Older Adults Turning to Pot for Common Health Problems

TUESDAY, Oct. 20, 2020 — Marijuana is fast becoming a favorite medication among older Americans, a new study finds.

Cannabis is being used to ease problems such as pain, sleep disturbances and psychiatric conditions like anxiety and depression, researchers say.

Among more than 550 patients surveyed, 15% had used cannabis within the past three years, and 50% of users said they used it regularly and mostly for medical purposes.

“Pain, insomnia and anxiety were the most common reasons for cannabis use and, for the most part, patients reported that cannabis was helping to address these issues, especially with insomnia and pain,” said researcher Christopher Kaufmann. He’s an assistant professor in the Division of Geriatrics and Gerontology in the Department of Medicine at the University of California, San Diego (UCSD).

Also, 61% of the patients who used cannabis had started using it after age 60.

“Surprisingly, we found that nearly three-fifths of cannabis users reported using cannabis for the first time as older adults. These individuals were a unique group compared to those who used cannabis in the past,” said researcher Kevin Yang, a third-year medical student at UCSD.

“New users were more likely to use cannabis for medical reasons than for recreation. The route of cannabis use also differed with new users more likely to use it topically as a lotion rather than by smoking or ingesting as edibles. Also, they were more likely to inform their doctor about their cannabis use, which reflects that cannabis use is no longer as stigmatized as it was previously,” Yang said in a university news release.

The report was published online recently in the Journal of the American Geriatrics Society.

“There seems to be potential with cannabis, but we need more evidence-based research,” Kaufmann added. “We want to find out how cannabis compares to current medications available. Could cannabis be a safer alternative to treatments, such as opioids and benzodiazepines? Could cannabis help reduce the simultaneous use of multiple medications in older persons?

“We want to find out which conditions cannabis is most effective in treating,” Kaufmann said in the release. “Only then can we better counsel older adults on cannabis use.”

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US hoping for two Covid-19 vaccines by end of November

Two American companies expect to apply for emergency approval for their COVID-19 vaccines by late November, welcome news as the US hits a third surge of its coronavirus epidemic and approaches its eight millionth case.

Pfizer said Friday it hopes to move ahead with its vaccine after safety data is available in the third week of November, a couple of weeks after the November 3 presidential election.

The announcement means the United States could have two vaccines ready by the end of the year, with Massachusetts biotech firm Moderna aiming for November 25 to seek authorization.

“So let me be clear, assuming positive data, Pfizer will apply for Emergency Authorization Use in the US soon after the safety milestone is achieved in the third week of November,” the company’s chairman and CEO Albert Bourla said in an open letter. The news lifted the company’s shares two percent in the US.

But experts warn that even when vaccines are approved, it will take many months until they are widely available.

In any case, they are unlikely to be a good substitute for mask wearing, social distancing and other recommended behavior to curb transmission because we don’t know how effective they will be.

Indoor gatherings in colder weather

After falling numbers throughout the summer, the country hit an inflection point in its coronavirus outbreak around the second week of September—with a new daily case average of more than 50,000 according to the latest figures, and the trajectory is upward.

With a shade under eight million confirmed infections and more than 217,000 deaths, America is the hardest-hit country in the world.

The US never came close to returning to its baseline after its first wave in spring, meaning the current spike can be more accurately termed a third surge.

Geographically, the major hotspots are in the Upper Midwest and parts of the Rocky Mountains in the west, while parts of the Northeast that were hit hard in spring are seeing their outbreaks starting to rekindle.

Harvard surgeon and health policy researcher Thomas Tsai told AFP there were multiple factors behind the rising cases—from under testing in the Midwest to authorities failing to monitor the reopening of bars and restaurants and dialing back when necessary.

What’s more, “from the contact tracing reports from various municipalities and states, the worry is that the spread is driven now, by indoor social gatherings in people’s homes,” he added, as the focus of social life shifts from public to private spaces in the colder weather.

One bright sign is that COVID-19 treatments have improved markedly, and since the cases are more spread out than before, hospitals aren’t being overwhelmed.

Widespread mask use might also mean that when people do get infected, they have less virus in their body which makes them less sick.

‘No magic bullet’

While vaccines are a crucial tool against the virus, experts have warned they can’t be a substitute for behavioral measures like masks and distancing.

“It’s welcome news that there will be one more thing that can help prevent COVID transmission,” said Priya Sampathkumar, an infectious disease doctor and professor at Mayo Clinic.

“But I think we need to be cautious and understand that a vaccine isn’t a magic bullet,” she added.

Pfizer and Moderna, both funded by the US government, launched Phase 3 of their clinical trials at the end of July, and both were producing their doses at the same time.

