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Photo from Deposit Photos

With the Food and Drug Administration expected to vote this week on boosters for Johnson & Johnson and Moderna vaccines for COVID-19, local doctors suggested the current studies may support some switching, particularly for those who received a single dose of Johnson & Johnson.

“There is preliminary data that has demonstrated that mixing and matching the vaccines may be beneficial,” said Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital.

Indeed, recent studies suggested that people who received the J&J vaccine had a considerably higher increase in their antibody response from a Moderna booster than from a second J&J shot.

“There may be some merit” to switching from the traditional method J&J deployed to create an antibody response to the mRNA-based approach from Pfizer-BioNTech and Moderna, Dhuper added.

Dr. Adrian Popp, chair of Infection Control at Huntington Hospital, added that data from studies with J&J are “showing that folks who received the initial J&J vaccine may benefit from receiving a booster with Pfizer or Moderna as this may lead to a very high immune response.”

As for side effects from the boosters, Popp explained that the reactions are similar to those for the initial series of vaccinations.

In an email, Popp noted that the Moderna booster is half the dose of the original shots, which “may lead to a decrease in side effects.”

Dr. Susan Donelan, medical director of the Healthcare Epidemiology Department at Stony Brook Medicine and assistant professor of Infectious Diseases in the Renaissance School of Medicine at Stony Brook University, is pleased that “many people are quite eager to obtain boosters. This bodes well for enhanced protection as we enter the indoor/ holiday season.”

In another encouraging sign, the percentage of people who have tested positive for COVID-19 in Suffolk County continues to decline, with the seven-day average falling to 3% as of Oct. 19, which is down from 4.2% a month earlier, according to the Suffolk County Department of Health.

Sporting events

Meanwhile, people have been attending college and professional sporting events in large numbers, often without masks. These competitions haven’t yet produced documented superspreader events.

“Outdoor venues overall provide a reduced opportunity for spread compared to indoor events,” Donelan explained in an email. “If proof of vaccination or a negative test within a set time frame (e.g. 72 hours) before the event is required for entry, it is reasonable to anticipate that inadvertent spread can be limited.”

Other health care professionals also suggested that outdoor events, despite thousands of people standing and shouting to urge on their teams, presented lower risk than indoor gatherings.

“In an outdoor event, the virus would get diluted within seconds,” said Dhuper. “You’re not going to get a high dose” of any viral particles at such a gathering.

As for the bigger picture, Popp said he is “happy to report that, as of Oct. 6, the fully vaccinated rate is 69% in Nassau and 65% in Suffolk. It is not as high as we would like to see, but it is an increase of 7% to 8% since July 29.”

Health care professionals urged residents who haven’t already done so to get a flu shot soon.

“With all the attention on COVID vaccinations, masks will come off as people are reassured that they are safer in regards to COVID, and flu will ‘take advantage’ of this scenario,” Donelan explained. “We need to be vaccinated against both viruses.”

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Steve Bellone at a recent press conference. Photo by Rita J. Egan

Suffolk County Executive Steve Bellone (D) announced on Oct. 20 that he tested positive for COVID-19.

“Today I tested positive for COVID-19 and will be following the recommended CDC protocols for fully vaccinated individuals,” he said. “I am experiencing mild symptoms at this point but otherwise feel in good health and spirits.”

The county executive had a reminder for residents.

“I hope this serves as a reminder to all residents that while we are making incredible progress in the war against COVID-19, we are not done just yet,” he said. “To that end, I encourage anyone who is eligible to receive their booster shot to do so.”

For more information on vaccination, you can go to suffolkcountyny.gov/vaccine.

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METRO photo

Much like Christmas, Halloween is no longer relegated to a single day. A number of Halloween enthusiasts now begin decorating at the start of October. Hijinks and autumn revelry fill the air as individuals eagerly count down to the end of the month. Though the lightheartedness of Halloween festivities, such as costumes and candy, garner the bulk of celebrants’ attention, it’s important to take safety into consideration as well.

