Category Archives: Preventative Medicine

Flu and viral: If you are down with the flu, you must isolate yourself to limit spread

A viral infection is known as influenza. It targets the respiratory system, including the nose, throat, and lungs. Although influenza is frequently referred to as the flu, it differs from stomach "flu" viruses that cause vomiting and diarrhoea. The flu often goes away on its own for most people. But occasionally, influenza and its side effects might be fatal.

Understanding the flu, its symptoms, prevention, and treatment can help you better deal with it. In this article, we discuss some of the most frequently asked questions regarding the flu.

1. How are flu virals spread?

Flu virals can spread in various ways. They may spread through airborne respiratory droplets (coughs or sneezes), touching a contaminated surface, saliva (kissing or shared drinks), skin-to-skin contact (handshakes or hugs), etc.

2. What causes flu spike in monsoon?

The sudden change in weather and fluctuation in temperature can cause influenza. Low immunity is also a reason. The best time for pathogenic microorganisms to reproduce is regarded to be the monsoon season, also referred to as the flu season.

The monsoon season has greater rates of disease than other times of the year because of the humidity, dirt, and standing water that function as a breeding ground for many viruses and bacteria. At this time of year, adopting a healthy lifestyle and improving living conditions can be effective preventative measures.

3. How can we prevent getting virals?

Physician Dr. Balamurugan suggests, The best way to prevent the flu is through annual vaccinations. Each flu shot protects against three to four different influenza viruses within that year's flu season.

Other ways to prevent spreading this disease include washing hands regularly, avoiding large crowds specifically during a flu outbreak, covering mouth and nose when cough or sneeze, staying home. Adds Dr. Balamurugan.

4. Should viral patients isolate? If yes, for how long?

Yes, 4 to 5 days after the onset of symptoms. The virus is transmissible and can transfer from one sick person to the other. Make sure to isolate and stay at home to reduce the spread.

5. Do flu virals cause long-term damage to us?

The flu can have some long-term effects, like increased risk of heart attack and stroke. And can worsen long-term medical conditions, like congestive heart failure, asthma, or diabetes. Mentions Dr. Balamurugan. Hence, it is ideal to seek the necessary vaccine and medication. Prevention is better than cure. You are encouraged to follow necessary preventive measures.

6. How to treat flu virals?

Dr. Balamurugan suggests, Flu is primarily treated with rest and fluid intake to allow the body to fight the infection on its own. Decongestant, Cough medicine, Nonsteroidal anti-inflammatory drug, Analgesic, and Antiviral drug. An annual vaccine can help prevent the flu and limit its complications.

7. How helpful is the influenza vaccine?

Flu vaccination can reduce the risk of flu-associated hospitalization. Flu vaccination has been shown in several studies to reduce the severity of illness in people who get vaccinated but still get sick. It is an important preventive tool for people with certain chronic health conditions. Vaccination helps protect pregnant people during and after pregnancy and may even be lifesaving in children.

In conclusion, proper care and isolation can help lower the spike in flu cases this monsoon. Proper vaccines and medication help eradicate the flu without causing severe damage to our bodies.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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TAKE CONTROL

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All levels of government, businesses, whether they be health care or tomato picking, seem to be of one mindset. Hire foreign-trained workers, increase immigration be damned if we dont have adequate housing, medical services, this is what will be the cure all. A Band-Aid measure at best. Training should begin at home, at the early stages of education. Wasted on me was five years of forced French language instruction, streaming me into an academic system when I belonged in a technical one. Any trade, profession is a good one, but there seems to be a collective lack of effort to encourage, showcase, anything but a basic regurgitation of worn, outdated curriculum, nothing hands on. Time to take control of our own job resources, train those already living in Canada, put more people in careers that best suit them, and stop the madness that is being driven by those woken socialists that believe some deserve a free lunch while others toil to provide that meal.

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Bill Vernon

(Those that come here want to contribute and work. The issue are the politicians that meddle in the system trying to score points by implementing ridiculous policies that help no one)

YOU GET WHAT YOU DESERVE

Re Trudeau returns from vacation, ignores problems we face at airports (Brian Lilley, Aug. 15): Of course, our entitled PM skips all the airport crises he created with his ArriveCan duplication, testing, layoffs, and lockdowns. Who really believes he follows all the mandates he imposes on us? With homage to that old Tiny Tim shrill song Tip Toe Thru the Tulips With Me, he free-floats in his loafers past all of us peasants especially those who stupidly voted for his not-at-all-liberal party (and the complicit-by-support NDP). Now, sing along, Tip toe past Pearson, over Ottawa, with meeee To quote early American president Thomas Jefferson, The government you elect is the government you deserve. That goes for Canada too. Canadians are now living their choices.

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Dyan CrossOttawa

(Sad but true)

TAX IMPACT

There is a lesson for our Liberal government in the Aug. 14 editorial regarding the U.S. rejection of a national carbon tax in favour of massive tax credits for green energy and increased support for off-shore drilling rights. Its probably too late, but I wish that Ministers Guilbeault and Wilkinson had shown a similar understanding of what is required to meet GHG emissions, as the U.S. has, before they became victims of the onerous anti-energy policies of the Liberal government and the ineffective carbon tax. The carbon tax will have zero impact on global GHG emissions, and as for relief for Canadian taxpayers, even the PBO disputes the purported rebate percentage to taxpayers of the carbon tax.

Duane SharpMississauga

(Exactly it will have no impact other than in our pocket books. The Trudeau/NDP government dont care for anything other than a good talking point)

HEAL UP

If Ontario has a medical crisis, why are we still practicing reactionary medicine and not proactive preventative medicine. Early detection through annual check-ups by either a doctor or trained medical nurse/practitioner can substantially reduce hospital care and crowding. Do the math.

William DivitcoffToronto

(The system is such a mess they probably dont even think this way)

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Letters to the Editor, Aug. 19, 2022 - Toronto Sun

By: Nyima Sillah

Covid-19 vaccine has immensely contributed to the immunization of the most vulnerable which includes pregnant women, children and the elderly.

Gibril Gando Baldeh, a senior health communications officer at the Ministry of Health highlighted the importance of the Covid-19 vaccine on children, pregnant women, and elderly persons, saying that the Covid-19 vaccine is a preventative medicine that is meant to ensure that these children, pregnant women, and elderly persons are protected from the pandemic.

However, the health official said that there has been increased coverage of the number of people who are vaccinated and this applies to an increase in the number of people who are protected and prevented from the pandemic.

There is a link between children, pregnant women, and the elderly when it comes to the Covid-19 transmission and disease. First of all, children are very energetic and they go about a lot, so getting children vaccinated will go a long way. It will not only prevent kids from the disease or from the virus but also will prevent them from hospitalization.

For pregnant mothers, it is very important since they are vulnerable it is important for them to receive the Covid-19 vaccine to avoid any complications due to the pandemic as we all know pregnant women have low immunity due to their pregnancy, so getting the vaccine will improve their immunity and will improve their health status especially when it regards to Covid-19, he said.

Finally, the elderly, are the most vulnerable when it comes to Covid-19 vaccination. The vaccination first targeted the elders because they mostly with low immunity and most of them are confronted with diabetes, hypertension, asthma, etc, these are the co-mobility which increase the risk of getting Covid-19 and also increased their chances of hospitalization, he added.

He confirmed that injecting children with the vaccine is not only going to improve their immunity but prevent them from Covid-19 or severe symptoms of Covid-19 but it also goes a long way by cutting down the chain of transmission which is very key.

He added that children are very active they can spread the virus to their parents and grandparents who will be at disadvantage due to their low immunity or due to the fact that they are having co-mobility diseases like diabetes, hypertension, and others that they are confronted with, so if the kids are not vaccinated the chances of transmission of diabetes and others will be high.