They aim to deliver tens of millions of doses in the US by the end of the year.

Both are “mRNA vaccines,” an experimental new platform that has never before been fully approved.

They both inject people with the genetic material necessary to grow the “spike protein” of SARS-CoV-2 inside their own cells, thus eliciting an immune response the body will remember when it encounters the real virus.

This effectively turns a person’s own body into a vaccine factory, avoiding the costly and difficult processes that more traditional vaccine production requires.

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New developments for the treatment of muscle spasticity after stroke and nervous system defects

Chronic muscle spasticity after nervous system defects like stroke, traumatic brain and spinal cord injury, multiple sclerosis and painful low back pain affect more than 10% of the population, with a socioeconomic cost of about 500 billion USD. Currently, there is no adequate remedy to help these suffering people, which generates an immense medical need for a new generation antispastic drugs.

András Málnási-Csizmadia, co-founder of Motorpharma Ltd. and professor at Eötvös Loránd University in Hungary leads the development of a first-in-class drug candidate co-sponsored by Printnet Ltd. MPH-220 directly targets and inhibits the effector protein of muscle contraction, potentially by taking one pill per day. By contrast, current treatments have low efficacy and cause a wide range of side effects because they act indirectly, through the nervous system.

“We receive desperate emails from stroke survivors, who suffer from the excruciating symptoms of spasticity, asking if they could participate in our research. We work hard to accelerate the development of MPH-220 to alleviate these people’s chronic spasticity,” said Prof. Málnási-Csizmadia.

The mechanism of action of MPH-220 and preclinical studies are recently published in Cell. Dr. Máté Gyimesi, CSO of Motorpharma Ltd. highlighted: “The scientific challenge was to develop a chemical compound which discriminates between skeletal and cardiac muscle myosins, the motor proteins of these contractile systems. This feature of MPH-220 makes it highly specific and safe.”

Prof. James Spudich, co-founder of Cytokinetics, MyoKardia and Kainomyx, all companies developing drugs targeting cytoskeletal components, is also very excited about MPH-220 as a possible next generation muscle relaxant. “Cytokinetics and MyoKardia have shown that cardiac myosin is highly druggable, and both companies have potential drugs acting on cardiac myosin in late phase clinical trials. Skeletal myosin effectors, however, have not been reported. Motorpharma Ltd. has now developed a specific inhibitor of skeletal myosin, MPH-220, a drug candidate that may reduce the everyday painful spasticity for about 10% of the population that suffers from low back pain and neurological injury related diseases,” said Professor Spudich, former chair of Stanford medical school’s Biochemistry department, a Lasker awardee.

Drug development specifically targeting myosins is becoming a distinguished area, as indicated by last week’s acquisition of MyoKardia by Bristol-Myers Squibb Co. for 13.1 billion dollars in an all-cash deal, in the hope of marketing their experimental heart drug targeting cardiac myosin. This business activity shows the demand for start-up biotech companies such as Myokardia or Motorpharma.

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Improving health care autonomy for young adults with autism

Independence has always been a driving force in Nancy Cheak-Zamora’s life. Now an associate professor at the University of Missouri School of Health Professions, she grew up undiagnosed with dyslexia, a learning disorder that can lead to difficulty reading.

“Although I wasn’t receiving all the assistance or services I probably needed because I was undiagnosed, I always had supportive people in my life who encouraged me and gave me opportunities to be successful,” Cheak-Zamora said. “That encouragement fundamentally allowed me to take on more independence and work through challenges in a way that has helped me succeed in both academia and in life.”

Eager to offer the same encouragement she received growing up, Cheak-Zamora’s research is rooted in a desire to improve the independence of young adults with developmental disabilities, particularly autism. One of her previous studies found young adults with autism were half as likely to receive health care transition services, such as learning how to schedule a doctor’s appointment or fill a prescription, compared to other young adults with special health care needs.

To help solve this disparity, she recently developed the world’s first health care “transition readiness assessment” specifically for adolescents with autism. A transition readiness assessment identifies skills adolescents need to transition from pediatric care to adult care and be able to manage their health appropriately. By partnering with five autism clinics across the United States, including the MU Thompson Center for Autism & Neurodevelopmental Disorders, Cheak-Zamora had 500 caregivers of young adults with autism in her study.

She found young adults with autism could benefit by better understanding medication management, insurance policies and health care finances; developing skills like scheduling a doctor’s appointment or filling a prescription; and receiving education on other areas like interactions with law enforcement and understanding their sexual health and relationship needs.

“Building their autonomy and independence in a health care setting is important because once they can meet the challenges in front of them in one aspect of their life, the research shows that confidence will carry over into other areas of their life as well,” Cheak-Zamora said. “Successfully scheduling a doctor’s appointment can translate into more autonomous behavior in school or taking more ownership of chores at home.”