According to the Mayo Clinic, children are twice as likely to be hit by a car on Halloween as other nights of the year. Cuts and burns also are more common on October 31. A good Halloween scare should come from costumes, not accidents or injuries. This Halloween, consider these safety measures, courtesy of Safe Kids Worldwide, the Mayo Clinic, the National Highway Traffic Safety Administration, and the Centers for Disease Control and Prevention.

• Make sure you’re visible when trick-or-treating. Reflective tape, glow sticks, flashlights, or camping lanterns can make pedestrians more visible to motorists.

• Pedestrians should walk on sidewalks if they are available. When sidewalks are not available, walk facing traffic and do so as far off to the side of the road as you can get.

• Drivers should be especially alert to pedestrians on Halloween. Drive slowly, as many kids scurry from house to house in search of Halloween candy.

• Pedestrians and drivers should follow the rules of the road, stopping at intersections and crossing in crosswalks.

• Consider alternatives to carving pumpkins, since the risk of being cut while carving is high. If you want to carve, leave the carving to adults. Utilize battery-operated flameless candles or glow sticks to illuminate jack-o’-lanterns.

• All costumes, wigs and accessories should be fire-resistant. Make sure that costumes do not impede your ability to walk or see.

• Test makeup to check for skin irritation before application. Remove it promptly after returning home.

• Set up a buddy system so that no one is going it alone. Agree on a specific time children should return home. Adults should chaperone young children.

• While incidences of candy tampering may be minimal, no one should snack on candy until it has been inspected. Inspections also protect against food allergies.

• The candy bounty should be rationed so no one overindulges and feels ill later on. Halloween season is a fun time of year, but safety should go hand in hand with all the celebrating on this special day.

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Stony Brook Trauma Center, Suffolk County’s only Level I Trauma Center, earns Safe States Alliance's Injury and Violence Prevention Program Achievement Award for 2020.

The Safe States Alliance awarded the Stony Brook Trauma Center, Suffolk County’s only Level I Trauma Center, an Injury and Violence Prevention Program Achievement Award for 2020. The award recognizes Stony Brook’s ability to pivot and make many of its injury prevention programs available to the community despite the impact of the COVID-19 pandemic. 

James A,. Vosswinkel, MD, Assistant Professor of Surgery, Chief, Trauma, Emergency Surgery, and Surgical Critical Care, Medical Director, Surgical Intensive Care Unit (SICU), Medical Director, Trauma Center

“This award is a thank you to the team here that works tirelessly to reach the community and provide the care they need no matter the circumstances,” says James A. Vosswinkel, MD, FACS, Trauma Medical Director and Chief of the Division of Trauma, Emergency Surgery, and Surgical Critical Care in the Department of Surgery at Stony Brook Medicine. “This is a reminder that every idea can make an impact. These programs can and will save lives.”

The Stony Brook Trauma Center offers free in-person injury prevention programs to the public, educating local communities on best practices in safety to prevent a trip to the emergency room and help save lives. In March 2020, that came to a halt when in-person injury prevention programs were cancelled due to the pandemic. Kristi Ladowski, MPH, Injury Prevention and Outreach Coordinator at Stony Brook Medicine, together with volunteers, staff, and community partners, quickly pivoted and made sure their programs could still be accessible to the community by moving to virtual programming. 

“The strength of our partnerships, everyone’s willingness to quickly adapt, and our passion for injury prevention ensured that this transition was accomplished quickly and seamlessly,” says Ladowski. “We developed win-win partnerships that harmonize organizational goals, student experiential learning, and most importantly served our community needs.”  

Stony Brook’s highly effective “Tai Chi for Arthritis,” a Fall Prevention workshop, immediately began a virtual schedule that allowed the team to hold more than 40 eight-week workshops, reaching over 1,000 participants. The availability of easily accessible recorded segments helped participants practice longer, more often and helped reduce attrition. Other programs such as “A Matter of Balance and Stepping On” also moved to virtual programming with great success. 

School-based programs were also pivoted to virtual platforms. Programs such as Impact Teen Driver and the extremely popular Teddy Bear Clinic both promote road safety. In an effort to reach even more schools and students, the Stony Brook Injury Prevention team created a Teddy Bear Clinic video utilizing a “Blues Clues” approach to appeal to children and get more classroom participation than ever before possible. The video will reach thousands of students and potentially hundreds of classrooms every year helping keep the community safe, informed and become a great tool for parents and teachers in preventing major trauma injuries in children. 

