Connect with us

Research

Management of IBD during the COVID-19 outbreak: resetting clinical priorities

The coronavirus disease (COVID-19) worldwide outbreak has led to a dramatic challenge for all healthcare systems, including inflammatory bowel disease (IBD) centres. Here, we describe the fast changes and clinical issues that IBD specialists could face during this SARS-CoV-2 infection pandemic, highlighting the potential rearrangements of care and resetting of clinical priorities.

Since December 2019 when the 2019 novel coronavirus (2019-nCoV as it was then termed, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the WHO) outbreak had been described in Wuhan, Hubei, China, the situation has dramatically evolved. The pandemic, as declared by the WHO, has led to >300,000 cases worldwide reported as of March 2020, in all continents, excluding Antarctica, spreading on a logarithmic scale in Europe. Italy is currently the second most affected country after China and, as of 13 March 2020, Europe was declared the centre of the pandemic2. Because of the very high transmission capacity, the WHO declared the outbreak of coronavirus disease (COVID-19) caused by SARS-CoV-2 infection a public health emergency of international concern.

As the need for hospitalization is very high among symptomatic cases (~10%), with an increased need to have access to intensive care units and mortality in the order of 3% globally2,3, European hospitals have started to intensively reduce elective activities, including surgery, to prepare for the high numbers of admissions. In addition, action by governments to contain the outbreak and slow the spread of COVID-19 has restricted regions and nations (the entire country of Italy, for example) by reducing their mobility within countries and across borders.

Patients with IBD

But what are the implications of COVID-19 for patients with inflammatory bowel disease (IBD)? With >5,000 patients with Crohn’s disease and ulcerative colitis, our IBD center in Milan, Italy, has been flooded by requests from the patients themselves inquiring about the risk of infection in patients with IBD, and asking what precautions to take, particularly regarding, but not limited to, their immunosuppressive treatment. The COVID-19 outbreak is a fast and evolving situation, and information on the incidence and/or risk of infection in patients with IBD is not yet available. However, it is important to counsel patients to inform them that >80% of reported cases of COVID-19 have been mild in published studies, and the proportion of fatal cases might be an overestimate as many asymptomatic cases are not identified.

In our opinion, the best advice for patients with IBD is to try to minimize the risk of infection by following good hand hygiene (frequent washing with soap and water), covering the mouth and nose with a tissue or your sleeve (not hands) when coughing or sneezing, avoiding close contact with anyone with influenza-like and/or upper respiratory symptoms, and staying home or isolated if possible. In addition to these measures, emerging reports state that patients might have viral RNA present in their faeces and live virus has been isolated from faecal samples. Thus, caution should be taken when using public toilets given the implications for the potential route of faecal–oral transmission.

An increasing number of patients with IBD treated with immunomodulators or biologic agents in our centre have asked whether a pause in their immunosuppressive therapy would be justified during the COVID-19 outbreak. At the moment, there are no formal evidence-based recommendations from clinical societies or governments for patients on immunosuppression, such as those with IBD. However, a study in a tertiary care population of 2,600 patients with IBD followed for >15,000 patient-years described an exhaustive characterization and validation (hospitalization reports) of all serious viral infections (for example, all that required hospitalization) including varicella zoster virus (VZV), herpes simplex virus (HSV), cytomegalovirus (CMV) and Epstein–Barr virus (EBV) but not SARS-CoV-2 (ref.7). The follow-up included >3,800 patient-years of exposure to anti-TNF agents, >4,800 patient-years of exposure to immunosuppressants, and >1,200 patient-years of follow-up in those >65 years. The researchers identified 31 cases of serious viral infections related to EBV, CMV, VZV and HSV infection. The two independent drivers of the risk were clinically active IBD and exposure to thiopurines. No cases of severe seasonal flu and no deaths by seasonal flu were observed. Although many of our patients have been vaccinated against seasonal flu, as recommended by European Crohn’s and Colitis Organisation (ECCO) guidelines, vaccination strategy adoption is very low and the protective effect of the vaccine is moderate, particularly in patients with an immunosuppression status. Thus, at the moment, it does not seem appropriate to recommend the pause of immunosuppressive treatment in patients with IBD, as stated by International Organization of IBD  Crohn’s & Colitis UK and Crohn’s & Colitis Foundation in their guidance for patients. Moreover, although thiopurines have been associated with risk of serious viral infection in IBD the IOIBD recommends they continue to be taken as these agents take months to leave the body and so stopping these medications will not help in the short term. In addition, a survey from the European Federation of Crohn’s and Colitis association and ECCO is ongoing to explore the need for education about COVID-19.

click here to read more on crohnsdigest

Research

Hand Sanitiser Handrub Formulation -100ml

It’s getting closer to the end of lockdown and where are all planning a good holiday to the sun we are dew a getaway from the long year we had with so much covid-19 all around us .

