quarta-feira, 28 de abril de 2021

Cancer is a Stark Reminder of the Importance of the Little Things

 

A cancer survivor recalls an experience from early on during the COVID-19 pandemic and reiterates how more than a year later, she thinks about those little things.

As I ponder over the past year and the COVID-19 pandemic, my gauge for the memories is the weekly visits I make to the local cancer center for shots to keep up my white blood cell counts. Every single week for almost two years, I have driven to the hospital, parked my car, walked to the elevators, and gone to the third floor where the infusion center is.

It was eerie immediately after my state was completely shut down. The staff at the entrance required my driver’s license, my temperature to be taken, my phone number, and the COVID questionnaire whether I suffered from fever, sore throat, or been exposed to anyone. As I walked the long hallways, they were empty with the gift shops and coffee shops completely closed, including nonemergency surgeries.

An occasional staff member would pass me but that would be all. No visitors were present, just us patients. It was the strangest feeling ever, since I had been coming here for treatments for a total of 10 years. Slowly we gradually reopened, but visitors were still not allowed. Later, surgeries were resumed, and limited numbers of visitors were allowed again. I ended up circling the parking lot repeatedly fighting for parking spots once more.

The funny thing is that one of the smallest memories made the biggest impact on me. My mother was a beautiful woman with flawless skin, and even as an elderly woman in her 90s, people remarked on it. I remember one time when someone from a cosmetic counter argued with her because she could not believe my mother never wore makeup and had come by it naturally. She said she never used skin makeup other than cream because she did not need it.

However, she never — and I mean never — left the house without putting on lipstick. I used to wear rouge, eye shadow, and mascara, but as I got older, I always tried to wear lipstick. My best friend told me I looked so much better with it.

And then came the pandemic. Why bother to wear it now? Masks covered my lips and if I applied it, the lip gloss smeared all over my masks. So I gave up the only makeup I used.

I was seated in a community room waiting for my shot and happened to look over at the next cubicle. It was around the second week of the shutdown. The curtain was open with an elderly woman receiving an IV; and a younger woman, who I presumed was her daughter helping her. When I peeked over, the older woman lifted her mask, got out a compact mirror, and carefully applied lipstick before pulling her mask back up.

I teared up as I remembered my mother, who would have done that. This patient was struggling for normalcy during the most turbulent of times. I was so proud of her thinking how I had given up.However, I never took my lipstick out of my purse.

Fast forward an entire year later. I am thinking of the small things, and the first thing I do before I go to a social gathering with friends and family is put on my lipstick in the car. I then put on my mask and take it off when I go inside. And someday I may not need the mask at all.

Cancer is like that. We miss the little things. We may have lost our hair, have burns from radiation, or am sore from treatments and the disease. My muscles ache and I am very fatigued. But we can still do the little steps. We can still put on lipstick and strive toward a little normally. Cancer and COVID-19 are the same types of situations. The little things we do are what counts, and we can never forget that!

Fonte: Cure

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Risk Factors in Older Adults With Cancer May Increase Symptom Burden Following Surgery, Highlighting Need for Supportive Care


Several factors including female sex, lower socioeconomic status and high intensity surgery were associated with a higher risk of moderate-to-severe symptoms in older adults with cancer following surgery.

Data presented at a recent medical conference demonstrated that older adults with cancer who undergo surgery experience moderate-to-severe symptoms such as tiredness and lack of appetite up to one year after surgery.

The results, according to study author Dr. Jesse Zuckerman, highlight the need to address any possible gaps in supportive care.

“Older adults are expected to account for a large majority of new cancer diagnoses over the next 10 years. Because of advances in patient selection in perioperative management demand-driven therapies, older adults are increasingly likely to have cancer surgery,” Zuckerman, a general surgery resident at the University of Toronto, explained during a presentation at the virtual Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care. He added that it has become evident that many older adults place a higher importance on post-operative outcomes, such as functional independence or quality-of-life, compared with short-term outcomes, such as morbidity and mortality.