To make sure clinical students at Stony Brook could still fulfill their learning requirements, the Trauma Center expanded their undergraduate and graduate experiential learning opportunities by offering student participation in virtual programs. Occupational therapy students created multiple one-hour fall prevention workshops that helped fill a need for more accessible, shorter, informational workshops. These workshops were so well received that they are being continued indefinitely along with multiple practicum opportunities for master’s in public health students.  

To learn more about the Injury Prevention Programs offered through the Stony Brook Trauma Center, visit https://trauma.stonybrookmedicine.edu/injury–prevention.

About Stony Brook University Hospital:

Stony Brook University Hospital (SBUH) is Long Island’s premier academic medical center. With 624 beds, SBUH serves as the region’s only tertiary care center and Regional Trauma Center, and is home to the Stony Brook University Heart Institute, Stony Brook University Cancer Center, Stony Brook Children’s Hospital and Stony Brook University Neurosciences Institute. SBUH also encompasses Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center. To learn more, visit www.stonybrookmedicine.edu/sbuh.

About Stony Brook University Trauma Center:

As Suffolk County’s only Level I Trauma Center, Stony Brook provides the highest possible level of adult and pediatric trauma care. We are state designated as the only Regional Trauma Center in Suffolk County, treating 1,800 trauma patients annually, including 200 children. For children, we provide a dedicated 24/7 Pediatric Emergency Department adjacent to the main Emergency Department, staffed by board-certified Pediatric Emergency Medicine physicians. The eight-bed Suffolk County Volunteer Firefighters Burn Center is Suffolk County’s only state-designated regional Burn Center. To learn more, visit www.trauma.stonybrookmedicine.edu.

About Safe States Alliance:

A national non-profit organization formed in 1993, comprised of public health and injury and violence prevention professionals. Their mission, to strengthen the practice of injury and violence prevention. To learn more visit, https://www.safestates.org/page/InnovativeInitiative.

Photos from Stony Brook Medicine

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METRO photo

With the holiday season just around the corner, the Centers for Disease Control and Prevention urged Americans on Friday to celebrate upcoming holidays by taking basic safety measures against the Covid-19 pandemic that still plagues the nation.

“Holiday traditions are important for families and children. There are several ways to enjoy holiday traditions and protect your health. Because many generations tend to gather to celebrate holidays, the best way to minimize COVID-19 risk and keep your family and friends safer is to get vaccinated if you’re eligible,” the CDC said in a press release.

The CDC recommended the following safer ways to celebrate the holidays:

Generally:

  • Protect those not yet eligible for vaccination such as young children by getting yourself and other eligible people around them vaccinated.
  • Wear well-fitting masks over your nose and mouth if you are in public indoor settings if you are not fully vaccinated.
    • Even those who are fully vaccinated should wear a mask in public indoor settings in communities with substantial to high transmission.
      • Outdoors is safer than indoors.
    • Avoid crowded, poorly ventilated spaces.
    • If you are sick or have symptoms, don’t host or attend a gathering.
    • Get tested if you have symptoms of COVID-19 or have a close contact with someone who has COVID-19.

If you are considering traveling for a holiday or event, visit CDC’s Travel page to help you decide what is best for you and your family. CDC still recommends delaying travel until you are fully vaccinated.

Special considerations:

  • People who have a condition or are taking medications that weaken their immune system may not be fully protected even if they are fully vaccinated and have received an additional dose. They should continue to take all precautions recommended for unvaccinated people, including wearing a well-fitted mask, until advised otherwise by their healthcare provider.
  • You might choose to wear a mask regardless of the level of transmission if a member of your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated.
  • If you are gathering with a group of people from multiple households and potentially from different parts of the country, you could consider additional precautions (e.g., avoiding crowded indoor spaces before travel, taking a test) in advance of gathering to further reduce risk.
  • Do NOT put a mask on children younger than 2 years old.