Cheak-Zamora added that health care providers can use her transition readiness assessment to better identify gaps in education and areas for improvement when caring for young adults with autism, which will take the pressure off already overburdened caregivers.

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Spain considers state of emergency for virus-hit Madrid

Spanish Prime Minister Pedro Sánchez is holding an emergency Cabinet meeting on Friday morning to consider declaring a state of emergency for Madrid and its surrounding region in order to impose stronger anti-virus restrictions on the reluctant regional governors.

The meeting comes a day after a Madrid court struck down a national government order that imposed a partial lockdown in the Spanish capital and its suburbs. The ruling sided with regional officials who had appealed the application of stricter measures against one of Europe’s most worrying virus clusters.

The judges said that travel restrictions in and out of the cities might be necessary to fight the spread of the coronavirus, but that under the current legal framework they were violating residents’ “fundamental rights.”

The national government said late Thursday night that Sánchez had spoken by telephone with Madrid regional chief Isabel Díaz Ayuso and gave her an ultimatum. Sánchez told Ayuso that if she did not quickly tighten measures or make a formal request for his national government to declare a state of emergency, then his government would go ahead and declare it anyway.

A state of emergency gives the national government extraordinary powers in time of crises to temporarily limit the constitutional rights of citizens. In this case, it would limit their freedom of movement by restarting perimeter controls on Madrid and some nearby towns also suffering from high contagion rates.

A much stricter nationwide state of emergency that began with home confinements was applied by the government from March until June to successfully rein in Spain’s first wave of the virus that causes COVID-19. Since it ended, the regions have regained control of health policy and their responses to controlling outbreaks has varied. Some have applied perimeter lockdowns around areas or towns with viral clusters.

The Madrid region has a 14-day infection rate of 591 coronavirus cases per 100,000 residents, more than twice Spain’s national average of 257 and five times the European average rate of 113 for the week ending Sept. 27.

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Study identifies brain cells most affected by epilepsy and new targets for their treatment

Epilepsy is one of the most common neurological diseases. It is caused by a malfunction in brain cells and is usually treated with medicines that control or counteract the seizures.

Scientists from the Faculty of Health and Medical Sciences, University of Copenhagen and Rigshospitalet have now identified the exact neurons that are most affected by epilepsy. Some of which have never been linked to epilepsy before. The newfound neurons might contribute to epileptogenesis—the process by which a normal brain develops epilepsy—and could therefore be ideal treatment targets.

“Our findings potentially allows for the development of entirely new therapeutic approaches tailored towards specific neurons, which are malfunctioning in cases of epilepsy. This could be a breakthrough in personalized medicine-based treatment of patients suffering from epileptic seizures,” says Associate Professor Konstantin Khodosevich from Biotech Research & Innovation Center (BRIC), Faculty of Health and Medical Sciences.

A major step towards more effective drugs

It is the first time a study investigates how every single neuron in the epileptic zone of the human brain is affected by epilepsy. The researchers have analyzed more than 117,000 neurons, which makes it the largest single cell dataset for a brain disorder published so far.

Neurons have been isolated from tissue resected from patients being operated as part of the Danish Epilepsy Surgery Programme at Rigshospitalet in Copenhagen.

“These patients continue to have seizures despite the best possible combination of anti-seizure drugs. Unfortunately, this is the case for 30-40% of epilepsy patients. Active epilepsy imposes serious physical, cognitive, psychiatric and social consequences on patients and families. A more precise understanding of the cellular mechanism behind epilepsy could be a major step forward for developing drugs specifically directed against the epileptogenic process compared to the current mode of action reducing neuronal excitability in general throughout the brain’ says associate professor Lars Pinborg, head of the Danish Epilepsy Surgery Program at Rigshospitalet.

From ‘neuronal soup’ to single cell analysis

The study from the Khodosevich Group differs from previous work by using single cell analysis. Earlier studies on neuronal behavior in regards to epilepsy have taken a piece of the human brain and investigated all the neurons together as a group or a ‘neuronal soup.” When using this approach, diseased cells and healthy cells are mixed together, which makes it impossible to identify potential treatment targets.

“By splitting the neurons into many thousands of single cells, we can analyze each of them separately. From this huge number of single cells, we can pinpoint exactly what neurons are affected by epilepsy. We can even make a scale from least to most affected, which means that we can identify the molecules with the most promising potential to be effective therapeutic targets,” says Khodosevich.

Next step is to study the identified neurons and how their functional changes contribute to epileptic seizures. The hope is to then find molecules that can restore epilepsy related neuronal function back to normal and inhibit seizure generation.