Considering the vulnerability of the pregnant women, children, and elderly, the Ministry of Health is appealing to the general public, especially to parents to ensure that since they are vaccinated to complete the cycle of prevention, they have to try and get their kids to be vaccinated.

It is very important for elders to get boosted. Not only receiving one shoot but it is important for elders to get a second dose or third dose which we refer to as boosters dose so that it will increase their immune system and prevent them from having a severe form of the disease, he revealed.

According to him, The Gambia started using the Covid-19 vaccine in 2021 March/ April until 2022, they reached all the vaccines that they were using for Covid-19, and they have people who are above the age of 18 and now since the arrival of the new Covid-19 vaccine which is Pfizer, they have been cleared by WHO to be used on children of 12 years and above.

Aminata Sambou, a pregnant woman said she took the Covid-19 J&J vaccination during her two months of pregnancy, adding that it happened at a time when pregnant women are more vulnerable to miscarriages.

She added that as she took the courage for the jab vaccination, she said nothing has happened to her except a common side effect that almost everyone that took the vaccine experienced which is a little bit of headache.

Aboubacarr Saidykan, a 67year old man also revealed that he took the jab vaccine since the introduction of the AstraZeneca which has boosted his immune system. The vaccine also showed a reduction in many of my severe illnesses. I felt some side effects on the first day but aside from that, I am fine and my health status is normal, he confirmed.

Furthermore, a mother of a 13-year-old child also explained the importance of the vaccine on his child and how it protected their old mother who is staying with them. I never hesitated for my child to get vaccinated, because I am 7 months pregnant and her grandmother is 69 years, so the risk of not getting vaccinated was high but now we all in good health, she confirmed.

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Gambia: How Covid-19 vaccine contributes to the immunization of the most vulnerable - - Voice Gambia Newspaper

Peter MA Calverley,1 Alberto Papi,2 Clive Page,3 Paola Rogliani,4 Roberto W Dal Negro,5 Mario Cazzola,4 Arrigo F Cicero,6 Jadwiga A Wedzicha7

1Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; 2Respiratory Medicine, University of Ferrara, Ferrara, Italy; 3Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, Kings College, London, UK; 4Respiratory Medicine Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy; 5National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona, Italy; 6Medical and Surgical Department, University of Bologna, Bologna, Italy; 7Respiratory Division, National Heart and Lung Institute, Imperial College London, London, UK

Correspondence: Peter MA Calverley, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK, Tel +44 1515295886, Fax +44 1515295888, Email [emailprotected]

Purpose: To explore the effect of erdosteine on COPD exacerbations, health-related quality of life (HRQoL), and subjectively assessed COPD severity.Patients and methods: This post-hoc analysis of the RESTORE study included participants with COPD and spirometrically moderate (GOLD 2; post-bronchodilator forced expiratory volume in 1 second [FEV1] 5079% predicted; n = 254), or severe airflow limitation (GOLD 3; post-bronchodilator FEV1 3049% predicted; n = 191) who received erdosteine 300 mg twice daily or placebo added to usual maintenance therapy for 12 months. Antibiotic and oral corticosteroid use was determined together with patient-reported HRQoL (St Georges Respiratory Questionnaire, SGRQ). Patient and physician subjective COPD severity scores (scale 04) were rated at baseline, 6 and 12 months. Data were analyzed using descriptive statistics for exacerbation severity, COPD severity, and treatment group. Comparisons between treatment groups used Students t-tests or ANCOVA as appropriate.Results: Among GOLD 2 patients, 43 of 126 erdosteine-treated patients exacerbated (7 moderate-to-severe exacerbations), compared to 62 of 128 placebo-treated patients (14 moderate-to-severe exacerbations). Among those with moderate-to-severe exacerbations, erdosteine-treated patients had a shorter mean duration of corticosteroid treatment (11.4 days vs 13.3 days for placebo, P = 0.043), and fewer patients required antibiotic treatment with/without oral corticosteroids (71.4% vs 85.8% for placebo, P < 0.001). Erdosteine-treated GOLD 2 patients who exacerbated showed significant improvements from baseline in SGRQ total scores and subjective disease severity scores (patient- and physician-rated), compared with placebo-treated patients regardless of exacerbation severity. Among GOLD 3 patients, there were no significant differences between treatment groups on any of these measures.Conclusion: Adding erdosteine to the usual maintenance therapy of COPD patients with moderate airflow limitation reduced the number of exacerbations, the duration of treatment with corticosteroids and the episodes requiring treatment with antibiotics. Additionally, treatment with erdosteine improved HRQoL and patient-reported disease severity.

Keywords: antibiotic, chronic obstructive pulmonary disease, erdosteine, COPD exacerbation, health-related quality of life, systemic corticosteroid

People with chronic obstructive pulmonary disease (COPD) can experience episodes of worsening symptoms (cough, breathlessness) of differing severity (mild, moderate, or severe exacerbations), and may need to be treated with antibiotics and/or oral steroids. We looked at the effects of adding an oral drug (erdosteine) to usual daily therapy for 12 months on exacerbation events, severity, treatment, and patient health status. We found that patients with moderate COPD had fewer exacerbations when taking erdosteine and that this was associated with a better health status. The patients with moderate-to-severe exacerbations were also less likely to require treatment with antibiotics or oral steroids. Patients with severe COPD did not show these effects when erdosteine was added to their usual therapy. Our results suggest that regular treatment with erdosteine may reduce exacerbations and improve the health status of some patients with COPD.

Acute episodes of symptomatic deterioration (exacerbations) have long been recognized as clinically important events for patients with chronic obstructive pulmonary disease (COPD) and were first used as a clinical trial endpoint over 20 years ago in the Inhaled Steroids in Obstructive Lung Disease in Europe (ISOLDE) study.1 Subsequent analyses of interventional and observational studies showed that exacerbations led to sustained worsening of health-related quality of life (HRQoL) and contributed to disease progression.2,3 Prolonged recovery from an exacerbation was associated with a poorer HRQoL and increased risk of further exacerbations.4 Treatment of COPD aims to prevent exacerbations and/or shorten their frequency, severity, and/or duration.5,6

A pragmatic definition of exacerbations based on worsening symptoms and increased use of treatment was developed for use in clinical trials and has subsequently been applied more widely.7,8 Moderate episodes were considered to require treatment with antibiotics and/or systemic corticosteroids while severe events require hospitalization. Using this definition, it was shown that long-acting inhaled bronchodilators alone9 or in combination with inhaled corticosteroids (ICS) could decrease the rate of exacerbations and that this was associated with improvements in health status.10 Recent data highlight the heterogeneity of these events11 with differential responses to preventative therapy12 and differing in clinical courses.13 The symptomatic episodes managed solely by increases in existing medication were harder to define and required daily diary card monitoring to characterize properly. Nonetheless, these milder events are associated with more health care utilization,14 and worse health status even in individuals who have yet to develop airflow obstruction.15 Whether treatment that reduces the number of mild exacerbations also improves patient health status is still unclear.

Erdosteine is a mucoactive drug with additional pharmacological properties (anti-inflammatory, antioxidant, bacterial anti-adhesiveness) that is commonly used in the treatment of COPD.16 The Reducing Exacerbations and Symptoms by Treatment with Oral Erdosteine in COPD (RESTORE) study showed that COPD patients treated with erdosteine with a history of moderate or severe exacerbations had a decreased exacerbation rate and shortened duration of events without alterations in lung function.16 In a further analysis of these data, we showed that the principal benefits of erdosteine treatment occurred in patients with less severe disease defined spirometrically and where more mild exacerbations occurred. In fact, in these patients there was a 58.3% reduction in the mild exacerbation rate with erdosteine, compared to placebo, irrespective of concurrent treatment with ICS.17

In this manuscript, we have further explored these data to better characterize the effect of erdosteine on the moderate-to-severe exacerbations, to determine whether the decrease in exacerbations in moderate COPD led to changes in health status, and whether this was the case for both mild and moderate-to-severe exacerbation events.

