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Long COVID Can Negatively Impact Physical and Cognitive Function, Employment, and Quality of Life for at Least One Year

Over 4 million deaths per year caused by obesity

Burning and Tingling in Your Feet? You May Have Small Fiber Neuropathy

Lactoferrin supplements could aid in the recovery of COVID19 & other Respiratory Tract Infections




Released: October 2021


Long COVID Can Negatively Impact Physical and Cognitive Function, Employment, and Quality of Life for at Least One Year

Patients experiencing post-acute COVID syndrome (PACS, also known as “long COVID”) may have symptoms for at least 12 months after initial COVID-19 infection, significantly and negatively impacting their cognition, ability to work, participation in physical activity, interaction with others, and overall quality of life, according to a new Mount Sinai study. 

The study, published in the October 25 issue of the American Journal of Physical and Rehabilitation Medicine, is one of the first to measure the actual impairment and impact of PACS on patients, and detail factors that may exacerbate their symptoms. This work will help guide lawmakers and national and international health agencies to develop strategies and policies to support these patients during their lengthy recovery.

“With millions of Americans at risk of developing PACS by the end of the pandemic, a second, longer-term public health emergency has emerged. It is imperative to understand the burden of this novel condition and develop targeted interventions to help patients participate in daily activities, as well as policies that will assist them with their disability and employment status,” says senior author David Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System. “This study is a concerning reminder of how severely debilitating PACS symptoms are, the toll they take on health and wellness, and the fact that, without active treatment, these symptoms appear to persist indefinitely.”

A team of researchers did a retrospective, observational study of 156 patients treated at Mount Sinai’s Center for Post-COVID Care between March 2020 and March 2021. The patients had previously had COVID-19 and had not yet been vaccinated at the time of the study. Patients filled out surveys on persistent symptoms and triggers of symptom exacerbation a median of 351 days from their first day of infection – patients received surveys after scheduling their first appointment and timestamped once submitted. They were asked detailed questions about fatigue, breathlessness, ability to complete moderate and vigorous intensity physical activity, cognitive function, health-related quality of life, anxiety, depression, disability, and their pre- and post-COVID-19 employment status.

The most common reported symptoms were fatigue (82 percent of patients), followed by brain fog (67 percent), headache (60 percent), sleep disturbance (59 percent), and dizziness (54 percent). Researchers performed a more detailed evaluation of the severity of self-reported cognitive impairment and discovered that more than 60 percent of PACS patients had some level of cognitive impairment (either mild, moderate or severe), with symptoms including diminished short-term memory, difficulty remembering names, and issues with decision-making and daily planning.    

In total, 135 patients answered questions about their employment pre- and post-COVID-19, and the number of patients in full-time work (102) went down to 55.

Going further, the study noted factors that the patients said made their PACS symptoms worse. The biggest trigger was physical exertion (reported by 86 percent of patients), followed by stress (69 percent), dehydration (49 percent), and weather changes (37 percent). 

“Many of the symptoms reported in this study have been measured, but for many this is the first time they have been objectively documented using well-validated patient-reported outcomes, and linked to changes in activities of daily living and quality of life,” explains Dr. Putrino. “The long duration of these symptoms remind us that this is a problem that is not going away, and that we need to aggressively pursue policies that will better support and protect these patients in the long-term. Future research should focus on more detailed monitoring of PACS symptoms—better understanding how and why they are happening will be crucial in developing targeted treatments.”

Source: Mount Sinai Health System  (add link www.mountsinai.org to Mount Sinai Health System)

Released: October 2021


Over 4 million deaths per year caused by obesity

Novel obesity treatments such as modulation of the gut microbiome and gene therapy are underutilized and could help fight the obesity epidemic, according to a new manuscript published in the Endocrine Society’s journal, Endocrine Reviews.

Nearly half of the adults and 20 percent of children in the United States have obesity, yet doctors are under prescribing effective weight loss medications and many patients are not receiving the treatment they need. The weight stigma that exists in healthcare settings makes people with obesity hesitant to seek care until comorbidities develop and reach a dangerous stage. Lack of insurance coverage and cost issues are another factor that creates barriers to obesity treatment.

