Latest Posts

Friday, November 10, 2023

Eight Measures that may Increase Your Longevity by about Six Years

Aging can be Chronological, and Biological. Chronological age is the age in years, as one grows older after birth. Biological aging is the aging at cellular and molecular level. Chronological age and Biological age can be well different depending on the different habits (food, physical activity, and accompanied diseases etc.).    

Aging is accompanied by gradual changes in most body systems. Research on the biology of aging focuses on understanding the cellular and molecular processes underlying these changes as well as those accompanying the onset of age-related diseases.

Gradual loss of the length of Telomeres, the highly repetitive DNA sequences located at the end of chromosomes, is associated with cell aging (biological aging). As cells divide, telomere length gets progressively shorter until eventually, proliferation stops entirely. Such cells, which have ceased dividing, are called senescent.

New research shows that the following eight simple health measures can help in slowing down ageing. According to researchers, following the American Heart Association's Life's Essential 8 can help slow down biological ageing by six years.

The identified health measures are

1.      Eating Healthy,

2.      Exercising Regularly,

3.      Not Smoking,  

4.      Getting Enough Sleep,

5.      Maintaining Low Cholesterol Levels,

6.      Healthy Blood Pressure,

7.      Healthy Sugar Levels and

8.      Staying Slim.

Experts believe that these eight measures can improve good heart health, which eventually helps to slow the pace of biological ageing. Researchers at Columbia University in New York looked at data from more than 6,500 Americans, aged 47, on average. They determined their phenotypic age by using an experimental gauge of biological age, which relies on the outcomes of nine biomarkers. These biomarkers encompass measurements related to metabolism, inflammation, and organ function.

The scientists then assigned each participant a cardiovascular score—categorized as high, moderate, or low—depending on their adherence to the Life Essential 8 checklist.

Factors that could skew the results, income, education and ethnicity, were accounted for.

People who had high cardiovascular health were associated with a lower biological age. This means that such participants were younger than expected physiologically. For example, the average actual age of those with high cardiovascular health was 41, yet their average biological age was 36.

On the other hand, people who had low cardiovascular health had a positive phenotypic age acceleration. This meant that they were older than expected biologically. An example of this is, the average actual age of those with low cardiovascular health was 53, while their biological age was 57.

A further analysis showed that having the highest healthy score was linked to being six years younger, biologically.

The researchers found that higher cardiovascular health is associated with decelerated biological ageing, as measured by phenotypic age. They also found a dose-dependent association — as heart health goes up, biological ageing goes down. That means the greater the adherence to all Life's Essential 8 metrics the more slow down body's ageing process and a lot of benefits down the line.

“Reduced biologic ageing is not just associated with lower risk of chronic disease such as heart disease; it is also associated with longer life and lower risk of death.”

 “Everyone wants to live longer, yet more importantly, we want to live healthier longer so we can really enjoy and have good quality of life for as many years as possible.”

The original publication can be accessed here.  

 

read more...

Wednesday, October 14, 2020

Survival of SARS-CoV-2 on different surfaces

The data presented in a study demonstrates that infectious SARS-CoV-2 can be recovered from non-porous surfaces for at least 28 days at ambient temperature and humidity (20 °C and 50% RH). Increasing the temperature, while maintaining humidity, drastically reduced the survivability of the virus to as little as 24 h at 40 °C. SARS-CoV-2 survivability on hospital PPE observed viable virus up to 21 days post inoculation on both plastic and N95 mask material when held at room temperature.

 (Reference:) 

Common Surfaces tested in the study:

Polymer bank notes, de-monetised paper bank notes, surfaces including brushed stainless steel, glass, vinyl and cotton cloth. Stainless steel is used in kitchen areas and public facilities; Glass prevalent in public areas, including hospital waiting rooms, public transport windows and shopping centres; high contact surfaces such as mobile phone screens, ATMs and self-serve check-out machines; Vinyl used in social settings, tables, flooring, grab handles on public transport, as well as mobile phone screen protector material; Cotton in clothing, bedding and household fabrics.

