents included in these trials challenged that standard-of-care.

The biggest updates presented at ESMO were in the setting of hormone receptor (HR)positive, HER2-negative advanced breast cancer. There were also some reports of efficacy with agents in triple-negative breast cancer and early breast cancer.

Updated results from the use of alpelisib (Piqray) in combination fulvestrant in the phase 3 SOLAR-1 trial were presented at ESMO by Fabrice Andre, MD, PhD, director of research at Gustave Roussy in France. First, Andre provided a recap of the primary analysis data.1

We previously reported in 2019 in the New England Journal of Medicine that alpelisib improves progression-free survival from 5 to 11 months in patients with PIK3CA mutations. There was no benefit observed in patients without PIK3CA mutations, Andre told Targeted Oncology, in an interview.

At ESMO we reported a secondary endpoint, overall survival. What was observed is that there was a difference in the median overall survival of 8 months between patients who did not receive alpelisib in patients who received alpelisib, Andre added.

The addition of alpelisib specifically prolonged overall survival (OS) in patients with HR-positive, HER2-negative, PIK3CA-mutant advanced breast cancer by 7.9 months as compared with chemotherapy alone. The median OS with alpelisib/fulvestrant was 39.3 months (95% CI, 34.1-44.9) compared with 31.4 months (95% CI, 26.8-41.3) in the placebo-plus-fulvestrant arm (HR, 0.86; 95% CI, 0.64-1.15; one-sided P .0161).

Considering stratification measures in SOLAR-1, subanalyses of patients with lung and/or liver metastases, as well as patients with PIK3CA mutations in plasma circulating-tumor DNA(ctDNA) were separately assessed. The OS result favored alpelisib plus fulvestrant in patients with lung and/or liver metastases. The median OS was 37.2 months (95% CI, 28.7-43.6) with added alpelisib versus 22.8 months (95% CI, 19.0-26.8) with fulvestrant alone (HR, 0.68; 95% CI, 0.46-1.00).

Patients with PIK3CA mutations in their plasma ctDNA also fared better in terms of OS with alpelisib/fulvestrant compared with placebo/fulvestrant with a median OS of 34.4 months (95% CI, 28.7-44.9) versus 25.2 months (95% CI, 20.7-29.6), respectively. The HR for risk of death in this subgroup was 0.74 (95% CI, 0.51-1.08).

The combination of alpelisib plus fulvestrant was overall beneficial for patients with HR-positive, HER2-negative advanced breast cancer, although the OS result did not meet the prespecified OBrien-Fleming boundary. Notably, there was a progression-free survival (PFS) benefit observed with patients, which Andre determined was supported by a numeric increase in OS.

The CDK4/6 inhibitor abemaciclib (Verzenio) was administered alone or in combination with tamoxifen as treatment of patients with HR-positive, HER2-negative metastatic breast cancer in the phase 3 nextMONARCH clinical trial. It was hypothesized with this study that, unlike other CDK4/6 inhibitors, abemaciclib monotherapy at 150 mg over 200 mg could improve survival on its own.2

To validate the theory, the study included 3 arms. In arm A, patients received abemaciclib 150 mg in combination with tamoxifen 20 mg. Arm B received abemaciclib 150 mg only, and arm C received abemaciclib 200 mg plus prophylactic loperamide.

The trial did show a promising OS improvement in the combination arm, despite not being powered for this result.

We have seen a lot of data in the first- and second-line space with CDK4/6 inhibitors, with ribociclib [Kisqali], palbociclib [Ibrance], and abemaciclib. Abemaciclib is a bit different because its the only CDK4/6 inhibitor that has a single-agent approval, Erika Hamilton, MD, told Targeted Oncology in an interview.

What we saw in nextMONARCH was that the progression-free survival and overall survival was quite similar to what was previously published, a 7.9-months difference that was not statistically significant. But we did see an overall survival benefit in [the combination arm] when abemaciclib was given in combination with tamoxifen.

The OS observed with abemaciclib plus tamoxifen was 24.2 months compared with 20.8 months among patients treated with single-agent abemaciclib at 150 mg and 17.0 months among those who received abemaciclib 200 mg. The difference between the arm A and arm C was calculated with a HR of 0.62 (95% CI, 0.40-0.97; P = .0341). The HR for the difference between arm B versus arm C was 0.96 (95% CI, 0.64-1.44; P = .8321).

It was noted during Hamiltons ESMO presentation that abemaciclib/tamoxifen also improved PFS at 9.07 months compared with 7.43 months with 200-mg abemaciclib alone (HR, 0.81; 95% CI, 0.56-1.16; P = .2493). Single-agent abemaciclib 150 mg had a median PFS of 7.23 months compared with the 200-mg dose (HR, 1.06; 95% CI, 0.74-1.53; P = .7400).

The survival results from nextMONARCH were said to have confirmed the benefit of abemaciclib that was previously observed in phase 2 MONARCH-1 clinical trial of abemaciclib alone in patients with refractory HR-positive, HER2-negative metastatic breast cancer (NCT02102490).

In the randomized, open-label phase 3 MonarchE trial (NCT03155997), abemaciclib in combination with endocrine therapy improved invasive disease-free survival (iDFS) compared with endocrine therapy alone in patients with HR-positive, HER2-negative early breast cancer, demonstrating the benefit of CDK4/6 inhibitors in other settings.3

The primary end point was invasive disease-free survival [in which we] saw significantly fewer events in those patients treated with abemaciclib compared to those who had endocrine therapy alone. It resulted in a 25% reduction in the risk of recurrence with a hazard ratio of 0.747 and this was statistically significant, Stephen R. D. Johnston, MD, PhD, FRCP, professor of breast cancer medicine and consultant medical oncologist, at the Royal Marsden, NHS Foundation Trust, told Targeted Oncology in an interview.

The HR Johnston mentioned was based on 136 iDFS events in the abemaciclib combination arm versus 187 in the endocrine therapy-only arm (95% CI, 0.598-0.932; 2-sided P = .096). At 2 years, the iDFS rate was 92.2% in the abemaciclib/endocrine therapy group versus 88.7% in the endocrine therapy-only group for an absolute difference of 3.5 percentage points. The benefit was carried over into subgroups populations, most notably among patients who had received prior neoadjuvant chemotherapy and those who were premenopausal.

A key secondary end point in this study was distant relapse-free survival (RFS), which did not include patients with local recurrence or second primary cancers. The data observed in this analysis were consistent with the primary end point showing 106 events in the abemaciclib combination arm versus 152 in the endocrine therapy arm (HR, 0.717; 95% CI, 0.559-0.920; 2-sided P = .0085). This resulted in a 28.3% reduction in the risk of distant recurrence. The 2-year distant RFS rate was 93.6% with abemaciclib/endocrine therapy versus 90.3% with endocrine therapy alone for an absolute difference of 3.3 percentage points.

The results overall imply that the addition of abemaciclib to the standard treatment of HR-positive, HER2-negative early breast cancer can prevent recurrence in these patients.

The anticipated primary analysis results from the phase 3 ASCENT trial of sacituzumab govitecan (Trodelvy) in patients with metastatic triple-negative breast cancer (NCT02574455) were presented during ESMO by Aditya Bardia, MD, MPH, medical oncologist at Massachusetts General Hospital, and assistant professor of medicine at Harvard Medical School. The results showed a significant improvement with sacituzumab govitecan over standard single-agent chemotherapy across all primary and secondary end points explored in the study.4

The first results from the ASCENT trial were presented at ESMO 2020. The primary and point of the study was progression-free survival and the study met its primary end point, Bardia told Targeted Oncology in an interview.

Overall the study was positive. Patients who received sacituzumab govitecan had a 59% lower risk of disease progression as compared with those who received standard therapy, Bardia added.

First, the median PFS achieved with sacituzumab govitecan was 5.6 months (95% CI, 4.3-6.3) versus only 1.7 months (95% CI, 1.5-2.6) with treatment of physicians choice (HR, 0.41; 95% CI, 0.32-0.52; P <.0001) per blinded independent central review. The PFS benefit was consistent across the subgroup populations explored in the study.

The OS analysis also demonstrated favor for the sacituzumab govitecan arm, which had a median OS of 12.1 months (95% CI, 10.7-14.0) versus 6.7 months (95% CI, 5.8-7.7) in the physicians choice arm (HR, 0.48; 95% CI, 0.38-0.59; P <.0001).

Finally, treatment with sacituzumab govitecan improved response from baseline in the ASCENT trial. The objective response rate (ORR) was 35% in the sacituzumab govitecan arm, which included complete responses (CRs) in 10 patients and partial responses (PRs) in 72 patients. In comparison, the physicians choice arm had an ORR of only 5% with 2 CRs and 9 PRs. Response were also more durable in the patients who received sacituzumab govitecan with a median duration of response of 6.3 months (95% CI, 5.5-9.0) versus 3.6 months (95% CI, 2.8-not evaluable) with physicians choice of therapy. The P value was .057.

Based on the primary ASCENT findings, Bardia et al concluded that the benefit of sacituzumab govitecan as treatment of metastatic triple-negative breast cancer is confirmed and should be considered a new standard-of-care treatment in this patient population.

Patients with HR-positive, HER2-negative advanced breast cancer were given treatment with ribociclib in both the MONALEESA-3 (NCT02422615) and MONALEESA-7 (NCT02278120) clinical trials. Among these patients, a subgroup had developed resistance to prior endocrine therapy.5

In MONALEESA-3 explored treatment with ribociclib in combination with fulvestrant in men and postmenopausal women with hormone receptor positive, HER2-negative, advanced breast cancer who have received no or only one line of prior endocrine treatment. MONALEESA-7 studied ribociclib compared with placebo plus tamoxifen in premenopausal women with HR positive, HER2 negative advanced breast cancer.

Pooled findings for outcomes for this subgroup from both studies were presented during ESMO by Sara Hurvitz, MD, a medical oncologist at the Ronald Reagan UCLA Medical Center, at UCLA Health - Santa Monica Medical Center.5The combined results showed a more than doubling of PFS with the addition of ribociclib to endocrine therapy.

What we showed in this exploratory analysis was that ribociclib was associated with 6-month improvement in overall survival compared with endocrine therapy alone. This underscores the activity of ribociclib in patients whose disease can be considered endocrine therapy-resistant, Hurvitz told Targeted Oncology, in an interview.

In MONALEESA-3, the 6-month PFS rate observed was 67% with ribociclib/endocrine therapy compared with 46% with endocrine therapy alone. In MONALEESA-7, treatment with ribociclib plus endocrine therapy led to a 74% 6-month PFS rate compared with 46% in the endocrine therapyonly arm.

The Kaplan-Meier curves for PFS in MONALEESA-3 showed that the median PFS favored the ribociclib combination over endocrine therapy alone at 13.4 months versus 5.7 months, respectively (HR, 0.621; 95% CI, 0.367-1.049). The benefit was also observed in MONALEESA-7 at 14.5 months versus 5.6 months, respectively (HR, 0.562; 95% CI, 0.342-0.922).

The median OS observed with ribociclib/endocrine therapy in the MONALEESA-3 study was 37.5 months compared with 31.7 months in the endocrine therapyalone arm (HR, 0.697; 95% CI, 0.365-1.330). In MONALEESA-7, the median OS was not yet reached in the ribociclib plus endocrine therapy arm versus 32.7 months with endocrine therapy alone (HR, 0.588; 95% CI, 0.304-1.136).

