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Damage to heart found in more than half of COVID-19 patients discharged from hospital

Around 50% of patients who have been hospitalized with severe COVID-19 and who show raised levels of a protein called troponin have damage to their hearts. The injury was detected by magnetic resonance imaging (MRI) scans at least a month after discharge, according to new findings.

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Around 50% of patients who have been hospitalized with severe COVID-19 and who show raised levels of a protein called troponin have damage to their hearts. The injury was detected by magnetic resonance imaging (MRI) scans at least a month after discharge, according to new findings published (Thursday) in the European Heart Journal [1].

Damage includes inflammation of the heart muscle (myocarditis), scarring or death of heart tissue (infarction), restricted blood supply to the heart (ischaemia) and combinations of all three.

The study of 148 patients from six acute hospitals in London is the largest study to date to investigate convalescing COVID-19 patients who had raised troponin levels indicating a possible problem with the heart.

Troponin is released into the blood when the heart muscle is injured. Raised levels can occur when an artery becomes blocked or there is inflammation of the heart. Many patients who are hospitalized with COVID-19 have raised troponin levels during the critical illness phase, when the body mounts an exaggerated immune response to the infection. Troponin levels were elevated in all the patients in this study who were then followed up with MRI scans of the heart after discharge in order to understand the causes and extent of the damage.

Professor Marianna Fontana, professor of cardiology at University College London (UK), who led the research together with Dr. Graham Cole, a consultant cardiologist at Imperial College London, said: “Raised troponin levels are associated with worse outcomes in COVID-19 patients. Patients with severe COVID-19 disease often have pre-existing heart-related health problems including diabetes, raised blood pressure and obesity. During severe COVID-19 infection, however, the heart may also be directly affected. Unpicking how the heart can become damaged is difficult, but MRI scans of the heart can identify different patterns of injury, which may enable us to make more accurate diagnoses and to target treatments more effectively.”

The researchers investigated COVID-19 patients discharged up until June 2020 from six hospitals across three NHS London trusts: Royal Free London NHS Foundation Trust, Imperial College Healthcare NHS Trust and University College London Hospital NHS Foundation Trust. Patients who had abnormal troponin levels were offered an MRI scan of the heart after discharge and were compared with those from a control group of patients who had not had COVID-19, as well as from 40 healthy volunteers.

“The recovering COVID-19 patients had been very ill; all required hospitalization and all had troponin elevation, with around one in three having been on a ventilator in the intensive care unit,” said Prof. Fontana.

“We found evidence of high rates of heart muscle injury that could be seen on the scans a month or two after discharge. Whilst some of this may have been pre-existing, MRI scanning shows that some were new, and likely caused by COVID-19. Importantly, the pattern of damage to the heart was variable, suggesting that the heart is at risk of different types of injury. While we detected only a small amount of ongoing injury, we saw injury to the heart that was present even when the heart’s pumping function was not impaired and might not have been picked up by other techniques. In the most severe cases, there are concerns that this injury may increase the risks of heart failure in the future, but more work is needed to investigate this further.”

The function of the heart’s left ventricle, the chamber that is responsible for pumping oxygenated blood to all parts of the body, was normal in 89% of the 148 patients but scarring or injury to the heart muscle was present in 80 patients (54%). The pattern of tissue scarring or injury originated from inflammation in 39 patients (26%), ischaemic heart disease, which includes infarction or ischaemia, in 32 patients (22%), or both in nine patients (6%). Twelve patients (8%) appeared to have ongoing heart inflammation.

Prof. Fontana said: “Injury relating to inflammation and scarring of the heart is common in COVID-19 patients with troponin elevation discharged from hospital, but is of limited extent and has little consequence for the heart’s function.

“These findings give us two opportunities: firstly, to find ways of preventing the injury in the first place, and from some of the patterns we have seen, blood clotting may be playing a role, for which we have potential treatments. Secondly, detecting the consequences of injury during convalescence may identify subjects who would benefit from specific supporting drug treatments to protect heart function over time.”

The findings of the study are limited by the nature of patient selection and included only those who survived a coronavirus infection that required hospital admission.

“The convalescent patients in this study had severe COVID-19 disease and our results say nothing about what happens to people who are not hospitalized with COVID, or those who are hospitalized but without elevated troponin. The findings indicate potential ways to identify patients at higher or lower risk and suggest potential strategies that may improve outcomes. More work is needed, and MRI scans of the heart have shown how useful it is in investigating patients with troponin elevation,” concluded Prof. Fontana.

The study is also the subject of a discussion between Prof. Fontana and Prof. Eike Nagel, at the Society for Cardiovascular Magnetic Resonance annual meeting on Friday 19 February, where it will be presented for the first time [2]. Prof. Nagel, director of the Centre for Cardiovascular Imaging at Deutsches Zentrum Für Herz-Kreislauf-Forschung (DZHK), Frankfurt, Germany, is the senior author on an earlier paper [3] that found ongoing heart problems in up to 78% of COVID-19 patients who were less sick and most of whom did not require admission to hospital.

