COVID-19 : How to quarantine yourself at home
The government issued the instructions for contacts who are being home quarantined.
The home quarantined person should :
- Stay in a well-ventilated single-room preferably with an attached/separate toilet. If another family member needs to stay in the same room, it’s advisable to maintain a distance of at least 1 metre between the two.
- Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household.
- Restrict his/her movement within the house.
- Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc.
The person should also follow the under mentioned public health measures at all times :
- Wash hands as often thoroughly with soap and water or with alcohol-based hand sanitizer.
- Avoid sharing household items e.g. dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people at home.
- Wear a surgical mask at all the time. The mask should be changed every 6-8 hours and disposed off. Disposable masks are never to be reused.
- Masks used by patients/care givers/close contacts during home care should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial.
- Used mask should be considered as potentially infected.
- If symptoms appear (cough/fever/difficulty in breathing), he/she should immediately inform the nearest health centre or call 011-23978046.
Instructions for the family members of persons being home quarantined :
- Only an assigned family member should be tasked with taking care of the such person.
- Avoid shaking the soiled linen or direct contact with skin.
- Use disposable gloves when cleaning the surfaces or handling soiled linen.
- Wash hands after removing gloves.
- Visitors should not be allowed.
- In case the person being quarantined becomes symptomatic, all his close contacts will be home quarantined (for 14 days) and followed up for an additional 14 days or till the report of such case turns out negative on lab testing.
Environmental sanitation :
- Clean and disinfect frequently touched surfaces in the quarantined person’s room (e.g. bed frames, tables etc.) daily with 1% Sodium Hypochlorite Solution.
- Clean and disinfect toilet surfaces daily with regular household bleach solution/phenolic disinfectants.
- Clean the clothes and other linen used by the person separately using common household detergent and dry.
Duration of home quarantine :
The home quarantine period is for 14 days from contact with a confirmed case or earlier if a suspect case (of whom the index person is a contact) turns out negative on laboratory testing.
2nd Person to be Cured of HIV Infection
A man in London appears to be the second person ever cured of HIV, his doctors said.
The man — whose case was first announced a year ago — has now been HIV-free for 30 months without the need for antiviral medications, according to a new report published Tuesday (March 10) in the journal The Lancet HIV.
Previously known only as the “London patient,” the man revealed his identity on Monday (March 9). He is Adam Castillejo, a 40-year-old who was first diagnosed with HIV in 2003, according to The New York Times.
Last year, researchers reported that Castillejo had experienced “long-term remission” from the virus after undergoing a special bone-marrow transplant. At that time, Castillejo had been HIV-free for 18 months. Now, 12 months later, his doctors are more sure that his case does indeed represent a cure.
“We propose that these results represent the second ever case of a patient to be cured of HIV,” study lead author Ravindra Kumar Gupta, a professor of clinical microbiology the University of Cambridge, said in a statement.
The first patient to be cured of HIV — Timothy Brown, also known as the “Berlin patient” — received a similar bone-marrow transplant in 2007 and has been HIV-free for more than a decade.
In the cases of both Castillejo and Brown, stem cells used for their transplants came from a donor who had a relatively rare genetic mutation that confers resistance to HIV.
However, the researchers stressed that such a bone-marrow transplant would not work as a standard therapy for all patients with HIV. Such transplants are risky, and both Castillejo and Brown needed the transplants to treat cancer, rather than for HIV.
In the new report, doctors found no active viral infection in Castillejo’s body. However, they did find “remnants” of HIV’s DNA in some cells. But the authors said these traces of DNA can be thought of as “fossils,” because they are unlikely to allow the virus to replicate. Such remnants were also found in Brown’s case.
Castillejo’s cure “means the first one [in the Berlin patient] wasn’t an anomaly or a fluke,” Gupta told The Guardian.
Source : Livescience
Indocyanine Green Improves Harvesting of Lymph Nodes in Gastric Cancer Patients
In patients with gastric cancer who undergo D2 lymphadenectomy, indocyanine green (ICG) helps surgeons harvest more lymph nodes than conventional dissection and reduces the number of nodes that should have been excised, but weren’t, a phase-3 trial reveals.
Drs. Chao-hui Zheng and Chang-Ming Huang of Fujian Medical University Union Hospital in China randomized 266 patients (mean age, about 59; two-thirds men) to ICG tracer-guided or conventional laparoscopic gastrectomy.
