Can I go to the dentist in lockdown? Here’s how new restrictions effect treatment

A fresh lockdown coming into force within days will have left many frantically cancelling appointments.

But a date with the dentist is a vital service – and many will be concerned they will lose their appointments as businesses are forced to shut down once again.

Dentists were closed to all but emergency appointments during the early stages of the first lockdown. 

But there will be different rules in place for the second national lockdown, which comes into force from Thursday, October 5, until at least Wednesday, December 2.

People will be allowed to leave their homes for medical appointments

Dentists will remain open during the fresh coronavirus lockdown that kicks in on Thursday, it has been confirmed.

They will remain open for appointments, including regular check-ups during England’s second major shut-down.

Businesses including non-essential shops will be forced to closed once again in the government’s latest bid to curb spread of Covid-19.

But the British Association of Private Dentistry assured dental practices were considered essential.

The association tweeted: “Despite an impending lockdown private practices will remain OPEN.

“It’s safe and essential to attend the dentist.

“We remain open to all, for both routine and emergency treatments. #DentalCare”.

One of the reasons people are permitted to leave their home is for “medical reasons, appointments or to escape injury”.


Boris Johnson urged people to continue to use the NHS for treatment during his speech on Saturday, in which he outlined the new rules.

He said: “So please – this is really important – unless your clinicians tell you otherwise, you should continue to use the NHS, get your scans, turn up for your appointments and pick up your treatments.

“If at all possible, we want you to continue to access these services, now and through the winter.

“Indeed it’s only by taking this action that we can protect the NHS for you.”

Under the new rules, people are allowed to leave the house for a limited number of reasons.

There will be no time limit on how long people can go out for exercise.

People can also go outdoors for recreation with their own household, or on their own with one person from another household.

People will not be allowed to meet in homes and gardens, except for with members of their household ‘bubble’.

People can also leave home to shop for food and essentials and to provide care for vulnerable people or volunteering work.

Overnight stays outside of the home will only be allowed for work purposes, the new rules state.

Click here for a list of reasons you are allowed to leave the house under the new coronavirus lockdown rules.

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Low dose of the medicine intravenous immunoglobulin decreases the effect of dangerous toxins during severe infections

immunity
Credit: Pixabay/CC0 Public Domain

During necrotizing soft tissue infections ordinary bacteria infect our body, spread rapidly and cause tissue death. Treatment with antibiotics is not sufficient and infected tissue needs to be removed through surgery. 22% of people who suffer from this disease need to amputate a limb and 18% do not survive.

A common cause of these infections is group A streptococcus. These bacteria form toxins that lead to overactivation of the body’s otherwise helpful immune cells, causing a so called “cytokine storm” which contributes to a severe course of the disease and the need of intensive care.

Recently, a study called INSTINCT was performed. In this study patients with necrotizing soft tissue infections were randomized to treatment with either intravenous immunoglobulin (IVIG) or placebo, in addition to other treatment. This study showed a trend towards better health after treatment with IVIG in the subgroup often caused by group A streptococcus, but no clear correlation during infections caused by other bacteria. However, the study used a lower dose than in previous studies: 25 g per day.

Bergsten et. al. tested blood samples from infected patients before and after treatment with IVIG, and found that treatment with IVIG leads to decreased effect of the toxins produced by the bacteria—even at the low dose of 25 g per day that was used in the INSTINCT study. Based on these results, the researchers suggest a new dosage regime of IVIG during these infections. It is still not proven that IVIG leads to better health during these devastating infections and the researchers suggest that the new dosage is tested in a controlled clinical trial of patients with necrotizing soft tissue infections caused by group A streptococcus.


IV immunoglobulin use up in interstitial lung disease


More information:
Helena Bergsten et al. Correlation Between Immunoglobulin Dose Administered and Plasma Neutralization of Streptococcal Superantigens in Patients With Necrotizing Soft Tissue Infections, Clinical Infectious Diseases (2020). DOI: 10.1093/cid/ciaa022
Provided by
Karolinska Institutet

Citation:
Low dose of the medicine intravenous immunoglobulin decreases the effect of dangerous toxins during severe infections (2020, October 28)
retrieved 28 October 2020
from https://medicalxpress.com/news/2020-10-dose-medicine-intravenous-immunoglobulin-decreases.html

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Rule of 6 and 10pm curfew ‘had zero effect on transmission’

BLACKPOOL, ENGLAND - OCTOBER 16: A barman serves drinks at a Wetherspoon pub on the promenade on October 16, 2020 in Blackpool, England. The Lancashire region will go into Tier 3 of Covid-19 lockdown restrictions from 00.01 Saturday 17th October. (Photo by Christopher Furlong/Getty Images)
A 10pm curfew on pubs and restaurants was introduced in England last month. (Getty)

The rule of six and 10pm pubs curfew are likely to have had “zero effect” on coronavirus transmission in England, a study has claimed.