The RESTORE study (NCT01032304) was a Phase III multinational, randomized, double-blind, placebo-controlled study conducted in 10 European countries. Full details of the study design, inclusion and exclusion criteria, ethical approval, and results have been reported elsewhere.16 Briefly, after a 2-week run-in period with their usual COPD therapy to confirm clinical stability, 467 COPD patients with moderate or severe airflow limitation (grade II/III, GOLD 2007 classification) were randomized to receive either oral erdosteine at a standard approved dose (300 mg twice daily, n = 228) or placebo (n = 239) for 12 months as add-on therapy to their usual COPD treatment. Participants were outpatients aged 4080 years, current or ex-smokers (10 pack-years), on a stable therapeutic regimen for 8 weeks prior to inclusion, and who had experienced 2 acute COPD exacerbations requiring medical intervention in the previous 12 months, but with no exacerbations in the preceding 2 months.

The study protocol was approved by local ethics committees as outlined in the primary report and subsequent data analysis.16,17 In the UK, this was done by the South Sefton Research Ethics Committee. Each participant provided written informed consent prior to study enrolment and the trial was conducted in accordance with the Declaration of Helsinki.

In this post-hoc analysis we reclassified patients participating in the RESTORE study using the spirometry criteria from the GOLD 2022 guidelines.8 Thus, COPD patients with moderate airflow limitation (GOLD 2) were defined as having a post-bronchodilator forced expiratory volume in one second (FEV1) between 50% and 79% predicted, and patients with severe airflow limitation (GOLD 3) had a post-bronchodilator FEV1 between 30% and 49% predicted; both subgroups had a post-bronchodilator fixed ratio FEV1/forced vital capacity [FVC] <0.70.

A COPD exacerbation was defined as a worsening of symptoms beyond normal day-to-day variation that required a change in regular medication and/or health care resource utilization.7 Exacerbations were confirmed by the investigators from the variation in daily symptom (dyspnea, cough, sputum) scores, changes in regular medication, use of additional medication or emergency hospitalization for COPD, as recorded in the patient diary. Exacerbation severity was graded as mild, moderate, or severe (Supplementary Table 1) and patients were grouped as having mild or moderate-to-severe exacerbations. Patients may have had more than one exacerbation during the 12-month treatment period: those in the moderate-to-severe exacerbations subgroup may also have had mild exacerbations, but patients in the mild exacerbations subgroup did not have moderate-to-severe exacerbations during the 12 months of treatment. Use of oral corticosteroids and/or antibiotics, and the duration of such treatment for an acute exacerbation was determined from data recorded in the daily diary. All use of oral corticosteroids was converted to prednisolone equivalent doses (Supplementary Table 2).

HRQoL was self-assessed by patients at baseline and after 6 and 12 months of treatment using the St. Georges Respiratory Questionnaire (SGRQ), a validated 76-item questionnaire developed to measure health status in patients with chronic airflow limitation.18 The questionnaire has three domains measuring symptoms, activity limitation, and impact on daily life. The total score is calculated from the domain scores and ranges from 0 (no effect) to 100 (maximum effect), with lower scores corresponding to a better health status. A change of 4 points is considered the minimal clinically important difference (MCID) relevant to the patient.19

Subjects and Physicians Global Assessment of Disease Severity was assessed at baseline and after 6 and 12 months of treatment. Subjects were asked: Overall, on a scale 04, how troublesome is your lung problem today? Responses were graded as: 0 = not troublesome at all; 1 = a little troublesome; 2 = moderately troublesome; 3 = very troublesome; 4 = unbearably troublesome. At the same visits, investigators were asked to respond to the following question: Based on clinical examination and patient interview, how would you rate patients COPD? Responses were graded as: 0 = subject with stable COPD, none or minimal symptoms; 1 = subject with stable COPD, occasional symptoms, fully functional; 2 = subject with stable COPD, recurring symptoms, slight functional impact; 3 = subject with stable COPD, frequent moderate to severe symptoms, functionality limited; 4 = subject with stable COPD, constant severe symptoms, functional impairment.

All post-hoc efficacy analyses were conducted using intention-to-treat (ITT) principles on randomized patients who received at least one dose of study treatment and had at least one available post-baseline efficacy evaluation.

Baseline characteristics are reported using descriptive statistics (means and standard deviations [SD] or percentages). Comparisons between treatment groups were performed using the Chi-squared test followed by Fishers exact test. Comparisons between COPD severity groups (GOLD 2 vs GOLD 3) were performed using Students t-tests for unpaired samples (if normal distribution) or MannWhitney U-tests.

SGRQ total scores and patient and physician subjective disease severity scores at baseline, 6 months, and 12 months in patients who experienced exacerbations are presented as mean (95% confidence intervals [CI]) by COPD severity (GOLD 2 or GOLD 3), exacerbation severity (mild or moderate-to-severe), and treatment group (erdosteine or placebo). Changes in trend over time for each treatment group were analyzed using Residual Maximum Likelihood (REML) or least squares method. Comparisons between treatment groups were based on an analysis of covariance (ANCOVA) model including the fixed effects of treatment. The percentage of people showing a decrease in SGRQ total score of at least 4 points was calculated for the GOLD 2 group by exacerbation severity and treatment group.

The percentage of patients with moderate-to-severe exacerbations who used antibiotics and/or oral corticosteroids are reported by COPD severity and treatment group. Comparisons between treatment groups were performed using the Chi-squared test followed by Fishers exact test. Oral corticosteroid doses are presented as mean (SD) prednisolone-equivalent daily dose and as total dose over 12 months, and comparisons between treatment groups used Students t-tests for unpaired samples. Duration of oral corticosteroid treatment was determined by COPD severity, exacerbation severity, and treatment group. Comparisons between treatment groups was based on an ANCOVA model including fixed effects of treatment.

Statistical analyses were performed using SPSS version 21.0 (IBM, Armonk, NY, USA). A two-sided p-value <0.05 was considered nominally significant for all tests.

In this post-hoc analysis of data from the RESTORE study, 254 patients had COPD with moderate airflow limitation (GOLD 2; post-bronchodilator FEV1 5079% predicted) and 191 patients had COPD with severe airflow limitation (GOLD 3; post-bronchodilator FEV1 3049% predicted). Of the GOLD 2 patients, 126 received erdosteine and 128 received placebo. In the GOLD 3 subgroup, 89 received erdosteine and 102 received placebo. Figure 1 shows the flow of patients considered in this analysis (ITT population).

Figure 1 Flow chart of patients in the analysis by treatment group, severity of COPD, exacerbation status, and severity of exacerbations (ITT population). All numbers refer to numbers of patients.

Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease; ITT, intention-to-treat.

The baseline demographic and clinical characteristics of the patients did not differ between treatment groups within each subgroup by COPD severity or for the total RESTORE population (Table 1). As expected, the GOLD 2 subgroup had significantly higher FEV1 and FVC values and significantly fewer patients were using ICS, compared with the GOLD 3 subgroup.

Table 1 Demographic and Baseline Characteristics of Patients (ITT Population)

In the GOLD 2 subgroup (n = 254), there were 127 exacerbations in 105 patients during the 12 months of treatment with erdosteine or placebo: 38 were moderate-to-severe exacerbations in 21 patients (7 patients in the erdosteine group and 14 patients in the placebo group), and 89 were mild exacerbations in 84 patients (36 patients in the erdosteine group and 48 patients in the placebo group). In the GOLD 3 subgroup (n = 191), there were 330 exacerbations in 161 patients: 133 moderate-to-severe exacerbations in 119 patients (55 patients in erdosteine group and 64 patients in placebo group), and 197 mild exacerbations in 42 patients (20 patients in erdosteine group and 22 patients in placebo group). The baseline demographic and clinical characteristics of patients with GOLD 2 and GOLD 3 COPD who experienced exacerbations by observed exacerbation severity are shown in Supplementary Tables 3 and 4.