As reported in JAMA Surgery, the mean number of lymph nodes retrieved in the ICG group was significantly more than in the non-ICG group (mean, 50.5 vs. 42.0, respectively).
Similarly, significantly more perigastric and extraperigastric lymph nodes were retrieved in the ICG group, and the mean total number of lymph nodes retrieved with ICG within the scope of the entire procedure was also significantly higher than without ICG (mean, 49.6 vs. 41.7).
Further, the ICG group’s lymph node noncompliance rate was significantly lower than in the non-ICG group: 31.8% vs. 57.4%.
Additional analyses showed that the number of metastatic lymph nodes in each station in the ICG group was not significantly higher than in the non-ICG group, regardless of the resection method. And an analysis of the relationship between the fluorescence lymph nodes and metastatic lymph nodes retrieved in the ICG group indicated that the diagnostic sensitivity and specificity of fluorescence and metastatic lymph nodes were 56.3% and 46.1%, respectively
Notably, no significant between-group differences were found during the postoperative recovery process in the incidence of complications (15.5% vs. 16.3%) or their severity within 30 days after surgery.
“This is a very important study that shows the usefulness of ICG for patients with gastric cancer,” Dr. Marco Giuseppe Patti of the University of North Carolina at Chapel Hill, coauthor of a related editorial, told Reuters Health by email. “The technique is very simple and safe and allows the retrieval of a larger number of lymph nodes. We feel that is even more important for us surgeons in the Western world, as we operate on very few patients with gastric cancer as compared to surgeons in the East.”
“In addition, our patients are often overweight with large amounts of intra-peritoneal fat, which makes the dissection more cumbersome and lengthy,” he noted. “Presently, we feel that infrared fluorescent imaging should be used in any patient with cancer.”
Dr. Amit Bhatt, director of Cleveland Clinic’s Endoluminal Surgery Center in Ohio, commented in an email to Reuters Health, “While there has been interest in the use of ICG tracer with near-infrared fluorescent imaging in gastric cancer for some time, previous studies focused on sentinel node identification or small patient populations. The strengths of the study are the high volume of gastric cancer surgeries involved, and the robust design of the study.”
“Moving forward,” he said, “the two main questions that remain are: 1) Is the long-term survival between these two groups different; and 2) Are these findings translatable to lower surgical volume centers like those in the West where gastric cancer surgery is less common.”
“Despite these questions,” he added, “the use of ICG is simple and should be considered in patients undergoing gastrectomy for gastric cancer.”
Drs. Chao-hui Zheng and Chang-Ming Huang did not respond to requests for comment.
Source : JAMA Surgery, online February 26, 2020.
Source : Medscape
Excellent Speech By Prakruthi Vanam Prasad
Colorectal Cancer Incidence Sliding Towards Younger Ages ?
New statistics on colorectal cancer in the United States confirm previously reported trends showing the burden of disease is shifting toward younger adults.
The new data, published online March 5, come from latest edition of Colorectal Cancer Statistics from the American Cancer Society.
During the 2000s, the incidence of CRC has shown a rapid decline in individuals aged 65 and older, but has increased by 1% annually among those aged 50 to 64 years, and increased by 2% annually in those younger than 50 years, the report notes.
CRC death rates from 2008 through 2017 declined by 3% annually in individuals aged 65 years and older, and by 0.6% annually in individuals aged 50 to 64 years, but they have increased 1.3% annually in those aged younger than 50 years.
“As a result of declining [CRC] incidence in older age groups coinciding with increasing incidence in younger individuals, the CRC patient population as a whole is rapidly shifting younger,” conclude the authors, led by Rebecca Siegel, MPH, scientific director, Surveillance Research, American Cancer Society, Atlanta, Georgia.
Commenting on the new figures, Kimmie Ng, MD, MPH, Dana-Farber Cancer Institute, Boston, Massachusetts, who was not involved with the statistical report, said, “The new American Cancer Society statistics reinforce previous trends that demonstrate a very concerning, steady rise in the incidence of young-onset colorectal cancer.”This rising burden on people younger than 50 years old is what keeps me up at night. Dr Kimmie Ng
“This rising burden on people younger than 50 years old is what keeps me up at night, and which is why we have redoubled our efforts to tackle the problem,” Ng told Medscape Medical News.
