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Coronavirus US: NIH to launch ‘flurry’ of treatment trials

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coronavirus us nih to launch flurry of treatment trials

The director of the National Institutes of Health (NIH) says the organization is gearing up to launch a ‘flurry’ of clinical trials with the aim to treat the novel coronavirus.

Currently, there are just two drugs – remdesivir and dexamethasone – that have been proven effective in treating severely ill COVID-19 patient. 

But Dr Francis Collins told STAT News that scientists have multiple studies in the pipeline to target different pathways and treat different classes of patients. 

This includes looking at patients who are either at home and hospitalized, trying to reverse dangerous immune system overreactions and relieving blood clot issues. 

Collins said he’s become ‘obsessed’ with the effort to find a successful treatment as researchers race against the clock to stop the virus, which has sickened more than million Americans, in its tracks.

Dr Francis Collins says the National Institutes of Heath is getting ready to launch dozens of clinical trials looking at coronavirus treatments. Pictured: Collins testifies during a Senate Appropriations subcommittee hearing on the plan to research, manufacture and distribute a coronavirus vaccine, July 2

Dr Francis Collins says the National Institutes of Heath is getting ready to launch dozens of clinical trials looking at coronavirus treatments. Pictured: Collins testifies during a Senate Appropriations subcommittee hearing on the plan to research, manufacture and distribute a coronavirus vaccine, July 2

Dr Francis Collins says the National Institutes of Heath is getting ready to launch dozens of clinical trials looking at coronavirus treatments. Pictured: Collins testifies during a Senate Appropriations subcommittee hearing on the plan to research, manufacture and distribute a coronavirus vaccine, July 2

Some studies will look at the effectiveness of monoclonal antibodies in the treatment of patients both at home and hospitalized and others will look at drugs to mitigate cytokine storms. Pictured: Blood samples from coronavirus vaccine trials are handled inside the Jenner Institute in Oxford, England, June 25

Some studies will look at the effectiveness of monoclonal antibodies in the treatment of patients both at home and hospitalized and others will look at drugs to mitigate cytokine storms. Pictured: Blood samples from coronavirus vaccine trials are handled inside the Jenner Institute in Oxford, England, June 25

Some studies will look at the effectiveness of monoclonal antibodies in the treatment of patients both at home and hospitalized and others will look at drugs to mitigate cytokine storms. Pictured: Blood samples from coronavirus vaccine trials are handled inside the Jenner Institute in Oxford, England, June 25

Collins told STAT News that some trials will be looking at monoclonal antibodies, which are antibodies that target a specific antigen on the surface of virus and are copied in lab.

These studies will test their effect on both hospitalized patients and patients who are quarantining at home.

Other trials will examine drugs that may mitigate a dangerous overreaction to the virus by the body’s immune system called a cytokine storm.

These so-called storms occur when the body doesn’t just fight off the virus but also attacks its own cells and tissues.

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31121896 0 image a 43 1595534769932

In cases of COVID-19, the disease caused by the virus, cytokine storms can trigger respiratory distress, which can lead to multi-system organ failure and death.  

Another class of studies will look at blood thinners in seriously ilI COVID-19 patients to see if they prevent blood clots issues.

Collins said the federal health agency will be done efficiently ‘so that you’re not wasting time, money, or people’s willingness to volunteer.’

He also promised that the same standards of safety would be held so that researchers don’t do shoddy work.   

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31121906 8553959 image a 45 1595534780513

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31121900 0 image a 44 1595534776333

‘We will not put something out, and [the US Food and Drug Administration] won’t let us, that is not safe and effective. That’s the bottom line,’ Collins told STAT News. 

‘Even if we come up empty, I will not tolerate the idea that you put something out that’s actually harmful.’ 

Collins, who has been at the NIH since 1982 and became director in 2009 said there at least 100 people also organizing trials a part of the’ NIH’s Accelerating Covid-19 Therapeutic Interventions and Vaccines (ACTIV) program. 

The public-private partnership’s goal is to coordinate the fast-track development of coronavirus treatments and vaccines. 

‘I think [ACTIV] has been just what was needed to keep us from going down a pathway of continued small studies and chaos about results,’ he told STAT News. 

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31121938 0 image a 46 1595534794199

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HEALTH NOTES: This’ll shake you… too LITTLE salt can be bad for us

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health notes thisll shake you too little salt can be bad for us

Health chiefs constantly tell us to slash our salt intake, but new research suggests that having too little also carries health risks.

Doctors at the Royal Free Hospital in London found that too little salt in the body, over a long period of time, weakens the immune system, increasing the risk of infections.