In the GOLD 2 subgroup, the baseline mean SGRQ total score for those erdosteine-treated patients who experienced exacerbations during follow-up was 38.5 (SD 10.9): the scores were 33.3 (SD 9.0) for those with mild exacerbations and 44.4 (SD 12.3) for those with moderate-to-severe exacerbations. In the corresponding GOLD 2 placebo group, the baseline mean SGRQ total score was 38.8 (SD 11.4) for those who experienced exacerbations: 33.4 (SD 11.2) for those with mild exacerbations and 43.8 (SD 11.8) for those with moderate-to-severe exacerbations. The baseline mean SGRQ total scores for patients with GOLD 3 COPD (all exacerbations) were 50.7 (SD 17.3) and 49.2 (SD 16.7) for the erdosteine and placebo groups, respectively (Supplementary Table 5).

The mean SGRQ total score decreased significantly from baseline over 12 months of treatment with erdosteine but not with placebo in GOLD 2 patients who experienced exacerbations; the decrease in SGRQ total score and between-treatment comparisons were significant regardless of exacerbation severity (Figure 2, Supplementary Table 5). There were no significant changes from baseline in SGRQ total score or between-treatment difference among GOLD 3 patients who experienced exacerbations or for all RESTORE patients with exacerbations (Supplementary Table 5). Of the GOLD 2 patients who exacerbated during 12 months of follow-up, a 4-point decrease in SGRQ score was seen for 13.9% of erdosteine-treated patients and 4.6% of placebo-treated patients. For those with moderate-to-severe exacerbations, this MCID occurred in a higher proportion of erdosteine recipients (28.5%) than in those taking placebo (7.2%; P < 0.001). Among the GOLD 2 patients with mild exacerbations, a 4-point decrease in SGRQ score was seen for 11.1% of erdosteine-treated patients and 6.3% of placebo-treated patients (P = 0.003).

Figure 2 Mean SGRQ total score for GOLD 2 patients with moderate COPD who experienced exacerbations in each treatment group (erdosteine or placebo) and for the subgroups by exacerbation severity (mild or moderate-to-severe). A lower score represents a better HRQoL. Patients may have experienced more than one exacerbation, but those in the mild exacerbations subgroup only experienced mild exacerbations, while those in the moderate-to-severe exacerbations subgroup may also have experienced mild exacerbations. The n value for each treatment group is the number of patients with exacerbations. There were 127 exacerbations overall (89 mild exacerbations and 38 moderate-to-severe exacerbations). Analysis was conducted in the ITT population and based on ANCOVA model including fixed effects of treatment. P values given above the columns are for significant changes in trend over time for each treatment and for the treatment comparison; they were analyzed using the Residual Maximum Likelihood or least squares method. *P < 0.05 versus placebo at each timepoint.

Abbreviations: ANCOVA, analysis of covariance; COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease; HRQoL, health-related quality of life; ITT, intention-to-treat; SGRQ, St Georges respiratory questionnaire.

The scores from the patients assessment of disease severity (Table 2) show that erdosteine-treated GOLD 2 patients experiencing exacerbations reported a significant reduction in mean disease severity score over time (1.49 at baseline to 1.25 at 12 months, P = 0.021) that was significantly different from the scores reported by the placebo group (1.50 at baseline and 1.54 at 12 months, P < 0.001 for treatment group comparison). The significant reduction in patient perception of disease severity in erdosteine-treated GOLD 2 patients was seen regardless of the severity of exacerbation. GOLD 3 patients with exacerbations did not report improved subjective severity scores over time or differences between treatment groups (Table 2). Similar results were found for the physician global assessment of disease severity (Supplementary Table 6).

Table 2 Patient Subjective Assessment of Disease Severity Over Time by COPD Severity, Exacerbation Severity and Treatment Group

Systemic corticosteroids were used by 89% (125/140) of the RESTORE population to manage exacerbations irrespective of the spirometric severity of their disease. In the GOLD 2 subgroup, systemic corticosteroids were used by a significantly lower proportion of patients receiving erdosteine (85.7%) compared with placebo (92.9%, P < 0.05), while 89% of GOLD 3 patients in both treatment groups were treated with oral corticosteroids. Different centers used different corticosteroids (see prednisolone-equivalent doses in Supplementary Table 2). Figure 3 shows the pattern of antibiotic use for moderate-to-severe exacerbation treatment in the RESTORE population. Significantly fewer GOLD 2 patients with moderate-to-severe exacerbations were treated with antibiotics oral corticosteroids when they were taking erdosteine (71.4%) as compared to placebo (85.8%, P < 0.05). This difference in antibiotic use oral corticosteroids between treatment groups was also seen in GOLD 3 patients (84.5% in erdosteine group vs 89.6% in placebo group, P < 0.05).

Figure 3 Proportion of patients with moderate-to-severe exacerbations who used antibiotics alone and with oral corticosteroids by disease severity (GOLD 2 or 3) and treatment group. The percentage value in italics above each stacked bar is the total percentage of patients treated with antibiotics (with or without oral corticosteroids); the remaining patients with moderate-to-severe exacerbations received oral corticosteroids alone. The P values above the columns are for the comparisons of erdosteine versus placebo for the total percentage of patients treated with antibiotics. The asterisks between columns represent *P < 0.05 for erdosteine versus placebo groups within each antibiotic treatment group (antibiotic + oral corticosteroid or antibiotic alone). Analysis used a Chi-square test followed by Fishers exact test.

Abbreviation: GOLD, global initiative for chronic obstructive lung disease.

In the GOLD 2 subgroup, the number of patients was similar in the erdosteine and placebo groups (Table 1). Among those GOLD 2 patients who experienced moderate-to-severe exacerbations, the mean total dose of oral corticosteroids over the 12-month study period was significantly lower for erdosteine-treated patients (251.9 mg) versus those receiving placebo (320.5 mg, P < 0.001), although the mean daily dose of oral corticosteroid treatment over the same time period did not differ between the groups (Table 3). The difference in total corticosteroid dose between the erdosteine and placebo groups was due to a significantly shorter treatment duration with oral corticosteroids for moderate-to-severe exacerbations (mean 11.4 days vs 13.3 days, P = 0.043). In the GOLD 3 subgroup, the oral corticosteroid dose (total dose or average daily dose) and treatment duration did not differ between the erdosteine and placebo groups.

Table 3 Oral Corticosteroid Total Dose and Average Daily Dose (Prednisolone-Equivalents) Over 12 Months in Patients Experiencing Moderate-to-Severe Exacerbations by COPD Severity and Treatment Group

Much of our understanding about COPD exacerbations and their prevention has been driven by the results of treatment trials and this further analysis of the RESTORE dataset contributes to this process. Early intervention in COPD patients could lead to beneficial effects on disease progression and clinical outcomes; the early treatment might be reasonable with the aim of achieving better clinical outcomes in COPD, ameliorating the decline in lung function, and improving the health status.20 Regular early treatment with erdosteine, as add-on therapy, showed a significant effect on rate and duration of exacerbations.16

Patients who had a moderate-to-severe exacerbation while taking erdosteine were less likely to receive antibiotics and had a lower requirement for oral corticosteroids than those taking placebo, especially if they had moderate airflow obstruction when stable The health status of GOLD 3 patients with severe COPD was worse than in those with GOLD 2 moderate disease and was uninfluenced by erdosteine. By contrast, erdosteine use was associated with better health status in GOLD 2 patients who experienced an exacerbation, and this was supported by the subjective global assessments of disease severity scored blinded to maintenance treatment. These observations have clinical relevance.