This effort includes the opening of the Young-Onset Colorectal Cancer Center at her institution a year ago, where Ng serves as the director.
At the center, providers are partnering with patients to address their unique needs and to carry out focused research aimed at identifying those at the highest risk for CRC as well as novel treatment strategies.
“Up until this point, there has been very limited scientific data available on CRC specifically in people younger than 50,” Ng noted.
“And we are working every day to make inroads in decreasing CRC incidence and mortality by raising awareness of what is a potentially preventable cancer, and underscoring the importance of screening tests,” she added.
The increase in CRC incidence among adults younger than 50 has also been seen in other countries, including Australia, New Zealand, Canada, and many across Europe, as reported by Medscape Medical News.
CRC Statistics Reveal a Shift
In terms of overall numbers, the majority of cases are still occurring in older individuals.
The report estimates that the overall number of newly diagnosed CRC patients in 2020 in the US is expected to reach 147,950. Of these, 12% are expected to occur in patients younger than 50. Additionally, the authors estimate there will 53,200 deaths from CRC in 2020; about 7% are expected to occur in patients younger than 50.
Important to note, the authors say, is that there has been a shift toward CRC incidence in younger adults.
This is reflected by the median age at the time of diagnosis, which has dropped from age 72 years in the period 1988-1989 to age 66 years in the period 2015-2016, they add.
The decline in CRC incidence in older adults is explained by the authors as a result of increased screening.
They note that rapid declines seen in the 2000s in the incidence of CRC in people age 50 and older reflect a surge in screening colonoscopy, which tripled from 20% in 2000 to 61% in 2018 in this age group.
More recently, however, the decline in CRC incidence was confined to those aged 65 years and older, among whom CRC incidence rates dropped by 3.3% a year between 2011 and 2016.
This has not held true for patients between the ages of 50 and 64 years. In this age range, the declines in the incidence of CRC of between 2% to 3% a year during the 2000s have now reversed, and increased by 1% a year in the period 2011 through 2016, the researchers note.
“The uptick is similar to the trend in individuals aged younger than 50 years and likely reflects elevated disease risk in generations born since 1950 being carried forward by aging birth cohorts, a phenomenon referred to as a birth cohort effect,” the authors write.
Asked to elaborate on this so-called “birth cohort effect,” Siegel explained that the underlying risk of being diagnosed with CRC exclusive of the impact of screening had been declining for a long time because of changing patterns in risk factors such as a drop in smoking rates and increases in the use of anti-inflammatory drugs.
“However, this changed with people born after the 1950s; their risk of disease is higher and has increased with each subsequent generation,” Siegel told Medscape Medical News in an email.
“People don’t just have a higher risk when they’re young and leave it behind as they age…they carry the elevated risk with them, which is why you see an uptick in CRC incidence over time in increasing age groups,” she explained.
“Since 1950, risk has been increasing for every subsequent generation,” Siegel emphasized.
Indeed, the report shows that CRC incidence rates in patients younger than age 50 have actually been increasing since the mid-1990s, largely driven by rectal tumors.
However, between 2012 and 2016, incidence rates for patients younger than 50 rose by 1.8% a year for tumors in the proximal and distal colon as well as in the rectum, and by 2.2% annually for total colorectum (excluding the appendix).
Alarmingly, “the increased incidence in those aged younger than 50 years is confined to advanced-stage diagnoses and is steepest among non-Hispanic Whites (NHW) [at] 2% per year and American Indian/Alaska Natives (AI/ANs) [at] 2.2% per year,” the researchers note.
As a result of these trends, “CRC incidence rates in NHWs aged 20 to 49 years are now equivalent to those in blacks…despite being 40% higher in blacks during 1995-1996,” they add.
Slightly more than 20% of patients between 45 and 49 years of age availed themselves of screening colonoscopy in 2018, as is now recommended by the American Cancer Society (many other medical associations, however, continue to recommend starting colonoscopy at age 50). There is an ongoing debate about whether the age to start screening for CRC should be lowered in the US. In other countries (eg, the United Kingdom), screening for CRC starts at 60 (using stool tests).
However, the authors also note that “patterns of CRC test use do not appear to explain the rise in early-onset CRC, particularly in light of the preponderance of advanced-stage disease diagnoses.”