Result:

The data presented in this study demonstrates that infectious SARS-CoV-2 can be recovered from non-porous surfaces for at least 28 days at ambient temperature and humidity (20 °C and 50% RH). The persistence of both SARS and SARS-CoV-2 on cotton has been demonstrated to be significantly shorter than on non-porous surfaces. The data presented in the study also shows a significant decrease in titre of recovered virus after just 1 h drying at room temperature (20 °C) the amount of virus recovered from cotton swatches was approximately 99% less than for comparable virus recovery time points for non-porous material. SARS-CoV-2 persists on both paper notes and polymer notes to at least 28 days at 20 °C, albeit with a faster rate of inactivation on polymer notes.

read more...

Sunday, April 26, 2020

Is Coagulopathy the Real Culprit in COVID-19 Deaths?


SARS-CoV-2 is a new disease and the scientific community is still learning about it. COVID-19 emerged as a respiratory disease from China in the December, 2019. In recent studies on SARS-CoV-2, it has been found that there are unusual diffuse small thromboses in the lungs tissue of patients, as well as vascular damage in different tissues and organs. Evidence from post-mortem findings of occlusion and microthrombosis formation in pulmonary small vessels of deceased with critical COVID-19 has been reported. The features prompted some scientists to describe the disease as a disease of vascular system.
After, SARS-Cov infects the body, it up-regulates the expression of related genes in the coagulation pathway, leading to activation of coagulation. Studies have shown that the abnormal characteristics of blood coagulation indexes caused by SARS-CoV-2 are not the same as SARS-CoV, and it is more likely to cause multiple organ failures other than the lungs.
Dysregulated coagulation with hypercoagulability has been found to be common in COVID-19 and can progress to disseminated intravascular coagulation (DIC). A retrospective analysis of patients admitted with severe SARS-CoV-2 infection found that 71.4% of patients who ultimately died from COVID-19 developed overt DIC compared with only 0.6% of survivors. On admission, non-surviving patients presented with higher D-dimer levels and prolonged prothrombin times (PT) and activated partial thromboplastin times (aPTT) compared with surviving.
SARS-CoV-2 infection damages human immune system and results in systematic inflammatory response. Activation of monocytes produce cytokines, such as interleukin 6, tumor necrosis factor, and many more, which in turn induce activation of the endothelial cells and tissue factor that trigger the blood coagulation cascade.  Activation of the vascular endothelium, platelets, and leukocytes results in dysregulated thrombin generation that occurs both systemically and locally in the lungs of patients with severe pneumonia, resulting in the deposition of fibrin with subsequent tissue damage and microangiopathic pathology. The effects of dysregulated thrombin generation are further exacerbated by an inhibition of fibrinolysis and the impairment of natural anticoagulant mechanisms. In addition, the hypoxia found in severe COVID-19 can stimulate thrombosis through not only increasing blood viscosity, but also a hypoxia-inducible transcription factor-dependent signaling pathway. All events may lead to DIC.
The activation of blood coagulation is essential in counteracting viral infections along with the immune system trapping viruses by forming a fibrin network, thus limiting their dissemination. However, a massive inflammatory and coagulative response is dangerous because it can lead to a local thrombosis in the lungs. Acute respiratory distress syndrome (ARDS) has been described in approximately 40% of 201 patients with COVID-19 pneumonia, in a study, and it was crucial in increasing the risk of death. ARDS may result from pulmonary vascular microthrombosis.
The concept of pulmonary thrombosis has been recently proposed for conditions such as pneumonia, asthma, and chronic obstructive pulmonary disease. It is known that viral diseases such as those from EBOLA and cytomegaloviruses can induce DIC. Therefore, it is not surprising that SARS-CoV-2 could be capable of doing the same.

Elevated plasmin(ogen) is a common feature in people with underlying medical conditions, including hypertension, diabetes, cardiovascular disease, cerebrovascular disease, and chronic renal illness, who are susceptible to SARS-CoV-2 infection. Plasmin enhances the virulence and infectivity of SARS-CoV-2 virus by cleaving its spike proteins. Extremely increased D-dimer in COVID-19 patients results from plasmin-associated hyperactive fibrinolysis. D-dimer and viral load are independent risk factors of disease severity and mortality. Antiproteases targeting plasmin(ogen) may be a promising approach to combat COVID-19.