“By working together, we can enjoy safer holidays, travel, and protect our own health as well as the health of our family and friends,” said the release.

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It's best to not eat right before bedtime and to avoid 'midnight snacks.' METRO photo
Salt use increases risk 70 percent

By David Dunaief, M.D.

Dr. David Dunaief

While occasional heartburn and regurgitation are common after a large meal, for some, this reflux results in more serious disease. Let’s look at the differences and treatments.

Reflux typically results in symptoms of heartburn and regurgitation, with stomach contents going backward up the esophagus. For some reason, the lower esophageal sphincter, the valve between the stomach and esophagus, inappropriately relaxes. No one is quite sure why it happens with some people and not others. Of course, a portion of reflux is physiologic (normal functioning), especially after a meal (1). As such, it typically doesn’t require medical treatment.

Gastroesophageal reflux disease (GERD), on the other hand, differs in that it’s long-lasting and more serious, affecting as much as 28 percent of the U.S. population (2). This is one reason pharmaceutical firms give it so much attention, lining our drug store shelves with over-the-counter and prescription solutions.

GERD risk factors are diverse. They range from lifestyle — obesity, smoking cigarettes and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, like hiatal hernia and pregnancy, also contribute (3). Dietary triggers include spicy, salty, or fried foods, peppermint, and chocolate.

Smoking and salt increase risk

One study showed that both smoking and salt consumption added to the risk of GERD significantly (4). Risk increased 70 percent in people who smoked. Surprisingly, people who used table salt regularly saw the same increased risk as seen with smokers.

Medication options

The most common and effective medications for the treatment of GERD are H2 receptor blockers (e.g., Zantac and Tagamet), which partially block acid production, and proton pump inhibitors (e.g., Nexium and Prevacid), which almost completely block acid production (5). Both classes of medicines have two levels: over-the-counter and prescription strength. Here, I will focus on proton pump inhibitors (PPIs), for which more than 90 million prescriptions are written every year in the U.S. (6).

The most frequently prescribed PPIs include Prilosec (omeprazole) and Protonix (pantoprazole). They have demonstrated efficacy for short-term use in the treatment of Helicobacter pylori-induced (bacteria overgrowth in the gut) peptic ulcers, GERD symptoms and complication prevention and gastric ulcer prophylaxis associated with NSAID use (aspirin, ibuprofen, etc.) as well as upper gastrointestinal bleeds.

However, they are often used long-term as maintenance therapy for GERD. PPIs used to be considered to have mild side effects. Unfortunately, evidence is showing that this may not be true. Most of the data in the package inserts is based on short-term studies lasting weeks, not years. The landmark study supporting long-term use approval was only one year, not 10 years. However, maintenance therapy usually continues over many years.

Side effects that have occurred after years of use are increased risk of bone fractures and calcium malabsorption; Clostridium difficile, a bacterial infection in the intestines; potential vitamin B12 deficiencies; and weight gain (7).

PPI risks

The FDA warned that patients who use PPIs may be at increased risk of a bacterial infection called C. difficile. This is a serious infection that occurs in the intestines and requires treatment with antibiotics. Unfortunately, it only responds to a few antibiotics and that number is dwindling. In the FDA’s meta-analysis, 23 of 28 studies showed increased risk of infection. Patients need to contact their physicians if they develop diarrhea when taking PPIs and the diarrhea doesn’t improve (8).

Suppressing hydrochloric acid produced in the stomach over long periods of time may result in malabsorption issues. In a study where PPIs were associated with B12 malabsorption, it usually took at least three years’ duration to cause this effect. B12 was not absorbed properly from food, but the PPIs did not affect B12 levels from supplementation (9). Therefore, if you are taking a PPI chronically, it is worth getting your B12 and methylmalonic acid (a metabolite of B12) levels checked and discussing supplementation with your physician for a deficiency.

Fiber and exercise

A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few (10). In the same study already mentioned with smoking and salt, fiber and exercise both had the opposite effect, reducing the risk of GERD (5). The analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (11).