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Notes:

[1] “Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance”, by Tushar Kotecha et al. European Heart Journal. doi:10.1093/eurheartj/ehab075

[2] Society for Cardiovascular Magnetic Resonance virtual scientific sessions 2021, 09.00-09.45 hrs Central Standard Time in USA (6 hours behind GMT): https://bit.ly/3oMn84t

[3] JAMA Cardiol. 2020;5(11):1265-1273. doi: 10.1001/jamacardio.2020.3557.

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What you eat could contribute to your menstrual cramps

Roughly 90% of adolescent girls experience menstrual pain. Most use over-the-counter medicine to manage the pain but with limited positive results. Evidence has highlighted that diets high in omega-3 fatty acids and low in processed foods, oil, and sugar reduce inflammation, a key contributor to menstrual pain.

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Despite the fact that menstrual pain (dysmenorrhea) is the leading cause of school absences for adolescent girls, few girls seek treatment. An analysis of relevant studies suggests that diet may be a key contributor, specifically diets high in meat, oil, sugar, salt, and coffee, which have been shown to cause inflammation.

Roughly 90% of adolescent girls experience menstrual pain. Most use over-the-counter medicine to manage the pain but with limited positive results. Evidence has highlighted that diets high in omega-3 fatty acids and low in processed foods, oil, and sugar reduce inflammation, a key contributor to menstrual pain.

This analysis was designed to study the effect of diet on menstrual pain and identify which foods contribute to it and which can reduce it. Research was conducted through a literature review that found multiple studies that examined dietary patterns that resulted in menstrual pain. In general terms, these studies found that diets high in omega-6 fatty acids promote inflammation and foods high in omega-3 fatty acids reduce it. The muscles in the uterus contract because of prostaglandins, which are active in inflammatory responses. When measuring the Dietary Inflammatory Index, it was found that those on a vegan diet (that excluded animal fat) had the lowest rates of inflammation.

“Researching the effects of diet on menstrual pain started as a search to remedy the pain I personally experienced; I wanted to understand the science behind the association. Learning about different foods that increase and decrease inflammation, which subsequently increase or reduce menstrual pain, revealed that diet is one of the many contributors to health outcomes that is often overlooked. I am hopeful that this research can help those who menstruate reduce the pain they experience and shed light on the importance of holistic treatment options,” says Serah Sannoh, lead author of the poster presentation from Rutgers University.

“Since menstrual pain is a leading cause of school absenteeism for adolescent girls, it’s important to explore options that can minimize the pain. Something like diet modification could be a relatively simple solution that could provide substantial relief for them,” said Dr. Stephanie Faubion, NAMS medical director.

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Cultivating well-being in today’s evolving digital world

Manulife invites Olympic gold medalist Hidilyn Diaz to share lessons amid digitalization at IMMAP DigiCon Valley 2022.

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As Filipinos navigate today’s evolving digital world and adjust to life-changing disruptions brought by the pandemic, Manulife shared key lessons on how to cope with changes and cultivate one’s overall well-being at this year’s DigiCon Valley 2022, the largest gathering of the digital marketing and advertising industry in the country organized by the Internet & Mobile Marketing Association of the Philippines (IMMAP).

Headlining Manulife’s segment were Melissa Henson, Chief Marketing Officer of Manulife Philippines and Hidilyn Diaz, Olympic Gold Medalist and one of Manulife’s brand ambassadors, while actor and stand-up comedian Victor Anastacio served as the host.

At the DigiCon’s special segment, Henson and Diaz shared their insights and personal takeaways based on Manulife’s recently released study, “The Modern Filipino Family: Exploring Family Dynamics in the new normal.” The study aimed to understand how Filipino families adapted to the new normal, as hyper-digitalization has impacted relationships, and has been deeply imbued in everyday decisions at home and in family life.

Make time for self-care and mental wellness

Victor Anastacio started the discussion on the challenges Filipinos faced at the height of the pandemic. “Sobrang daming challenges ang kinaharap natin noong nagsimula ang pandemic – physical, emotional and financial challenges. Lahat ito nakaapekto sa ating pamilya, dahil sa maraming hindi pagkakaintindihan.”

These challenges still impact majority of Filipinos today. While people across generations have said that their well-being has improved compared to during the peak of the pandemic, Generation Zs expressed that they are still grappling with negative pandemic effects. Henson shared: “Our study found that 65% of Gen Zs are dealing with digital fatigue, prompting them to seek more offline interactions with friends and family. They also shared that they are sleep-deprived, developed unhealthy eating habits and have increased occurrence of stress, fatigue, and depression. These younger Filipinos may need further guidance on reacquainting themselves in the real world as they have spent most of their time online in the past two years.”

Younger Filipinos may also look to Generation X and millennials for inspiration and ideas on how to deal with stressors. “Gens X and Y have learned to focus on self-care, mental well-being, and personal development, which helped empower them despite the many changes they’ve had to weather,” Henson added. 