Expanding knowledge on underlying mechanisms of epilepsy

The study confirms expression from key genes known from a number of previous studies, but is also a dramatic expansion of knowledge on the subject. Previously, gene expression studies have identified a couple of hundred genes that changes in epilepsy.

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Antibiotics May Be Best First Treatment for Appendicitis

TUESDAY, Oct. 6, 2020 — For some patients suffering from appendicitis, antibiotics may do the trick, a large U.S. trial suggests.

More than 70% of patients who received antibiotics avoided surgery for at least 90 days, according to the new report.

“When we compared the outcomes of people treated with antibiotics alone or surgery to remove the appendix, we found that people receiving either treatment felt well at 30 days,” said co-principal investigator Dr. David Talan. “In terms of overall health status, antibiotics were no worse than surgery and allowed most people to avoid an operation in the short term.”

Talan is a professor of emergency medicine and infectious diseases at the David Geffen School of Medicine at UCLA.

In the trial, more than 1,500 patients in 14 U.S. states randomly received antibiotics first or an appendectomy. The trial is the largest ever clinical randomized look at appendicitis treatment, the study authors said.

According to Bonnie Bizzell, chairwoman of the trial’s patient advisory board, “People treated with antibiotics more often returned to the emergency department, but missed less time from work and school. Information like this can be important for individuals as they consider the best treatment option for their unique circumstance.”

About three in 10 patients given antibiotics had surgery within 90 days, according to researcher Dr. David Flum, associate chairman of surgery at the University of Washington School of Medicine, in Seattle. “There were advantages and disadvantages to each treatment, and patients will value these differently based on their unique characteristics, concerns and perspectives.”

Initial treatment with antibiotics created a higher risk for patients with an appendicolith — a calcified deposit within the appendix that occurs in roughly one-quarter of patients. It is associated with more complications and a 40% chance of surgery within 90 days, the researchers said.

The findings were published online Oct. 5 in the New England Journal of Medicine.

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Podcast: The making of a fast, accurate saliva test for COVID-19

A new episode of our podcast, “Show Me the Science,” has been posted. At present, these podcast episodes are highlighting research and patient care on the Washington University Medical Campus as our scientists and clinicians confront the COVID-19 pandemic.

Since the start of the COVID-19 pandemic, health officials have talked about the need for better, faster and more frequent testing. Recently, researchers at Washington University School of Medicine in St. Louis developed a saliva test that can detect the SARS-CoV-2 virus without inserting a nasopharyngeal swab into the nose or throat.

The saliva test also doesn’t require chemical reagents to extract RNA from the sample. Such reagents have been in short supply, often resulting in delays in reporting test results. The test can be run in a few hours and, ideally, can return results the next day. Further, it can test for more than one virus at a time, making it particularly useful as the COVID-19 outbreak stretches into flu season. The new test was developed by a team from the School of Medicine’s Department of Genetics and the McDonnell Genome Institute, in collaboration with the biotechnology company Fluidigm. The test has attracted the attention of state officials in Missouri, who are planning to use the test to screen populations known to be at risk for the virus.

In this episode, scientists Jeffrey Milbrandt, MD, PhD, and Richard Head discuss why they believe the saliva test will be important in detecting the virus’s presence even before people begin having symptoms, including in individuals who remain asymptomatic. Milbrandt is the James S. McDonnell Professor and head of the Department of Genetics and the McDonnell Genome Institute, and Head is a professor of genetics and director of the Genome Technology Access Center at the McDonnell Genome Institute.

The podcast, “Show Me the Science,” is produced by the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis.

Transcript

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Jim Dryden (host): Hello, and welcome to Show Me the Science, conversations about science and health with the people of Washington University School of Medicine in St. Louis, Missouri, the Show-Me State. As we continue to look at Washington University’s response to the COVID-19 pandemic, better testing is an area that many say is key to controlling the outbreak. And a major recent step in the Washington University response came when the US Food and Drug Administration granted emergency use authorization to a new saliva-based coronavirus test developed by researchers at the School of Medicine’s Department of Genetics and the McDonnell Genome Institute. Here in the Show-Me State, the governor and the first lady of Missouri recently were shown to test positive for the virus. But before he tested positive himself, the new saliva test brought Missouri governor Mike Parson to campus.

Mike Parson: By enabling rapid testing, this new saliva test is a major development that will improve our testing capabilities even more. I want to thank WashU and all the researchers, not only for their work on this new test, but also their continued support throughout the COVID-19 crisis.

Dryden: The saliva test is fast, accurate and inexpensive. One of the test developers, Jeffrey Milbrandt, also spoke to members of the press during the governor’s visit.