According to Hurvitz et al, these poster data demonstrate the consistent efficacy of ribociclib in patients with early breast cancer and endocrine therapy resistance.

References:

1. Andre F, Ciruelos EM, Juric D, et al. Overall Survival (OS) Results From SOLAR-1, a Phase 3 Study of Alpelisib (ALP) + Fulvestrant (FUL) for Hormone Receptor-Positive (HR+), Human Epidermal Growth Factor Receptor 2-Negative (HER2) Advanced Breast Cancer (ABC). Presented at: 2020 ESMO Congress; September 19-21, 2020; Virtual. Abstract LBA18.

2. Hamilton EP, Cortes J, Ozyikan O, et al. nextMONARCH: Final overall survival analysis of abemaciclib monotherapy or in combination with tamoxifen in patients with HR+, HER2- metastatic breast cancer. Presented at: 2020 ESMO Congress; September 19-21, 2020; Virtual. Abstract 2730.

3. Johnston SRD, Harbeck N, Hegg R, et al. Abemaciclib in high risk early breast cancer. Presented at: 2020 ESMO Congress; September 19-21, 2020; Virtual. Abstract LBA5_PR.

4. Bardia A, Tolaney SM, Loirat D, et al. ASCENT: A randomized phase 3 study of sacituzumab govitecan (SG) vs treatment of physicians choice (TPC) in patients (pts) with previously treated metastatic triple-negative breast cancer (mTNBC). Presented at: 2020 ESMO Congress; September 19-21, 2020; Virtual. Abstract LBA17.

5. Hurvitz SA, Lee SS, Jerusalem G, et al. Ribociclib (RIB) in patients (pts) with HR+/HER2_ advanced breast cancer (ABC) and resistance to prior endocrine therapy (ET) in the MONALEESA (ML) -3 and -7 trials. Presented at: 2020 ESMO Congress; September 19-21, 2020; Virtual. Abstract 329P.

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Leading Research From ESMO 2020 Further the Potential of Targeted Agents in Breast Cancer - Targeted Oncology

Since his coronavirus diagnosis last week, President Trump has received a variety of cutting-edge treatments, including an experimental polyclonal antibody infusion administered at the White House last Friday.

But the president, who returned to the White House on Monday after being treated at Walter Reed National Military Medical Center and reported no symptoms Tuesday, is also taking a cocktail of seemingly routine over-the-counter supplements and medications.

A recent memorandum from Trump physician Sean Conley noted that the President has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin.

As the COVID-19 pandemic rages on, with 210,000 deaths in the US and 1.04 million worldwide, can Trumps drugstore-available meds aid others in the treatment of COVID-19?

Thats still unclear, according to Dr. Bruce Farber, the chief of infectious diseases at Northwell Healths North Shore University Hospital and Long Island Jewish Medical Center.

Theres no evidence that any over-the-counter medication is active in treating or preventing COVID, Farber told The Post, adding that patients should always contact their doctors before taking any new supplements.

I think this [regimen] is somewhat unique to [Trump], Farber added.

Heres what we know so far about these supplements and how they might help treat the potentially deadly bug.

If theres one pill that stands out to Farber, its aspirin. The painkiller and blood thinner has long been part of treatment plans for those with histories of heart attacks or strokes.

Coronavirus dramatically increases the risk of spontaneous blood clots, said Farber. Thats part of COVIDs MO.

People with COVID who are sick should be on some [anti-clotting] medication, and that could be aspirin, he added.

A COVID-related aspirin trial at Xijing Hospital in China earlier this year hypothesized that early use of aspirin would reduce the incidence of severe and critical patients; however, that studys results have not yet been posted.

Famotidine, more commonly known as the over-the-counter heartburn medication Pepcid, has also been the subject of recent research.

According to a September hospital study from Connecticuts Hartford HealthCare, COVID patients who took famotidine were 45 percent less likely to die in the hospital, as well as 48 percent less likely to require a ventilator to breathe.

Current thoughts are that it may lessen the hyperimmune inflammatory response, said cardiologist Dr. Raymond McKay, the studys primary investigator, who added that the results ought to be considered preliminary and that the specific reasons for these positive outcomes were still theoretical.

Zinc, an over-the-counter mineral, is known to regulate the immune system and metabolism.

According to preliminary research from doctors working in a Barcelona hospital, patients with lower zinc levels were more likely to die from the coronavirus.

Older people and others more susceptible to COVID, such as those with a heart condition or diabetes, may also have lower zinc levels due to diet or lower absorption levels, according to a recent Wall Street Journal column,Trump Takes Zinc. Maybe You Should Too.

But Farber warns that there is too much of a good thing.

It can cause toxicity, he said. Symptoms of too much zinc can include nausea and vomiting, as well as flu-like symptoms of fever, chills or fatigue.

Zinc is not totally benign particularly if taken in large quantities for long periods of time, he added.

A recent study from the University of Chicago Medicine found a link between vitamin D deficiency and testing positive for COVID-19.

Vitamin D is important to the function of the immune system and vitamin D supplements have previously been shown to lower the risk of viral respiratory tract infections, said David Meltzer, lead author of the study.

Last month, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recommended vitamin D supplements, which he himself takes, noting that it has an impact on your susceptibility to infection.

The hormone melatonin, known to regulate sleep and produced by the brains pineal gland, can also be taken as an oral supplement.

Its usually used for sleep and sleep health, said Farber.

Additionally, the hormone has anti-inflammatory and antioxidant qualities.

Researchers at the State University of New York at Buffalo recently began a yearlong trial to determine whether melatonin can reduce the severity and halt the progression of COVID-19 when taken while symptoms are mild.

Excerpt from:
Inside Trump's supplement regimen and what experts say you can try too - New York Post

The flu shot is the best defense that we have to protect ourselves and others from getting sick with the influenza virus. Every year, new flu shots are developed that will protect against multiple strains of the flu. The CDC recommends that everybody over the age of 6 months old get the flu shot, with only a few rare exceptions.

Luckily, allergic reactions to the flu shot are extremely uncommon, leaving little reason for us to avoid getting the flu shot, unless your doctor specifically advises against it for you. For example, if you have an egg allergy, you might need to take certain precautions and discuss the shot with your doctor.

However, a preservative allergy is even rarer, and should not deter you from getting the flu shot, says Ryan Steele, DO, board-certified allergist-immunologist and internist at Yale Medicine.

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If you experience these symptoms, contact a healthcare provider immediately.

You should get the vaccine under the careful supervision of a healthcare provider in a medical setting if you:

You should only avoid the flu vaccine altogether if you have previously had a severe reaction to the flu shot itself.

It is a myth that Guillain-Barr syndrome (GBS) is a common reaction to the flu shot. In reality, there are only one to two cases of GBS per million flu shots administered.

GBS causes your immune system to attack nerves in your own body, resulting in symptoms like tingling or numbness that start in the lower body and escalate. This has the potential to result in paralysis, but most people can recover from GBS and live life normally.

The benefits of getting the flu shot greatly outweigh the risks. If you don't get a flu shot, your chances of becoming seriously ill from the flu are much higher than your chances of having an allergic reaction to the vaccination.

If you have personal concerns about the flu shot and any allergies, consult your doctor.

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Can you have an allergic reaction to the flu shot? It's very rare, but those with egg allergies may be at risk - Business Insider India

NEW YORK (PRWEB) October 08, 2020

With the health of every American being a consistent topic of conversation, and rightfully so, it has become more important than ever for individuals to be equipped with the knowledge necessary to protect themselves and their loved ones from everyday diseases and ailments. In an effort to provide the resources and information that will create informed citizens who are taking control of their health, Dr. Michelle Sands, licensed Naturopathic Physician (ND) and Co-Founder of GLOW Natural Wellness will launch Natural Medicine at Home, the free online series that focuses on making health building tools, foundational skills, and healthy lifestyle protocols accessible and affordable for all people. The virtual event goes live October 18, 2020 until October 18, 2020 but participants can take advantage of early admission now and be granted access to several of the talks, the meal plan and a host of health building resources.

As the author of the internationally best-selling book, "Hormone Harmony Over 35: A New, Natural, Whole-Body Approach to Limitless Female Health, Dr. Sands is excited to utilizing her expertise in womens and metabolic health, autoimmunity conditions and genetics to help those in need. These natural medicine techniques will help both women and men that are looking to learn affordable accessible at home health building tools and techniques to help them combat chronic disease, fortify their immune health and live healthier. Each day of the seven day long immersive event will provide the platform for Dr. Sands to teach participants how to use natural medicine safely and effectively in the privacy of their own homes, with the purpose of overcoming the various medical conditions that they may be enduring or subjective to. Virtual attendees will be treated to a well-defined daily schedule that is personally curated by Dr. Sands herself and will include:

"Naturopathic Physician on a mission to help Americans get healthy, right at home, says Dr. Sands. In the midst of the COVID pandemic, we are seeing those with chronic health conditions being at an inherent higher risk for illness, so it was an important mission of mine to bring together the top health and wellness experts in the world to teach Americans how to build health in a accessible and affordable way, right at home; while being free and online.

The Natural Medicine at Home program is the first step for those that are ready to take their health into their own hands and make the life changes necessary for a long and healthy life.

For additional information and to view the video trailer, list of topics, and international panel of experts please visit:

Registration

ABOUT DR. MICHELLE SANDSDr. Michelle Sands is a licensed Naturopathic Physician (ND), Co-Founder of GLOW Natural Wellness and author of the #1 Internationally best-selling book, "Hormone Harmony Over 35: A New, Natural, Whole-Body Approach to Limitless Female Health". She is a highly sought-after Female Hormone and Epigenetics Expert specializing in womens health, holistic fertility treatments and autoimmune conditions. Dr. Michelle, her book and resulting programs, have been featured on various platforms including ABC, CBS, Outside Magazine, The Boston Herald, NBC, Fox News, and USA Today to name a select few. Her groundbreaking program, "DNA Made Simple" takes away the confusion around genetics and epigenetics and gives people a personal, scientifically supported instruction manual for optimal health. She uses data driven science, holistic lifestyle medicine, natural supplementation, epigenetic coaching, and eastern philosophies to pinpoint the source of various chronic conditions and as a result helps patients restore their overall health and increase vital energy. Dr. Michelle is also a Board-Certified Holistic Nutritionist, Certified Personal Trainer and award-winning endurance athlete.

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GLOW Natural Wellness Creates Free Online Resource To Promote Healing At Home And Managing Chronic Disease During Pandemic - PR Web

Nadia Smetana

Lansford

This letter is in response to the letter from Elizabeth Larson published in the Sept. 26-27 issue of the MDN, Abortion Reversal not medically sound.

I am happy for the chance to clarify some things that were brought up in the letter. First of all, lets talk about terms. The letter used the term abortion reversal. The fundraiser held by Dakota Hope featured a woman who had experienced abortion pill reversal.

Surgical abortions are completed within minutes and of course, are not reversible. A medical abortion is a 2-step process. The first abortion pill (mifepristone or RU-486) is given at the abortion clinic. It causes an abortion by blocking progesterone receptors. Progesterone is a necessary hormone that nurtures and supports a pregnancy.

