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Influenza’s presence in Sault, Algoma will prompt hike in ER visits: Sault Area Hospital

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Sault Area Hospital continues to see a “steady” number of children with respiratory infections, and “fortunately” the region’s principal health-care facility has not exceeded its bed or staffing numbers – yet, says the facility’s chief of pediatric and neonatal services.

But after having circulated in southern Ontario for weeks, influenza is now in Algoma District, said Dr. Jonathan DellaVedova.

“So, we predict the number of emergency room visits and hospital admissions will increase,” he told the Sault Star Thursday.

Algoma Public Health reported Nov. 3 the first two confirmed cases of influenza A this respiratory season in the Sault Ste. Marie area.

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“Our experience so far suggests that patients are staying in the hospital longer to recover from respiratory infections, especially when they have multiple viruses at the same time,” DellaVedova said.

Ontario children’s hospitals are especially reporting longer-than-usual wait times as providers see rising rates of respiratory illness amid dropped public health measures and ongoing worker shortages, and experts say the situation could worsen as cold and flu season ramps up.

Sault Area Hospital said recently it had not exceeded its capacity to care for children, but warned that could easily change.

Currently, SAH still has open beds to care for infants, children and adolescents, whether for respiratory infections or other reasons.

“To my knowledge, there are no children in our ICU, which is designed for adults,” said DellaVedova, but added the province has directed the hospital to keep critical adolescents, aged 14-17, there rather than transferring them to a children’s hospital.

“Given that all pediatric ICU beds in the province are currently full, it is not clear what would happen day-to-day if we had a critically ill child under 14 years who needed an ICU bed,” DellaVedova said.

The situation in southern Ontario is much more severe.

For example, a perfect storm of illness – COVID-19, the flu and a respiratory syncytial virus (RSV) to which children are especially vulnerable – has put more strain on London, Ont.’s already-burdened hospitals and is only likely to get worse, officials warn.

“We anticipate significant ongoing pressures in the coming weeks and support the government’s recommendation for individuals to mask in public places, as we know masking is one of the most effective tools for preventing disease transmission,” London Health Sciences Centre said in a statement on Wednesday.

LHSC said occupancy at Children’s Hospital is at 115 per cent, the highest it’s ever been. Non-urgent patients in the Children’s Hospital emergency room can expect average wait times of six to eight hours, mainly due to the large volume of patients coming in with RSV and influenza symptoms.

A shortage of children’s pain relievers, including Tylenol and Advil, in Canada has parents looking elsewhere.

DellaVedova said he is aware of “some” Sault Ste. Marie parents travelling to nearby Michigan to acquire children’s acetaminophen and ibuprofen.

“In that respect, we have a slight advantage over other communities in the province,” he added. “Keep in mind Sault Ste. Marie, Mich., is also a small community, and this option is only available to families with the means.”

Drug shortages in Canada started as early as last spring, but the supply crunch has been exacerbated in recent months by soaring demand amid the spread of influenza, RSV and COVID-19. Lingering pandemic supply chain snags have also contributed to the problem. Panic buying as news of the lack of availability for the medicines spread compounded the issue

After nearly two months of discussions between governments and manufacturers, Health Canada arranged to import doses from the United States and Australia. The first U.S. shipment is already on the ground.

DellaVedova said he is unable to comment on SAH’s overall supply of children’s fever medications.

“But they have always been available when I have called for them,” he added.

The increase in the number of children ending up at hospitals’ emergency rooms prompted Ontario’s chief medical officer of health, Kieran Moore, on Monday, to ask Ontarians to wear masks in all indoor settings to help overwhelmed children’s hospitals and reduce the spread of respiratory illnesses.

If the situation gets worse, Moore said he would consider mandating masks, especially in day-care centres. Most of the sick children in hospital are aged four and under. Moore urged Ontario residents to help protect children by wearing a mask, getting flu and COVID-19 vaccinations, staying home when sick and washing their hands.