“Obesity is the epidemic crisis of our time. The disease leads to serious comorbidities such as diabetes, fatty liver disease and cardiovascular disease and significantly shortens a person’s length and quality of life,” said Christos S. Mantzoros, M.D., Sc.D., of Beth Israel Deaconess Medical Center in Boston, Mass. “Until recently we did not understand the genetic and hormonal causes of obesity and how obesity leads to these comorbidities. We have recently started to understand the causes of obesity in humans, which is a big discovery that has led to designing effective therapies.”

In the article, the researchers map out the molecular and hormonal pathways that lead to obesity and the disease’s related comorbidities. This data gives researchers the insights they need to design, test and implement new obesity therapies.

The researchers highlight the need for safer and more effective obesity therapies, including new drug delivery systems, vaccines, modulation of the gut microbiome and gene therapy. Novel medications, including combinations of gastrointestinal hormones and other molecules, are being tested and are expected to lead to significant percentages of weight loss with less side effects once available. As our understanding of obesity improves, more effective medications with fewer side effects will be developed.

Recently approved medications such as semaglutide, a modified gastrointestinal hormone administered once a week, can lead to 15% weight loss when combined with lifestyle changes. Bariatric surgery can lead to up to 40% weight loss, but it is invasive and linked to complications.

"Insurance companies need to pay attention to data from studies and the scientific progress we are making and start covering the medications that are and will be approved soon, given that currently only a small minority of patients with obesity have coverage for the medications and medical care they need,” Mantzoros said. “It would be much more cost effective to cover treatments early instead of waiting for comorbidities and their complications to develop.”

Other authors of the study include: Angeliki Angelidi and Matthew Belanger of Harvard Medical School in Boston, Mass., and Alexander Kokkinos and Chrysi Koliaki of Laiko General Hospital in Athens, Greece.  

Released: October 2021


Burning and Tingling in Your Feet? You May Have Small Fiber Neuropathy

The number of people experiencing numbness, tingling and pain in their feet with no known cause has been increasing over the last two decades, according at a new study published in the October 27, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology. Called small fiber neuropathy, the condition has different symptoms than large fiber neuropathy, which can cause weakness and balance issues. But in many cases people have both types of neuropathy.

For the study, researchers looked at records for everyone diagnosed with small fiber neuropathy in Olmsted County, Minn., and the adjacent counties during a 20-year period. They then compared those 94 people with 282 people of similar age and sex who did not have neuropathy. Participants were followed for an average of six years.

The study found that the condition occurred in 13.3 per 100,000 people, with the rate increasing during the study.

“This increase could be due in part to greater awareness,” said study author Christopher J. Klein, MD, of the Mayo Clinic in Rochester, Minn., and a Fellow of the American Academy of Neurology. “Another possibility is that increasing levels of overweight and obesity in our area could be a factor in the higher rates of small fiber neuropathy. Higher body mass index, or BMI, is a risk factor for diabetes and high triglycerides, which may also lead to neuropathy.”

The people in the study with neuropathy had an average BMI of 30.4, compared to 28.5 for the people who did not have neuropathy. A BMI of 18.5 to 24.9 is considered healthy; 25.0 to 29.9 is considered overweight; and 30.0 and higher is considered obese.

About 50% of the people with neuropathy had diabetes, compared to 22% of those without neuropathy.

The people with neuropathy were also more likely to have insomnia, at 86% compared to 54% for those without neuropathy. They were also more likely to have heart attacks, at 46% compared to 27%.

“Based on these findings, people with small fiber neuropathy should be screened for heart problems and their blood glucose should be monitored for signs of diabetes,” Klein said.

The people with neuropathy were also more likely to take opioids for pain.

For 67 of the people with neuropathy, no cause could be determined, called idiopathic neuropathy. For 14 people, the neuropathy was caused by diabetes. Other causes included Sjögren syndrome and lupus.

A total of 36% of the people developed large fiber neuropathy during the study, an average of five years after they developed the small fiber version.

“The good news is that most people with idiopathic neuropathy do not develop major impairments or disability, but they did have many other conditions and an increased risk of heart attack, so the development of treatments and prevention methods is crucial,” Klein said.