For many years, treatment trials and observational studies have used a health care utilization definition of exacerbation in identifying differing clinical courses of these acute episodes.13 However, it is now clear that episodes that are not treated with antibiotics and corticosteroids still impact the patients health status,14 while some preventive treatments (ICS) mainly act by decreasing episodes where corticosteroids are used15 or are less effective as airflow obstruction worsens.21,22 Anti-inflammatory therapies like ICS and the phosphodiesterase-4 inhibitor roflumilast are most effective in patients with higher blood eosinophil counts.23,24 Erdosteine has a different anti-inflammatory action and its effects on exacerbation prevention are unrelated to the blood eosinophil count.17 Erdosteine may enhance the effectiveness of co-administered antibiotics in vivo and when given as a treatment for COPD exacerbations, by a variety of mechanisms including effects on bacterial adhesiveness and increasing sputum antibiotic concentrations.2527 In our analysis, fewer patients required antibiotic treatment when they experienced an exacerbation if erdosteine was used as maintenance therapy, although the reason for this cannot be definitively addressed with the data available. The episodes treated with oral corticosteroids were managed similarly in terms of the daily dose but the overall corticosteroid exposure was reduced as the exacerbations were shorter when erdosteine was used. Decreasing the patients exposure to systemic corticosteroids is an important goal of management and the results observed with erdosteine in this study suggest that this drug could be helpful in this regard, at least in patients with less severe airflow obstruction.

The association between worse health status and a higher exacerbation frequency is well established for both reported and unreported exacerbations.14,28 The focus on episodes treated with antibiotics and/or corticosteroids has led to the impression that only these episodes are important. Our data suggest that this is not so, at least among patients with moderate COPD who experience an exacerbation. In our GOLD 2 group, where similar numbers received erdosteine or placebo, the SGRQ scores over the year differed between the exacerbators in these two groups. Among the erdosteine-treated GOLD 2 patients who had a moderate-to-severe exacerbation event, health status had improved significantly by 6 months after randomization and this change was maintained at 12 months compared to those who exacerbated while using placebo. The same was observed for patients with mild exacerbations. These findings were also supported by the subjective global assessment questions, which identified reduced disease severity in the erdosteine-treated GOLD 2 group, regardless of exacerbation severity. The health status of exacerbators taking placebo was stable in moderate disease but improved with erdosteine, with approximately 14% of erdosteine-treated GOLD 2 patients reaching and maintaining the conventional 4-point threshold of clinical significance in SGRQ score over one year. Whether this difference reflected the shorter duration of these exacerbation events or the conversion of more severe events into less severe ones cannot be resolved here. However, there was a clear difference in the behavior of the moderate and severe disease groups. In the latter, exacerbations were more frequent, involved both mild and moderate-to-severe episodes in the same individual, and showed no impact of erdosteine on patient health status. Whether these differences in the response to an exacerbation reflect differences in the triggers to exacerbation or the host response to the event requires further prospective study.

Our study has both strengths and limitations. The RESTORE population was well characterized with both diary card data and an agreed prospective classification of exacerbations based on treatment given. The lack of side effects associated with erdosteine16 helped with patient retention in the trial and there was no evidence of differential dropout, something which has complicated the interpretation of other trials.29 Although our treatment groups were well matched at baseline, we did not adjust further for potential covariates of interest given the relatively small sample size available in each arm of the study. We did not pre-specify criteria for the way in which exacerbations should be managed but left this to the clinicians usual practice. We recognize that different countries adopt different policies to the selection of antibiotics and the dose of oral corticosteroids used in exacerbation management, but we do not believe that these differences introduced a systematic bias into our data. We used the SGRQ as our principal measure of health status, although the validity of our observations of a differential effect in moderate and severe COPD are supported by the patient and physician global health assessments. Although less robustly validated, these simple clinically applicable tools showed consistency with each other and with the longer SGRQ tool, supporting the usefulness of rapid clinical assessment in evaluating patient health status. However, our study was relatively small compared with other intervention studies and the analyses performed in this manuscript were all post hoc evaluations; thus, the results presented are not conclusive and need to be interpreted with caution, but they do allow the generation of hypotheses that can be tested in future studies.

This further analysis of the RESTORE data set confirms the heterogeneity of exacerbation events which are defined by their differing needs for medical treatment. Patients who have moderate COPD not only have fewer exacerbations when taking erdosteine, but also are less likely to require antibiotic treatment in those that do occur. Furthermore, their overall exposure to systemic corticosteroids of all types is less as the events needing treatment are briefer and less frequent. Measurable improvements in health status are seen in both mild and moderate-to-severe exacerbations in patients who still go on to exacerbate and these are recognizable to both the patient and their doctors, emphasizing the need to not only reduce the number of exacerbations, but also the duration of the ones that do occur. The lack of an impact of erdosteine in patients with more severe disease also indicates that not all exacerbations are the same and that different factors drive the clinical presentation of these events at different stages in the natural history of COPD. Importantly for our understanding of COPD exacerbations, mild exacerbations do affect patient health status, and their reduction following chronic treatment with erdosteine is associated with improved health status that is noticeable to both patients and their physicians. Managing these mild-to-moderate episodes should not be neglected and our data suggest that regular treatment with erdosteine, a drug that is orally active and well tolerated may be a useful treatment in early disease.

ANCOVA, analysis of covariance; BMI, body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; GOLD, global initiative for chronic obstructive lung disease; HRQoL, health-related quality of life; ICS, inhaled corticosteroid; ITT, intention-to-treat; MCID, minimal clinically important difference; REML, residual maximum likelihood; RESTORE, reducing exacerbations and symptoms by treatment with oral erdosteine in COPD; SD, standard deviation; SGRQ, St Georges respiratory questionnaire.

The data included in this paper are from a post hoc analysis of the RESTORE study and are not publicly available.

Medical writing assistance was provided by Deirdre Elmhirst, PhD, of Elmhirst Scientific Consultancy Limited, funded by Edmond Pharma.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the manuscript; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding, medications, and investigators meeting costs for the RESTORE study were provided by Edmond Pharma. No specific funding was received regarding this manuscript.

P Calverley reports personal fees from Recipharm, during the conduct of the study; personal fees from Edmond Pharma, Novartis, Phillips Respironics, and Genentech, outside the submitted work. P Rogliani participated as a lecturer and advisor in scientific meetings sponsored by Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline (GSK), Menarini Group, MSD, Mundipharma, Novartis, Edmond Pharma and Roche. Her department was funded by Almirall, Boehringer Ingelheim, Chiesi Farmaceutici, Novartis, and Zambon. J Wedzicha reports grants from AstraZeneca, personal fees from Chiesi Farmaceutici, Novartis, grants, personal fees from GSK, grants from Boehringer Ingelheim, personal fees from Gilead, grants from Genentech, outside the submitted work. A Papi reports grants from Chiesi Farmaceutici, AstraZeneca, GSK, Boehringer Ingelheim, Teva, Sanofi, personal fees from Chiesi Farmaceutici, AstraZeneca, GSK, Novartis, Sanofi, IQVIA, Avillion, Elpen Pharmaceuticals, MSD, Boehringer Ingelheim, Menarini, Zambon, Mundipharma, Teva, Edmond Pharma, outside the submitted work. M Cazzola and C Page are consultants to Edmond Pharma who manufactures and markets erdosteine. C Page reports personal fees from Edmond Pharma, during the conduct of the study; equity from Verona Pharma, personal fees from Glycos Innovation, personal fees from Eurodrug, personal fees from worldwide clinical trial, outside the submitted work; and Non Executive Director of Epiendo Pharmaceuticals. AF Cicero reported personal fees from Edmond Pharma. The authors report no other conflicts of interest in this work.

1. Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double blind, placebo-controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ. 2000;320(7245):12971303. doi:10.1136/bmj.320.7245.1297

2. Spencer S, Calverley PM, Burge PS, Jones PW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J. 2004;23(5):698702. doi:10.1183/09031936.04.00121404

3. Celli BR, Anderson JA, Cowans NJ, et al. Pharmacotherapy and lung function decline in patients with chronic obstructive pulmonary disease: a systematic review. Am J Respir Crit Care Med. 2021;203(6):689698. doi:10.1164/rccm.202005-1854OC

4. Donaldson GC, Law M, Kowlessar B, et al. Impact of prolonged exacerbation recovery in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015;192(8):943950. doi:10.1164/rccm.201412-2269OC

5. Wedzicha JA, Calverley PMA, Albert RK, et al. Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;50(3):1602265. doi:10.1183/13993003.02265-2016

6. Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;49(3):1600791. doi:10.1183/13993003.00791-2016

7. Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000;117(5):398401. doi:10.1378/chest.117.5_suppl_2.398S

8. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2022 report. Available from: https://goldcopd.org/2022-gold-reports-2/. Accessed August 3, 2022.

9. Calverley PMA, Anzueto AR, Carter K, et al. Tiotropium and olodaterol in the prevention of chronic obstructive pulmonary disease exacerbations (DYNAGITO): a double-blind, randomised, parallel-group, active-controlled trial. Lancet Respir Med. 2018;6(5):337344. doi:10.1016/S2213-2600(18)30102-4

10. Jones PW, Anderson JA, Calverley PM, et al. Health status in the TORCH study of COPD: treatment efficacy and other determinants of change. Respir Res. 2011;12(1):71. doi:10.1186/1465-9921-12-71

11. Bafadhel M, McKenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med. 2011;184(6):662671. doi:10.1164/rccm.201104-0597OC

12. Martinez FJ, Vestbo J, Anderson JA, et al. Effect of fluticasone furoate and vilanterol on exacerbations of chronic obstructive pulmonary disease in patients with moderate airflow obstruction. Am J Respir Crit Care Med. 2017;195(7):881888. doi:10.1164/rccm.201607-1421OC

13. Calverley PM, Anzueto AR, Dusser D, Mueller A, Metzdorf N, Wise RA. Treatment of exacerbations as a predictor of subsequent outcomes in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:12971308. doi:10.2147/COPD.S153631

14. Labont LE, Tan WC, Li PZ, et al. Undiagnosed chronic obstructive pulmonary disease contributes to the burden of health care use. Data from the CanCOLD Study. Am J Respir Crit Care Med. 2016;194(3):285298. doi:10.1164/rccm.201509-1795OC

15. Woodruff PG, Barr RG, Bleecker E, et al. Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med. 2016;374(19):18111821. doi:10.1056/NEJMoa1505971

16. Dal Negro RW, Wedzicha JA, Iversen M, et al. RESTORE group. Effect of erdosteine on the rate and duration of COPD exacerbations: the RESTORE study. Eur Respir J. 2017;50(4):1700711. doi:10.1183/13993003.00711-2017

17. Calverley PM, Page C, Dal Negro RW, et al. Effect of erdosteine on COPD exacerbations in COPD patients with moderate airflow limitation. Int J Chron Obstruct Pulmon Dis. 2019;14:27332744. doi:10.2147/COPD.S221852

18. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St Georges Respiratory Questionnaire. Am Rev Respir Dis. 1992;145:13211327. doi:10.1164/ajrccm/145.6.1321

19. Jones PW. St Georges Respiratory Questionnaire: MCID. COPD. 2005;2:7579. doi:10.1081/COPD-200050513

20. Sun Y, Zhou J. New insights into early intervention of chronic obstructive pulmonary disease with mild airflow limitation. Int J Chron Obstruct Pulmon Dis. 2019;14:11191125. doi:10.2147/COPD.S205382

21. Wedzicha JA, Banerji D, Chapman KR, et al. FLAME Investigators. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. N Engl J Med. 2016;374(23):22222234. doi:10.1056/NEJMoa1516385

22. Wedzicha JA, Buhl R, Singh D, et al. Tiotropium/olodaterol decreases exacerbation rates compared with tiotropium in a range of patients with COPD: pooled analysis of the TONADO/DYNAGITO trials. Adv Ther. 2020;37(10):42664279. doi:10.1007/s12325-020-01438-3

23. Bafadhel M, Peterson S, De Blas MA, et al. Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials. Lancet Respir Med. 2018;6(2):117126. doi:10.1016/S2213-2600(18)30006-7

24. Martinez FJ, Rabe KF, Calverley PMA, et al. Determinants of response to roflumilast in severe chronic obstructive pulmonary disease. Pooled analysis of two randomized trials. Am J Respir Crit Care Med. 2018;198(10):12681278. doi:10.1164/rccm.201712-2493OC

25. Dal Sasso M, Bovio C, Culici M, Braga PC. The combination of the SH metabolite of erdosteine (a mucoactive drug) and ciprofloxacin increases the inhibition of bacterial adhesiveness achieved by ciprofloxacin alone. Drugs Exp Clin Res. 2002;28(23):7582.

26. Moretti M. Pharmacology and clinical efficacy of erdosteine in chronic obstructive pulmonary disease. Expert Rev Respir Med. 2007;1(3):307316. doi:10.1586/17476348.1.3.307

27. Ricevuti G, Mazzone A, Uccelli E, Gazzani G, Fregnan GB. Influence of erdosteine, a mucolytic agent, on amoxycillin penetration into sputum in patients with an infective exacerbation of chronic bronchitis. Thorax. 1988;43:585590. doi:10.1136/thx.43.8.585

28. Miravitlles M, Ferrer M, Pont A, et al. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax. 2004;59(5):387395. doi:10.1136/thx.2003.008730

29. Vestbo J, Anderson JA, Calverley PM, et al. Bias due to withdrawal in long-term randomised trials in COPD: evidence from the TORCH study. Clin Respir J. 2011;5(1):4449. doi:10.1111/j.1752-699X.2010.00198.x

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The Effect of Maintenance Treatment with Erdosteine on Exacerbation Tr | COPD - Dove Medical Press

A stitch in time saves nine, they say and a blood thinner in time saves a trip to the emergency room for a heart attack, as Diagnostic Robotics hopes to show. The companys machine learning-powered preventative care aims to predict and avoid dangerous (and costly) medical crises, saving everyone money and hopefully keeping them healthier in general and it has raised $45 million to scale up.

Its important to explain at the start that this particular combination of AI, insurance, hospital bills and predictive medicine isnt some kind of technotopian nightmare. The whole company is based on the fact that its both better for you and cheaper if you, for example, improve your heart health rather than have a heart attack.

Thats why your doctors tell you to cut down on red meat and maybe even take a cholesterol-maintenance medication instead of saying well, if you have a heart attack just go to the ER. Its just common sense, and it also saves patients, hospitals and insurance companies money. And dont worry, this kind of prediction cant be used to raise your premiums or deny care. They want you making monthly payments they just dont want to have to shell out for a $25,000 operation if they can help it.

The question is, what about less obvious conditions, or ones that patients havent had specific tests for? This is where machine learning models come in; theyre very good at teasing out a signal from a large amount of noise. And in this case the AI was trained on 65 million anonymized medical records.

We see how people look before the problems everything we do is preventative care, said Kira Radinsky, CEO and co-founder of Diagnostic Robotics. Its all about offering the right intervention, at the right time, to the right patient.