Obesity’s impact

In one study, obesity exacerbated GERD. What was interesting about the study is that researchers used manometry, which measures pressure, to show that obesity increases the pressure on the lower esophageal sphincter significantly (12). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with normal body mass index. This is yet another reason to lose weight.

Late night eating triggers 

Though it may be simple, it is one of the most powerful modifications we can make to avoid GERD. A study that showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more prior to bedtime. Of note, this is 10 times the increased risk of the smoking effect (13). Therefore, it is best to not eat right before bedtime and to avoid “midnight snacks.”

Although there are a number of ways to treat GERD, the most comprehensive have to do with modifiable risk factors. Drugs have their place in the arsenal of choices, but lifestyle changes are the first — and most effective — approach in many instances. Consult your physician before stopping PPIs, since there may be rebound hyperacidity (high acid produced) if they are stopped abruptly.

References:

(1) Gastroenterol Clin North Am. 1996;25(1):75. (2) Gut. 2014 Jun; 63(6):871-80. (3) emedicinehealth.com. (4) Gut 2004 Dec.; 53:1730-1735. (5) Gastroenterology. 2008;135(4):1392. (6) Kane SP. Proton Pump Inhibitor, ClinCalc DrugStats Database, Version 2021.10. Updated September 15, 2021. Accessed October 12, 2021. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) www.FDA.gov/safety/medwatch/safetyinformation. (9) Linus Pauling Institute; lpi.oregonstate.edu. (10) Arch Intern Med. 2006;166:965-971. (11) JWatch Gastro. Feb. 16, 2005. (12) Gastroenterology 2006 Mar.; 130:639-649. (13) Am J Gastroenterol. 2005 Dec.;100(12):2633-2636.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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David Thanassi. Photo by Jeanne Neville
*Please note: This article was updated on Oct. 15 to include a reference to former President Bill Clinton (D) in the fifth paragraph.

By Daniel Dunaief

David Thanassi wants to give dangerous bacteria in the kidney a haircut.

No, not exactly, but Thanassi, Zhang Family Professor and Chair of the Department of Microbiology and Immunology at the Renaissance School of Medicine at Stony Brook University, has studied how hair-like structures called P pili in the bacteria Escherichia coli are assembled on the bacterial surface. 

These pili allow bacteria to hang on to the walls of the kidney, where urine would otherwise flush them out.

Learning about pili at different stages of development could provide a way to keep them from attaching themselves to the kidney and from entering the bloodstream, which could lead to the potentially lethal problem of bacterial sepsis. Indeed, this week, former President Bill Clinton (D) checked into the intensive care unit at the University of California Irvine Medical Center after a urinary tract infection spread to his bloodstream.

“We have been looking at this as a really important aspect of initiating infection from a bacteria’s point of view,” Thanassi said. “How do they build these structures” that lead to infection and illness?

Recently, Thanassi published the structure of these pili in the journal Nature Communication.

The current work builds on previous efforts from Thanassi to determine the structure of these pili in the bladder. He has been exploring how the thousands of proteins that make up the pili get transported and assembled in the correct order. “If we can understand that aspect, we can disrupt their assembly or function,” he said.

Urinary tract infections are a major infectious disease, particularly for women. Indeed, about half of all women will have at least one urinary tract infection, which can be uncomfortable and can require some form of medication. 

In some cases, the infections can be recurrent, leading to frequent infections and the repeated need for antibiotics.

The bacteria that cause these infections can become resistant to antibiotics, increasing the importance of finding alternative approaches to these infections, such as interfering with pili.

To be sure, the solution to reducing the bacteria’s ability to colonize the kidney or urinary tract would likely require other steps, as these invaders have additional ways beyond the pili to colonize these organs. Nonetheless, disrupting the way they adhere to the kidney could be a constructive advance that could lead to improved infection prevention and treatment.

One likely strategy could involve using an anti-pilus treatment in combination with other antibiotics, Thanassi explained.

For people who have recurrent infections, anti-pilus therapeutics could offer a solution without resorting to long-term antibiotics.

In his lab, Thanassi is interested in small molecules or chemicals that would disrupt the early stage in pili assembly. “We think of these as protein-protein interactions that are required to build these” pili, he said.