Jeffrey Milbrandt, MD, PhD: So the test requires only a small amount of saliva collected by spitting into this tube. It is very accurate. It is quick, simple, and is not limited by supply-chain shortages that we’ve seen in others. It’s also very economical. Importantly, this saliva test can be altered in the future to accommodate other viruses such as the influenza viruses that will soon raise their head.

Dryden: Milbrandt is the head of genetics and of the McDonnell Genome Institute. He says the test was designed to run on a machine that already was being used at the Genome Institute, one of the original centers that was involved in the mapping and sequencing of the human genome.

Milbrandt: We hope that we will always be able to give a result in about 24 hours.

Richard Head: I’m Richard Head. I’m a professor of genetics and I’m also the director of the Genome Technology Access Center within the McDonnell Genome Institute.

Dryden: Richard Head also worked to develop the saliva test. He says for months, there’s been an urgent need to simplify testing so that infected people can be identified easily and quickly. And the test does not require anyone to stick a long nasopharyngeal swab, or NP swab, up anyone else’s nose. In this episode, we discuss the new saliva test with Milbrandt and Head from Washington University’s McDonnell Genome Institute.

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Dryden: Testing has been a problem since the beginning of the pandemic. How to test, who to test, how often to test. How does this new saliva test contribute to answering the need for faster, better testing? At least at Washington University and in our region, how does this fit into that question, I guess?

Head: I think there are really three ways. The first way is that the original tests that were being done, NP swabs, have met with a number of supply-chain issues as a result of maxing out the capacity for the reagents. And so as we continue to expand the need for testing, and let’s face it, this is really unprecedented in the amount of testing that we’re doing for anything and the amount of time that we’re doing it, so the supply chain that has existed for the tests that have been used has really been maxed out. And so in order to continue to expand, we really need additional mechanisms for testing that use different types of equipment, different types of reagents, etc., so that we’re able to continue to expand the testing need to fill that gap. I think another aspect of this is that anyone who’s ever had an NP swab or has seen an NP swab done, knows that they’re extremely uncomfortable. And so, even though that’s been the standard test, I don’t think anyone was ever hoping that would continue to always be the only option moving forward, to the point where a lot of folks have probably avoided getting a test, not only because of the availability of tests early on but because of the discomfort involved, so having a test like a saliva test that uses different types of equipment and reagents that’s also much more comfortable or there’s really no discomfort at all. We’ve also noted that there are some sampling issues with NP swabs that the saliva tests seem to be– because of the fact that you don’t have the discomfort factor, we’re able to detect certain individuals that NP swabs miss and vice versa. So I think having multiple avenues to test also gives us a better overall sampling and understanding of the prevalence of the virus in the community.

Dryden: Now this is not the only saliva test that has been approved for emergency use authorization, but this is a different type of test in that you don’t have to go through one of the key steps in many of the other tests, which is extracting RNA from the sample. Can you first tell me what RNA extraction is and why eliminating that step might be an advantage here?

Head: Sure. So the RNA-extraction step is something that’s common for the NP swabs and it’s also involved in some of the saliva assays. And what this is, is this is a step where you have to take the sample, and usually a significant volume of the sample, and you take it through a procedure that allows you to extract the RNA from the viral particles. And it requires kits or reagents that are necessary to do that step. Tests like ours does not require that extraction step. We actually take the crude saliva sample directly into the assay, so it saves on the need for those reagents which can also be limiting due to supply-chain issues, since many, many of the different tests require that step to occur.

Dryden: You guys developed this test with the idea of using a machine that you already had at the McDonnell Genome Center, correct?

Head: That’s correct. We use the Fluidigm Biomark platform for this, which we’ve been using here for both clinical and research testing for about eight years.

Dryden: What kind of testing? What is it normally used for?

Head: We use it for tests similar to the ones that we’re running now. We’ve used it for looking at disseminated tumor cells in bone marrow and it’s a fairly robust platform.

Dryden: Now, Dr. Milbrandt, I want to ask you a question. What was the harder thing to do here? To develop this test, or to make it possible to scale it up so that it could be used? I mean, to do things like coming up with a funnel to catch the saliva, getting it made, putting the kits together, setting up this whole infrastructure. Was the science part easier, or the organizational, how to actually implement it part?

Milbrandt: I think the science part is easier once you discover the answer. I mean, so, it was a broad-based team of people. That’s the key step here, the infrastructure that has been developed at the MGI over the years in terms of personnel and expertise and equipment. We have expertise on developing the kits, finding samples, learning how to take the specimens in the very best, most efficient way through occupational health, to help the student screening. All those attributes came together and organizing that was an interesting exercise. But I think that part now is complete and you see the results. There were a couple solutions with the saliva that adapted it, that Rich and his team came up with. Adapted it to the Fluidigm, which really set the stage for this rapid, non-supply chain limited, very sensitive saliva test.