The study by the London School for Hygiene and Tropical Medicine (LSHTM) examined the impact of both measures, which were introduced last month.

It interviewed thousands of individuals to assess if their contacts had been reduced by the rule of six, working from home and the 10pm curfew on pubs and restaurants.

It found that 42% of the 3,222 individuals it surveyed about the rule of six had the same amount of contacts before and after the measure was introduced.

Just over three out of ten (31%) reduced their contacts, while 26% saw more people after the rule was introduced.

Researchers interviewed 1,868 people about the 10pm pubs curfew and found the data was “consistent with no change in other contacts”.

When asked about the 10pm closure, 50% said their number of contacts had remained the same, while 25% said they had decreased and 24% said they had increased.

In its conclusion, the authors of the study wrote: “We determine that the rule of six and encouraging people to work from home, has seen the average person reduce contacts but these reductions are likely small.

Watch: Revellers head out before rule of six comes into force

“There was little suggestion that 10pm closure has affected the number of contacts that participants make outside home, work and school.

“In contrast to national restrictions, there was a strong suggestion that local restrictions reduced the number of contacts individuals make outside of work and school, though again, this effect was small in comparison to the national lockdown.”

LONDON, Sept. 14, 2020 -- People sit on the lawn at Potters Fields Park in front of Tower Bridge in London, Britain, on Sept. 14, 2020. In order to curb the rise in coronavirus cases, tough new limits on social gatherings came into force in Britain on Monday, meaning that in most regions, it is now illegal for groups of more than six to meet up. The "rule of six" kicked off at midnight across England, Wales and Scotland in the latest push to curb the recent surge in coronavirus infections. (Photo by Tim Ireland/Xinhua via Getty) (Xinhua/Tim Ireland via Getty Images)
The rule of six was introduced in England in September. (Getty)

The study has yet to be peer reviewed.

The rule of six was introduced on 14 September, followed ten days later by the pubs curfew.

One government science adviser said the rule of six laws “did not go far enough”.

Earlier this month, it emerged the government’s own scientific advisers had warned that the 10pm curfew would have only a “marginal impact” on the spread of coronavirus.

There was criticism that prime minister Boris Johnson “never discussed” the curfew with his science advisers, one of whom described the plan as “fairly trivial” and said it would have a “very small impact on the epidemic”.

Watch: Can you catch coronavirus twice?

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LIDDS’ NanoZolid-TLR9 agonist demonstrates strong and durable preclinical anti-tumoral effect

UPPSALA, SWEDEN – LIDDS AB (publ) announces that intratumoral injection of NZ-TLR9, NanoZolid (NZ) formulation of a Toll-Like Receptor 9 (TLR9), results in strong antitumoral efficacy combined with prominent antitumoral immune responses in mouse tumor models. NZ-TLR9 forms an intratumoral depot which releases the TLR9 agonist for least 6 weeks and thus minimizes the need for repeated injections. Furthermore, we have identified both intratumoral- and plasma biomarkers needed to measure the activity of NZ-TLR9 in clinical trials.

LIDDS has completed a preclinical data package using a TLR9 agonist formulated with NanoZolid®(NZ-TLR9) showing that a single NZ-TLR9 injection is reducing tumor growth and improves the survival of mice, with increase of intratumoral cytotoxic T- cells and activated dendritic cells. The TLR9 agonist is released during at least 6 weeks with equal in vivo efficacy which minimizes the need for repeated injections, which are needed when using standard formulated TLR9 agonists. In addition, the study also identified plasma biomarkers which are suitable to measure the biological activity of NZ-TLR9 in coming clinical trial.

-I’m really happy to see our convincing preclinical data package with NanoZolid formulated TLR9, especially the six weeks of controlled release with strong anti-tumor effect. The results indicate that NanoZolid technology®, with controlled and sustained drug release, can be used to treat deep lying cancer tumors. These tumors are not suitable to be treated with standard TLR9 due to the necessity of weekly injections. The planning for a Phase I study treating solid tumors with intratumoral NZ-TLR9 is ongoing and we plan to start the study towards the second half of 2021, commented Monica Wallter, CEO of LIDDS.