Therefore, the investigators conducted a population-level study of 48,748 patients (64% female) aged older than 70 years; 28% of which were 80 years or older. These patients had all undergone cancer surgery between 2007 and 2018. More than half (54%) of the patients underwent a high surgical intensity procedure and 51% of patients received adjuvant therapy (additional treatment administered after initial treatment). The goal of the study was to determine symptoms over time and identify factors associated with high symptom burden after cancer surgery in older adults.

The investigators collected data prospectively from Edmonton Symptom Assessment System (ESAS) scores — a system used to address the severity or absence of pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath — to calculate the monthly prevalence of moderate-to-severe symptoms over one year after surgery. Symptoms were analyzed 90 days prior to surgery and 180 days after surgery.

One year after surgery, most common symptoms patients reported as moderate-to-severe included tiredness (57.8%), poor well-being (51.9%), and lack of appetite (39.3%). However, the study authors noted that those patients with moderate-to-severe symptoms were stable for over one year after surgery, meaning that the surgery neither improved nor worsened the patients’ cancer symptoms.

“However, these trajectories may be influenced by common, yet less intense, procedures such as breast and prostate resections,” Zuckerman said.

Therefore, the authors also examined patients who underwent higher intensity procedures.

Although similar patterns were observed for all procedures, those who underwent high-intensity procedures for lung and upper gastrointestinal/hepato-pancreato-biliary resections showed an initial rise in symptoms one month after surgery. These symptoms were resolved by three months after surgery.

Older age, female sex, lower socioeconomic status, frailty, high comorbidities, receipt of adjuvant chemotherapy within two weeks and high intensity surgery were associated with a higher risk of moderate-to-severe symptoms. Living in a rural area was the only factor that was associated with a lower risk of moderate-to-severe symptom burden.

“These findings are encouraging as neither surgery nor adjuvant therapies lead to important symptom worsening, even among patients who required high intensity surgery and experienced higher initial symptom burden. Their trajectory stabilized in the long-term, suggesting either that surgery and adjuvant therapies do not significantly increase older adults’ experience of symptoms, or that current support mechanisms are effective in getting patients back to their perceived baseline,” Zuckerman said.

However, he concluded, patients are still experiencing a certain level of moderate-to-severe symptoms for up to a year after surgery, “highlighting the potential gaps in supportive care for older adults after surgery.”

Fonte: Cure

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Cancer’s Side Effects Are Always in the Rear-View Mirror

 


No matter how far you think you’ve gotten away from them, cancer’s side effects are always in your rear-view mirror, writes this caregiver.

My daughter officially finished active cancer treatment, including 20 weeks of chemotherapy and six weeks of five-days-a-week radiation, on February 14, 2020. She was challenged with the typical side effects that comes with her oncologist choosing an aggressive treatment plan from the get-go because being diagnosed with breast cancer at 27 is a very scary proposition.

I use the term “typical” in the sense of typical for the types of chemotherapy and radiation she received and the ones that are typical in the public perception. Nausea … check. Hair loss … check. Radiation sunburn … check. And once those treatments were over, those typical side effects ended with them.Her appetite came back, her hair grew in, and her skin had mostly gone back to its pre-radiation color.

What isn’t part of the public perception is the lingering side effects that some people who have undergone these types of treatments deal with for months, for years, or for the rest of their lives. And that they can appear months or years later just when you think you’ve put the cancer experience in your rear-view mirror.

Four months after the last chemotherapy bag finished dripping, Adrienne called me to tell me that her eyebrows and eyelashes were falling out … again. She had watched with hesitant joy as they grew back in and would keep me updated as each new six or seven hairs would appear until they had filled back in just as they were before. On the morning she called, she had been dragged out of denial that they were falling out again by seeing a pile of them on her makeup removal pad and she was sobbing as she asked me if I had ever heard of that.

I hadn’t, but I was able to find out that it does, indeed, happen. Facial hair can go through cycles of growth and falling out for months after treatment is finished until they achieve a balance between normal growth and shedding.