The second abortion pill (misoprostol or Cytotec) is taken at home and its purpose is to cause the uterus to contract and expel the baby.

Some women regret the abortion soon after taking the first pill. For these women there is a possibility for a second chance to save the pregnancy. Abortion Pill Reversal is a cutting-edge application of a time-tested, FDA approved treatment used safely for decades to prevent miscarriage and preterm birth. It involves an off-label prescription of progesterone to counteract the effects of the first abortion pill. Time is of the essence. The goal is to start the progesterone within 24 hours of taking the first abortion pill, but there have been many successful reversals when treatment was started within 72 hours.

A woman who wants to continue her pregnancy should not take the second abortion pill. She should also connect to a local prescribing physician for abortion pill reversal and a pregnancy help center by calling the 24/7 helpline at 1-877-558-0333 or go to the APR website, abortionpillreversal.com

According to the APR website, more than 1000 women have successfully reversed their pill abortions since the program began and many of their stories can be found on the above referenced website. Everyone is invited to listen to the powerful story of Rebekah Hagan who spoke at the Dakota Hope Fundraising Banquet. Listen free for a limited time until Oct. 21 on the Dakota Hope Clinic website event page.

As to the question of whether this is a safe and effective medical procedure, there is good evidence that it is. I would refer anyone to the resources I will post on the Friends of Dakota Hope FB page and on the Dakota Hope Clinic website under the Partner With Us tab.

After spending 16 years as a research nurse, I know that headlines on research articles can be misleading and you must take a second look at details. This is true of the 2019 study Larson referred to in her letter that purported to show that the abortion pill reversal procedure was not credible and could be harmful to patients. That study actually pointed to the riskiness of the abortion pill itself because the two patients that needed treatment for severe bleeding had received placebo, not progesterone, after taking the first abortion pill.

Another criticism leveled at abortion pill reversal proponents is that women who do not take the second abortion pill may retain the pregnancy anyway. The literature indicates that up to 25% of women who only take the first abortion pill will stay pregnant. The latest published study shows that the percentage of women who stayed pregnant when progesterone was added was 68%, a significant increase.

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Abortion pill reversal is medically sound | News, Sports, Jobs - Minot Daily News

As COVID-19 continues to sweep across the globe, people with thyroid disease are searching for answers.

"Does my thyroid condition put me at higher risk for infection?""What about complications?""Is it safe to continue taking my thyroid medication?"

These are common questions that endocrinologists face every day.

As of September 2020, there have been 56,236 articles on COVID-19 published in the medical literature, but only a handful address the relationship between thyroiditis and COVID-19. Because the evidence remains extremely limited, we aim to summarize the available data and offer clinical guidance to practicing endocrinologists and other clinicians.

We know that SARS-CoV-2 enters target cells by binding to angiotensin-converting enzyme 2 (ACE2). Because of the high relative expression of ACE2 on thyroid cells compared with lung cells, one hypothesis for thyroid involvement is that ACE2 in thyroid tissue might be a receptor for SARS-CoV-2 invasion.

Case reports, case series, and retrospective studies describing the association of COVID-19 and thyroiditis have reported subacute thyroiditis/de Quervain thyroiditis manifesting as subclinical hyperthyroidism or overt hyperthyroidism, often with high circulating concentrations of IL-6. Both typical (painful) and atypical (not painful) clinical presentations have been described.

Thyroid dysfunction in subacute thyroiditis usually follows a triphasic course (ie, thyrotoxicosis first, followed by hypothyroidism, and then, finally, euthyroidism) that lasts about 3 months. Symptomatic thyrotoxicosis occurs in the majority of patients, but clinical hypothyroidism is uncommon. Because viral infections such as mumps, influenza, adenovirus, coxsackie, and Epstein-Barr and cytomegalovirus viruses are known environmental triggers for subacute thyroiditis, from a biological standpoint it is not surprising that one of the manifestations of COVID-19 could be an episode of thyroiditis.

In a recent study, about 20% of hospitalized patients with COVID-19 and no previous thyroid disease were found to have elevated serum free T4 concentrations in association with decreased (but not suppressed) serum TSH concentrations and a negative antibody panel that included TSH receptor, antithyroglobulin, and TPO antibodies.

The administration of heparin, which can displace T4 from binding proteins, could play a role in these observations. However, these findings are more consistent with a diagnosis of mild hyperthyroidism possibly due to thyroid inflammation and related destructive thyroiditis due to systemic immune activation. As such, management of these patients should focus on controlling adrenergic symptoms rather than initiating antithyroid drugs.

Similarly, another study found that a substantial portion (15%) of patients with COVID-19 requiring ICU care had low TSH concentrations. However, the mean serum free T4 concentrations were not significantly different between ICU patients with and without COVID-19. The biochemical abnormalities and clinical presentation were not typical of either subacute thyroiditis or nonthyroidal illness, also known as euthyroid sick syndrome.

Multiple mechanisms may contribute to the development of euthyroid sick syndrome in the critical care setting, including alterations in TSH secretion, peripheral 5'-deiodination of T4 to T3, thyroid hormone binding to plasma proteins, transport of thyroid hormone in peripheral tissues, and thyroid hormone receptor activity. Currently available data do not support a clear benefit of treatment with thyroid hormones in euthyroid sick syndrome; ongoing clinical trials are focusing on new management strategies to explore whether restoration of normal serum thyroid hormone concentrations improves patient prognosis and clinical outcomes.

Further studies are needed to determine whether it is appropriate to increase thyroid function testing in critically ill patients with COVID-19. While awaiting these data, clinical judgement is required; symptoms of hypothyroidism or thyrotoxicosis in patients with COVID-19 should prompt thyroid function testing.

There is no evidence to date that patients with existing autoimmune thyroid disease are more susceptible to contracting viral illnesses, including infection with SARS-CoV-2, or that they are at higher risk of developing more severe COVID-19 disease. There is also no evidence to suggest increased risk for COVID-19 in poorly controlled thyroid disease, but patients with uncontrolled thyroid dysfunction (especially hyperthyroidism) may be at higher risk for complications of overt thyrotoxicosis and thyroid storm triggered by infection. Hence, patients should continue their antithyroid medications to decrease this risk.

We must educate patients about the potential complications of severe neutropenia, the signs and symptoms of agranulocytosis that may occur with antithyroid medications, and the need for urgent medical evaluation. Because symptoms of neutropenia (sore throat, mouth ulceration, fever, and flu-like illness) may overlap with symptoms of COVID-19 (fever, new continuous cough, and flu-like illness), clinical differentiation can be challenging. The best suggested approach is to stop the medication and obtain a complete blood panel to evaluate for neutrophil count. Test for COVID-19 if indicated, as lymphopenia and thrombocytopenia are seen in COVID-19 and are less likely to be related to antithyroid drugs.

After symptom resolution, antithyroid drugs can be resumed at a lower dose, or an alternative drug may be considered. If symptoms recur after reinitiation of the drug, alternative treatments for hyperthyroidism, such as radioactive iodine ablation or surgery, should be considered.

There are no suggested changes for the diagnosis and treatment of hypothyroidism during the COVID-19 pandemic. Advise patients to continue the same form and dosage of thyroid hormone replacement therapy. Thyroid function testing with TSH and FT4 levels is indicated if a patient reports significant change in hypothyroidism-related symptoms, such as worsening fatigue or weight changes, in order to adjust medication if needed. For pregnant patients, the dose of levothyroxine should be titrated to achieve the usual trimester-specific TSH targets.

In conclusion, there are no data available to suggest that patients with preexisting thyroid conditions are at higher risk for COVID-19 or its complications. Advise patients to continue their current treatment for their underlying thyroid condition but to be vigilant about reporting new symptoms. In patients severely affected by COVID-19, changes in thyroid function may be transient and related to thyroiditis or euthyroid sick syndrome, but specific thyroid-related damage and sequelae may also occur, requiring further investigation.

Physician and patient resources on COVID-19 and the thyroid are available on the American Thyroid Association website.

Spyridoula Maraka, MD, MS, is an assistant professor of medicine at the University of Arkansas for Medical Sciences (UAMS), program director of the UAMS Endocrinology fellowship program, and staff physician at the Central Arkansas Veterans Healthcare System. She has published more than 50 articles in high-impact journals, has received multiple awards and invitations to present at national and international conferences, and serves on committees of several professional organizations.

Soumya Thumma, MD, is a senior UAMS clinicalfellow in endocrinology with clinical practice interest in thyroidology. She has worked on promoting patient education and serves on national committees of two professional organizations.

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Is Thyroid Disease Worsened by COVID? - Medscape

Sevar Yaldo gets outdoors to relief the stress of an exam. Image: Lillian Young.

By Capital News Service

Fresh from what was conceivably the most important exam of his life, aspiring physician Sevar Yaldo sat on a Bailey Park bench for some fresh air in East Lansing.

Having spent the majority of the pandemic indoors preparing for the Medical College Admission Test, Yaldo understands and literally studied the psychological importance of getting outdoors during quarantine.

The slightest bit of fresh air can go such a long way in improving his thoughts, relationships and self-esteem, Yaldo said. Whenever I have a chance to not be inside, I will be outside, whether Im walking or running.

We often hear about how crucial it is to eat our greens. But rarely do we talk about the importance of seeing green.

Relationships with nature have diminished in an increasingly artificial world. Depression and obesity are reaching unprecedented levels.

While there are a host of treatments including medication and therapy regimens mitigating such problems may be simpler.

Anne Bretton enjoys birdwatching at Harris Nature Center in Okemos: Image: Yue Jiang.

I encourage patients with all kinds of mental health conditions be it anxiety, depression, or whatever else to get outside. Ill suggest that they walk to my office rather than driving there, said Okemos psychologist Pamella Montgomery. By the time they arrive, they always report feeling significantly better.

Montgomery has long advocated spending time outdoors.

I worked and went to graduate school full time with a 30-hour-a week internship on the side, but I still managed to run outdoors. To this day, regardless of the weather, I run outside, Montgomery said. Being outdoors and in nature is crucial to our being. Were creatures that need to interact with nature.

Psychologically, she said, Going outside gets you out of your indoor rut. It makes you stop and think about things, which you dont do sitting in front of the TV or computer.

Paul Smith of Ann Arbor drove about 1 hours to go rock-climbing at Oak Park in Grand Ledge.

This is a sport you cant really do by yourself, which I know is very insane during our COVID times, said Smith, who was with a group of people at the Ledges.

Since the start of the pandemic, Smith said hes spent less time outside. With winter coming, hes trying to get outside more.

In addition to it being physically healthy, being outdoors has a good mental impact, he said. If youre just inside all the time, I definitely find it causes a lot of drain and wear on your emotions.

Kobe is out for a morning walk in Westland. Image: Kalah Harris.

In the age of COVID-19, getting fresh air takes on new meaning.

Those fortunate enough to be near parks and trails can safely socially distance.

When Craig Dennis needs to kill time, he hits a nature trail in East Lansings Harrison Meadows Park. It gave me a purpose to go out and exercise and feel good, he said.

Outdoor activities are bustling as people have taken to hiking, walking dogs, biking and running because indoor activities remain limited. Dennis said hes seen coronavirus-wary older neighbors get outside more.