Measuring D-dimers, prothrombin time and platelet count (decreasing order of importance) in all patients who present with COVID-19 infection, may help in stratifying patients who may need admission and close monitoring or not. Any underlying condition (e.g.; liver disease) or medication (e.g.; anticoagulants) which may alter should be accounted for while using the algorithm.
Measuring D-dimer had been recommended for Covid-19 patients, however, the optimal cut off for D-dimer remains to be well-established. D-dimer = 2.0 ug/ml (fourfold increase) on admission might be the optimum cut off to predict in-hospital mortality for Covid-19. The in-hospital mortality was significant higher in patients with D-dimer 2.0 ug/ml than those who had D-dimer < 2.0 ug/ml on admission. Among routine tests, D-dimer might be the best early marker to improve management of Covid-19.
According to researchers, heparin treatment has been recommended for COVID-19, however, its’ efficacy remains to be validated. The 28-day mortality between heparin users and nonusers were compared in stratified patients. The 28-day mortality of heparin users were lower than nonusers in patients with SIC score ≥4 or D-dimer > 3.0 ug/mL. Heparin treatment appears to be associated with better prognosis in severe COVID-19 patients with coagulopathy.
They suggested, based on a review of the very limited current peer-reviewed literature with low quality of evidence combined with discussions with international clinicians on the frontlines

  • All patients with COVID-19 should undergo coagulation studies at admission, in particular: D-dimer, prothrombin time, and platelet count.
  • Because of the possibility of patients to develop coagulopathy later in their hospital course, routine serial measurements of coagulation studies should be undertaken in all COVID-19 patients. The ideal interval has not yet been defined.

  • All patients with COVID-19 should be placed on prophylactic doses of anticoagulation, preferably with LMWH, unless there is a contraindication, such as acute kidney injury (AKI), wherein unfractionated heparin is preferred.
  • Therapeutic anticoagulation should be strongly considered in patients at high-risk for coagulopathy (including CRRT and ECMO), demonstrating signs of microthrombi-induced organ dysfunction, or with documented or strongly suspected macro-thromboembolism.
  • Determination of high-risk patients by laboratory measures of coagulopathy may include: platelet count, prothrombin time, fibrinogen, fibrinogen-degradation products, D-dimer, and TEG. Of note, some centers are therapeutically anticoagulating all patients on admission when no absolute contraindications exist.

  • Given the significant rate of AKI seen in COVID, intravenous contrast for imaging should be used with caution. Duplex ultrasonography, echocardiography, and clinical suspicion can play an increased role in these cases.
  • Some early reports support use of larger bolus-dose tPA (50mg or 100mg bolus) without holding anticoagulation in order to prevent recurrence of the suspected pulmonary microvascular thrombosis underlying COVID-19 ARDS, is worthy of consideration in  COVID-19 ARDS associated exceptionally high mortality, weighed against the risks of tPA having ~1% risk of catastrophic bleeding in non-stroke patients.
  • Aspirin should be considered in cases with elevated troponin and cardiac dysfunction, particularly with elevated maximal amplitude on TEG.

This information has been compiled from the study of various literatures on the subject.


Credit:

1.      Wiley Online Library: Covid-19: Novel Coronavirus Outbreak

2.      COVID-19 complicated with DIC: 2 cases report and literatures review

 

 







read more...

Wednesday, April 22, 2020

Atypical Symptoms of COVID-19


             A novel coronavirus emerged in China in 2019, named as SARS-CoV-2, become a pandemic. Scientists, Researchers and Health care professionals are still learning about it. It is an endeavor to compile the unusual/atypical symptoms, as far as possible, from different reputed sources. It will help the health care personnel to remain aware of the possibility of dealing with a COVID-19 patient, when patients present with symptoms, similar to some other disease.
Fever, Cough, Shortness of breath; these are what have become known as the classic, tell-tale COVID-19 symptoms. However, there can be additional non-specific, atypical symptoms or different, less common ones that should alert the health care profession, the possibility of the infection. Those include, Sore throat, Diarrhea, Myalgia (muscle aches, body aches), abdominal pain, loss of smell or taste, conjunctivitis, Tiredness or fatigue.
At present the definition of a COVID-19 Suspected Case:
Suspected Case Definitions
A. Symptoms +
Travel History
B. Symptoms +
Epidemiologic Link
C. Severe Symptoms
A patient with ALL of the following:
  • acute respiratory illness
  • no other etiology that fully explains the clinical presentation
  • a history of travel to or residence in a country, area or territory that has reported local transmission of COVID-19 disease during the 14 days prior to symptom onset
A patient with ALL of the following:
·       any acute respiratory illness
·       contact of a confirmed or probable case of COVID-19 disease during the 14 days prior to the onset of symptoms
A patient with ALL of the following:
·       severe acute respiratory infection
·       requires hospitalization
·       no other etiology that fully explains the clinical presentation