But covid-19 will be around a long time and we still need to wash or hand and sanitize correctly.
Traveling abroad and going through the airport with the restriction on the fluids we carry.
And can be very expensive if you get stopped and lose your liquid , worrying about how you smell is a thing of the past.

How you wash or sanitize your hands is now the most important thing to know whenever you travel. Having a 100ml bottle is a must and can fit into your pocket comfortably and is the correct amount that airport guidelines allow you to carry on board so stay safe wash and sanitizer and have a great holiday.

click on link and get 10% of hand sanitiser

Continue Reading

Diet and Lifestyle

SUPPORTING EXAM STRESS and Kids going back to School.

stress

Tests and exams can be a challenging part of school life for children and young people and their parents or carers. But there are ways to ease the stress.

Watch for signs of stress

Children and young people who are stressed may:

  • worry a lot
  • feel tense
  • have headaches and stomach pains
  • not sleep well
  • be irritable
  • lose interest in food or eat more than normal
  • not enjoy activities they previously enjoyed
  • be negative and have a low mood
  • feel hopeless about the future

Having someone to talk to about their work can help. Support from a parent, tutor or study buddy can help young people share their worries and keep things in perspective.

Encourage your child to talk to a member of school staff who they feel is supportive. If you think your child is not coping, it may also be helpful for you to talk to their teachers.

Try to involve your child as much as possible.

Make sure your child eats well 

A balanced diet is vital for your child’s health, and can help them feel well during exam periods.

Some parents find high-fat, high-sugar and high-caffeine foods and drinks, such as energy drinks, cola, sweets, chocolate, burgers and chips, make their children hyperactive, irritable and moody.

Where possible, involve your child in shopping for food and encourage them to choose some healthy snacks.

Read more about healthy eating for teens.

Help your child get enough sleep 

Good sleep improves thinking and concentration. Most teenagers need 8 to 10 hours’ sleep a night. Learn more about how much sleep children need.

Allow half an hour or so for your child to wind down between studying, watching TV or using a computer and going to bed, to help them get a good night’s sleep.

Cramming all night before an exam is usually a bad idea. Sleep will benefit your child far more than a few hours of panicky last-minute study.

Be flexible during exams

Be flexible around exam time. When your child is revising all day, do not worry about household jobs left undone or untidy bedrooms.

Staying calm yourself can help. Remember, exams do not last forever.

The Family Lives website has more about coping with exam stress.

Help them study

Make sure your child has somewhere comfortable to study. Ask them how you can support them with their revision.

Help them come up with practical ideas that will help them revise, such as drawing up a revision schedule or getting hold of past papers for practice.

To motivate your child, encourage them to think about their goals in life and see how their revision and exams are related to them.

Talk about exam nerves

Remind your child that it’s normal to feel anxious. Nervousness is a natural reaction to exams. The key is to put these nerves to positive use.

If anxiety is getting in the way rather than helping, encourage your child to practise the activities they’ll be doing on the day of the exam. This will help it feel less scary.

For example, this may involve doing practice papers under exam conditions or seeing the exam hall beforehand. School staff should be able to help with this.

Help your child face their fears and see these activities through, rather than avoiding them.  

Encourage them to think about what they know and the time they’ve already put into studying to help them feel more confident.

Encourage exercise during exams

Exercise can help boost energy levels, clear the mind and relieve stress. It does not matter what it is – walking, cycling, swimming, football and dancing are all effective.

Activities that involve other people can be particularly helpful.

Support group Childline says many children who contact them feel that most pressure at exam time comes from their family.

Listen to your child, give them support and avoid criticism.

Before they go in for a test or exam, be reassuring and positive. Let them know that failing is not the end of the world. If things do not go well they may be able to take the exam again.