Eight months after Adrienne finished radiation, a rash appeared all over her upper left chest which was the side the breast cancer was on. There was also a spot of it on her upper back where she had experienced a radiation burn. We tried very hard not to panic as she reached out to her oncologist to see him to get his opinion because inflammatory breast cancer often presents with the affected breast being covered in a rash.

The only thing that saved our sanity was that spot on her back. The oncologist diagnosed it as radiation recall dermatitis, which is a rash that can appear long after radiation is over.A biopsy confirmed it later that week. And it’s a lifelong issue that will flare up without warning.

A year after Adrienne’s third and final surgery, she found that she was struggling more and more with range of motion in her left arm. The last surgery was to remove lymph nodes in her left armpit, and despite doing everything right to ensure her left hand could climb a wall as high as her right, regardless of her diligence at doing the exercises recommended to not have her arm movement restricted, she has developed cording in her arm, a restriction that impacts everything in her day because she is left handed.

Fourteen months after Adrienne completed chemo, her doctor did blood work and was concerned about some of her liver numbers. She decided to repeat the test two months later and the numbers had gotten worse, so she ordered an abdominal ultrasound to check out her liver. We are still waiting on that one. In the meantime, my daughter has to manage having too much iron in her blood from the chemotherapy-induced liver damage. The girl who loves spinach and broccoli and whole grains now has to change her diet to lower her iron intake.

I have written many times that cancer is a never-ending story, and this is one of the biggest reasons why. The lingering and sometimes new side effects that come with the life-saving treatment people undergo to save them from cancer’s invasion constantly remind them that, “Hey, remember you had cancer?”

And I haven’t even touched on the emotional baggage that has to be carried. When you’re as young as much daughter was, if her remission holds, that’s a long time to be dealing with things that she had no idea she’d be looking at when treatment began.

And it’s a long time for me to pick up the phone and hear her resigned voice tell me one more thing is happening. I want so much for this story to have a happier ending for her than it has right now.But all I can do is raise my fist and silently yell, “Come on, universe.Enough already.” And to be very, very grateful that she’s still around so I can be angry about it.

Fonte: Cure

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Oral drug successfully treats SARS-CoV-2 infections in hamsters

While vaccinations reduce the incidence of SARS-CoV-2 infections, there is still a need for drugs that can treat people who have contracted the virus.

The National Institutes of Health (NIH) have recommended two drugs to treat COVID-19: the steroid dexamethasone and the antiviral drug Remdesivir.

Doctors limit the use of dexamethasone to severe disease, where trials have shown it to reduce mortality in mechanically ventilated patients by a third.

Remdesivir canTrusted Source decrease the length of time a person has COVID-19 and does provide some benefit to some people, but it has little effect on its own. Remdesivir also requires intravenous administration, which lessens its clinical use.

Researchers with the NIH have found that the oral antiviral drug MK-4482 effectively fights SARS-CoV-2 infections in hamsters.

MK-4482, which scientists are now testing in human clinical trials, reduced the level of SARS-CoV-2 replication and disease damage in the lungs of hamsters. The researchers administered MK-4482 orally.

If trials can confirm the therapeutic value of MK-4482 in humans, it will be the first drug for SARS-CoV-2 that people can take orally in the community.

The research appears in the journal nature communicationsTrusted Source.

Scientists initially developed MK-4482 as an anti-influenza drug by the Drug Innovation Ventures group of Emory University in Atlanta, GA, with funding support from the National Institute of Allergy and Infectious Diseases. The original names for MK-4482 were molnupiravir and EIDD-2801.

When scientists hydrolyze MK-4482, the resulting compound is EIDD-1931, originally developed at the beginning of this century for treating hepatitis C.

The compound shows promiseTrusted Source for stopping MERS-CoV and SARS-CoV-1 in epithelial cells in vitro and in mouse models.