Speaking of dogs, one chilly morning in Westland, Kobe, with tongue hanging low was out for a walk with owner Jacquis Smith.

I shortened the time of how much time I spend outside. Ive noticed people arent wearing their mask when they are walking their dogs, but I always have mine on, Smith said,

Michigan State University education professor David Stroupe walks a trail alongside the Red Cedar River on campus.

I try to go in the woods and hear the birds, Stroupe said.

Michigan State professor David Stroupe hikes near the Red Cedar River. Image: Chioma Lewis

Stroupe was already going on regular walks before COVID 19 but has noticed more animals since the pandemic began. I think theyre more bold.

He doesnt bring technology. Being unplugged makes the walk more enjoyable. Since were on computers a lot now, I try and leave my phone at home, he said.

Green, leafy environments can boost a persons mood, speed up brain activity and improve overall health, according to research from the Department of Psychology at Ottawas Carleton University.

And like an all-natural ventilation system, trees and plants encountered on nature walks produce oxygen and scrub carbon dioxide from the atmosphere.

More sunshine helps. Direct sunlight isnt enough to wipe out COVID-19, the Centers for Disease Control and Prevention says, but can help produce vitamin D to gear up the immune system to fight infectious disease.

Sunlight also causes the brain to produce the hormone serotonin, which can heighten happiness.

Lansing resident Driscilla Tettey has been spending more time outdoors. Image: Audrey Porter.

On a rainy recent evening, the weather and COVID-19 didnt stop the daily busy world, especially not for Lansing resident Driscilla Tettey, whod been running errands all day.

Ive been spending more time outside now during the pandemicbecause we were social distancing and in isolation. We had to be indoors all the time, and that can take a toll on your mental health, so definitely spending more time outside helped boost my mental health and my overall well-being, Tettey said.

Anne Breton, who has been coming to the Harris Nature Center in Okemos for more than 20 years, said its been a gift to have parks in Meridian Township during this COVID-19 era.

We can walk with friends at a social distance,she said after finishing a birdwatching trip in the park.

Shes seen an uptick in the number of people of all ages using the park and said she hopes some who hadnt been enjoying the outdoors will make that a part of their lives, even after they can again go to movies.

Mckenzie Dickens takes a break from walking around the Michigan State Botanical Gardens. Image: Anne Hooper.

Mckenzie Dickens walks barefoot through rows of plants in the MSU Botanical Gardens. Sitting on the grass, crossing his legs and tucking his dreadlocks into a bandana, he said time outdoors is precious, especially in the face of COVID-19.

Theres a point when watching Netflix gets tiresome.Thankfully, though, Gov. (Gretchen) Whitmer kept state parks open so people can visit them, Dickens said of Michigans early lockdown.

For all the harm this pandemic has caused, maybe it has a silver lining. Maybe it can teach everyone how to be outside again, he said.

And its not only people in Michigan who see a silver lining.

Before the pandemic, getting outdoors wasnt easy for Bernard Crawford, an advertising student at Florida Atlantic University. With more time on his hands, being outside is the new highlight of his day.

Bernard Crawford takes a stroll in Boca Raton, Florida. Image: Lea Mitchell.

On an afternoon stroll in the 90-degree weather along Boca Raton streets, Crawford said hes felt a greater sense of connection with nature and is outdoors much of the day.

Being a full-time student, I never had the chance to get out and enjoy Gods beautiful creation. Im upset I was always inside playing video games before, he said.

This story was reported and written by Kathleen Fitch, Kalah Harris, Anne Hooper, Yue Jiang, Chioma Lewis, Lea Mitchell, Claire Moore, Audrey Porter and Lillian Young, and edited by Jiang and Lewis.

Excerpt from:
Engaging with nature and just getting outside help in the age of COVID-19 - Great Lakes Echo

Chantix, the brand name version of a drug called varenicline, is a nicotine-free prescription pill used to help people quit smoking gradually. Unlike nicotine replacement therapies, varenicline blocks the brain from getting pleasure due to nicotine.

Smoking is the leading cause of preventable death worldwide. This is likely because it's so difficult to quit, thanks to how nicotine affects the brain.

When you smoke, nicotine attaches to receptors located in the brain's reward center. This causes those receptors to release dopamine, a hormone that elicits feelings of pleasure. Once that dopamine rush wears off, you begin to crave nicotine, says Panagis Galiatsatos, MD, the director of the Tobacco Treatment Clinic at Johns Hopkins Medicine.

Chantix helps break this nicotine addiction in two ways:

When smoking becomes an addiction, your brain associates certain smells, locations, or emotions with the action. This makes you want to smoke when you're in certain situations, even if your brain isn't in need of a dopamine rush, says Galiatsatos.

If you smoke on Chantix, not only will it be unsatisfying, but it will also break the association between specific circumstances and the need to smoke.

"If you try to smoke [while on Chantix], it won't be successful," says Galiatsatos. "Varenicline also keeps [higher] dopamine [levels] in the brain, satisfying pleasure sensors without nicotine, and cuts cravings."

Chantix is available by prescription only and is usually prescribed for 12 weeks. It's important to speak with your healthcare provider to determine the right dosage and plan for you.

There are three proven ways you can use Chantix to quit smoking:

How long quitting takes will depend largely, but not solely, on your smoking habit. "Some patients can quit immediately but others need to be on it for longer than 12 weeks. Guidelines are fine but they are not rules, you have to adapt treatment to the patient," Galiatsatos says.

In the United Kingdom, one in four people who quit smoking were using Chantix.

A 2020 report found that experts specializing in tobacco addiction recommended that those who wish to quit smoking take varenicline over all other treatment options. The experts also recommended pairing Chantix with a nicotine patch.

A 2016 review also found that varenicline is "the most effective single-use agent for treating tobacco addiction." Two large trial studies compared smokers who took either varenicline, bupropion, or a placebo for 12 weeks. It found that 44% of those in the varenicline group had successfully quit smoking four weeks after they completed their 12-week dose, compared to 30% in the bupropion group and 18% in the placebo.

The study also found that the efficacy of varenicline is improved when paired with bupropion an antidepressant and nicotine replacement therapies such as gum, patches, or lozenges.

While there are side effects to be aware of when taking Chantix, Galiatsatos says that the drug poses no more of a risk than commonly used antidepressants. However, some people, especially those with a history of mental illness, may experience serious adverse side effects, such as:

If you experience any of these symptoms, stop taking Chantix immediately and see your doctor.

Chantix works by delivering a one-two punch to smoking: It blocks nicotine from reaching receptors in the brain, which breaks the pleasure cycle of habitual smoking, and prevents cravings by releasing small amounts of dopamine.

Studies show that Chantix is particularly effective when paired with nicotine replacement therapies such as a nicotine patch. However, those on Chantix should pay close attention to any adverse side effects, especially mood changes, and check-in with your doctor if you experience them.

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Chantix may be the most effective way to quit smoking here's how it works - Insider - INSIDER

Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

Over the weekend, President Donald Trump said the country needs and wants a second stimulus bill. But on Tuesday, President Trump called off any chance of a stimulus bill until after the November election.

Trump says he is asking Senate Majority Leader Mitch McConnell to spend his energy confirming Trumps Supreme Court nominee, Amy Coney Barrett, and not negotiate further with Democrats, who wanted $2.6 trillion in stimulus relief. The White House had offered $1.6 trillion.

Millions of unemployed Americans hoped to get another round of enhanced unemployment benefits. Even more Americans might have gotten a stimulus check, as they did in the spring.

The presidents order came just hours after Federal Reserve Chair Jerome Powell warned the nations economic recovery could falter without more federal stimulus. The Associated Press reported:

Powell said Tuesday that the risks of Congress pouring too much stimulus into the economy are far lower than the risk of not doing enough. Although government spending is adding to an already sky-high federal budget, lawmakers should act, Powell argued.

The presidents announcement came just before the stock market closed Tuesday, but in the short period left in the trading day, the Dow dropped 400 points.

The Dow Jones Industrial Average dropped minutes after the president called off talks with Democrats

Airlines, in particular, saw a selloff. Airlines had said they could reverse some of the more than 35,000 layoffs they announced last week if Congress could approve a stimulus bill.

The Senate has a two-week hold on floor sessions after three GOP senators tested positive for COVID-19. Many experts predict the election will not be settled for days or even longer after Election Day, so it is difficult to imagine Congress being able to successfully take on a multi-trillion-dollar relief package in the midst of disruption, particularly if the balance of power changes in the election.

Some business analysts Tuesday evening offered the notion that the president might be bluffing and will reengage in talks.

Air travel is going to be more complicated this year. Beyond all of the COVID-19 testing and mask-wearing, there are going to be a lot fewer flights. Southwest Airlines, for example, says it will have 90,000 fewer flights in November and December. The Dallas Morning News reported:

Southwest cut 38,000 flights from its November plans, or about 36% of all trips, according to Dallas-based Airline Data Inc. The carrier also cut 55,000 flights for December, nearly half of its schedule.

American Airlines announced this week it was cutting holiday season flights, too. American removed 86,000 flights, almost half of its normal schedule, from the November calendar.

Boeing said this week that the pandemic will hurt jet sales for more than a decade.

Six states are now in the process of reversing orders that reopened public gatherings, businesses and schools. Four more have paused further reopenings for now.

Wisconsin Gov. Tony Evers says starting Thursday morning, the state will reimpose restrictions on the size of indoor gatherings. Evers said, Were in a crisis right now and need to immediately change our behavior to save lives.

Wisconsin has four of the top 10 cities on The New York Times calculation of average daily cases compared to population over the last two weeks.

New polling from Axios/Ipsos finds about one in five Americans say President Trumps COVID-19 diagnosis makes them more likely to wear a mask and stay six feet away from other people.

(Ipsos)

Another poll, this one from Long Island University, finds that one in 10 Americans do not believe masks help prevent COVID-19 infections.

Journalists have repeatedly pointed out two COVID-19 risk factors that make President Trump more vulnerable to the virus. First is his age. The other is that he is obese.

What does obesity have to do with COVID-19 risk? It is a serious question since about 42% of American adults are obese.

Since the beginning of this pandemic, dozens of studies have shown obesity to be a key factor in who is likely to get the sickest from the virus. In one study involving 399,000 patients, People with obesity who contracted SARS-CoV-2 were 113% more likely than people of healthy weight to land in the hospital, 74% more likely to be admitted to an ICU, and 48% more likely to die.

One study of New York City COVID-19 cases found:

Being an individual with obesity increases the odds of COVID19 patients being hospitalized. Among diagnosed COVID19 patients, the prevalence of individuals with obesity in hospitalized patients was much higher than that in non-hospitalized patients. For example, a report that included 5700 patients with obesity in New York City showed that 41.7% of COVID19 hospitalized patients were individuals with obesity, whereas the average prevalence of individuals with obesity in New York City was 22.0%.

Another study of nearly 17,000 COVID hospitalized patients in the United States found 77% of those patients were either overweight or obese.

In fact, obesity is the No. 1 risk factor for developing a severe case of COVID-19 in people under the age of 55, warns Dr. Kyle Stephens, weight loss surgeon at Houston Methodist Hospital. Dr. Stephens says:

What we know historically from the influenza, tetanus and hepatitis B vaccines is that people who are obese seem to benefit less from vaccination than people who are at a healthy weight.