Asked what she thinks is driving the shift of CRC incidence in younger patients, Siegel admitted that reasons for the rise are still unknown.
“The obesity epidemic is probably contributing to it but it doesn’t seem to be the sole cause,” she said.
However, diet has a large influence on CRC risk as well; there is considerable interest now in looking at how things like antibiotics influence gut health — specifically their role in determining the microorganisms that make up the microbiome, which could influence CRC risk, Siegel suggested.
Siegel and five other authors of the report are employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research outside of the submitted work. Author Andrea Cercek serves on the advisory board for Bayer and Array Biopharma and receives research support from Tesaro, RGenix, and Seattle Genetics, all outside the submitted work.
CA Cancer J Clin. Published online March 5, 2020. Full text
Source : Medscape
1st Clinical Guidelines For Thyroid Related Surgical Treatment
The American Association of Endocrine Surgeons (AAES) has issued a
first-of-its-kind set of clinical guidelines for the surgical treatment of thyroid disease, offering evidence-based recommendations on the wide-ranging aspects of thyroidectomy and the management of benign as well as malignant thyroid nodules and cancer.
Whereas various endocrine and thyroid societies issue guidelines on many aspects of management of thyroid disease, the new AAES guidelines are the first focusing specifically on surgical management of thyroid disease in adults.
“These guidelines truly focus on the surgical decision-making and management of thyroid disease; however, there is something for all clinicians who take care of patients with thyroid disease,” lead author Kepal N. Patel, MD, of NYU Langone Health in New York City, told Medscape Medical News.
The guidelines, published this week in the Annals of Surgery, include a total of 66 recommendations from a multidisciplinary panel of 19 experts. The group reviewed medical literature spanning from 1985 to 2018. (The authors of the guidelines report no conflicts of interest, although the article lists several disclosures.)
More than 100,000 thyroidectomies are performed each year in the United States alone, and as surgical indications and treatment paradigms evolve, the need for surgical guidance is more important than ever, Patel said.
“Such transformations have propagated differences in clinical interpretation and management, and as a result, clinical uncertainty and even controversy have emerged,” he said.
“Recognizing the importance of these changes, the AAES determined that evidence-based clinical guidelines were necessary to enhance the safe and effective surgical treatment of benign and malignant thyroid disease.”
Key areas addressed in the guidelines include the addition of new cytologic and pathologic diagnostic criteria, molecular profiling tests, operative techniques and adjuncts, and the nuances surrounding the sometimes challenging newer concept of ‘borderline’ thyroid tumors, Patel noted.
In terms of imaging recommendations, for instance, the guidelines recommend the preoperative use of CT or MRI:
“CT or MRI with intravenous contrast should be used preoperatively as an adjunct to ultrasound in selected patients with clinical suspicion for advanced locoregional thyroid cancer,” the guidelines state, citing the recommendation as being “strong,” with a “low quality of evidence.” (Recommendation 6).
Further diagnostic recommendations cover issues including voice assessment, the risk for vocal fold dysfunction related to thyroid disease and surgery, and the use of fine-needle aspiration biopsy in evaluating suspicious thyroid nodules and lymph nodes.
The guidelines also address the indications for thyroidectomy, with recommendations regarding the extent and outcomes of surgery spanning different categories of thyroid disease.
A key recommendation along those lines, for instance, indicates that, when possible, thyroidectomy should be performed by surgeons who perform a high volume of such procedures.
Approaches for safe and effective perioperative management are also covered, including measures to prevent complications and the use of thyroid tissue diagnosis during surgery, such as core needle biopsy of the thyroid and cervical lymph nodes and incisional biopsy of the thyroid, nodal dissection, and concurrent parathyroidectomy.
Recommendations further address the optimal management of thyroid cancer, with an emphasis on a personalized, evidence-based approach tailored to the patient’s situation and preferences.
The authors underscore that, as technology rapidly evolves, “in the future, this work will certainly and rightly need to be done again.”
In the meantime, the recommendations should be relevant to “the target audience [of] the practicing surgeon in a community hospital, academic center, or training program.”
An AAES press release notes that “the members of the expert panel hope their efforts will meet the need for evidence-based recommendations to ‘define practice, personalize care, stratify risk, reduce healthcare costs, improve outcomes, and identify rational challenges for future efforts.’ ”
Ann Surg. Published online March 2, 2020.
Source : Medscape
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