Merck and Ridgeback Biotherapeutics are currently conducting Phase 2 and 3 human clinical trials of MK-4482 as a SARS-CoV-2 treatment. 

Rocky Mountain Laboratories, which is a branch of NIH’s National Institute of Allergy and Infectious Diseases in Hamilton, Montana, conducted the study of MK-4482 in hamsters. Researchers there collaborated with scientists at the University of Plymouth in the United Kingdom.

Last year, the researchers developedTrusted Source the model for emulating human SARS-CoV-2 infections and mild cases of COVID-19 in golden Syrian hamsters. The team determined the dosing of MK-4482 for the hamsters based on its previous successful use in stopping SARS-CoV-1 and MERS-CoV.

In the current study, the researchers tested the effects of MK-4482 using three hamster groups, allocating six hamsters to each group. The researchers gave the drug to the first group of hamsters at 12 hours and 2 hours before infecting them with SARS-COV-2. The second group received MK-4482 12 hours after infection.

The researchers gave MK-4482 to the hamsters in both these groups every 12 hours for 3 days.

Researchers infected the third — control — group with the virus but did not treat them with MK-4482.

When the trial concluded, the researchers found that the animals who had received the drug had 100 times lower levels of infectious SARS-CoV-2 in their lungs than the untreated group.

These hamsters had also developed significantly fewer lesions in lung tissue than their untreated counterparts.

The authors of the research note that after they submitted their work for publication, a second study reporting MK-4482’s effectiveness for treating SARS-CoV-2 was released.

While the two studies differ in some details, “both studies support a significant effect of MK-4482 pre-treatment on SARS-CoV-2 replication in the lung, both in terms of viral RNA and virus titer [virus load], which was also reflected in decreased lung pathology.”

If MK-4482 proves as successful in ongoing human clinical trials as it has been for hamsters, it would be an easy-to-take, oral medication for those who have contracted SARS-CoV-2 and those who have developed symptoms of COVID-19.

Fonte: MNT

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All About Olives: Five Reasons to Eat Them


Olives are not only rich in healthy fats but also in antioxidant and anti-inflammatory phytonutrients, making them a powerful superfood in support of heart and metabolic health

Olives are one of the oldest cultivated trees worldwide, with the oldest known tree thought to be at least 2,000 -- and possibly more than 3,000 -- years old.[i] The tree, known as the "olive tree of Vouves" and located on the island of Crete, still produces olives and acts as a symbol of everything olives stand for -- longevity, prosperity and peace, for starters.

Valued for their oil for at least 6,000 to 8,000 years, humans have been embracing olives for food, medicine, cosmetics and other uses for centuries, including using their oil to light the original Olympic torch. Pliny the Elder reportedly described olives as one of the most important plants in existence, and as noted by National Geographic, "To destroy an enemy's olive trees, in Old Testament days, was the ultimate act of war."[ii]

Olives, though, are incredibly bitter in their raw form due to oleuropein, a compound the plant uses to ward off various predators. Birds still eat them, however, swallowing them whole to avoid the unpleasant flavor and helping to disperse their seeds in the process.[iii]

It's unclear exactly when humans discovered how to make olives palatable, but ancient Romans are often credited with figuring out that fermenting olives in brine with lye quickly got rid of the bitterness and rendered olives a tasty snack.[iv]

Why Eat Olives? Five Top Benefits

Olives are technically called drupes, which are fruits with a pit or stone in the middle. Other drupes include cherries, mangoes and nectarines. An estimated 90% of olives produced worldwide are used to make oil, consumption of which has tripled in the U.S. over the last two decades.[v] Whether you prefer to consume it as an oil or in whole form, there are many reasons to make olives a regular part of your diet.

In addition to providing a healthy source of monounsaturated fat, olives are rich in antioxidant and anti-inflammatory phytonutrients, including terpenes like oleuropein, flavones such as apigenin and luteolin, anthocyanidins, flavonols and hydroxybenzoic acids like gallic acid.[vi] Taken together, eating olives may play a role in reducing nearly 200 diseases and can provide a number of benefits to your health.