About TLRs and TLR9
Toll-like receptors (TLRs) are key targets in the search for new treatments against cancer. TLRs are expressed on various immune cells, including dendritic cells, and upon activation they initiate the body’s immune response. TLR9 activation leads to an immunologically active tumor environment with recruitment of the cytotoxic T cells which are necessary for an antitumor response in immunotherapy. Thus, TLR9 agonists can convert immunologically “cold” tumors to immunologically “hot” tumors. The most promising target cancers for the TLR9 project are head and neck cancer, prostate cancer, sarcomas and lymphomas. These malignancies are diagnosed in around 2 million patients each year. The market for TLR agonists is expected to be worth hundreds of millions of dollars over the coming years.  

For additional information, please contact:
Monica Wallter, CEO LIDDS, +46 (0)737 07 09 22, [email protected]

This information is such that LIDDS AB (publ) is obliged to disclose pursuant to the EU Market Abuse Regulation. The information was released for public disclosure, through the agency of the contact persons above on October 26, 2020 at 08:30 CET.

LIDDS AB (publ) is a Swedish-based pharmaceutical company with a unique drug delivery technology NanoZolid®. NanoZolid® is a clinically validated drug development technology and superior in its ability to provide a controlled and sustained release of active drug substances for up to six months. LIDDS has licensing agreements where NanoZolid

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Covid survivors deal with another lingering side effect: Dramatic hair loss

When Stacey Maravola’s hair started falling out in clumps two months after she tested positive for Covid-19, she was not initially concerned.

“I washed my hair one day and I’m pulling handfuls upon handfuls. And I’m like, ‘Maybe because it was up in a scrunchie,’” Maravola, 44, of Leetsdale, Pennsylvania, said.

But nearly two months later, the hair loss has not stopped. Each time Maravola, a health and lifestyle coach, shampoos her hair, fistfuls come out, getting tangled around her fingers and sticking to her legs as she showers.

“I’ve had to limit hair washes because I’m terrified,” she said. “I’m not a big emotional person, but I can tell you, this has changed me. I cry every single time I take a shower.”

Image: Stacey Maravola (Courtesy Stacey Maravola)
Image: Stacey Maravola (Courtesy Stacey Maravola)

Maravola is one of many coronavirus survivors dealing with dramatic hair loss, something that experts say is not entirely unexpected following a serious illness — but can be jarring nonetheless.

“It is upsetting, especially for those who have gone through a significant clinical course of Covid, to then experience this as well,” said Dr. Sara Hogan, a dermatologist and health sciences clinical instructor at the David Geffen School of Medicine at the University of California, Los Angeles. “But oftentimes, patients, once they have a diagnosis and they understand that typically this will get better, they feel better.”

Sudden hair loss can happen after any stressful event, including major surgery or even an emotional stressor such as starting a new job, Hogan said. The pandemic appears to have led to a large uptick in people who are seeing their hair thinning, she said: Hogan used to see an average of three to five hair loss patients a week and now sees up to seven a day.

Related:

Why severe assaults to the body or mind sometimes trigger hair loss is not entirely understood. In the majority of these cases, the patient is diagnosed with telogen effluvium, a temporary condition in which he or she sheds many more hairs than the typical 100 or so that people lose in a day. Telogen effluvium usually begins about three to six months after the stressor has happened, and in most patients, the problem will resolve within four to six months, according to Hogan. (In rare cases, unremitting stress can lead to chronic shedding, she added.)

Researchers do not believe Covid-19 attacks the hair follicles, meaning the hair loss is the body’s reaction to the physiological and emotional stress that the disease caused, rather than a symptom of the disease itself. And many hair loss patients that Hogan and other dermatologists are currently seeing have never had the coronavirus to begin with.

“It’s just all the other tolls of the pandemic that are leading to the hair loss,” such as financial worries or grieving the death of a family member, said Dr. Lauren Kole, an assistant professor of dermatology at the University of Alabama at Birmingham School of Medicine.

Hair loss following Covid-19

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‘Weekend Effect’ Affects Survival Odds for Rural Stroke Patients | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 21, 2020 (HealthDay News) — Stroke patients have a higher risk of death if they’re admitted to a rural hospital on the weekend, a new study finds.