Patients with Gitelman syndrome and Bartter syndrome, which cause an excessive loss of salt through the kidneys, were more likely than others to suffer from recurrent fungal and urinary infections. 

The authors of the study, published in the medical journal Nature Communications, explain that a lack of salt halts the production of a type of white blood cell called interleukin 17, which detects and destroys infections.

Health chiefs constantly tell us to slash our salt intake, but new research suggests that having too little also carries health risks. Pictured: Stock image

Health chiefs constantly tell us to slash our salt intake, but new research suggests that having too little also carries health risks. Pictured: Stock image

Health chiefs constantly tell us to slash our salt intake, but new research suggests that having too little also carries health risks. Pictured: Stock image

Holding hands soon after a row could help couples bring a swift end to any disagreement, research suggests.

Partners who held hands and gazed at one another for three minutes after a heated discussion became less stressed, and saw their heart rates return to normal more quickly, the study found. 

One theory is that touching hands raises levels of oxytocin, the so-called cuddle hormone, which is linked to happy feelings. 

The researchers, from the University of Amsterdam, suggest the technique could prove useful in couples therapy.

Leukaemia warnings we ignore 

Half of British adults wouldn’t seek help for telltale signs of blood cancer, according to a survey.

Research by charity Leukaemia Care found that half of participants surveyed would not visit the GP with unusual bruising or bleeding – the most common signs of leukaemia.

The survey of 2,000 people also found three-quarters wouldn’t seek help for other symptoms, such as fevers or night sweats, and two in five wouldn’t speak to a doctor about feeling weak and breathless.

Zack Pemberton-Whiteley, patient advocacy director at Leukaemia Care, said: ‘If anybody is experiencing one or more of these symptoms, it’s always worth contacting a GP and requesting a blood test.’

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Robot and 14 surgeons work on a single cancer patient

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robot and 14 surgeons work on a single cancer patient

A robot and three teams of surgeons worked simultaneously on a single patient to perform what is thought to be a first-of-its-kind cancer operation, slashing recovery time by a third.

The astonishing procedure, involving 14 surgeons, was carried out in July on a married father-of-one with advanced rectal cancer.

The experts behind it hope the breakthrough will throw open the doors for further operations involving more than one surgeon working at the same time.

About 43,000 Britons are diagnosed with bowel cancer each year. The majority of cases occur in the rectum. 

Symptoms include changes in bowel patterns and bleeding, and more than 50 per cent of cases are diagnosed at a late stage when extensive surgery may be required.

The astonishing procedure, involving 14 surgeons, was carried out in July on a married father-of-one with advanced rectal cancer. Pictured: An illustration of the procedure

The astonishing procedure, involving 14 surgeons, was carried out in July on a married father-of-one with advanced rectal cancer. Pictured: An illustration of the procedure

The astonishing procedure, involving 14 surgeons, was carried out in July on a married father-of-one with advanced rectal cancer. Pictured: An illustration of the procedure

An example of the type of surgery that may be needed is pelvic extenteration, in which the organs in the pelvic region, including the bladder, rectum, prostate and part of the kidney, are removed to stop the disease spreading.

It requires the expertise of at least three surgical teams, and the patient is left with colostomy and urinary bags for life.

Until now the operation has been done in shifts. One team follows the other, with a bowel doctor going in first, followed by a prostate specialist and finally plastic surgeons to repair the damage.

But doctors at Norfolk and Norwich University Hospital took the decision to do all three stages simultaneously with a £1 million Da Vinci Si robot. 

The procedure took less than ten hours, compared to the 12 hours required when done step by step. 

But the greatest success of the operation was the recovery time. Pelvic extenteration patients typically spend three weeks in hospital – this patient was there for just seven days.

Colorectal surgeon Irshad Shaikh said the idea started as ‘just a thought’ but quickly became a concrete plan when he discussed with his colleagues the potential advantages. 

The experts behind it hope the breakthrough will throw open the doors for further operations involving more than one surgeon working at the same time. Pictured: Stock image

The experts behind it hope the breakthrough will throw open the doors for further operations involving more than one surgeon working at the same time. Pictured: Stock image

The experts behind it hope the breakthrough will throw open the doors for further operations involving more than one surgeon working at the same time. Pictured: Stock image

He says: ‘Pelvic extenterations are extremely traumatic because so much tissue has to be removed. Working together, we realised we could make the procedure less invasive and so could reduce tissue trauma significantly and blood loss.’