He adds that while researchers do not know exactly why vaccines do not work as well on obese people, it seems to have something to do with a chronic state of inflammation associated with obesity that interferes with a vaccines ability to do its work.

And obese patients are more likely to have other underlying health issues including diabetes, heart disease and lung disease which makes it more difficult to fight an invading virus.

Science Magazine described something physicians refer to as sticky blood that is associated with obesity:

For starters, the blood of people with obesity has an increased tendency to clot an especially grave risk during an infection that, when severe, independently peppers the small vessels of the lungs with clots. In healthy people, the endothelial cells that line the blood vessels are normally saying to the surrounding blood: Dont clot, says Beverley Hunt, a physician-scientist whos an expert in blood clotting at Guys and St. Thomas hospitals in London. But we think that signaling is being changed by COVID, Hunt says, because the virus injures endothelial cells, which respond to the insult by activating the coagulation system.

Add obesity to the mix, and the clotting risk shoots up. In COVID-19 patients with obesity, Hunt says, Youve got such sticky blood, oh my the stickiest blood I have ever seen in all my years of practice.

For a more detailed explainer on some of the theories about the connections between obesity and COVID-19, go to this study and flip down to Section 4.

I am not sure how well this claim would sit with the Food and Drug Administration if a mattress or pillow company tried to claim their product fights COVID-19. But National Geographic ran an interesting piece quoting Monika Haack, a psychoneuroimmunologist at Harvard Medical School, as saying, We have a lot of evidence that if you have an adequate amount of sleep, you definitely can help to prevent or fight any kind of infection.

When you do not get enough sleep, the body can reduce antibody responses to hepatitis A, hepatitis B and H1N1 swine flu vaccines. Researchers say one sleepless night might make a difference.

The story says:

Growing evidence also shows that sleep deprivation impairs a persons ability to fight off a disease once they are infected. In a number of studies, people with sleep disorders, people who catch less than five or six hours of shut-eye per night, and people with low levels of sleep efficiency (the percentage of time spent snoozing during the night) report higher rates of respiratory illnesses, head colds, and related ills.

In a 2019 study, Haack and colleagues listed more than three dozen ways that various immune-system players vary based on sleep changes. For instance, T cells are part of the immune system and are often described as the soldiers that fight infections. During sleep, according to studies by German researchers, T cells normally move out of the blood and likely into lymph nodes, where they conduct surveillance for invading pathogens, Haack says. But just one night of sleep deprivation, studies show, is enough to keep T cells circulating in the blood, making them less able to learn about and respond to invading viruses. When the body is denied sleep, T cells also become less able to interact with virus-infected cells, reducing their power to fight the infection.

Cytokines, a category of inflammatory molecules connected to the pandemic, are also a major focus of research on sleep and immunity. Pro-inflammatory cytokines normally help organize an immune response to infections, triggering other cells to come fight, says Sheldon Cohen, a psychoneuroimmunologist at Carnegie Mellon University. But the production of too many of these molecules adds up to a cytokine storm, an overreaction associated with severe and fatal cases of COVID-19. In studies of colds and influenza, infected people with poor sleep show worse symptoms, probably because elevated levels of pro-inflammatory cytokines interfere with T cells and other immune cells.

The National Geographic story points to a fascinating study from the University of California, San Francisco, and Carnegie Mellon University in Pittsburgh that took 164 healthy adults and squirted the virus connected with the common cold up their noses. The adults who slept less than six hours a night before being infected were more than four times more likely to get sick.

Other evidence shows that when you do not get enough sleep, you are more likely to make bad decisions that may include not adequately protecting yourself from viral hazards.

The Sleep Foundation says the pandemic is interrupting our sleep, even when we try to get enough rest. Worry, anxiety and working on computers late in the day before you go to bed are all sleep-killers. The blue light from screens can suppress the natural production of melatonin, a hormone that the body makes to help us sleep, the Sleep Foundation says.

Other ways the pandemic may be messing with your sleep:

It can be difficult to adjust to a new daily schedule or lack of a schedule.

Keeping track of the time, and even the day, can be hard without typical time anchors like dropping kids at school, arriving at the office, attending recurring social events, or going to the gym.

Being stuck at home, especially if it has low levels of natural light, may reduce light-based cues for wakefulness and sleep, known as zeitgebers, which are crucial to our circadian rhythm.

If you are not working at the moment or your weekly hours have been decreased due to COVID-19, you may be tempted to oversleep each morning. Sleeping more than seven to eight hours per night can make waking up on time much more difficult, even if you use an alarm. Oversleepers may also feel groggy, irritable and unfocused throughout the day.

Eddie Van Halen died, which just adds to the pain.

Joint Chiefs of Staff in quarantine,stock market tanks, stimulus talks collapse, learning to live with Covid, East Wing staff in full PPE, Pence doesnt want Plexiglas at debate. its barely noon on the West Coast!

Michael M. Grynbaum (@grynbaum) October 6, 2020

Dan Zak, White House correspondent for The Washington Post, documented a moment you never thought you would see. A guy in a hazmat suit walked through the West Wing press area with a sanitizing wand.

This is going on at the White House today. (This is the press area.) Video by @jabinbotsford. pic.twitter.com/46nFvIeKHs

Dan Zak (@MrDanZak) October 6, 2020

Well be back tomorrow with a new edition of Covering COVID-19. Sign up hereto get it delivered right to your inbox.

Al Tompkins is senior faculty at Poynter. He can be reached at atompkins@poynter.org or on Twitter, @atompkins.

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Coronavirus stimulus talks break down: There will be no stimulus until after the election - Poynter

WASHINGTON, D.C. (WCBD) Dr. Sean P. Conley, Physician to the President, on Friday announced that President Donald Trump is receiving treatment for COVID-19 after testing positive for the virus early Friday morning.

Conley said that POTUS received a single 8-gram dose of Regenerons polyclonal antibody cocktail via infusion.

President Trump is also taking zinc, vitamin D, famotidine, melatonin, and a daily aspirin, according to the letter. It is unclear whether this regiment is related to his COVID-19 diagnosis.

According to the National Institutes of Health, zinc is a natural mineral and immunity booster often used to reduce the severity and duration of cold symptoms.

Vitamin D, most often associated with sunlight, may be used for the reduction of inflammation as well as modulation of such processes as cell growth, neuromuscular and immune function, and glucose metabolism, according to the National Institutes of Health.

Famotidine is a heartburn relief and acid-reducing drug.

Melatonin is a naturally occurring hormone often taken as a sleep aid.

Aspirin is taken for a variety of reasons. It can serve as an anti-inflammatory, fever reducer, pain reliever, and blood thinner.

Despite feeling fatigued, Conely reports that the President is in good spirits.

First Lady Melania Trump also tested positive and is experiencing mild symptoms as well. There is no word on whether the First Lady has received treatment.

Continue reading here:
POTUS being treated with antibody cocktail, according to letter from his physician - WCBD News 2

President Donald Trump has now received two experimental treatments for his coronavirus infection, a combination that doctors say is logical but untested.

After being flown to Walter Reed Medical Center, President Donald Trump received an IV infusion of the antiviral drug remdesivir, the White House physician said Friday night. He previously got a dose of an experimental antibody cocktail.

After testing positive for the coronavirus, Trump had a fever, a mild cough, nasal congestion, and fatigue, Conley said. The timeline on when exactly the president tested positive was not immediately clear, but Conley said the COVID-19 diagnosis was confirmed via testing on Thursday.

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Shortly after Conley provided an update on Trump's health Saturday, an anonymous source familiar with the president's health appeared to contradict the physician's assessment.

"The thought is if you can reduce the viral burden with an antiviral early on, then maybe the progression will be halted in some way," Dr. Mangala Narasimhan, an intensive care doctor who oversees ICU care at Northwell Health, told Business Insider on Saturday.

"Given the fact he's 74, a male, and obese, I think he's in a higher-risk category, so his chances of getting sick from this are higher," she added. "They are trying to prevent that from happening"

The antibody treatment is made by the biotech company Regeneron and is not approved by the FDA. The experimental treatment aims to boost the body's immune response to help in fighting the virus.

Read more: Trump just received Regeneron's experimental COVID-19 treatment. Here's the inside story of the biotech and its 2 billionaire founders.

"We are clearly in a data-free zone right here," Dr. Taison Bell, an infectious-disease and critical-care physician at the University of Virginia's medical center told Business Insider on Saturday. "What his medical team is doing is trying what they can. The more we learn about these different combinations, the more we'll be informed. Right now, it's kind of like we're driving in the dark."

"It's right at that cusp where someone is sick or starting to get sick, but they aren't quite super sick," said Bell, who was a principal investigator for a National Institutes of Health trial that tested remdesivir.

Read more: Trump got a dose of Regeneron's experimental coronavirus treatment. Here's how the biotech and 8 others are racing to develop new ways to fight COVID-19.

Both physicians emphasized the lack of publicly available, detailed information on Trump's health.

Bell and Narasimhan both said there is no reason to not believe the health reports are accurate.

A possible sign that Trump's condition is worsening would be if he begins to receive steroids, the doctors said.

Read this article:
Trump's doctors are targeting a 'sweet spot' in fighting COVID-19 by using experimental treatments early, but - Business Insider India

By Deena Beasley and Diane Bartz

(Reuters) - President Donald Trump has been treated with an experimental antibody cocktail for COVID-19 and is moving to a military hospital as a precautionary measure, White House officials said on Friday.

The president's physician, Dr. Sean Conley, said in a statement that Trump "remains fatigued but in good spirits" after receiving an intravenous dose of Regeneron Pharmaceuticals Inc's dual antibody. Trump was also taking immune system boosters zinc and vitamin D, aspirin, and other generic drugs.

Trump, 74, walked to a helicopter on Friday before being moved to a special suite at Walter Reed National Military Medical Center in Bethesda, Maryland, for the next few days.

Regeneron's drug, REGN-COV2, is part of a class of experimental COVID-19 drugs known as monoclonal antibodies: manufactured copies of human antibodies to the virus that are being studied for use in patients with early illness.

Trump's doctors "must be sufficiently concerned with what they are seeing that they decided to use an experimental medicine ... Experimental drugs are by definition risky," said Dr. Edward Jones-Lopez, infectious disease specialist at the Keck School of Medicine of the University of Southern California in Los Angeles.

Antibodies are proteins made by the body's immune system that recognize, bind and neutralize an invading virus. Regeneron's cocktail - which contains an antibody made by the company and a second isolated from humans who recovered from COVID-19 - is designed so that its two antibodies bind to the coronavirus' spike protein, limiting the ability of viruses to escape.

The technique is already in wide use for treating a range of illnesses. Data so far is limited for COVID-19 antibodies, but U.S. infectious disease chief Dr. Anthony Fauci is among those saying it has promise.

Regeneron this week reported trial results showing that its drug improved symptoms in non-hospitalized COVID-19 patients, with no serious side effects, and said it planned to talk with the Food and Drug Administration (FDA) about an emergency use authorization.

Eli Lilly & Co has also announced encouraging early data from a trial of its coronavirus antibody, and said it is seeking an emergency authorization from the FDA.

Shares of Regeneron rose about 3% in after hours trade, following the announcement that Trump was given the drug.