The main limitation of the study was that researchers looked back in time at medical records. A study examining all people with symptoms of small fiber neuropathy and following them over time should be conducted to confirm these findings, Klein said.

The study was supported by the Mayo Clinic Foundation, Mayo Clinic Center or Individualized Medicine and Mayo Clinic Center of MS and Autoimmune Neurology.

Learn more about neuropathy at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on FacebookTwitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com.

Released: October 2021


Lactoferrin supplements could aid in the recovery of COVID19 & other Respiratory Tract Infections

THE antiviral properties of lactoferrin makes it a great natural supplement that could also be used as an adjunct for COVID-19 and for various other Respiratory Tract Infections (RTIs) according to a team of researchers led by the University of Huddersfield. 

Lactoferrin is a protein naturally found in breastmilk, for example in cow milk and human milk, and is also found in fluids in the eye, nose, respiratory tract, intestine, and elsewhere.  The benefits are well documented however, it wasn’t known if taking the molecule as a supplement would have the same beneficial value, until now. 

The findings of the study, headed by the University’s Dr Hamid Merchant from the University’s Department of Pharmacy is one of the first meta-analyses carried out on multiple independent lactoferrin clinical trials that is now published in an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). The study has made evident that the administration of Lactoferrin shows promising efficacy in reducing the risk of RTIs, which is proven to be a key ingredient for our natural defence systems against invading viruses. 

“This is a very promising molecule which can be adopted as an adjunct therapy for COVID-19 and could be part of a daily routine for people to take, along with vitamin C, D and Zinc supplements to keep our immune system healthy. Particularly now winter is almost upon us we need this extra protection a lot more now than during the summer.”

Dr Hamid Merchant, University of Huddersfield

Lactoferrin - a great supplement

It is this antiviral property of lactoferrin that makes it a great supplement for use as an adjunct for COVID-19 and other respiratory infections, but Dr Merchant believes these are still preliminary findings and warrants further evidence from a large, well-designed randomised controlled trial. 

“Given the high clinical importance of respiratory tract infections amid the COVID-19 pandemic, we aimed to systematically examine the interventional Randomised Clinical Trials on the ef?cacy of bovine lactoferrin in preventing the occurrence of RTIs,” said Dr Syed Hasan, another of the University’s researchers involved in the study. 

“The administration of Lactoferrin showed promising ef?cacy in reducing the risk of RTIs and may also have a beneficial role in managing symptoms and recovery of patients suffering from RTIs,” he said. 

“Current evidence also favours lactoferrin forti?cation of infant formula - it won't be long until parents should be able to find lactoferrin fortified infant formulas readily available on the shelves,” Dr Merchant added.

Supplements dissolved slowly in the mouth tend to be superior

Lactoferrin is prepared by specialised dairy companies who make milk, infant formulas or milk-based products who isolate this biomolecule from the milk and various other companies then procure it to sell as a supplement.

However, Dr Merchant argues that lots of low cost lactoferrin supplements being sold online are not of desired quality because with it being a biomolecule that is classed as a nutritional supplement, the production of lactoferrin isn’t legally enforced to follow the same strict regulatory process as for medicines. 

The natural form of lactoferrin isolated from the milk by a specialised filtration process have superior biological properties than the most lactoferrin products that are chemically processed and treated. Moreover, supplements available in the form of orodispersible tablets (dissolved slowly in the mouth) are superior to commonly available lactoferrin products that are meant to be swallowed with water. The buccal tablets not only increase the mucosal concentration of Lactoferrin but also helps with its absorption and avoids its deterioration by the stomach acid. 

“This is a very promising molecule which can be adopted as an adjunct therapy for COVID-19 and could be part of a daily routine for people to take, along with vitamin C, D and Zinc supplements to keep our immune system healthy. Particularly now winter is almost upon us we need this extra protection a lot more now than during the summer,” concluded Dr Merchant. 

Members of the team who also helped with the study included international researchers Akbar Shoukat Ali from The Aga Khan University Karachi and Chia Siang Kow from The Monash University Malaysia.

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