Dryden: Now, for either of you, how long does it take to actually run a test? I participated a couple of weeks ago in one of the WashU studies and we got results back in 48 hours, but the test itself, is this something can be run in minutes? Does it take hours on the machine? How long does an individual sample take?

Head: From the time that we start to physically process a sample to the time a result comes off of the instrument and can be viewed in a report, is on the order of about three and a half to four hours.

Dryden: So it’s much faster, also, than the NP swab test?

Milbrandt: It can be, but I think it shouldn’t be characterized as the so-called rapid test. We strive for 12- to 24-hour turnaround for the test, so that would put it not in the category that people are talking now about rapid-turnaround tests. So it’s not one of those but it’s good turnaround time.

Dryden: Well, and I know it wasn’t just how long it took to run an actual test, but we were, earlier in the summer, having the experience of people waiting five, six, seven, eight days in order to get results. Even if the results were negative, eight days later you might be positive. I mean, it wasn’t turning around quickly enough to do much good, I guess.

Milbrandt: Yeah. It’s an important point that’s now being recognized that testing needs to be turned around probably within 24 hours to really make it useful for public health purposes. Rich mentioned that the NP swab, the swabs, actually, were limiting for a time. So you couldn’t perform the swab, the actual test. The other thing about the NP swab is that it also exposes the health-care worker. So you need a health-care worker, you need a nurse to actually do the NP swab. That takes time. That costs money. But also it exposes that worker to potential viral infection. Imagine if the person sneezes when you’re doing the test, so there are extra protective equipment that needs to be used for that purpose and saliva eliminates a number of those as well.

Dryden: We’re now heading into the fall. School has started again. This has long been predicted to be a time period where we might be experiencing a second wave. How does having a test like this, in the arsenal, make it possible now to perhaps better prevent or contain the pandemic in the months ahead, at least in this region where the test is available?

Milbrandt: If you can screen quickly and you can screen large numbers of people and you know where the infection lies, you can stop the spread with social distancing, quarantining, best practices for preventing the spread. But if you don’t, of course, know where the asymptomatic patients or even symptomatic patients are located, without testing then, of course, you can’t institute those measures. So the availability of a test that can do large numbers of people and pick up asymptomatic infections can be very helpful. The other thing that should be said about this test is that we can— in the fall, now, we’re worried about flu at the same time as COVID. How will you distinguish the symptoms? It will be a diagnostic nightmare in the beginning. And this test can easily be adapted to add additional viruses, so that when you run the diagnostic test for no extra time and little extra cost, we will be able to screen for multiple viruses at once as the Fluidigm Corporation comes out with those new chips. So we’re excited about that and I think that will be another big help in mitigating some of the issues we’re going to come up with in the fall.

Dryden: Is there a target on how many tests you want to run? Who you want to test? I mean, I know that when the freshmen showed up at their dorms at WashU, they were doing the saliva test. You were running that. But what about other schools or businesses in the region? How big are you looking, I guess?

Milbrandt: As you know, the state of Missouri, they’re very interested in exporting our test to other sites within the state of Missouri and disseminating the testing platform throughout the state of Missouri. We’ll be doing a large number of individuals for the state. The priority is to take care of the students, work with the state. There are so many institutions — colleges, public schools, businesses, assisted-care facilities —that need our help. We cannot help everyone that we would like to be able to help. We’re prioritizing that list and trying to do the testing where we can make the biggest impact. One thing I would like to mention, that there are NIH grants that will likely be awarded now, to Washington University, that will help in the underserved populations.

Dryden: Rich, did you want to add anything to that?

Head: Just to follow up on what Jeff said. Yeah. We’ve been working with and communicating with a number of other facilities, both in the state of Missouri and even some outside of Missouri as well, that have had interest in the platform and the test format. Basically, we’re trying to give them what we know about the tests and make it easier for them to make a decision as to whether or not the use of this particular platform would work in their environment as well. And basically, just disseminate the test as broadly as we can.

Dryden: Would you want to screen everybody, like happened with the freshmen when they were moving in, or do you want to test people who seem to be symptomatic, or— Who gets this test in the places where it might be available?

Milbrandt: We’re going to let the state determine somewhat what populations they think are best to screen. Certainly, the assisted-care facilities will be one of those that they’re very interested in doing, but much of this is flowing from the state in terms of the screening and surveillance that’s necessary.

Dryden: As we’re having this conversation today, a lot of us who work at WashU are there sometimes and other times we’re working from home. Would you see this as something that might be used, “Coming to work on Monday, it’s test day,” or how will that work?

