Monthly Archives: April 2021

Heart patients advised to move more to avoid strokes

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Elevated blood pressure, high cholesterol and diabetes increase the risk of heart disease. But a large study today reveals that in people with these conditions, increasing activity levels is associated with a reduced likelihood of heart events and mortality. The research is presented at ESC Preventive Cardiology 2021, an online scientific congress of the European Society of Cardiology (ESC).1

Study author Dr. Esmée Bakker of Radboud University Medical Center, Nijmegen, the Netherlands said: “Previous research showed that improvements in physical activity are beneficial to health. However, those studies were performed in the general population. In our study, we were interested to see if there were similar effects in individuals with cardiovascular risk factors such as high blood pressure, high cholesterol, and diabetes.”

The study included 88,320 individuals from the LifeLines Cohort Study. Participants underwent a physical examination and completed questionnaires about their medical history and lifestyle including exercise. The questionnaires were repeated after approximately four years.

Study participants were divided into five groups according to activity levels at baseline and four years: large reduction, moderate reduction, no change, moderate improvement, and large improvement.2 Participants were followed-up for a median of seven years after the first assessment for the occurrence of cardiovascular disease or death.

Hyper tension

A total of 18,502 (21%) individuals had high blood pressure, high cholesterol, and/or diabetes at the start of the study. The average age of this group was 55 years. After adjusting for age, sex, and baseline physical activity, the researchers found that those with a moderate to large improvement in physical activity were around 30% less likely to develop cardiovascular disease or die during follow-up compared to those who did not change their activity level.

The remaining 69,808 (79%) participants did not have high blood pressure, high cholesterol, or diabetes at the start of the study. The average age of this group was 43 years. After adjusting for age, sex, and baseline physical activity, the researchers found that those with large reductions in physical activity had a 40% higher risk of cardiovascular disease or death compared to those who did not change their activity level.

Dr. Bakker said: “Our study suggests that to prevent heart attacks and strokes and boost longevity, healthy individuals should maintain their physical activity levels, while those with risk factors need to become more active. The associations we found were even more pronounced in people who were relatively sedentary at the start of the study, indicating that inactive people have the most to gain.”

To prevent heart disease, European guidelines recommend at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity or an equivalent combination.3

Dr. Bakker said: “If you are currently sedentary, walking is a good activity to start with. If you are already hitting the recommended amount, try doing 10 minutes more each day or increasing the intensity.”

Covid vaccine may not protect blood cancer patients fully, studies suggest booster dose

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Two new studies published in Blood suggest that the mRNA COVID-19 vaccine may have reduced efficacy in individuals with chronic lymphocytic leukemia (CLL) and multiple myeloma, two types of blood cancer.
According to researchers, these studies could help inform the ideal time for vaccination of these populations. One study suggests two-dose COVID-19 vaccine is less effective for people with CLL as compared to healthy controls.

The first study reports that people with CLL had markedly lower immune response rates to the two-dose mRNA COVID-19 vaccine than healthy individuals of the same age. Because clinical trials of these vaccines did not include patients with blood cancers, who are at high risk of severe illness and complications from the virus, gauging the effectiveness of the vaccine in this population is critically important.

Vaccine-fda

In this study of 167 patients with CLL, only four out of 10 (39.5%) had a positive antibody-mediated response to the vaccine; all healthy adults (controls), by comparison, marshalled an immune response.

First Study

Interestingly, the research revealed wide variations in immune response among patients with CLL depending on where they were in their cancer treatment process. For example, patients undergoing active cancer treatment had significantly lower response rates to the vaccine when compared with people who had completed treatment and were in remission, 16% vs 79% respectively.

Treatment naïve patients (those whose disease is being watched but not yet treated) had a 55.5% response rate. As well, response to the vaccine was markedly higher in people who completed CLL treatment at least a year before vaccination compared with those who were still in treatment within the last year, 94% vs 50%, respectively.

“Overall, the response rate to the vaccine was significantly less than what we see in the general population, which is most likely attributed to the presence of cancer itself and certain CLL treatments,” said lead author of the study Yair Herishanu, associate professor in hematology and head of the CLL service at the Tel Aviv Sourasky Medical Center in Israel.

“It would seem that if you are untreated, in what we call ‘watch and wait’ or do not have active disease, you can gain more benefit from the vaccine. Patients who responded the best were in remission, which makes sense because their immune system had a chance to recover.”

Lower response to Vaccine

In addition to poorer qualitative antibody responses to the vaccine, patients with CLL also had lower antibody titers, which tells us that the intensity of the response was also lower.

For the study, researchers included 167 patients with CLL and 53 healthy controls from December 2020 through February 2021. All participants received two doses of BNT162b2 messenger RNA (Pfizer) COVID-19 vaccine 21 days apart; this was the only vaccine used in Israel at the time of the study.

Patients were 71 years old on average, and 67% were men. Fifty-eight patients (34.7%) were treatment naïve; 75 (44.9%) were on active therapy; 24 (14.4%) were previously treated and in complete or partial remission; and 10 (6%) were in relapse. Antibody titers were also measured two weeks after the second dose.