1. Reduce Oxidative Stress

Oleuropein is one of the most plentiful antioxidants in olives, which is also responsible for scavenging free radicals and reducing tissue damage caused by oxidative stress.[vii]

Olive fruit extract has also been found to protect against low-density lipoprotein (LDL) cholesterol oxidation,[viii] which is linked to heart disease. By lowering oxidative stress as a whole, olives may offer protection against a number of related metabolic disorders.[ix]

2. Support Heart Health

Olives are well-known for their heart-protective properties and have even been said to be largely responsible for the reduction of heart disease and oxidative stress seen among those following a Mediterranean diet,[x] which counts olive oil as a primary source of fat.

Polyphenolic compounds in olives have significant cardioprotective effects and support heart health in a multitude of ways, including:[xi]

Increase high-density lipoprotein (HDL)

Prevent oxidative stress

Reduce thrombogenic endothelial dysfunction

Support healthy blood pressure

Lower inflammation

Favorably alter gene expression responsible for atherosclerosis

3. Anticancer Effects

Oleuropein has significant anticancer effects and has been found to inhibit proliferation and induce apoptosis (programed cell death) by modifying important epigenetic factors in breast cancer cells.[xii] Researchers even stated oleuropein has the "potential to be a therapeutic drug for BC [breast cancer] prevention and treatment."[xiii]

4. Shorten Upper Respiratory Infections

Olive leaf extract is another of the olive plant's claims to fame, and its notable polyphenols, such as oleuropein and hydroxytyrosol, have antiviral, antibacterial, anti-inflammatory and antioxidant properties.[xiv]

When a group of high school athletes with sub-optimal diets in terms of immune support were given an olive leaf extract supplement, they experienced a 28% reduction in sick days for respiratory illness, suggesting that olive leaf helped to decrease the duration of infection.[xv]

5. Antidiabetic Effects

Consumption of olive oil is linked to a lower risk of developing Type 2 diabetes and improved glucose metabolism.[xvi] Hydroxytyrosol, one of the primary polyphenols in olive oil, is known to improve lipid profile and insulin sensitivity while reducing oxidative and inflammatory processes.[xvii]

Green, Black and Spanish: What's the Difference?

There are more than 1,000 olive varieties, but about 139 of them make up about 85% of worldwide olive production.[xviii] Picual and arbequina olives are popular for olive oil production, while mission olives, which are one of the primary varieties grown in California, are popular as table olives.

Kalamatas, a popular olive from Greece, are used for both table purposes and oil and are only harvested once they're fully ripened and dark purple to black in color.[xix]

For most people, however, olives are thought of as two main varieties: green or black. Green olives, which are also known as Spanish olives, are picked in their green, unripened state then cured prior to eating. Black olives, which come from California and are also known as California ripe olives, are also picked when they're green and firm.

A lye-based curing process involving exposure to air is what gives these "black" olives their final black color.[xx] When choosing olives, look for those processed using traditional curing instead of lye processing, which will maximize both the health potential and the flavor.

Fonte: Green Med Info

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The Next Generation of COVID-19 Vaccines Could Be a Pill

The three COVID-19 vaccines authorized in the United States may be key to helping get the pandemic under control in the near future.

But while these vaccines, released by Pfizer-BioNTech, Johnson & Johnson, and Moderna, are effective, they do come with some challenges.

All require getting an injection, which can make people with needle phobias extremely hesitant to get the shot. Additionally, side effects including feelings of fever, flu-like symptoms, and arm soreness are common with all three vaccines.

The Johnson & Johnson vaccine has been paused as officials investigate extremely rare blood clots that may be associated with the vaccine.

To make the vaccination process simpler and faster, researchers are working to develop the next generation of COVID-19 vaccines, namely in pill and nasal spray forms.

These next-generation vaccines may make it easier to eradicate the coronavirus from the globe.