Milbrandt: We did consider that possibility. As we ran a number of the pilots, we found that the percent positivity rate amongst our employees, as well as amongst many of the students, was very low. Much lower than we anticipated, so that the decision has been made now that repetitive testing of Washington University employees will probably not be necessary if things continue as they are now.

Dryden: And one final question. We always talk about this test as being inexpensive. How inexpensive is it? I mean, if you have a lot of money, $1,000 might not be all that expensive. But for me, $5 is a little bit more reasonable. I assume it’s somewhere in that range, but how inexpensive is it?

Milbrandt: You are correct, Jim. It is somewhere between five and a thousand dollars.

[laughter]

Dryden: Well, thank you.

Milbrandt: We haven’t established all of the guidelines for final pricing yet. There’s a number of factors that need to be considered, but we’re working on that diligently.

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Dryden: As use of the new saliva test ramps up in the St. Louis region and in the state of Missouri, Milbrandt and Head believe they have the capacity to do 20 to 30,000 tests per week. They also have an agreement in place to get more machines from the Fluidigm Corporation in order to run even more tests. And, in theory, more testing — along with quarantining, wearing masks, and contact tracing — are key steps toward getting life back to something that’s a little closer to normal while we wait for more effective therapies and vaccines. Show Me the Science is a production of the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis. The goal of this project is to keep you informed and maybe teach you some things that will give you hope. Thank you for tuning in. I’m Jim Dryden. Stay safe.

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How to boost your immune system in good time for flu season

Already starting to panic about flu season? You’re not alone.

Do you need a flu jab? How can you tell the difference between flu symptoms and coronavirus? How can you boost your immune system ahead of winter?

There has been an intense focus on health and immunity this year thanks to Covid-19 and now everyone’s starting to think about how best to protect themselves for the winter.

‘The immune system is one of the most complex and comprehensive systems in the human body,’ says Mike Wakeman, a clinical pharmacist and ambassador for health food supplement CurraNZ.

‘It’s also one of the most important. It’s the invisible barrier against all sorts of foreign assaults from micro-organisms (fungal infections, bacteria and Covid-19) and allergens (pollens, dust mites and chemicals) that we encounter on a daily basis.’

Our first level of immunity is called the innate immune system and is activated as soon as a disease-causing micro-organism is detected. It can detect invaders such as viruses, bacteria, parasites and toxins and attempt to kill them off, before they can enter the body.

‘Innate immunity is made up of things like skin, the gastrointestinal tract and the respiratory tract. Inside these parts of the body are barriers like mucus, secretion and gastric acid, which try to stop the invaders getting in. The innate system also has immune cells (called macrophages), which are some of the most abundant cells in the human body and specialise in detecting and destroying bacteria and other harmful organisms by engulfing and killing them,’ says Mike.

The second level of protection is called the adaptive immune system, which is activated to enhance the innate system.

‘This is mainly cells called lymphocytes,’ explains Mike. ‘They are a type of white blood cell that have the ability to recognise a unique part of a micro-organism, memorise it and produce specific pathogen-neutralising compounds known as immunoglobulins. So when the body encounters this particular antigen [foreign substance] again it can produce more of the immunoglobulins it knows can kill it. This is the basis of how immunisations and flu jabs work.’

Generally, our immune system does an amazing job of defending us but a recent review in the Journal of Sport and Health Science found that ageing, obesity, and inactivity have a negative effect on the immune system.

‘The idea of boosting your immunity sounds like a simple enough process, but it’s not like giving yourself an injection or taking a shot,’ says Mike.

‘You need to think more about optimising your immunity on a daily basis as some vitamins and minerals take longer to generate their effect than others. Vitamin C is water soluble so absorbed straight away, while vitamin D is fat-soluble so is stored in fat cells rather than circulating in the body.

‘Autumn is the best time to think about how to build up immunity for winter and a good quality multi-vitamin is a cheap way to start optimising your protection.’

Spot the signs of a weakened immune system

Don’t wait until you become poorly to start looking after yourself – if you are suffering from any of these problems it’s worth taking stock and taking some extra care, says Mike.

Spot the signs

Cracks in the corner of the mouth

‘This can indicate some aspects of the immune system might be under stress. Vitamins and minerals are vital as they can help to resolve minor issues like this.’

Constant cold symptoms or infection

‘Constant and repeated colds are not only a sign of a weakened immune system, but also place extra demands on immune micronutrient status.’

Wounds take longer to heal

‘Poor healing is a typical symptom of a challenged immune system, and a number of vitamins, such as vitamin C can help improve the skin function.’

Bleeding gums

‘Often poor oral hygiene can be a major challenge to the immune system, so brush your teeth regularly, twice daily and don’t forget to floss.’