She noted that providers often focus on the most expensive patients in order to reduce costs for example, someone with advanced heart disease. But while acute and maintenance care continues to be important for them, that money has already gone out the door. On the other hand, if you diagnose someone with early signs of congestive heart failure, you can stop it from advancing and save money and possibly even a life. And the technique applies beyond things that can be detected in labs.

Say the challenge is to find patients suffering from depression or anxiety, but arent taking any medications, Radinsky proposed. How do you identify someone with depression or anxiety based on medical records? We identify the entropy of their visits lots of providers, lots of complaints thats a strong signal. Then you do specific questions, a medical triage, and you get them connected to a psychologist or psychiatrist, and theyre no longer deteriorating.

The company claims it can reduce ER visits by three quarters, which is important beyond the immediate benefits for a person and their provider; ERs and urgent cares are overwhelmed in the U.S., paradoxically due to the pervasive fear of incurring huge medical expenses.

Example of a tablet interface showing a patients info as sorted by Diagnostic Robotics models. Image Credits: Diagnostic Robotics

In many cases, she said, medical providers or insurers will offer medications or treatment for free or at nominal cost, because they know theyre saving themselves a bigger bill down the line. Sure, its all out of self-interest, but that means you can trust them.

The Tel Aviv-based Diagnostic Robotics just raised a $45 million B round, led by StageOne investors, with participation from Mayo Clinic, Technion (Israel Institute of Technology) and Bradley Bloom. Radinsky said this will help the company start working more directly with providers, taking on more holistic health goals in addition to specific high-risk conditions. (The company currently tracks around 20.)

A pilot test of this broader approach was recently validated in a study of a few hundred patients, in which the AI-prepared health plan was statistically indistinguishable from a clinicians. The company is already serving millions of patients in some capacity, in Israel, South Africa and the U.S., with Blue Cross Rhode Island.

If they expand to your provider, dont expect some kind of robotic examination, though the name obviously suggests this.

Youll get phone calls from care managers offering additional treatments, for free or almost for free, Radinsky said. The AI will already have done its work, and maybe your test results and location suggest youre at risk for something and youd do well to take these recommendations seriously. AI may have a lot of room to grow still but its good at sniffing out statistical correlations.

She was careful to add that they are also actively working on finding, defining and mitigating bias in the algorithms, whether it results from biased data or human error somewhere else along the lines. What the algorithm is trying to do is see who will benefit the most, Radinsky explained, but as with other forms of AI and machine learning, only careful monitoring will tell whether its idea of who benefits matches the real world.

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Diagnostic Robotics has AI catching health problems before they take you to the ER - TechCrunch

Roche has received approval from the US Food and Drug Administration (FDA) for a supplemental New Drug Application (sNDA) for Xofluza (baloxavir marboxil). The approval is specifically for the treatment of acute, uncomplicated influenza in otherwise healthy children aged five to less than 12 years of age who have been symptomatic for no more than 48 hours.

In addition to this, the FDA has granted approval for Xofluza to be used as a preventative treatment of influenza in children aged five to less than 12 years old, following contact with someone who is infected with influenza.

The FDAs decision makes Xofluza the first single-dose oral influenza medicine to be approved in the US for children in this age group.

The approval is supported by phase 3 trial results taken from miniSTONE-2 which assessed the use of Xofluza in children and BLOCKSTONE which assessed Xofluza as a preventive treatment for households, in both adults and children. The results were published in The Pediatric Infectious Disease Journal and The New England Journal of Medicine, respectively.

There were more than six million illnesses, thousands of hospitalisations and over 100 deaths among children aged five to 17 caused by influenza in the US 2018-2019 influenza season.

miniSTONE-2 was a phase 3, multicentre, randomised, double-blind study that evaluated the safety, pharmacokinetics and effectiveness of a single-dose of Xofluza versus oseltamivir, in otherwise healthy children aged one to less than 12 years with influenza infection and displaying influenza symptoms for no more than 48 hours. The results showed that Xofluza was well tolerated with no new safety signals identified.

BLOCKSTONE was a phase 3, double-blind, multicentre, randomised, placebo-controlled, post-exposure prophylaxis study that evaluated single-dose Xofluza versus placebo in household members adults and children who were living with someone with influenza confirmed by a rapid influenza diagnostic test.

In the BLOCKSTONE trial, Xofluza showed a statistically significant preventative impact on influenza after a single dose, by reducing the risk of individuals aged 12 years and above from developing influenza after exposure to an infected household member by 90% versus placebo. The proportion of household members aged 12 years and above who developed laboratory-confirmed clinical influenza was 1.3% in participants treated with Xofluza and 13.2% in the placebo-treated group.

Levi Garraway, Roches chief medical officer and head of global product development, said: Xofluza has proven to be an important tool in fighting and preventing influenza in adults as well as adolescents, and we are pleased to now offer households and younger children our single-dose oral treatment.

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Roches Xofluza issued FDA approval to treat influenza in children aged five years and older - PMLiVE

The Global Manufacturer's High-Quality Supplements and Medications Are Designed to Help Support a Healthy Body

FORT LAUDERDALE, Fla., July 14, 2022 /PRNewswire/ -- Reactive medicine is important and essential. However, it is often focused on things like addressing critical dangers, providing damage control, and aiding in recovery. In contrast, often the best form of medicine and healthcare is reactive in nature.

It's a theme that the team at health and wellness manufacturer Ananta Medicare takes to heart. "Our goal isn't to temporarily address a medical issue," explains company president Pradeep Jain, "Our tagline is literally 'endless care about your health.' Most of our products are geared towards the prevention of medical conditions, not just now, but over the long term."

Ananta Medicare's company vision is to create a constant level of care that maintains health and improves the quality of human life across the board. It's this perpetual preventative mentality that has guided the manufacturer over the more than two decades of its existence so far.

Ananta Medicare already operates multiple manufacturing facilities in India. It also has offices in Europe, including the U.K. and Ukraine. This global reach, coupled with the company's devotion to high quality products, has enabled Ananta to lead the charge in shining a light on preventative health for consumers and medical professionals, alike.

"We have earned the confidence of patients and doctors from different countries around the world through our team's exemplary results," Jain explains, " Our success isn't accidental. It is the result of tireless work, devotion to our mission, and the high degree of professionalism our employees display on a daily basis."

The scale of production allows Ananta to focus on preventative health solutions across a broad product range that includes both food supplements and other herbal products. Some of these, such as Femimens and Femicycle, focus on women. Others, like Anantavati Kids, are for younger ages.

The Ananta team always strongly recommends consulting with a doctor before utilizing their products (or any health-related solution) to ensure that it meets the needs dictated by their particular symptoms. Even so, the ability to access clean, effective herbally-based remedies from a reputable manufacturer is a welcome relief for the many Ananta Medicare customers around the globe soon to include the United States.

About Ananta Medicare: Ananta Medicare Limited was founded in 1999 and consists of a group of companies that specialize in the manufacturing and marketing of high-quality products with natural components. These include generic medicines, food supplements, and cosmetics. The brand has plants in India each dedicated to specific manufacturing needs. It also has offices in the UK, India, and Ukraine. The vision of the company is and always has been to protect and preserve health and increase quality of life. Learn more at anantamedicare.com.