By using a fluorescence reporter, Thanassi and his colleagues can screen libraries of chemicals to determine what might inhibit the process.

As with many biological systems, numerous compounds may seem appropriate for the job, but might not work, as medicine often requires a specific molecule that functions within the context of the dynamic of a living system.

For the helpful bacteria in the gut, pili are not as important as they are for the harmful ones in the kidney, which could mean that an approach that blocked the formation of these structures may not have the same intestinal and stomach side effects as some antibiotics.

To determine the way these pili develop structurally, Thanassi and his lab used molecular and biochemical techniques to stop the assembly of pili at specific stages.

Bacteria assemble these pili during the course of about 30 minutes. An usher proteins serves as the pilus assembly site and pilus secretion channel in the bacterial outer membrane. The usher acts as a nanomachine, putting the pilus proteins into their proper order. A chaperone protein brings the pilus subunits to the usher protein.

In their development, the pili require a protein channel, which is an assembly site.

Thanassi started by working on the usher protein in isolation. The usher proteins function to assemble the thousands of pilus subunits that make up each pilus fiber. The process also involves chaperone proteins, which bind to nascent subunit proteins and help the subunits fold. The chaperone then delivers the subunit proteins to the usher for assembly into the pilus fiber. He used molecular and biochemical methods to express and purify the usher protein.

The assembly process involves interactions between chaperone-subunit complexes and the usher. Over the years, Thanassi has determined how the different proteins work together to build and secrete a pilus.

He was able to force the bacteria to express only one version of the assembly step and then isolate that developmental process.

The majority of the pilus is like a spring or a coil, which can stretch and become longer and straighter to act as a shock absorber, allowing the bacteria to grab on to the kidney cells rather than breaking.

Other researchers are studying how they might make the pili more brittle, preventing that spring-like action from working and compromising its ability to function.

“We’re trying to prevent the pili from assembling in the first place,” Thanassi explained. “Our approach is to try and get molecules that prevent the interaction from occurring.” He is looking at the specific function of one molecule that prevents the usher assembly platform from developing properly, which would wipe out the assembly site.

Thanassi credits former Stony Brook Professor Huilin Li, who is now Chair in the Department of Structural Biology at the Van Andel Institute in Grand Rapids, Michigan, with providing structural insights from his work with the cryo-electron microscoipe. The technology has “revolutionized the work we do,” said Thanassi.

Residents of Smithtown, Thanassi and his wife Kate Kaming, who is Senior Director of Cancer Development at Northwell Health Foundation, have two children. Joseph, 22, attends Northeastern University. Miles, 20, is studying at the Massachusetts Institute of Technology.

Thanassi grew up in South Burlington, Vermont and is an avid skier. He also enjoys mountain biking, walking and music.

Thanassi hopes this latest structural work may one day offer help either with the prevention of infections or with their treatment.

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Photo from Deposit Photos

Amid a steady drumbeat of worry and anxiety, the last week produced several potential encouraging signs in the battle against COVID-19.

Pfizer recently applied for emergency use authorization for a vaccine for children who are five to 11 years old, a group that has returned to school but that hasn’t yet had access to any vaccines.

Pfizer will get early approval as “long as the [Food and Drug Administration] has enough data,” said Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital. “They’re going to get early approval.”

A vaccine would be a welcome defense for children who now constitute anywhere between 25% and 35% of infections, Dhuper said.

Vaccinations for those over the age of 12 have helped drive down an infection rate that had climbed toward the end of the summer.

In recent weeks, the percentage of positive cases in Suffolk County has continued to decline, with the seven-day average falling to 3.2% as of Oct. 10, according to data from the Suffolk County Department of Health.

While health officials and pharmacies continue to administer booster doses of the Pfizer BioNTech vaccine, Johnson & Johnson has applied for Emergency Use Authorization for a booster dose that enhances the immune response to the virus.

As of now, people who received J&J’s original vaccine are not eligible for the Pfizer BioNTech booster, according to Dr. Sritha Rajupet, director of Population Based Health Initiatives and director of the Post-COVID Health Clinic at Stony Brook Medicine,

Meanwhile, Merck recently produced a drug in pill form called Molnupiravir that reduced hospitalizations and death by 50% when taken within the first five to eight days of developing COVID symptoms.