Trump is also taking the heartburn drug famotidine - often sold in the U.S. under the brand name Pepcid. Although the drug has not been shown to work against COVID-19, researchers are studying it as a possible treatment.

Zinc and vitamin D are believed to boost the immune system. Melatonin is a hormone that helps to regulate daily body rhythms. Trump has said in the past that he takes a daily low-dose aspirin, which is recommended for some adults at increased risk of heart attack or stroke.

(Reporting by Deena Beasley and Diane Bartz; Additional reporting by Michael Erman; Editing by Jonathan Oatis, Daniel Wallis and Peter Henderson)

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Trump treated with experimental antibody cocktail for COVID-19 - WTVB News

The aggressiveness of early breast cancer and the overall prognosis of patients with the disease is highly dependent on the presence of aberrations in the tumor. HER2 overexpression, in particular, is found in 10% to 40% of breast tumors, which make tumors with these characteristics less responsive to the hormone therapy and cytotoxic agents most commonly used for the treatment of breast cancer.1

Although HER2 positivity has been identified as a predictive factor of response to chemotherapy, it remains controversial considering that responses to chemotherapy can vary in patients with certain disease characteristics. Once trastuzumab (Herceptin), the first targeted therapy for HER2-positive breast cancer entered the paradigm, it was clear that patients had more options,1,2 but, experts were unaware of how far targeted therapies could go in terms of improving outcomes.

Treatment should be individualized based on the patients presenting characteristics, including tumor size, lymph node status, and hormone receptor status, Kari B. Wisinski, MD, medical oncologist, UW Health and the University of Wisconsin Carbone Cancer Center, told Targeted Oncology, in an interview.

Individualizing therapy for our patients with HER2-positive disease can help us improve outcomes and decrease toxicity for our patients, added Sara Tolaney MD, MPH, associate director, Susan F. Smith Center for Women's Cancers, director, Clinical Trials, Breast Oncology, and senior physician, at the Dana-Farber Cancer Institute, and assistant professor of medicine, at Harvard Medical School.

Before the Agent Boom in HER2-Positive Breast Cancer

As a newly introduced targeted therapy in the field of HER2-positive breast cancer in 1998, trastuzumab added to cytotoxic chemotherapy demonstrated a significant improvement in disease-free survival (DFS) in patients with HER2-positive breast cancer, according to results from the N9831 trial (NCT00005970). The result was a 10-year DFS rate of 73.7% with the addition of trastuzumab compared with 62.2% with chemotherapy alone (HR, 0.60; 95% CI, 0.53-0.78) and the 10-year OS rate achieved was 84% versus 75.2% (HR, 0.63; 95% CI, 0.54-0.73).3

As scientific advances were made, trastuzumab continued to be used with chemotherapy, but novel targeted therapies also emerged in the landscape.2

The Thriving Targeted Therapy Research in HER2-Positive Breast Cancer

Many targeted therapies are now FDA approved as treatment of patients with early HER2-positive breast cancer and, unsurprisingly, many of the regimens used in clinical trials for these patients include trastuzumab or are intended to be administered after trastuzumab treatment is completed.

Several new targeted therapies have emerged in the last several years for HER2-positive breast cancer. First of all, we have pertuzumab [Perjeta], the anti-HER2 monoclonal antibody, which has been supported in the neoadjuvant setting as well as in the adjuvant setting. There is neratinib [Nerlynx], which is an oral tyrosine kinase inhibitor that is now approved as an extended duration anti-HER2 treatment following completion of 1 year of trastuzumab in the adjuvant setting, Wisinski explained.Lastly, we have recent data for T-DM1 [trastuzumab emtansine; Kadcyla], which is now FDA approved in the post-neoadjuvant setting in patients with residual disease after standard upfront chemotherapy and anti-HER2 directed therapy. Each of these 3 medications has significantly changed our landscape.

One of the most revolutionary clinical trials exploring the use of novel targeted therapies in patients with breast cancer is the I-SPY-2 platform trial, which includes a subset of patients with HER2-positive disease. I-SPY-2 is a series of mini studies of novel drugs combined with chemotherapy compared with single-agent standard of care, which is the combination of paclitaxel plus trastuzumab followed by doxorubicin and cyclophosphamide. The trial includes 4000 patients.

The combination treatment arms being explored in I-SPY-2 include AMG 386 with or without trastuzumab, AMG 479 (Ganitumab) plus metformin, MK-2206 with or without trastuzumab, T-DM1 plus pertuzumab, pertuzumab plus trastuzumab, talazoparib (Talzenna) plus irinotecan, patritumab plus trastuzumab, durvalumab (Imfinzi) plus olaparib (Lynparza), and cemiplimab (Libtayo) plus durvalumab plus olaparib. The monotherapy arms include ganetespib, ABT-888, neratinib, PLX3397, pembrolizumab (Keytruda), SGN-LIV1A, tucatinib (Tukysa), and cemiplimab, in all breast cancers.4

Aside from the I-SPY-2 trial, vaccine therapies including the HER2-sensitized dendritic

cell vaccine (NCT0338755), the dendritic cell vaccine compared to the WOKVAC vaccine (NCT03384914), and TPIV100, another HER2 vaccine (NCT04197687) are under investigation in phase 1/2 clinical trials.

There have also been studies of combination chemotherapy like trastuzumab plus chemotherapy (NCT03894007), which is a phase 2 study evaluating treatment before surgery in patients with HER2-amplified early breast cancer. Therapeutic strategies that are even further along in the pipeline are immune checkpoint inhibitor monotherapy and immunotherapy and chemotherapy combination that first demonstrated efficacy in other diseases.

The immunotherapy agents and combinations currently under investigation for early HER2-positive breast cancer include the phase 2, open-label, randomized, multicenter trial of paclitaxel plus pembrolizumab versus pembrolizumab alone (NCT03747120); the phase 2 trial of doxorubicin, cyclophosphamide, and paclitaxel plus nivolumab (Opdivo; NCT03742986) in inflammatory breast cancer, which includes patients with HER2-positive disease in 1 arm who will be treated with added trastuzumab and pertuzumab; as well as the single-arm, open-label study of M7824 ahead of standard neoadjuvant therapy (NCT03620201), which is evaluating patients with stage II or III HER2-positive breast cancer.

Expanding the Possibilities of Trastuzumab

Trastuzumab is considered a standard chemotherapy backbone in the landscape of HER2-positive breast cancer.1 To keep the efficacy going, Wiscinski suggests using trastuzumab not only to escalate but also to de-escalate treatment.

One of the strategies that still needs to be considered is not just escalating treatment with these newer agents, but also the idea of deescalating for smaller HER2-positive breast cancer. In particular, I am thinking about either the regimen of paclitaxel with trastuzumab or T-DM1 as a single-agent, Wiscinski stated. Overall, the escalation treatment strategy is sometimes appropriate, but other times, de-escalation is a critical thing for treating HER2-positive breast cancer.

Tolaney also noted, during an interview, that de-escalation plays a critical role in how patients with HER2-positive breast cancer are treated.

By tailoring adjuvant therapy based on response to preoperative therapy, we are able to escalate therapy for patients with residual disease, and de-escalate for patients with pathologic complete response, Tolaney stated.

The de-escalation strategy is an area of active research as well. Currently, the CompassHER2-pCR study (NCT04266249), the PALTAN study (NCT02907918), and the TOUCH trial (NCT03644186) are all investigating de-escalation of trastuzumab-containing regimens.

Wiscinski noted, however, that challenges do exist with this strategy and should be explored future.

An unmet need is having better predictors of who needs an escalation treatment and who can have their treatment de-escalated. For example, right now we rely a lot on nodal status and tumor size, but there could potentially be genomic markers or diagnostic tests that could help us identify which patients have very HER2-sensitive disease and potentially could be treated with less chemotherapy, she explained.

References:

1. Kurebayashi J. Biological and clinical significance of her2 overexpression in Breast Cancer. Breast Cancer. 2001;8(1):45-51. doi:10.1007/BF02967477

2. Sharifi M, Wisinski KB. Advances in the treatment of early-stage her2-positive breast cancer. Clin Adv Hematol Oncol. 2020;18(8):482-492.

3. Perez EA, Romond EH, Suman VJ, et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831. J Clin Oncol. 2014;32(33):3744-3752. doi:10.1200/JCO.2014.55.5730

4. The I-SPY 2 Trial. I-SPY2 website. Accessed October 2, 2020. https://bit.ly/36qn2Kk

Read this article:
Trastuzumab-Containing Regimens and Novel Drugs Mark the Precision Medicine Era of HER2-Positive Breast Cancer - Targeted Oncology

HACKENSACK, N.J. One year ago, despite having had a negative mammogram and ultrasound four months earlier, 67-year-old Doris Barnhill of Cliffside Park did a quick dance of her fingertips around her breasts to feel for lumps anyway until she stopped at what felt like a pea-sized marble beneath her skin in one of them.

The following week, Barnhill made an appointment with her primary care physician who referred her back to a breast specialist who saw her that day. Last September, she was diagnosed with Stage III Triple Negative Breast Cancer. According toBreastCancer.org, this type of breast cancer, found in 10-20% of patients, tests negative for estrogen and progesterone receptors and excess HER2 protein, meaning the cancer is not triggered by these hormones nor the HER2 protein and thus does not respond to hormonal therapy medicines or the ones that target HER2 protein receptors. However, other medicines are used to successfully treat it.

It took me over the edge, said Barnhill through her pink surgical mask at a table outside Hackensack University Medical Centers Breast Cancer Awareness Month kickoff event Thursday, organized by the Betty Torricelli Institute for Breast Cancer. Hearing that for the first time was devastating for me because I lost a sister, so all I could see was, This is it. I couldnt see past the fact that its breast cancer. She didnt survive, why would I?"

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Barnhill had lost her estranged sister, Dolores, to breast cancer 15 years ago just two years after she was diagnosed. While the circumstances surrounding her sisters condition remain unclear, Barnhill says shes glad she advocated for herself when her body told her something felt off. And breast specialists at Hackensack University Medical Center, where Barnhill is currently being treated, agree.

You never want tobe cavalier and ignore something, said Dr. Gail Starr, Chief of Breast Imaging at Hackensack UMC. You should always bring it to medical attention and have it evaluated.Early detection is the key to finding things earlier , when theyre more treatable , and you have less aggressive treatment options."

Any noticeable changes in a womans breasts merit a trip to the doctor, Starr said, especially changes in the areola like flakiness, clear or bloody discharge from the nipple, and of course, firm lumps. Barnhill received chemotherapy at the John Theurer Cancer Center at Hackensack UMC in Edgewater closest to her home. While she was scheduled for a mastectomy this past May, her surgery was on hold whenshe was diagnosed with Covid-19 on April 10 when the virus which has to date claimed more than 1 million lives around the world was at its apex. Barnhill was five days shy of her last chemotherapy treatment when she was diagnosed with the potentially deadly virus.

I just could not get up, she recalled of her symptoms.

Apart from chronic fatigue caused by the highly contagious virus affecting the respiratory system, she had been experiencing bouts of nausea and vomiting. While her Covid diagnosis temporarily derailed her cancer treatment, the mother of three and soon-to-be grandmother of five decided to stay positive and applied the same optimistic attitude she used to power through her cancer diagnosis to get her through Covid.