“At this time, SARS-CoV-2 vaccines are injectable. Several vaccine manufacturers have started initial development of a nasal vaccine spray,” said Dr. Javeed Siddiqui, co-founder and chief medical officer at TeleMed2U.

“Nasal spray vaccine could be available as soon as 2022, however this is highly variable based on clinical efficacy and vaccine effectiveness in clinical trials,” he said.

Siddiqui added that future vaccine generations are anticipated to include activity against variants of the virus.

According to FasterCures, a center of the Milken Institute that’s currently tracking the development of COVID-19 vaccines, five companies are developing oral vaccines. Two of these companies have moved on to phase 1 clinical trials.

Of the 13 companies working on a nasal spray vaccine, five are in early clinical trials.

“It’s exciting. It speaks to the innovation that scientists, government, and academia are working to improve what we have,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University and the medical director for the National Foundation for Infectious Diseases.

“What we know from the current vaccines are which parts of the virus are important in order to stimulate an immune response,” he said. 

\How the original COVID-19 vaccines work

According to the Centers for Disease Control and Prevention (CDC)Trusted Source, the current COVID-19 vaccines help our bodies develop immunity by supplying them with “memory” T-lymphocytes and B-lymphocytes. These white blood cells remember how to fight the coronavirus, should it enter your body in the future.

Currently, three types of COVID-19 vaccines are authorized in the United States, although the Johnson & Johnson vaccine has been temporarily paused as it potentially triggered a rare blood clot in a very small percentage of the population.

One vaccine is the mRNA vaccine. It contains material from the virus, which instructs our cells to make a protein unique to the coronavirus to fight it in the future.

Another vaccine is the protein subunit vaccine. It includes harmless proteins of the virus instead of the entire germ. After vaccination, the body recognizes the protein and will remember how to fight it.

The third type is the vector vaccine. It contains a modified version of a different virus. Inside the shell of the modified virus is material from the coronavirus. Once the viral vector is in the cell, the cells produce a protein and then copy it, which prompts our bodies to build the T- and B-lymphocytes that can protect against the coronavirus.

ImmunityBio, one of the companies working to develop other versions of the COVID-19 vaccine including a capsule and a dissolvable tablet, has been authorized by the FDA to expand a phase 1 clinical trial.

The three injectable vaccines (Pfizer-BioNTech, Moderna, and Johnson & Johnson) prompt the immune response to generate antibodies that fight against the coronavirus spike protein.

The ImmunityBio vaccine, however, targets both the mutation-prone outer spike protein and the more stable inner protein, which activates antibodies, memory B cells, and T cells against the coronavirus.

The goal is to create longer-term protection as well as provide protection from variants.

Altimmune is another company working on a next-generation vaccine. This one would be a nasal spray.

A nasal delivery method is designed to produce an immune response at the point where the virus enters the body, causing mucosal immunity in the nasal cavity.

Called AdCOVID, the nasal spray vaccine is designed to stimulate an immune response including both antibody and T-cell responses in the nasal cavity.

At this point it’s too early to know whether these vaccines will be as effective as the first round of injectable vaccines.

But past cases have shown that an original injectable vaccine can be followed by oral versions.

In 1953 the polio vaccine was introduced as an injectable. Nine years later an oral version was developed, which essentially wiped the poliovirus from the planet.

“We’re right on the edge of eliminating [polio] from the world. We’re doing something similar with an oral vaccine against rotavirus. We had a nasal flu vaccine, although that had its ups and downs,” Schaffner said. “It’s not a straight line here, but there are precedents.”

New vaccines that are easier to administer and target virus variants can only mean there’s potential for eradication of the coronavirus, or at least an easier way to prevent infection or lessen its effects.

“If you could deliver vaccines by an effective nasal spray or a pill, you could deliver vaccines safely to a huge number of people very quickly. You won’t need to have trained people to give injections. All issues of using needles and syringes safely would disappear,” Schaffner said.

Being able to store the vaccine at room temperature would also make it much easier to administer.

Fonte: Healthline

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