School of Medicine review proposes treatments for COVID-related blood clots

Yale News

Scientists at Yale have synthesized research from around the world to suggest new treatment methods for COVID-19.

A multidisciplinary team of Yale physician scientists, researchers, nursing staff and others have collaborated since early on in the pandemic to figure out why COVID-19 patients are so prone to blood-clotting. Their recent review, published on Nov. 19 in Nature Reviews Cardiology, details how COVID-19 causes blood clots in sick patients and why the disease has been so difficult to treat.

“Blood clotting is a complex process that involves many types of cells in the body including platelets and endothelial cells,” John Hwa, professor of medicine at the Yale Cardiovascular Research Center and one of the review’s senior authors, wrote in an email to the News. “It isn’t often that all components involved are in serious disarray and thus synergizing to promote massive blood clotting. In some ways it’s like ‘a perfect storm’ where all the components are perturbed and are tipped over the edge by COVID-19.”

Hwa said his colleague Hyung Chun, co-author of the review and director of Translational Research at the Yale Pulmonary Vascular Disease Program, contacted him in March when he suspected that endothelial cells, which line the interior surface of blood vessels, might be involved in the pathogenesis of COVID-19. 

Alfred Lee, associate professor of Medicine and another author of the review, also reached out to Hwa in March and informed him of potential abnormalities in platelets — cells responsible for blood clotting — that he was observing in COVID-19 patients. The team, which included Lee, Hwa and Chun, expanded those observations into a massive collaborative effort that included many frontline healthcare workers helping with patient treatment.

Platelets and endothelial cells are not usually considered important in the development of a disease from viral infection, according to Hwa. But COVID-19 and the body’s resulting immune response can lead to damage in many different cells and cause a wide range of complications — including those related to platelets and endothelial cells.

“A major adverse outcome of those critically ill with Covid19 is formation of blood clots, many of which are likely undiagnosed,” Chun wrote in an email to the News. “This is likely occurring due to a combination of endothelial injury/activation and platelet activation.”

To make matters worse, the functions of these cells can already be compromised in elderly people and in people with diabetes or other cardiovascular risk factors. Then, when the cells are introduced to COVID-19, the “perfect storm” that Hwa described forms. 

Another complication can come in the form of elevated cytokine levels, according to Jennifer Kwan, co-author of the review and clinical fellow at the Yale School of Medicine.

“The cytokines are essentially our messaging system released by immune cells to ramp up the immune defense or offense against a microbial threat,” Kwan said. “But when

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‘I’m an Psychologist and These Are The Light Therapy Treatments I Recommend for Seasonal Affective Disorder’

If you’re finding yourself cursing the reality of darker mornings and even darker, longer nights, you could be dealing with the pangs of seasonal affective disorder (SAD), a very real type of depression that becomes more severe as winter approaches.



a man that is standing in the dark: Chances are you're not the only one experiencing the blues as the mercury drops. Here's how you can push back


© Mint Images – Getty Images
Chances are you’re not the only one experiencing the blues as the mercury drops. Here’s how you can push back

Despite how it may feel, you’re not the only one — it’s thought that around 10-20 per cent of people in the UK experience “mildly debilitating” symptoms of seasonal affective disorder as the weather gets colder and six per cent of adults will experience “recurrent major depressive episodes with seasonal pattern”. Currently, the average age at which seasonal affective disorder symptoms present themselves is 27-years-old in both men and women. Both genders are equally affected.

Despite enjoying an extra hour in bed, most of us will, especially at this time, be spending the majority of daylight hour indoors. For many, this could impact mental health — a 2019 YouGov poll found that 29 per cent of UK adults will experience some kind of depressive symptoms this winter, while six per cent of us will suffer seasonal affective disorder to the point where they’re unable to work or to function properly.