University of Georgia researchers analyzed 2016 data on stroke deaths at U.S. hospitals to learn whether the so-called “weekend effect” influenced stroke outcomes.

“The weekend effect is the phenomenon where the risk of bad or adverse outcomes, such as mortality in our study, increases for those who are admitted to the hospital over the weekend as opposed to a weekday,” said lead author Birook Mekonnen, who was a graduate student in the College of Public Health when the research was conducted.

There was evidence to support the weekend effect in all hospitals. But outcomes were especially poor for rural patients who had hemorrhagic (bleeding) strokes on a weekend, as opposed to ischemic strokes (ones caused by blocked blood flow to the brain).

But the time of week may be just one factor in unfavorable outcomes for rural stroke patients, according to study co-author Donglan Zhang, an assistant professor of health policy and management in public health.

Zhang noted that rural hospitals tend to have fewer resources, including stroke specialists and equipment for particularly severe cases. They also serve a wider area and it’s not uncommon for rural patients to be more than an hour’s drive from the nearest hospital.

The researchers said one way to protect stroke patients from the weekend effect is to invest in telemedicine. They noted that more rural hospitals are joining telestroke care networks, enabling them to connect with specialists and collaborate on treatment for stroke patients.

Mekonnen advised people who are at risk for stroke or other major health problems to look into the telemedicine options available to them. “This may be the new norm,” he said in a university news release.

The findings were published in the October issue of the Journal of Stroke & Cerebrovascular Diseases.

The American Academy of Family Physicians has more on stroke.

Copyright © 2020 HealthDay. All rights reserved.

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Selexipag Has No Effect on Daily Activity in PAH Patients

Selexipag (Uptravi) does not change the level of daily activity of patients with pulmonary arterial hypertension (PAH), results from the phase 4 TRACE trial suggest.



Luke Howard

“We had no preconceived idea if this drug would improve exercise capacity,” said Luke Howard, MD, from Imperial College Healthcare NHS Trust in London. It was clear, however, that 6-minute walk tests conducted a few times a year “don’t paint a picture of what daily life is like for patients on selexipag.”

The oral prostacyclin IP receptor agonist is prescribed to slow the progression of PAH and reduce hospital admissions, but there are no studies that show whether it improves quality of life.

Howard and his team turned to wearable technology to “capture a snapshot of everyday life,” he explained during his presentation at CHEST 2020.

The primary concern of the investigators was to get TRACE participants — all with PAH — to wear a wrist device; they did not encourage patients to become more active. “We wanted a true picture of the impact of the drug itself,” he noted.

After 24 months of daily tracking, “there was no benefit to increased daily activity for patients taking this drug,” Howard told Medscape Medical News. “That was a bit deflating.”

The daily activity of TRACE participants was “slightly more elevated” in the selexipag group than in the placebo group. “We saw some numerical drops in activity in the placebo group, and a trend that might make a difference over a longer, bigger study, but not in a statically significant way,” he reported.

In the randomized, blinded trial — the first to track the activity of PAH patients — 53 participants received selexipag and 55 received placebo. All 108 wore a wrist accelerometer (GT9X Link) that counted the number of steps taken each day, providing an indication of daily activity.

Device compliance — the mean number of days in which the device was worn for at least 7 hours during a 14-day predrug period — was similar in the selexipag and placebo groups (13.2 vs 13.0 days).

Baseline Characteristics of the TRACE Participants
Measure Selexipag Group Placebo Group
Median time from diagnosis, months 38 34
Mean 6-minute walk distance, m 453.1 449.5
WHO class II PAH, % 62.3 74.5

“We wanted to make sure we had people who were stable and weren’t enrolled in a rehabilitation program; we didn’t want any competing influences,” Howard explained. All in all, the participants were in pretty good shape. “There was a low risk of a bad outcome.”

The primary end point was change in activity from baseline to week 24. The secondary end points were PAH-SYMPACT health quality-of-life tests and 6-minute walk distance.

Similar Activity Levels in Both Groups

Change in Activity From Baseline to Week 24
Activity Selexipag Group Placebo Group
Nonsedentary activity, min –0.7 –15.0
Steps, n –32 –171
6-minute walk distance, m 18.3 9.8

As expected in a population in which the majority of patients meet the criteria for WHO FC II PAH, all

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