Media Contact:SourabhKumarBusiness Development ManagerAnanta Medicare Limited+91 9570620303[emailprotected]

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Ananta Medicare Provides Preventative Health Solutions to the World - PR Newswire

Preventative health care is important not just for prevention, but for the early diagnosis and treatment of age-related diseases. "While care for medical emergencies is critical, preventive care is also important to optimize health, especially among older adults," says Dr. Laurie Archbald-Pannone, associate professor of medicine and geriatrics, University of Virginia. "As a geriatrician and professor of medicine, I think one of the best things the US health care system could do now is focus on preventive care, particularly for older adults." Here are five health care tips older adults should ignore, according to experts. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Using aspirin as a daily blood thinner is no longer standard medical recommendation, experts warn. "Most health professionals agree that long-term aspirin use to prevent a heart attack or stroke in healthy people is unnecessary," warns the FDA. "If you are using aspirin to lower these risks and have not talked with a health professional about it, you may be putting your health at risk. You should ONLY use daily aspirin therapy under the guidance of a health care provider."6254a4d1642c605c54bf1cab17d50f1e

Carbs are not created equalwhile ultra processed carbs and junk food should be avoided, people over 50 can benefit from eating healthy carbs, especially for exercise. "Carbohydrate remains the most important fuel during high-intensity exercise, and there are countless studies to prove it," says registered dietician Edwina Clark.

Researchers believe over 40% of older adults have chronic sleep issues, many of which are undiagnosed. Napping during the daytime can make it harder to sleep at night, experts say. "Limiting naps is one strategy to improve overall nighttime sleep," says Dr. Suzanne Bertisch, an Associate Physician and Clinical Director of Behavioral Sleep Medicine at Harvard-affiliated Brigham and Women's Hospital. "If you take a nap in the late afternoon or evening, it will likely be harder to fall asleep later If you need to nap during the day, it is important to assess why you may be sleepy enough to fall asleep during the day, especially if you nap regularly."

A healthy diet is crucial for healthy agingand no, supplements cannot undo the damage of an unhealthy lifestyle. "The thinking is that taking these pills can somehow improve your health or protect you from disease," says Dr. Pieter Cohen, associate professor at Harvard Medical School and general internist at Harvard-affiliated Cambridge Health Alliance. "While some people may need specific vitamins or supplements to help with deficiencies, for the average healthy person, following a diet with plenty of fruits and vegetables provides all the essential vitamins and minerals."

Healthy fats can help prevent heart disease and stroke, experts say. "After the no-fat eating craze of the '90s, some people still have a dietary fat phobia," says Harvard Health. "Fats do have more calories per gram compared with carbohydrates and protein, but unsaturated fats are important for cardiovascular health. They've been found to lower LDL and total cholesterol when substituted for saturated fats. Include healthy fats in your diet by choosing avocados, olive oil, nuts, nut butters, and seeds."

Ferozan Mast

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5 "Health Tips" That are Terrible for Over 50s Eat This Not That - Eat This, Not That

While enjoying the warm weather of summer, pet parents should take precautions to protect their dogs from dangerous variations of mushrooms along paths, trails and yards.

Death cap mushrooms, in particular a member of the amanita genus of mushrooms are a poisonous species found in Wisconsin and, more broadly, in the U.S. Ingesting even a single mushroom can be fatal to an adult human. Because pets typically have smaller body weights, doses can be lethal in less quantity.

These large mushrooms, known scientifically as Amanita phalloides, have a broad, off-white cap. When mature, they measure several inches tall and across; immature death cap mushrooms have a rounded cap. They grow readily in moist and warm conditions and are often found in late summer and fall, particularly during heavy rainfall, growing under trees or in forests.

Death caps look fairly bland and have no reported distinctive taste, notes Megan Climans, a veterinary pathology resident with the University of WisconsinMadison School of Veterinary Medicine. For pets, unfortunately, that means there isnt much deterrent to eating them.

If ingested, toxins within death cap mushrooms damage the bodys cells. They target the liver and kidney specifically and can become deadly when the exposure leads to liver failure.

According to Climans, an animal will not typically experience noticeable signs in the first six to 24 hours after ingestion. However, a period of gastrointestinal upset follows, with the affected pet experiencing abdominal cramping and vomiting.

After the abdominal pain passes, patients can seem to fully recover, but damage to the liver and kidney is ongoing, and organ failure can result, Climans explains. This progression of signs and symptoms can vary depending on the size of the patient and the toxic dose consumed.

In Wisconsin, fatal cases of death cap poisoning have occurred in dogs. Organ transplants arent typically an accessible treatment option for dogs, so taking preventative steps remains vital.

Monitor your pets when they go outside, particularly if they tend to be indiscriminate eaters, Climans advises. Its very important to catch a case of mushroom poisoning as early as possible.

If you see your pet eating a wild mushroom, contact a veterinarian or poison control immediately, she adds. Save a sample of the mushroom that was eaten or others growing next to it if possible, for later identification.

If there is suspicion of intoxication, the UW School of Veterinary Medicine can diagnose mushroom poisoning through mushroom identification or laboratory urine tests. Several UW Veterinary Care hospital services are also currently partnering to potentially begin carrying a patient-side urine test to detect toxins.

Alisyn Amant

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'Death Cap' Mushrooms Pose Threat to Dogs - University of Wisconsin School of Veterinary Medicine - University of Wisconsin School of Veterinary...

RICHMOND, Va. -- New moms receiving Medicaid assistance will now have their healthcare costs covered for a longer period of time.

Starting this month, Virginia Medicaid will expand from 60 days to 12 months of postpartum health coverage for enrollees.

Sara Cariano, a health policy analyst with Virginia Poverty Law Center, says the goal is to lower the maternal mortality rates in Virginia.

"A lot of women are still dying from pregnancy related complications after their coverage ends, so we want to get women in care, keep them in care, and not make them change health plans two months after having a baby," Cariano said.

This change applies those enrolled in FAMIS Moms and Medicaid for Pregnant Women.

"Medicaid and FAMIS cover a third of the births in Virginia, so this is really going to impact a lot of women, and a lot of these women previously, after 60 days, didnt have access to care because they didnt have coverage," Cariano said.

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According to the Virginia Department of Health, more than half of pregnancy-related deaths happen 43 days or more after the end of pregnancy. In Virginia, the mortality rate among Black mothers is more than two times higher than the mortality rate among white mothers.

Kenda Sutton-El, the Executive Director of Birth in Color RVA, works one-on-one with moms at higher risk.

"Theres always the stigma, especially when it comes to Black women, as soon as we go in there, the condition of our skin already puts us at a higher risk than other people," Sutton-El said. "One of the biggest concerns is that providers dont listen to what they have to say, or they dont feel comfortable telling their providers.

Non-English speakers and immigrants are also at higher risk of pregnancy-related health issues.

The folks who are the most vulnerable across the board who have the largest disparities are also most likely to not know about the coverage or a little nervous to enroll in it because they dont want it to interfere with immigration status or immigration proceedings," Cariano said.

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Dr. Tashima Lambert Giles, a board-certified OB/GYN with VCU Health, sees the impact of a lack of coverage first-hand.

"The truth is that a lot of our patients that are Medicaid have lower socioeconomic status. They have a lot more reasons to feel a lot more stressed, unsupported. They might have to get back to work a lot sooner than other moms," Dr. Lambert Giles said. "This might cause them to lose that access and lose the ability to recognize if theres something medically related thats going on, and not see a physician, because theyre continuing with normal life.

The expansion covers everything from regular check-ups, to substance abuse disorders, to postpartum depression care.

Dr. Lambert Giles said in her practice, she's seen more new mothers struggling with heart disease, underlying conditions left untreated, and mental health issues.

"I think Medicaid expansion allows us to tackle all of those things, but most importantly, getting preventative medicine to patients so that they overall patient is healthy, and we can get a community thats healthier," she said

Children born to Medicaid/FAMIS enrollees are entitled to 12 months of continuous coverage. Criteria and benefit details can be found here.

This is a developing story, so anyone with more information can email newstips@wtvr.com to send a tip.

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What Medicaid expansion means for new moms in Virginia - CBS 6 News Richmond WTVR