The drug didn’t completely prevent hospitalizations or death but greatly reduced it, generating excitement in the health care community. Merck applied earlier this week for emergency use authorization for Molnupiravir.

“It’s a great study,” Dhuper said. “We are very delighted that there is going to be another alternative” treatment for patients.

Up to this point, hospitals, urgent care centers and doctors have not had access to an outpatient drug.

When given at the onset of symptoms, Molnupiravir acts like the flu drug Tamiflu, helping to reduce the symptoms and health challenges associated with COVID-19.

This medicine could help reduce hospitalizations, providing relief to patients and enabling hospitals to manage their resources better, Dhuper said.

Doctors remained cautiously optimistic about the ongoing battle against COVID-19. Dhuper added that the real challenge for the community would come within the next three to four weeks, during which time hospitals and count officials will watch carefully for any increase in infections in between when children return to schools and the FDA approves any vaccine for this age group.

Long haul issues

While health officials were pleased with the potential availability of additional medical tools to prevent or treat COVID-19, they said numerous residents continue to battle long haul COVID.

Described as persistent symptoms that can develop four to eight weeks after the initial symptoms, long haul COVID can include fatigue, brain fog, shortness of breath, palpitations and a wide range of other neurological discomforts.

Doctors said 10 to 35% of people who contract COVID can develop these longer-term symptoms.

Long haul COVID-19 remains a “big concern,” Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services, wrote in an email. “We remind people who remain unvaccinated that people of all ages have suffered from long-range symptoms” from the virus. “We don’t know yet if these symptoms will be limited or if they may develop into chronic life-long conditions. We will be looking at the literature to learn more.”

Dhuper said some of those with long-haul symptoms feel as if they are “continuously living with an illness, almost like a flu.”

Such extended discomfort has an extended impact on the quality of life.

Treatment of these long-haul symptoms “is tailored to the patient’s specific symptoms,” Stony Brook’s Rajupet described in an email. “Identifying the organ systems involved and the symptoms or autoimmune conditions that have manifested are essential to developing a treatment plan.”

Rajupet suggested that leading a healthy lifestyle, with balanced sleep, nutrition and exercise can help in recovery. Stony Brook encourages this approach not only in the management of long-haul symptoms, but also for a patient’s overall health.

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Photo from SBUH
Stony Brook Medicine experts discuss diagnosis, treatment, support and more during livestream event

WHAT:

Tic disorders are common, affecting about 15 percent of the overall population. Tourette’s Disorder, a subtype of tic disorder, is estimated to affect 1 out of every 162 children (0.6%). The nervous system disorder involves repetitive movements or unwanted sounds, such as repeatedly blinking one’s eyes or unintentionally uttering words that might be inappropriate. The first symptoms usually occur between the ages of 5 and 10 years, generally in the head and neck area and may progress to include muscles of the trunk, arms and legs. Motor tics generally occur before the development of vocal tics and simple tics often precede complex tics.

​​The Stony Brook Center for Tics and Tourette’s Disorder provides a comprehensive evaluation to devise a developmentally appropriate treatment plan to address tics. Treatment varies from person to person but may include:

  • Oral Medication
  • Botulinum toxin injections
  • CBIT (Comprehensive Behavioral Intervention for Tics) — a structured therapy specific for tics
  • DBS (Deep Brain Stimulation) — a surgical option for severe cases that don’t respond to other treatments

Experts from Stony Brook Medicine’s Center for Tics and Tourette’s Disorder will discuss treatments, diagnosis, support and more during a livestream event on Thursday, October 14, 2021 at 2pm EST. Viewers can submit questions via the comment section and have them answered by the experts.