The patient, Peter Fabb, 53, from Heveningham, Suffolk, is thought to be the first person in the world to have the operation done like this. He was relieved to get out of the hospital so quickly and is now recovering with his family at home. 

He said: ‘I’m still getting back on my feet, but the other day I managed a one-mile walk with the dog, which felt like an achievement.’

Peter was diagnosed with colon cancer in November after suffering discomfort and lower-back spasms while driving.

A beer delivery driver, he began to feel uncomfortable sitting in his truck as he did his rounds.

He was at first given antibiotics because his GP believed he had a prostate infection but when the pain didn’t go away he went for a scan, and that revealed cancer had spread from his rectum and into his prostate.

He was recommended for the surgery after chemotherapy failed to have the desired impact.

Mr Shaikh felt he would be the perfect candidate to trial the new ‘tandem’ pelvic extenteration.

In the past, pelvic extenterations have been an open surgery, where the pelvis area is cut open. Mr Shaikh and prostate surgeon Omar Al Kadhi performed the procedure through keyhole incisions with the helping hands of the Da Vinci Si.

Surgical instruments are attached to the robot’s four arms, each of which has fully rotating wrists. The arms are controlled by the surgeon, sitting at a console with two joysticks and a 3D screen.

In the weeks before, the teams at Norfolk and Norwich carried out a dress rehearsal – mapping out everyone’s positions in theatre.

Peter arrived the morning of the procedure and was in the operating room, under general anaesthetic, less than an hour later. Throughout the ten-hour operation, Mr Sheikh and Mr Al Kadhi would take turns controlling the robot.

First, the colon and most of the rectum were removed, followed by the bladder and prostate. 

At the same time, plastic surgeons Anais Rosich-Medina and Richard Haywood took muscles from Peter’s inner thighs, which were transplanted into the pelvis to provide support once the organs had been removed. 

Finally, Peter’s colostomy and urinary bags were attached, via stomas (ports) in his mid-abdomen.

Mr Shaikh said the team had to be careful of the robot’s arms, which are capable of knocking people off their feet, but he said the operation went very smoothly thanks to ‘fantastic teamwork’.

Returning home seven days later, Peter says he was surprised at how small the scars were considering the size of the procedure – and he is now cancer-free.

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DR ELLIE CANNON: Can anything cure my sore and swollen legs?

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dr ellie cannon can anything cure my sore and swollen legs

I suffer from dreadfully swollen, red and sore legs, which the doctor said is due to cellulitis, a skin infection. I’ve been given an ointment but it doesn’t seem to help. 

I’m at my wits’ end. Can you help?

Cellulitis is a relatively common infection of the skin and the underlying tissues which causes swelling, redness, heat and pain.

To get it under control, it needs to be treated urgently with antibiotics, often in hospital.

But the problem can persist, which seems to be the case here. It can get so bad that walking is affected – in fact, cellulitis can be debilitating, so medical intervention is absolutely vital to prevent worsening complications.

This may come directly from the GP, district nurse or the local healthy leg or tissue viability teams – exactly which of these is dependent on the services provided in your area, but the GP is always the first port of call.

Cellulitis is a relatively common infection of the skin and the underlying tissues which causes swelling, redness, heat and pain, writes Dr Ellie Cannon. Pictured: File image

Cellulitis is a relatively common infection of the skin and the underlying tissues which causes swelling, redness, heat and pain, writes Dr Ellie Cannon. Pictured: File image

Cellulitis is a relatively common infection of the skin and the underlying tissues which causes swelling, redness, heat and pain, writes Dr Ellie Cannon. Pictured: File image

Cellulitis is most often caused by problems with the blood supply in the legs. If the veins are not channelling the blood properly back to the heart, fluid accumulates, leading to swelling and infection.

Along with medication, caring for the skin is an important part of treatment, as recurrent swelling and infections can lead to splitting, ulceration and even permanent damage.

The professionals involved in care should advise on applying moisturising creams to the legs – for instance, it should be applied in a downward direction, as this is proven to work best, particularly at night.

Compression stockings, exercise and other lifestyle measures, such as giving up smoking and maintaining a healthy weight, will be needed, too. No one should be managing this alone.

I was diagnosed with high blood pressure about 15 years ago, aged 50, and I have been on medication ever since. For years my reading has been about 125/80. I had a check yesterday and was told it was 150/80. 

When I asked if this was too high, the nurse was very dismissive and said it was all right. Do you agree?

High blood pressure causes very few symptoms itself but is a significant problem, putting those who suffer from it at higher risk of stroke and heart attacks. 

Large trials over the past few decades have shown us that strict control of blood pressure numbers is really important in preventing these problems.