Patients were followed for a median of 75 days since receiving their first shot, and none had developed COVID-19 infection. There were no significant differences in reported side effects to the vaccine compared to the healthy population.

They found similarly low response rates among patients who were receiving common targeted therapies, including Bruton’s tyrosine kinase (BTK) inhibitors (ibrutinib or acalabrutinib) or a combination of venetoclax with anti-CD20 antibodies such as rituximab.

Notably, none of the patients who received anti-CD20 antibodies within 12 months of COVID-19 vaccination responded. Because only five patients were on venetoclax monotherapy, Dr. Herishanu said they could not draw any conclusions about the impact on response.

People with CLL and other blood cancers remain at high risk for severe illness and complications with COVID-19 infection, and while response rates are lower than ideal, vaccination against COVID-19 is strongly recommended.

Booster dose

The authors suggest that an additional booster dose of the vaccine might be needed for patients with CLL who have completed therapy and previously failed to respond to COVID-19 vaccine, though this would need to be studied.

“Even though response rates were not optimal, patients with CLL should still get the vaccine and, if appropriate, it may be better to do so before CLL treatment starts although the disease itself may affect the response,” said Dr. Herishanu. “Equally important is continuing to take precautions – wearing a mask, avoiding crowds, keeping a social distance, and being sure close contacts get vaccinated against COVID-19.”

He and his team will continue to follow these patients for 12 months to see how many, if any, develop COVID-19 infection following vaccination. Since this study only assessed antibody response, they also plan to check the cellular immune response to gain a more complete picture of the extent to which patients are protected after vaccination.

The researchers note that the same trends would be expected with the other mRNA vaccine (Moderna).

 

Coronavirus doesn’t infect the brain but inflicts damage, says Columbia University study

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The Coronavirus or SARS-CoV-2 that causes COVID-19 does not directly infect the brain but can still inflict significant neurological damage, said a new study from neuro experts at Columbia University Vagelos College of Physicians and Surgeons.

“There’s been considerable debate about whether this virus infects the brain, but we were unable to find any signs of virus inside brain cells of more than 40 COVID-19 patients,” says James E. Goldman, professor of pathology & cell biology, who led the study with Peter D. Canoll, professor of pathology & cell biology, and Kiran T. Thakur, an Assistant Professor of Neurology.

“At the same time, we observed many pathological changes in these brains, which could explain why severely ill patients experience confusion and delirium and other serious neurological effects–and why those with mild cases may experience ‘brain fog’ for weeks and months.”

The study, published in the journal Brain, is the largest and most detailed COVID-19 brain autopsy report published to date, suggests that the neurological changes often seen in these patients may result from inflammation triggered by the virus in other parts of the body or in the brain’s blood vessels.

No Virus in Brain Cells

The study examined the brains of 41 patients with COVID-19 who succumbed to the disease, ranged in age from 38 to 97 and half had been intubated and all had lung damage caused by the virus. Many of them were of Hispanic ethnicity. All of the patients had brain MRI and CT scans.

To detect any virus in the brain, the researchers used multiple methods including RNA in situ hybridization to detect viral RNA within intact cells; antibodies that can detect viral proteins within cells; and RT-PCR, a sensitive technique for detecting viral RNA. But they found no coronavirus in the patients’ brain cells. They did detect very low levels of viral RNA by RT-PCR, but it was likely due to virus in blood vessels or leptomeninges covering the brain.

“Though there are some papers that claim to have found virus in neurons or glia, we think that those result from contamination,” Canoll says. Despite the absence of virus in the brain, they noticed many areas with damage from a lack of oxygen. They all had severe lung disease, so it’s not surprising that there’s hypoxic damage in the brain, caused by strokes, he said.

Persistent Neurological Problems in Survivors

Goldman says that more research is needed to understand the reasons why some post-COVID-19 patients continue to experience symptoms. The researchers are now examining autopsies on patients who died several months after recovering from COVID-19 to learn more.

They are also examining the brains from patients who were critically ill with acute respiratory distress syndrome (ARDS) before the COVID-19 pandemic to see how much of COVID-19 brain pathology is a result of the severe lung disease.

Prince Philip is Dead

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Buckingham Palace announced Friday, 9 April 2021, that Prince Philip, Duke of Edinburgh, has died.

In a statement, the British Royalty said:” It is with deep sorrow that Her Majesty The Queen announces the death of her beloved husband, His Royal Highness The Prince Philip, Duke of Edinburgh.

His Royal Highness passed away peacefully this morning at Windsor Castle. Further announcements will made in due course. The Royal Family join with people around the world in mourning his loss.”

The same message has been shared on Twitter:

 

The husband of Britain’s Queen Elizabeth II, Philip was in hospital for a month until March 16 and returned to Windsor Castle after being treated for an infection and undergoing a medical procedure.

He had been treated in two different hospitals — King Edward VII’s Hospital and St Bartholomew’s Hospital. On March 4, he had undergone a successful medical procedure on a heart condition.

Philip retired from public duties in 2017, and had withdrawn from the public. In fact, both he and the Queen received their coronavirus vaccinations in early January.

His last public statement was early this month when praised those involved in the fight against the pandemic. He and Queen Elizabeth II had been married for 73 years.