1.    Loss of smell and taste has been reported with such a frequency in COVID-19 that some medical professionals suggest to take it as a cardinal feature for diagnosis, if, associated with features of respiratory infection, even common cold or seasonal flu. According to Carol Yan, an otolaryngologist from the University of California San Diego in the US, “if, you have smell and taste loss, you are more than 10 times more likely to have COVID-19 infection than other causes of infection."
The loss of smell reported to be so profound that the patient starts nauseating just at the sight of food. He further says, while the most common first sign of a COVID-19 infection remains fever, fatigue/loss of smell and taste follow as other very common initial symptoms.
Based on the findings, UC San Diego Health has included loss of smell and taste as a screening requirement for visitors and staff, as well as a marker for testing patients who may be positive for the virus. The original article was published in The Week on April 14, 2020 15:14 IST, can be accessed here.
2.   Abdominal discomfort may be the presenting symptom in as many as 20 percent of patients. Recent literature has revealed that as many as 20 percent of patients present to the hospital with a digestive symptom, such as diarrhea, vomiting, pain, accompanying their respiratory symptoms. And, roughly 5 percent show up with an abdominal complaint alone.
This is where abdominal radiologists can play an integral role, said industry experts in a recent article published in the American Journal of Roentgenology. A team, led by Abraham Dachman, M.D., professor of radiology and abdominal imaging specialist with UChicago Medicine, shared three cases where patients were referred for abdominal imaging and providers distinguished findings indicative of COVID-19 infection in the lung base.
Axial CT of abdomen and pelvis shows left basilar round airspace and ground-glass opacities (arrow). Appearance is highly compatible with atypical infection such as coronavirus disease (COVID-19) pneumonia.
The article published on April 20, 2020, can be accessed here. 
3.   The gastrointestinal presentation can delay the initiation of COVID-19 diagnostic workup. Notably, however, the first case of COVID-19 infection confirmed in the United States reported a 2-day history of nausea and vomiting on admission followed by loose stools in hospital on day 2, and COVID-19 viral nucleic acids of loose stool and respiratory specimens were reported positive. In a recent report from Hubei, China, 204 COVID-19-infected patients were studied, and the authors reported that digestive symptoms are not uncommon in patients with COVID-19. The original article, published in The Karger, can be accessed here.

According to the WHO, digestive issues like diarrhea and nausea may be a more common symptom than previously thought.