Worried about SAD? Don’t be. We’re here to help with our digestible guide on seasonal affective disorder including expert advice, study commentary, actionable advice, product information and more.



a sunset over a grass field: Cold Dawn Sunrise


© George W Johnson
Cold Dawn Sunrise

What Causes Seasonal Affective Disorder?

A form of depression that’s directly related to the changing of the seasons, seasonal affective disorder is experienced most commonly when summer transitions into winter. As it’s as seasonal issue, seasonal affective disorder is often experienced every 12 months. “Patients often begin experiencing symptoms of depression during autumn and often do not feel an improvement in mood until the spring,” explains Dr. Chun Tang, general Practitioner at Pall Mall Medical.

But how is seasonal affective disorder caused?

The research is sporadic, but one cause, it’s believed, is the correlation between the reduced exposure to sunlight and shorter days in winter. That’s because the hormone melatonin, responsible for controlling our sleep cycles, becomes “phase delayed” by people experiencing seasonal affective disorder, leading us to feel sluggish, tired and irritable — regardless of how many espressos have bene imbibed. Stress levels will rise, too, thereby impacting our mental wellbeing, immunity and overall health.

Similarly, serotonin, a neurotransmitter that regulates anxiety, happiness and mood, could have a bigger impact than previously thought. Due to winter having shorter days and darker weather, there typically isn’t enough natural daylight, which causes a drop in serotonin levels in our brains. On a biological level, this increases the likelihood of someone experiencing a depressive episode.

Seasonal Affective Disorder: What Are The Symptoms?

According to the NHS, symptoms of SAD can include:

  • A persistent low mood
  • A loss of pleasure or interest in normal everyday activities
  • Irritability
  • Feelings of despair, guilt and
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Medicare and CPAP machines: Coverage, treatments, and costs

Medicare covers some durable medical equipment (DME), including a continuous positive airway pressure (CPAP) machine, when a doctor prescribes it for home use. Medicare Advantage plans may also cover CPAP therapy.

Medicare typically covers CPAP therapy for people who have a condition called obstructive sleep apnea.

This article discusses the types of sleep apnea and some of the treatments for the condition. It also looks at Medicare coverage.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Sleep apnea is a condition in which a person temporarily stops breathing while asleep. The pauses in breathing are usually at least 10 seconds long and may last for more than a minute, according to the American Sleep Apnea Association (ASAA). These pauses may occur hundreds of times a night.

Types of sleep apnea

The three main types of sleep apnea are:

  • Obstructive sleep apnea: This condition happens when a person’s airway becomes blocked during sleep. It can occur if the soft tissue at the back of the throat collapses and creates a blockage.
  • Central sleep apnea: This condition happens when a person’s brain does not send the appropriate signal to the muscles that play a role in breathing.
  • Mixed sleep apnea: This condition is a combination of obstructive and central sleep apnea.

Obstructive sleep apnea is the most common type of sleep apnea.

Causes of sleep apnea

According to the National Heart, Lung, and Blood Institute (NHLBI), the causes of obstructive sleep apnea include:

  • obesity
  • large tonsils
  • heart or kidney failure, which may cause fluid buildup in the neck
  • genetic syndromes that affect facial structure

A person with sleep apnea may not know that they have the condition. They might only become aware of it because a partner or family member notices that the person’s breathing is irregular while sleeping.

Sleep apnea typically prevents a person from having deep, restful sleep.

Symptoms of sleep apnea

According to the NHLBI, the signs and symptoms of sleep apnea may include:

  • excessive daytime sleepiness
  • loud snoring
  • gasping for air while asleep
  • morning headaches
  • trouble concentrating

Sleep apnea may also increase a person’s risk for certain conditions, including:

Read more about sleep apnea here.

The most common treatment for someone with moderate-to-severe sleep apnea is a breathing device, such as a CPAP machine. CPAP therapy delivers a flow of air through a mask to help keep the airway open while a person is asleep.

Other potential treatments for sleep apnea include:

  • Oral appliance therapy: A person wears a custom-fitted
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