Diaz agreed and emphasized that caring for one’s mental health has a tangible impact on one’s physical well-being too. “When I started training for the Tokyo Olympics, I needed to condition my mind that I could win at hindi ako nag-iisa sa pag-abot ng pangarap na ito. Naging malaking part ng aking preparations ang mental training at eventually, ang ‘”ma-manifest” ko na makakuha ng gold medal.”

Learn to seek help when needed

According to Manulife’s study, more Filipinos have also explored various financial products during the pandemic. In the past 12 months, among those surveyed, 25% of Generation X and 33% of Millennials bought insurance products online, while 41% of Generation Z expressed a desire to purchase insurance in the next 12 months. To guide them in their financial journey and make more informed decisions, Henson emphasized the importance of seeking expert advice to help sift through the overwhelming wealth of information available.

“Seeing how more Filipinos are exploring various financial channels to diversify their portfolios is a good sign that they are actively seeking ways to grow their wealth. However, we will need to double down our efforts to provide them expert financial guidance, so they’ll also understand how to balance risk and reward,” Henson said. “Seeking advice from a financial advisor is one way to help Filipinos get a clearer picture of their financial goals and find ways to achieve them while being conscious of their risk appetites to yield better returns.”

To achieve the historic Olympic gold medal, Diaz also underscored the importance of asking for help, by having people around you whom you can rely on for support. “There is a team behind my success. Hindi ko kakayanin ito ng mag-isa. I needed the support of Team HD, Manulife, at ng aking mga kababayan.

Life has no guarantees, but we can get ahead of uncertainty

The pandemic showed how fast things can change, and Filipinos must be ready to keep up with the pace as it can accelerate further. Such mindset and attitude transcend to Filipinos’ heightened desire for protection and security. “The interest in insurance products and life protection increased during the pandemic because Filipinos became hyper aware of the physical and financial impact of falling ill, and the broader impact of other financial challenges. However, this has been a reactive stance. The power of insurance and financial planning is that it helps us prepare for the unexpected before it happens, so we continue to encourage and empower Filipinos to embrace the value of planning ahead and being financially prepared,” said Henson.

To help Filipinos better prepare for uncertainty, Manulife launched a series of flexible and highly customizable financial solutions that can be tailor-fit depending on needs and budget — HealthFlex, which provides protection coverage for critical illnesses, including heart disease, cancer, and stroke; and FutureBoost, which gives additional rewards on top of insurance protection coverage so Filipinos can grow their wealth simultaneously.

As change is inevitable and developments can be beyond our control, Henson noted that it helps to live by an attitude of lifelong learning. “We are all learning creatures. We always find ways to retool ourselves to better cope with the changes in our environment, which is crucial to making us more resilient.”

Diaz added that just as essential is acquiring knowledge on how to plan ahead. “Having a strong foundation sa kung paano mag-plano para ma-achieve ang financial goals ay crucial para sa kinabukasan natin. Mahalaga na maging mas aware ka sa mga financial options available as early as possible para mas maintindihan ang mga kailangang gawin to achieve your goals. Once you decide to grow your investments, you’ll be more consistent with your decisions to make every day better.”

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Pfizer had no idea if mRNA vaccine would prevent COVID-19 transmission

Pfizer, the pharmaceutical company expected to become a $100 billion giant this year thanks to COVID-19 drug and vaccine, has admitted that it actually had no idea if its mRNA vaccine would prevent transmission of the coronavirus when they released the same.

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Photo by Daniel Schludi from Unsplash.com

Pfizer, the pharmaceutical company expected to become a $100 billion giant this year thanks to COVID-19 drug and vaccine, has admitted that it actually had no idea if its mRNA vaccine would prevent transmission of the coronavirus when they released the same.

One of Pfizer’s top executives, the company’s president of international development markets, Janine Small, stated this when she testified before the COVID committee of the European Parliament. Small was there in place of Pfizer CEO Albert Bourla who tested positive for COVID-19 again.

In the exchange that happened in the committee hearing, a Dutch member of the European Parliament asked Small if there is evidence from Pfizer that showed that the vaccine it developed would prevent transmission prior to its wide release in late 2020.

“Was the Pfizer COVID vaccine tested on stopping the transmission of the virus before it entered the market? If not, please say it clearly. If yes, are you willing to share the data with this committee?” the member of parliament specifically asked.

The executive answered: “Regarding the question around, did we know about stopping immunization before it entered the market? No.”

Small added that “we had to really move at the speed of science to really understand what is taking place in the market. And from that point of view, we had to do everything at risk.”

The Dutch politician said that messaging in the past focused on getting vaccinated to one does not spread COVID-19. “If you don’t get vaccinated, you’re anti-social! This is what the Dutch prime minister and health minister told us. You don’t get vaccinated just for yourself, but also for others — you do it for all of society. That’s what they said. Today, this turns out to be complete nonsense.”

The politician said he found the revelations “shocking, even criminal.”

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