Our blood pressure does change throughout the day – if you were to take it yourself at home, you would see these fluctuations with tiredness, emotions and even simply at different times of the day. Blood pressure is recorded with two numbers. 

The first figure shows systolic pressure – the force of blood as the heart beats. The second is diastolic – the pressure inside blood vessels between beats. About 125/80 would be an excellent reading.

High blood pressure causes very few symptoms itself but is a significant problem, putting those who suffer from it at higher risk of stroke and heart attacks. Pictured: File image

High blood pressure causes very few symptoms itself but is a significant problem, putting those who suffer from it at higher risk of stroke and heart attacks. Pictured: File image

High blood pressure causes very few symptoms itself but is a significant problem, putting those who suffer from it at higher risk of stroke and heart attacks. Pictured: File image

Ideally, the blood pressure for someone who is not diabetic (those with diabetes are at higher risk of heart attacks, so have a lower blood pressure target) would be under 140/90.

So 150/80 is not all right, as it is above this target. And there is another problem.

No one should be looking at just one reading and deeming it to be fine or not fine. This should have been repeated either at the time or over the course of a few appointments to determine if there has been an increase.

A one-off blood pressure reading is just one moment in time and not a true reflection of what is going on.

Ideally, at this stage, I would recommend a patient gets a home blood pressure machine and take readings twice a day for a week or two. Mornings and evenings are best, and keep a record of your results. With this information, you can then have an online or telephone consultation with your GP about what to do next, if it is indeed high.

This will be far more accurate than a one-off clinic reading.

Tests at the start of the year showed I had raised blood sugar, and the doctor said I could be at risk of diabetes. 

I decided to go on a diet and managed to lose 3st in three months. I have just had another blood test and it showed I still have high blood sugar. I felt deflated. 

Just what do I have to do to get into the healthy zone?

Significant weight loss is very hard to achieve, so anyone who’s managed to lose 3st should feel proud of themselves.

But in some ways the weight loss is the easy part – a crash diet can feel exciting and results are seen quickly.

The challenge is finding a way to stay a healthier weight. This will need to be less strict than the crash diet, so that you can enjoy life, but not a return to the eating patterns that caused you to become overweight in the first place.

Exercise is a key part of that. Walking and cycling are great – again, nothing too extreme, but something you can do every day that’s enjoyable.

Blood sugar levels may take time to change. We use a test called HbA1c to look at diabetes risk, which reflects blood sugar levels over the preceding 12 weeks, so it may be that a test after three months of weight loss wouldn’t show a dramatic change.

Aim to have another test in three to six months.

It’s also important not to focus too much on a single factor. Weight loss itself and an increase in exercise levels have a beneficial effect, aside from blood sugar levels.

As virus cases climb, are you shielding?

Are you one of the two million Britons with high-risk health problems who were advised to shield from March to August?

If so, I’d like to know how you feel at the moment, as Covid-19 cases rise.

Many of my own patients have been asking if they need to isolate again, for the sake of their health. And I’m also aware there are many in these groups who never stopped shielding, despite the official advice saying it was safe to go out again.

Are you one of the two million Britons with high-risk health problems who were advised to shield from March to August? Pictured: File image

Are you one of the two million Britons with high-risk health problems who were advised to shield from March to August? Pictured: File image

Are you one of the two million Britons with high-risk health problems who were advised to shield from March to August? Pictured: File image

Some doctors have been calling for an immediate return to shielding, while many vulnerable people themselves have been calling for another national lockdown. 

But equally, there are others who say they want to live their lives and be allowed to make their own risk assessment, and the freedom to choose whether they venture out.

Please write to me, using the email address below, and let me know what you think.

No fears over vaccine trial halt

As readers may be aware, I’m a guinea pig on a Covid-19 vaccine trial.

WRITE TO DR ELLIE 

Do you have a question for Dr Ellie Cannon? 

Email DrEllie@mailonsunday.co.uk 

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I had my first dose about three months ago and was due a booster jab on September 8 – just as the trial was halted after a woman participant in her 30s became ill.

Drug firm AstraZeneca has now revealed that she had been given a dose in June, after which she felt fine, and a second at the end of August. But after tripping over, she started to suffer pain and weakness in her arms, and had trouble walking and a headache.

Experts now say it was not a side effect of the vaccine. This might sound worrying, but I find it reassuring. Trial breaks are par for the course when a participant becomes ill. It gives the experts time to investigate what caused it.

Strict safety nets are in place, and it implies the other 16,000 of us are fine. And I’m getting that booster this week. 

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