After each exam, encourage your child to talk it through with you. Discuss the parts that went well rather than focusing on the questions they found difficult. Then move on and focus on the next test, rather than dwelling on things that cannot be changed.

Make time for treats

With your child, think about rewards for doing revision and getting through each exam.

Rewards do not need to be big or expensive. They can include simple things like making their favourite meal or watching TV.

When the exams are over, help your child celebrate by organising an end-of-exams treat.

When to get help

Some young people feel much better when exams are over, but that’s not the case for all young people.

Get help if your child’s anxiety or low mood is severe, persists and interferes with their everyday life. Seeing a GP is a good place to start.

Some basic rules coming up to exam time

A quiet place to study – A suitable environment to study is important to help concentration levels.

A balanced diet – Good nutrition is essential at any time of year, but especially during exam time. Batch cook some healthy meals and stock up on nutritious snacks. Having some of the student’s favourite dinner to hand is important too.

Omega 3 is essential to fuel the hard-working brain at this time. Keep brain and vision in tip top shape by making sure to top up your good fats daily. Consider taking Cleanmarine® Krill Oil High Strength. It contains 590mg of concentrated, high strength Omega 3 Krill Oil. This concentrated formula of EPA, DHA, Astaxanthin and Choline provides the essential fatty acids required for the normal function of the heart, brain and vision. DHA contributes to the maintenance of normal brain function and vision, the beneficial effect is obtained with a daily intake of 250mg. Also eating 2 – 3 portions of oily fish a week will provides more essential fats for your body. Examples include salmon, mackerel and herring. Easy to cook in steam parcels in the oven with garlic, lemon and oil.

A good night’s sleep – Studying all night may seem like a good idea but if your child doesn’t get enough sleep, they are more likely to forget the information or under perform. When your mind is buzzing with exam questions, quotes and scientific theories, having something to help you switch off, relax and support deep sleep is a must. Try melissa-dreams which contains all-natural ingredients including the herbs lemon balm (Melissa officinalis) and Chamomile in combination with selected B-vitamins, Magnesium and the amino acid L-theanine. Magnesium contributes to a reduction of tiredness and fatigue while vitamins B6 and B12 contribute to the normal function of the nervous system. With no drowsiness or side effects the next day, Melissa Dream helps you to wake up rested and full of energy.

Exercise – Even a 20-minute walk will help your child to relax and destress their mind, this will also help oxygenate the entire body.

Stress is the biggest obstacle to overcome. It’s so important to get enough B vitamins in foods like broccoli. Kale, spinach. Getting your 5-a-day is bound to be the least of your worries as exam time approaches; ironically this is when your nutritional and energy needs are at their highest. Make sure you keep your nutrient and energy levels up with One Nutrition® Organic Power Greens. This is a unique combination of nature’s finest green foods including kale, broccoli, spirulina, wheat grass and barley grass juice powders in a handy capsule or powder to add to your morning smoothie.

Take time out to do something you love such as walking your dog, reading a magazine, chat online to your best friend. Journaling is also therapeutic, to put your thoughts and feelings onto paper. Try family time such as playing a board game to distract your mind from the books for a while.

Don’t forget to celebrate – when the exams are over, go out and celebrate together, hopefully everything will be back to normal by then.

GET 10 % OF ALL PRUDUCTS WHEN YOU BUY THROUGH LINK BELOW

click link to buy melissa dream supplements

click link to buy one Nutrition Organic powder Greens

click link to buy One Nutrition® B12 Max – 30ml Spray

Continue Reading

Research

Can vitamin D really prevent Covid-19? Here’s what the evidence says.


Vitamin D supplement sales have soared amid the pandemic as people try to curb their risk of contracting the novel coronavirus—but some experts are urging caution, noting that not enough research has been done to establish a definitive relationship between taking the supplement and fending off Covid-19.

What the research says about vitamin D and Covid-19

According to Sabyasachi Sen, a professor of endocrinology and medicine at George Washington University (GW), deficiencies of vitamin D are “not rare” and are especially common in older adults, obese people, and people with darker skin—some of the same populations most affected by Covid-19.

While vitamin D is known for protecting bone health, it also helps with the immune system, Sen said. It’s believed that vitamin D improves the function of certain cells, including T cells, which fight off pathogens and can assist in modulating inflammatory responses.