Constantly tired and over-stressed

‘Stress can really impact on our immune function, so take time out to look after yourself, get some exercise and relieve stress and exhaustion as much as possible.’

A weakened immune system can be helped with simple diet changes. ‘Most of us are deficient in vitamin D which is produced by the body when we’re exposed to sunshine,’ says Mike.

‘We don’t get enough of it during the summer and definitely not in winter. Oily fish, like pilchards, sardines, mackerel and some salmon are a good source of vitamin D and also high in omega-3 fatty acids, which may also help enhance the function of the immune cells.’

Mike is keen to emphasise that lots of what you need to bolster the immune system can be found in food. ‘You should be eating at least five portions of fruit and veg a day,’ he says.

‘Not only do vitamins and minerals optimise the immune system, they have an anti-inflammatory effect too, so if the immune system over-responds, these micronutrients can help resolve the inflammation this causes. These vitamins and minerals also help the body produce anti-bacterial compounds that fight infection within the body while compounds known as polyphenols support immunity.’

So, a healthy diet has never been more important. When teamed with a good quality multi-vitamin you should stand a better chance of fighting off the winter nasties.

Supplements to help boost your immune system

Five of the best supplements to give a helping hand

1. Extra special

Vitabiotics Immunace Extra Protection contain lycopene, resveratrol, astaxanthin, alpha lipoic acid and vit D. £10.15 (30 tablets)

2. Gum deal

Sambucol ImmunoForte Gummies contain black elderberry flavonoids, plus vitamin C, zinc and high levels of antioxidants. Suitable for vegans. £11 (30 gummies)

3. Vit blitz

Urgent-C Everyday Immune Support contains 1,000mg of vitamin C, plus vitamin D, zinc, selenium, beta glucans and elderberry extract which all help the normal function of the immune system. £14.95 (30 sachets)

4. Berry nice

Blackcurrants offer anti-viral and anti-microbial properties to help the body ward off infection. A single capsule of CurraNZ is equivalent to a handful of berries. £21.75 (30 capsules)

5. Sweet Treat

Made with all-natural ingredients and boosted with 100 per cent NRV vitamin D, C and B12, these new Perkier +Immune bars are tasty plant-based snacks to boost immune health. £15.99 (15 bars)

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Woman loses four stone by swapping takeaways for home-made healthier fakeaways

Like so many of us, Lucy Robathan, 20, piled on weight after getting into a relationship.

At her heaviest she weighed 15 stone, thanks to curling up on the sofa and ordering a takeaway with her new man every night.

But after realising that none of her clothes fit, Lucy decided to make a change.

She managed to lose four stone and completely transform her body by making one simple change: ditching the takeaways and making her own healthier fakeaway versions at home.

By making her own pizza wraps, vegan kebabs, and McMuffin dupes, Lucy soon saw the weight fall off, and is now just 11 stone.

Lucy, from Hinckley, Leicestershire, said: ‘I have always felt uncomfortable with my body but I never had the motivation to do anything about it.


‘I was bullied when I was younger for my weight but as you get older it stops.

‘I was very uncomfortable going out with my boyfriend, because he was so fit.

‘When I got into a relationship I gained almost two stone- I realised we would order takeaways on most days or go out for meals.

‘I used to get fizzy drinks every day and binge junk food-I didn’t really think about what I was eating.

‘I found Instagram accounts and started calorie counting and making fakeaways.

‘It was more of a lifestyle change for me rather than a diet, I didn’t feel restricted at all.’

Lucy’s fakeways included a 258 calorie kebab, a 307 calorie McMuffin fakeaway made with quorn sausage patties, and 250 calorie pizza wraps.

Lucy’s diet before and after:

BEFORE

  • Breakfast: bacon or sausage baguette
  • Lunch: pizza
  • Dinner: takeout
  • Snacks: chocolate and crisps
  • Drinks: fizzy drinks

AFTER

  • Breakfast: overnight oats or eggs on toast
  • Lunch: homemade pizza wraps
  • Dinner: fakeaways
  • Snacks: low cal bars, fruits, boiled eggs
  • Drinks: water


Along with tweaking her diet, Lucy, who shares her journey on Instagram, also started doing weight training four times a week.

Her advice to others hoping to lose weight is to go slow and steady rather than doing crash diets and expecting instant results.

‘It took me almost two years to get where I am right now, weight loss needs patience,’ Lucy said.



‘I had a lot of people telling me I look great, ask me how I’ve done it and if I can share any tips.

‘My advice for people trying to lose weight would be that it takes time, it doesn’t happen overnight, don’t be too restrictive.

‘I think it’s important to keep a balance, don’t limit yourself too much and don’t stop socialising because you are on diet.’

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