To learn more about the Stony Brook Center for Tics and Tourette’s Disorder, visit:

https://neuro.stonybrookmedicine.edu/centers/movement/tics_tourette_center

WHEN:

Thursday, October 14, 2021 at 2PM EST

The livestream event can be seen on:

Facebook at https://www.facebook.com/stonybrookmedicine/posts/4361066807282521

Or

Youtube at https://www.youtube.com/watch?v=hsCjIRPv8g0

MODERATOR:

  • Wilfred Farquharson, IV, PhD, Licensed Psychologist, Director of Child and Adolescent Psychiatry Outpatient Services, Stony Brook Medicine

PANELISTS:

  • Carine Maurer, MD, PhD, Movement Disorders Neurologist, Director of Stony Brook Tics and Tourette’s Disorder Center
  • Jenna Palladino, PsyD, Comprehensive Behavioral Intervention for Tics (CBIT)-certified, Clinical Psychologist, Co-Director of Stony Brook Tics and Tourette’s Disorder Center

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October is Breast Cancer Awareness Month. METRO photo

Understand your risk profile and design a screening plan with your physician

By David Dunaief, M.D.

Dr. David Dunaief

Get out your pink attire, because October is Breast Cancer Awareness Month.

The most common cancer diagnosed in U.S. women, an estimated 30 percent of 2021 cancer diagnoses in women will be breast cancer (1). Of these, 85 percent of cases occur in those with no family history of the disease, and 85 percent of new cases will be invasive breast cancer.

A primary objective of raising awareness is to promote screening for early detection. While screening is crucial, prevention should be just as important, including primary prevention, preventing the disease from occurring, and secondary prevention, preventing recurrence.

Here, we will discuss current screening recommendations, along with tools to lower your risk.

At what age and how often should we be screened?

Here is where divergence occurs; experts don’t agree on age and frequency. The U.S. Preventive Services Task Force currently recommends mammograms every other year, from age 50 through age 74, with the option of beginning as early as age 40 for those with significant risk (2). It’s important to note that these guidelines, published in 2016, are currently being refined and are pending publication.

The American College of Obstetricians and Gynecologists recommends consideration of beginning annual or biennial mammograms at 40, but starting no later than 50, and continuing until age 75. They encourage a process of shared decision-making between patient and physician to determine age and frequency of exams, including whether to continue after age 75 (3).

The American Cancer Society’s physician guidelines are to offer a mammogram beginning at age 40 and recommend annual or biennial exams from 45 to 54, with biennial exams after 55 until life expectancy is less than 10 years (4).

While the recommendations may seem nuanced, it’s important to consult with your physician to determine your risk profile and plan or revise your regular screening schedule accordingly.

Do bisphosphonates help?

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) and are used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials (RCTs), FIT and HORIZON-PFT, results showed no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The study population involved 14,000 postmenopausal women from ages 55 to 89 women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

In a more recent meta-analysis of 10 studies with over 950,000 total participants, results showed that bisphosphonates did indeed reduce the risk of primary breast cancer in patients by as much as 12 percent (6). However, when the researchers dug more deeply into the studies, they found inconsistencies in the results between observational and case-control trials versus RCTs, along with an indication that longer-term use of bisphosphonates is more likely to be protective than use of less than one year.

Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

A Lancet metanalysis focused on breast cancer recurrence in distant locations, including bone, and survival outcomes did find benefits for postmenopausal women (7). A good synopsis of the research can be found at cancer.org.

How much exercise?

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (8). These women exercised moderately; they walked four hours a week over a four-year period. If they exercised previously, five to nine years ago, but not recently, no benefit was seen. The researchers stressed that it is never too late to begin exercise.

Only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise for prevention as we do screenings.

What about soy?

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis, those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (9). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk when compared to those who consumed the least. In addition, higher soy intake has been associated with reduced recurrence and increased survival for those previously diagnosed with breast cancer (10). The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References:

(1) breastcancer.org. (2) uspreventiveservicestaskforce.org. (3) acog.org. (4) cancer.org. (5) JAMA Intern Med. 2014;174(10):1550-1557. (6) Clin Epidemiol. 2019; 11: 593–603. (7) Lancet. 2015 Jul 23. (8) Cancer Epidemiol Biomarkers Prev. 2014 Sep;23(9):1893-902. (9) Br J Cancer. 2008; 98:9-14. (10) JAMA. 2009 Dec 9; 302(22): 2437–2443.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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