In addition, Sen continued, research has found vitamin D deficiencies have been associated with an increased risk of infection. “Now, what is unknown is whether it’s a cause and effect rather than an association,” he said.

According to the Washington Post, researchers studying the relationship between vitamin D and Covid-19 outcomes are interested in precisely that question: whether there’s a cause and effect relationship, or merely an association.

For example, one study, published in JAMA Network Open, looked at the health records of 489 people in Chicago and found patients with a vitamin D deficiency in the year prior to testing for Covid-19 were 77% more likely to test positive for the disease than those with normal vitamin D levels. Taking a converse approach, another study looked at a small group of Covid-19 patients in Italy who had been hospitalized with acute respiratory failure and found that 81% of them had a vitamin D deficiency.

Meanwhile, an experimental study in France at a nursing home with 66 people found that taking vitamin D supplements was “associated with less severe Covid-19 and a better survival rate.” Similarly, a study in South Korea of 200 people found that a deficiency of vitamin D could “decrease the immune defenses against Covid-19 and cause progression to severe disease.” And a small study in Spain involving 76 hospitalized Covid-19 patients found that those treated with calcifediol—an activated version of vitamin D, distinct from the over-the-counter supplement—seemed to curb the severity of the disease.

On the flipside, however, a recent paper considered by the National Institute for Health and Care Excellence in the United Kingdom looked at vitamin D levels from up to 14 years ago and didn’t find any correlation between vitamin D levels and Covid-19 mortality. And while the lead author of that study has in other papers called for further research on the link between vitamin D and Covid-19 outcomes, the researchers concluded, “For now, recommendations for vitamin D supplementation to lessen Covid-19 risks appear premature and, although they may cause little harm, they could provide false reassurance leading to changes in behaviour that increase risk of infections.”

Similarly, a double-blind randomized controlled trial of 240 patients in Brazil, which has yet to be peer-reviewed, found that one large dose of vitamin D didn’t reduce hospital stay length or mortality rates among patients with a severe case of Covid-19 compared with those in a placebo group.

Correlation—not necessarily causation

“We do know that people who have lower blood levels of vitamin D tend to have a higher risk of being infected with Covid-19 and having severe Covid-19 illness,” JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, said. “But as we say in epidemiology, ‘Correlation doesn’t prove causation.’ We don’t know for sure that the low vitamin D level is causing an increased risk of Covid-19.”

According to Natasha Chida, an infectious disease expert and assistant professor of medicine at Johns Hopkins University, people who have a vitamin D deficiency typically have other health factors that could affect how likely they are to develop a severe case of Covid-19—and people who do develop diseases such as Covid-19 often experience a drop in vitamin D levels.

“Unless you take into account all those factors and separate all those out and look at just vitamin D … it’s really hard to make any inferences about what vitamin D is doing here,” she said.

Chida added that there’s “some biologic plausibility” that vitamin D could help Covid-19 patients. “It’s just that despite years of research into the use of vitamin D in respiratory tract infections, there still hasn’t really been a clear, slam-dunk answer that there’s a benefit.”

Research into the relationship is ongoing, however. According to the Washington Times, about 70 clinical trials assessing vitamin D and Covid-19 have been filed in the U.S. National Library of Medicine database.

Should you take vitamin D supplements?

As of now, experts say people who know they have vitamin D deficiencies should continue their treatment, and those thinking about taking supplements should talk to their health care provider first, given there’s no firm evidence that vitamin D supplements curb people’s risk of infection or serious Covid-19 illness.

“People should be wary of taking mega doses of vitamins or unproven interventions specifically for Covid-19, because we don’t have good quality data yet to suggest that this is of any help,” Hana Akselrod, an infectious disease specialist at GW, said.

Instead of supplements, people can add more vitamin D to their lives by being outdoors for 15 or 20 minutes a day, Akselrod added. And some foods, such fatty fish or fortified dairy products, could also improve vitamin D levels, Manson said.

“There are all of the positive confluences around nutrition and outdoor exercise that aren’t just limited to the number of how many units of vitamin D you get every day,” Akselrod said. “And on top of that, people absolutely need to continue all the other safety precautions, like masking and safe distancing and avoiding gatherings, because we’re in the most dangerous phase of the pandemic yet”.

click here to read more on crohns news

Continue Reading

Most Read