I refused to give up, she said. My attitude was such that I came through my chemo treatments with flying colors. I remember there was hair loss and skin discoloration. In terms of how I felt when undergoing chemo, I didnt have those issues. I continued to work. I did everything I needed to do.

Because Barnhills cancer was more aggressive, she wound up going in for surgery in May despite having had the virusstill. Her Covid-19 test was negative the following month. After overcoming Covid, Barnhill completed her radiation treatments following her mastectomy and is currently on pill therapy, which she will continue for the next five years. A retired manager for a health care plan working in the customer service division, Barnhill continues her lifes purpose of serving to interact with others to teach everyone with whom she comes in contact diplomatic relations so they walk away feeling like they were treated with respect and dignity, she says.

Similarly, at Hackensack UMC, the same can be said of the hospital staff who she said continue to assume the role of her cheerleader throughout her cancer journey.

You dont feel like youre another cancer patient coming in, said Barnhill. Its been so very personal. Im just not accustomed to people as personable as they are and constantly assuring you. I initially didnt have any hope.

While many newly diagnosed cancer patients can feel that way, treatment options are promising provided early detection. While genes can play a role in ones development of breast cancer, physicians say a number of patients dont have any risk factors or family members diagnosed. Breast specialists say being female alone and older age significantly increase your risk, in addition to younger women carrying the BRCA gene.

Patients who are considered high-risk classically are the patients who carry the genetic mutations of the BRCA 1 and 2 breast cancer mutation genes, explained Dr. LeslieMontgomery, a surgical oncologist specializing in breast cancer at the hospital. People with a strong family history of breast or ovarian cancer. Women who have had radiation very young in life sometimes for lymphoma. People who get radiation to their breasts in their teens and 20s. Those are the people who are at very, very high-risk and we follow them in high-risk programs and do additional imaging and do an even earlier than the average person who starts getting mammograms or MRIs. There are also certain types of pathology that we see on breast biopsies that will make people high risk. But even a person with a first-degree relative a mother, a daughter or a sister who has breast cancer is considered higher risk than the average population.

A woman who has a grandmother who had breast cancer could also contract cancer if her father carries a breast cancer gene, she said. For women who have a history of breast cancer in her family, with multiple members having had the disease, genetic testing is recommended to test for the nine genes associated with the cancer via a simple blood test performed by her gynecologist.

While other risk factors such as having dense breasts, or breasts with more glandulartissue than fat, and a woman having her first child after age 30 can also increase ones risk for the disease, doctors agree that limiting alcohol consumption in addition to quitting smoking can also help to reduce ones risk for developing breast cancer. A healthy lifestyle in addition to post-menopausal women remaining at a healthy weight by incorporating a personalized exercise regimen on top of following a healthy diet are also ways toprevent most other diseases including heart disease, another top killer of women, especially African-American.

I think everything in moderation is a good strategy, said Montgomery. With respect to preventing breast cancer, I think all of us need to recognize that women are 10 times more likely to die of heart disease in this country than we are to die of breast cancer. And I think for some reason we may make so much effort to try to prevent breast cancer, but obesity, hypertension, diabetes, these are the things that are really killing us in terms of heart disease. I do agree with not gaining weight, drinking alcohol in moderation, exercising, the things are also very beneficial in reducing heart disease so they go hand in hand.

Dr. Starr recommends women begin having annual mammograms at 40, and for those who test positive for the BRCA gene to test 10 years sooner than that.

Most patients dont carry the gene, said Starr of the women diagnosed. Being a woman and getting older are the two most common risk factors you cant change or do anything about.

She said if women do test positive for the BRCA gene, having a mastectomy is one way to reduce her risk for developing breast cancer in the future. However, having one does not guarantee breast cancers prevention.

Having mastectomies does not make your risk zero, said Starr. Theres still always a small risk because there are cells underneath the skin and against the chest wall. But it does decrease your risk significantly."

Starr added that if women do have the BRCA gene, the best approach is seeing a breast specialist and oncologist who can explore breast imaging and hormone therapy as preventative treatment options.

In addition to the Prospect Avenue hospitals Breast Cancer Awareness and Risk Evaluation Program, Hackensack UMC also offers cutting-edge technology for detection, including 3-D imaging which allows doctors a clearer viewing of any hidden tumors, which lead to a reduced need for further biopsies.

As for Barnhill?

I feel great, she said. I feel healthy. Ive survived a lot. When I take a minute to think about what Ive gone through based on my original diagnosis where I had no hope to get to the point where I am now I cant give up.

Here is the original post:
'I Refused To Give Up.' This Woman Was Diagnosed With Stage 3 Breast Cancer Then Covid Months Later. How She Survived - TAPinto.net

Oral contraceptive pills are the most commonly used method of hormonal contraception in the United States. According to the National Survey of Family Growth conducted in 2015-2017, 80.5% of reproductive-aged women who had ever been sexually active had used oral contraceptive pills (OCPs) at some point.

A survey of reproductive-aged women who have ever been sexually active found that 12.6% currently use pills.1

There are two general types of OCPscombined oral contraceptives (COCs), which contain both ethinyl estradiol (EE) and progestin, and progestin-only pills (POPs). Current COCs offer a range of doses and progestins to choose from.2

COCs are a moderately effective method of contraception. They have a perfect use failure rate of <1% and a typical use failure rate of 9%.3 Several clinical trials have quoted failure rates of POPs between 1-13% in the first year.4-7

Little data is available directly comparing the efficacy of different types of progestins; however, a few studies suggest no difference.5,6 It is likely that typical use failure rates are higher in POP users due to the strict dosing timeframe, including recommendations to take the pill within a 3-hour window.3

EE and progestin each work separately, as well as synergistically, to provide contraceptive benefit. EE mainly works by suppressing the release of follicle-stimulating hormone (FSH) from the pituitary, which hinders folliculogenesis.

It is also suggested that EE causes endometrial edema, which affects implantation. EE has an added benefit of stabilizing the endometrium, which reduces spottinga favorable effect. As EE potentiates the effects of progestin, smaller doses of progestin may be used in COCs.8

Progestin works in three major ways: 1) it suppresses GnRH release from the hypothalamus, decreasing LH and FSH release; 2) it prevents the LH surge from the pituitary, which prevents ovulation; and 3) it thickens cervical mucus, which impedes sperm entry into the uterus.

There may be some inhibition of peristalsis and tubal mobility as well. Progestin causes endometrial atrophy, which impairs implantation. Each progestin has a different potency and dose for which it blocks ovulation. POPs rely on these multiple mechanisms to prevent pregnancy.8

Although oral contraceptives are a great choice for many women, it is important to understand the conditions that may increase risk for the user. We will outline some of the risks below and the CDC Medical Eligibility Criteria chart can be referenced for more information.9

It is important to remember that the risks and benefits must be weighed for each woman individually and that in most cases, pregnancy is more dangerous than pill use.

In patients who have conditions in which pregnancy would increase their risk of adverse health outcomes (Table 1), long-acting reversible contraception (LARC) may be the best choice to avoid unintended pregnancy.10 It is also important to review a patients medication history, as there may be drug interactions that reduce efficacy of COCs and POPs.9

EE is pro-coagulable and is contraindicated in a number of situations. Progestin also has risks to the user. Providers should screen for personal or family history of venous thromboembolism, as this increases coagulation risk in COC users.

Additionally, because of hypercoagulability in the postpartum state, COCs should not be used until 6 weeks after childbirth. Women who smoke and are over age 35, women with migraine with aura, or those who have uncontrollable hypertension or vascular disease are at increased risk of stroke and should not use estrogen-containing methods.9

There are self-screening tools available to check for COC eligibility, such as the one used in a study by Grossman et al, which showed a sensitivity of 83.2% and specificity of 88.8% in patients using the survey to determine true contraindications to COC use.11 These tools can be helpful to both providers and patients, particularly as we increase use of telemedicine (Table 2).

As with any medical decision, it is exceptionally important to utilize shared decision-making in choosing the right contraceptive method for each patient, which should improve satisfaction, encourage compliance, and reduce unintended pregnancy.

Shared decision-making involves the patient and provider working together to make a decision through discussion of all options while taking patient preference into account.12

Because there are many contraceptive options available, it is important to discuss values (including the acceptability of an unplanned pregnancy if there is a contraceptive failure), beliefs, dosing frequency, financial considerations, and risks and benefits of each method.

Other considerations include how often women want to have withdrawal bleeding, and desired benefits such as improvement in dysmenorrhea, acne, and mood symptoms. All women should be provided with a multiple-month prescription to improve medication adherence.

As with any method, there are side effects of COCs and POPs that are important to discuss with patients as they decide which method is best for them. Of women who have ever discontinued using COCs or POPs, 34% reported that they were dissatisfied and 64.4% stopped due to side effects.1

Some common side effects to discuss with women are breast tenderness, nausea, bloating, and breakthrough bleedingall of which often improve or completely resolve after the first several months.13 Women may not always discuss their choice to stop taking COCs or POPs, making it essential for clinicians to ask about the experience of past side effects, as well as to provide preventive guidance about the possibility of side effects before starting a new method.

Once a woman and her provider have decided on using COCs, there are multiple options. Patients desiring a withdrawal bleed may prefer a pill pack with monthly placebo pills, while patients desiring fewer menses prefer continuous use without placebo pills and may opt for extended cycle use.

Additionally, providers may identify other co-existing conditions that may be treated with COCs such as acne, undesired facial hair growth, bloating, and/or headaches. COCs can also help reduce risk of ovarian cysts, fibroids, and benign breast disease.14

As mentioned earlier, all COCs have a progestin and EE component and doses differ by pill type. COCs have a range of EE between 10-35 mcg.

A systematic review showed higher discontinuation rates for COCs with lower doses of EE, due to side effects such as breakthrough bleeding. To reduce estrogenic risks, it is reasonable to start at 20 mcg EE and increase if necessary,15 although for adolescents, data supports using a dose of 30 mcg EE or greater as lower doses of EE have been associated with impaired bone acquisition.16,17

Providers should consider the progestin component of the COC, or which progestin to use on its own in a POP, as this may result in undesired side effects.2,18-20

Some progestins are noted to have androgen-like effects, with users reporting oily skin, facial hair growth, or acne. Of note, all COCs have been shown to help with acne, but it is reasonable to choose a pill with a less androgen-like progestin and/or higher estrogen content if this is a concern.19,21,22

First-generation progestins have a lower potency and half-life, which can result in breakthrough bleeding. While second-generation progestins are more potent with a longer half-life, they may have an androgen-like effect. Third-generation progestins maintain a high potency but have lower androgen-like effects.

Some third-generation formulations are even approved to treat mild to moderate acne. Finally, the only fourth-generation progestin, drospirenone, has both anti-mineralocorticoid and anti-androgenic properties and is newly available in a progestin-only pill.18,19 It has an improved bleeding profile while matching COCs in efficacy, as well as extending the missed-pill window to 12 hours for ease of use23 (Table 3).