4.   Conjuctivitis: Several reports suggest that SARS-CoV-2 can cause a mild follicular conjunctivitis otherwise indistinguishable from other viral causes, and possibly be transmitted by aerosol contact with conjunctiva. However, at this point in the COVID-19 pandemic, practically any patient seen by an ophthalmologist could be infected with SARS-CoV-2, regardless of presenting diagnosis, risk factors, indication for visit or geographic location. Updated on April 21, 2020, online by American Academy of Ophthalmology, can be accessed here.  Access the Ocular manifestations of a hospitalized patient with confirmed 2019 novel coronavirus disease in The British Journal of Ophthalmology here.
5.    Malaise and Confusion can be present in varied number of patients of COVID-19 are some of the atypical symptoms, according to an article published in The Lancet.
               In a study, the most common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhea (one [3%] of 38). More than half of patients (22 [55%] of 40) developed dyspnoea.
6.       Headaches and dizziness may also be signs of the viral infection: According to the study in The Lancet, about 8 percent of COVID-19 patients reported headaches. Dizziness has also been reported in some cases – frequent dizzy spells or very severe or abrupt bouts of dizziness could indicate a more serious health risk, according to the Cleveland Clinic.
7.       Chills or muscle aches occasionally accompany COVID-19. Aches and chills can be symptoms of many illnesses, including the flu, but coronavirus patients have reported them. It's not clear how prevalent these symptoms are, but about 11 percent of people studied reported chills, and 14 percent reported muscle aches, according to the WHO report.
8.       Runny nose is rarely a sign of coronavirus: It is more indicative of allergies or a cold. A minority of COVID-19 patients experience nasal congestion or a runny nose – less than 5 percent of people experience these symptoms, according to the WHO report.
9.       Acute myocarditis is thought to be a possible complication associated with COVID-19. While, it is required to closely monitor such patients for the complication, medical profession should keep in mind to test for the COVID-19, whenever other symptoms or epidemiologic link is available. Laboratory testing, including troponin levels, in individuals with recent symptoms of an acute illness should be performed to guarantee appropriate identification and prompt isolation of patients at risk of COVID-19 and eventually to reduce further transmission. The article published in JAMA Network on March 27, 2020, can be accessed here.
10.    Necrotizing encephalopathy: A woman who tested positive for COVID-19 developed a rare brain disease known as acute necrotizing encephalopathy, a condition that can be triggered by viral infections like influenza and herpes.
               At this point, the brain damage "has yet to be demonstrated as a result of COVID-19 infection," according to a case report published March 31 in the journal Radiology. However, as the novel coronavirus continues to spread, "clinicians and radiologists should be watching for this presentation among patients presenting with COVID-19 and altered mental status," the authors wrote.
               The original article published online by the Radiological Society of North America on here
11.                  Asymptomatic (subclinical): Now-a-days, a large number of asymptomatic (in pre-clinical/pre-symptomatic stage) patients are seen positive for COVID-19; many are also seen with mild symptoms (easily ignored). Many more asymptomatic contacts are also positive for COVID-19. It may go up to 80%. Another study suggests that the number can be between 5% and 80%.
                       In those mild cases, the predominant CT in Lungs can be diagnostic, with the findings of ground-glass opacification, consolidation, bilateral involvement, and peripheral and diffuse distribution. Notably, in Shi and colleagues' study, the asymptomatic (subclinical) group of patients showed early CT changes, supporting what was first observed in a familial cluster with COVID-19 pneumonia. Published on February 24th, 2020 in The Lancet can be accessed here.
12.    Atypical symptoms of COVID‑19 can be more common in immune-suppressed or immune-compromised patients. They may present with the symptoms of COVID‑19; neutropenic sepsis and pneumonitis may be difficult to differentiate at initial presentation. Medical profession has to keep in mind to screen and triage all those patients to assess, whether they are known, suspected to have COVID‑19, or have been in contact with someone with confirmed infection. In that case, COVID-19 rapid guidance from National Institute for Health & Care Excellence, updated on April 17, 2020, can be followed. 


Atypical symptoms in COVID-19: the many guises of a common culprit: COVID-19 exhibits a diverse range of clinical presentations. Whilst classical respiratory symptoms of a dry cough have been underscored, these may be preceded by atypical symptoms. More generally, it is important not to neglect other disease manifestations, since they may represent alternative modes of viral dissemination.
In critically ill patients, evidence of raised inflammatory markers suggests that cytokine storm syndrome occurs in COVID-19 and may underlie some atypical presentations. Notably, the elderly and those with multiple co-morbidities are severely affected by COVID-19, and atypical symptoms in these susceptible groups warrant further investigation.

More Readings at:

1.    Published on Mar 31st, 2020, 23:28 IST in The Business Insider, India; 10 coronavirus symptoms you may not be aware of, from malaise and dizziness to digestive issues.

2.    Published on 1st April, 2020 in The ScienceAlert; Some COVID-19 Symptoms Are Turning Out to Be Atypical. Here's What We Know So Far

3.    Published on 05 April 2020 in thebmj in a letter to the Editor, under caption, “Atypical symptoms in COVID-19: the many guises of a common culprit.”

4.    Published on April 17th, 2020 in Medscape:   Unusual Presentations of COVID-19: 'Our Ignorance Is Profound'


 

 

(A Paradip Port Trust Hospital Document)


read more...
Related Posts Plugin for WordPress, Blogger...