Many of the common side effects of COCs will resolve on their own in the first few months. Thus, in the absence of severe side effects, patients should be encouraged to continue their pills for an initial 3-month interval. If these side effects continue or are particularly bothersome, Table 4 shows some options providers can use to approach them.19,24

In addition to bleeding patterns and progestin options, COCs can be monophasic or multiphasic. We recommend that most providers start with a monophasic preparation for ease of use and ability to extend to continuous use, although some data show that triphasic preparationsspecifically those with newer progestinshelp reduce acne, irregular bleeding, and menorrhagia.25

In addition to contraception, COCs have non-contraceptive benefits that can be advantageous to patients. One of these benefits is helping to improve menstruation, reduce pain, and improve blood loss. Dysmenorrhea is the most common menstrual symptom complaint, affecting up to 90% of women.26

COCs have been shown to reduce dysmenorrhea by 60%, and in those with severe dysmenorrhea even further (90%). This reduces absences for school or work, as well as a patients need for pain medication. In women who suffer from dysmenorrhea, it can be especially helpful to be on extended or continuous COC preparations to further decrease pain.19 The desogestrel-only POP has also been shown to help improve dysmenorrhea.27

Menorrhagia is less common, yet still problematic, for patients, as it can lead to iron-deficiency anemia. COCs are particularly helpful for normalizing bleeding patterns and decreasing both amount and duration of bleeding.

However, other forms of contraception, such as hormonal intrauterine devices, can have similar effectsenhancing the need for shared decision-making with a patient when deciding which hormonal method is right for her.28

Additional benefits to COCs include the ability to allow a woman to predict her bleeding episodes and skip them if desired. While older generations of POPs often caused abnormal bleeding patterns in patients, new drospirenone-only pills have a more favorable bleeding profile.23

COCs can also improve premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). A study looking at both POPs and COCs and their effect on premenstrual mood found that use of either one of these pills did not affect mood in over 71% of women. The remaining women were split as to whether their mood was improved or worsened.

Having a history of premenstrual mood changes prior to starting a POP or COC was a strong predictor of the ability to improve mood, as was onset of premenstrual mood disturbance at a younger age. However, those with a history of depression prior to pill use were twice as likely than those without a history to have mood deterioration.29

Studies have also shown that in women being treated for depression, COCs containing drospirenone can improve mood deterioration in the premenstrual period, as well as reduce both physical and behavioral symptoms of PMDD.30 Another way to reduce PMS and PMDD symptoms is with extended or continuous cycles and reduction of withdrawal bleeding.19

COCs can also be very useful to women who suffer from endometriosis. COCs have been shown to reduce pain associated with endometriosis and continuous cycles are often even more beneficial for pain reduction.

However, it is important to remember that COCs work by causing endometriotic implants to undergo atrophy and become inactive. Upon discontinuation of COCs, the implants become active again, resulting in return of pain and other symptoms.

Initiation of COCs after surgery for endometriosis can reduce recurrence rates of endometriomas, as well as the size and growth rates of those that do recur.31 For women who cannot take COCs but suffer from endometriosis, desogestrel-containing POPs have been shown to be equally effective in reducing endometriosis pain.14

Oral contraceptive pills are a widely used form of contraception and nearly all providers in all specialties will encounter patients who are taking them.

While different variations between pills can seem complicated, thereby making it hard to choose a pill, it is important to tailor the decision to each patients needs and desires. Sometimes it can take several adjustments to find the best OCP for a particular patient.

As long as the provider and patient continue to work together through shared decision-making, many women will be able to satisfactorily find a reliable form of contraception while also taking advantage of the many non-contraceptive benefits that pills offer.

__

About the Authors

DR. LODER is a clinical assistant professor at Michigan Medicine, University of Michigan, Ann Arbor.

DR. ROSEN is a clinical assistant professor at Michigan Medicine, University of Michigan, Ann Arbor.

DR. CHASE is a fourth-year medical student at the University of Michigan Medical School, Ann Arbor.

__

1. National Center for Health Statistics. National Survey of Family Growth 2015-2017. https://www.cdc.gov/nchs/nsfg/nsfg_2015_2017_puf.htm. Accessed May 10, 2020.

2. David PS, Boatwright EA, Tozer BS, et al. Hormonal contraception update. Mayo Clin Proc. 2006;81(7):949-954.

3. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404.

4. Broome M, Fotherby K. Clinical experience with the progestogen-only pill. Contraception. 1990; 42(5):489-95.

5. Sheth A, Jain U, Sharma S, et al. A randomized, double-blind study of two combined and two progestogen-only oral contraceptives. Contraception. 1982;25(3):243-252.

6. Korver T. A double-blind study comparing the contraceptive efficacy, acceptability and safety of two progestogen-only pills containing desogestrel 75 g/day or levonorgestrel 30 g/day. Eur J Contracept Reprod Health Care. 1998;3(4):169-178.

7. Vessey MP, Lawless M, Yeates D, McPherson K. Progestogen-only oral contraception. Findings in a large prospective study with special reference to effectiveness. Br J Fam Plann. 1985;10:117-121.

8. Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Am J Obstet Gynecol. 1999;181(5 Pt 1):1263-1269.

9. Centers for Disease Control and Prevention. Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use. https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf. Accessed May 10, 2020.

10. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65(3):1-103.

11. Grossman D, Fernandez L, Hopkins K, Amastae J, Garcia SG, Potter JE. Accuracy of self-screening for contraindications to combined oral contraceptive use. Obst Gynecol. 2008;112(3):572-578.

12. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: A model for clinical practice. J Gen Intern Med. 2012;27(10):1361-1367.

13. Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: Risk indicators for poor pill taking and discontinuation. Contraception. 1995;51(5):283-288.

14. Amat L, Bulach A, Leclercq M, et al. Bnfices non contraceptifs des contraceptions. Additional Non-Contraceptive Effects of Contraception: CNGOF Contraception Guidelines. Gynecol Obstet Fertil Senol. 2018;46(12):883-888.

15. Gallo MF, Nanda K, Grimes DA, Lopez LM, Schulz KF. 20 g versus >20 g estrogen combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013;2013(8):CD003989.

16. Golden NH. Bones and Birth Control in Adolescent Girls. J Pediatr Adolesc Gynecol. 2020;33(3):249-254.

17. Scholes D, Ichikawa L, LaCroix AZ, et al. Oral contraceptive use and bone density in adolescent and young adult women. Contraception. 2020;81(1):35-40.

18. Lawrie TA, Helmerhorst FM, Maitra NK, Kulier R, Bloemenkamp K, Glmezoglu AM. Types of progestogens in combined oral contraception: effectiveness and side-effects. Cochrane Database Syst Rev. 2011;11(5):CD004861.19. Raney EC, Scott SC, Cauthon KAB. Individualizing selection of hormonal contraception. Osteopathic Family Physician. 2014;6(4):8-14.

20. Sitruk-Ware R. Pharmacology of different progestogens: The special case of drospirenone. In Climacteric. 2005;8(Suppl 3):4-12.

21. Thorneycroft IH. Update on androgenicity. Am J Obstet Gynecol. 1999;180(2 Pt 2):288-294.

22. Stanczyk FZ. All progestins are not created equal. Steroids. 2003;68(10-13):879-890.

23. Palacios S, Regidor PA, Colli E, et al. Oestrogen-free oral contraception with a 4 micrograms drospirenone-only pill: new data and a review of the literature. Eur J Contracept Reprod Health Care. 2020;Apr 21;1-7. https://doi.org/10.1080/13625187.2020.1743828. Online ahead of print.

24. Barr NG. Managing adverse effects of hormonal contraceptives. Am Fam Physician. 2010;82(12):1499-1506.

25. Cedars MI. Triphasic oral contraceptives: Review and comparison of various regimens. Fertil Steril. 2002;77(1):1-14.

26. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996;87(1):55-58.

27. Ahrendt HJ, Karckt U, Pichl T, Mueller T, Ernst U. The effects of an oestrogen-free, desogestrel-containing oral contraceptive in women with cyclical symptoms: Results from two studies on oestrogen-related symptoms and dysmenorrhoea. Eur JContracept Reprod Health Care. 2007;12(4):354-361.

28. Lethaby A, Wise MR, Weterings MAJ, Rodriguez MB, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. In Cochrane Database System Rev. 2019;2(2):CD000154.

29. Joffe H, Cohen LS, Harlow BL. Impact of oral contraceptive pill use on premenstrual mood: Predictors of improvement and deterioration. Am J Obstet Gynecol. 2003; 189(6):1523-1530.

30. Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. 2005;106(3):492-501.

31. Zorbas KA, Economopoulos KP, Vlahos NF. Continuous versus cyclic oral contraceptives for the treatment of endometriosis: a systematic review. In Arch Gynecol Obstet. 2015;292(1):37-43.

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Choosing the right pill - Contemporary Obgyn

Yep, cheese and fruit are healthy bedtime snacks.

Many of us have been taught that eating before bed is a bad idea. But what should you do if you wake up in the middle of the night with a growling stomach, or you can't fall asleep because you were already hungry before bed? Or, sometimes you're just craving a snack while binge-watching Netflix, even if you're not that hungry. Whatever the reason for snacking, some bedtime snacks are healthier than others.

"Bedtime snacks can be healthy and can help you sleep better," says Tony Castillo, a registered dietician and performance dietician at Nutrition for Performance. He says people who workout regularly and are active in particular can benefit, since you can add in nutrients that can help muscles repair and recover while you sleep.

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But there are some foods you may want to avoid eating before bed because they may disrupt your sleep. You'll want to avoid junk food that contains lots of sugar and processed carbs, since those can work against helping you get a good night's sleep. "The fast-digesting carbs could cause a boost of energy," says Castillo.

Something else you'll want to avoid before bed? Spicy foods, since those can cause acid reflux, and no one wants to wake up to digestive issues throughout the night. Another common heartburn trigger is chocolate, because it'shigh in fat and contains other ingredients that can mess with digestion at night.

Keep reading below for more bedtime nutrition tips and ideas for healthy snacks that can help you sleep better tonight.

Besides focusing on balancing nutrition with high quality foods (like the ones below) at night, you should also consider timing your snacks in a way that does not interfere with sleep. This can vary from person to person, but typically you will want to avoid eating immediately before falling asleep.

"There are some individuals that can eat something right before bed and have no issues. Others may have to have a cutoff time of two hours [before bed] because eating the food may cause acid reflux," Castillo says. It may take some trial and error, but giving yourself some room to digest before bed can help prevent problems.

Peanut butter and bananas or peanut butter on whole-grain, high-fiber toast are examples of balanced night-time snacks.

"I recommend a slow-digesting protein and high-fiber carbohydrate," Castillo says. "You want the slow-digesting protein to keep the muscle-building switch on while you sleep. You want a high-fiber carb because a fast-digesting carb can cause a blood sugar spike and keep you awake."

Slow-digesting and high fiber carbs are ones that tend to be easier on your blood sugar, helping avoid spikes or subsequent crashes. Examples of slow-digesting carbs are whole grains, oats, brown rice, fruits and veggies. Slow-digesting proteinsinclude casein, which is found in dairy, such as yogurt and cheese, and is available as a protein powder. Peanut butter is also useful to eat before bed because it contains tryptophan, which helps your brain and muscles relax.

Healthy bedtime snack examples:

Almonds contain melatonin and magnesium, which can help you sleep better.

Certain foods can promote better sleep, for reasons other than helping you feel full. Certain foods naturally contain nutrients that promote sleep like melatonin, the hormone that makes you feel sleepy.

Foods that can help you sleep:

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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Healthy bedtime snacks that won't mess with your sleep - CNET