DellaVedova said masks “work,” but most people will not wear them in “sufficient numbers” unless a mandate is in place.

“Doctors and nurses are very empathetic to pandemic fatigue … we share it, too,” he added. “However, we also spend our days face-to-face with children who are struggling to breathe. By comparison, masking seems like a minor inconvenience.”

Masking for a short period of time could help flatten the curve of not just COVID but influenza and RSV, DellaVedova said.

“This could prevent a dangerous accumulation of cases in a short time span,” he added. “It is already too late for southern Ontario, but not too late for us.

“Keep in mind there is another other tool to prevent each of COVID-19 and influenza, which is a safe, effective, free and publicly-available vaccine.”

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Deadly fungal infections a concern in patients post-COVID-19, flu | CTV News – CTV News Calgary

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While fungi are not about to start turning the human race into zombies, like in the HBO blockbuster series The Last of Us, the World Health Organization (WHO) says invasive fungal infections are an increasing threat to human health.

Aspergillosis is one fungal infection common in our environment but, in some circumstances, it can turn deadly. In an average day, most of us will inhale hundreds to thousands of Aspergillus spores with no adverse effects, but for people with weakened immune systems it can cause deadly infections. That includes people undergoing cancer treatments, or bone marrow transplants, but it is now recognized that some viral infections, like influenza (flu) and SARS-CoV-2 (COVID-19) increase the risk of deadly fungal infection even in otherwise healthy people.

“When these kinds of things happen in the ICU, it can be devastating because even advanced medicines still can’t treat these infections,” said Dr. Bryan Yipp, an intensive care physician and researcher at the University of Calgary.

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“Once many of these infections really get ingrained and take over, clearing them with medications alone, antifungal or anti microbials, can be very difficult.”

Dr.Yipp began studying Aspergillus — a type of fungus that is a common mould — and its connection to viral infections in 2019, following three deaths in intensive care units of patients initially admitted for influenza, but who subsequently died of the fungal infection.

“It was very much a surprise when people first started identifying the fungus in the lung.  There was a lot of discussion around the table of ICU doctors, infectious disease doctors, asking ‘Was Aspergillosis really the cause of death, or was this just a secondary finding?'” said Yipp. “The pathologists who looked at the samples and the autopsies, were convinced that it was Aspergillosis that was the main problem.”

UCalgary researchers have determined exposure to Aspergillus, a common fungal mould, can lead to a potentially dangerous Aspergillosis infection in people with weakened immune systems.

Working in Yipp’s lab, lead researcher Nicole Sarden, a PhD candidate, isolated the mechanism by which the immune system starts failing to prevent fungal infections.

“In healthy humans. specific immune cells, called B cells, produce molecules (antibodies) that basically tag invaders so that other cells in the immune system, called neutrophils, can recognize them, eat them, and clear the infection,” said Sarden

“But when you have infections with viruses, such as influenza, or if you get COVID, these molecules are no longer present, which means that the immune systems that are trying to eat, and clear the fungi cannot do it because they cannot see it.”

Working with both mice and human blood and tissue samples, the researchers discovered that following a viral infection, neutrophils could identify a fungal infection and surround it but did nothing to destroy it.  

“The virus kills the B cells, no messenger molecules exist, so the neutrophils that would normally attack, the fungus, are blinded. They sit there and don’t know what to do,” said Sarden.

The research team also discovered that reintroducing Aspergillosis reactive antibodies can protect infected mice, leading to hopes a similar treatment will be available in the near future for humans with Aspergillosis infections.

While Yipp and Sarden focused on Aspergillus, it is not the only fungus that can cause serious, or fatal infections. It is estimated fungal infections kill an estimated 1.5 million people worldwide every year. Most of those are due to four different fungi; Cryptococcus, Candida, Aspergillus, and Pneumocystis.  Since the advent of COVID, a previously rare infection of the fungus Mucormycosis has been increasing rapidly in India. It affects the sinuses, brains and lungs of its victims. The rise in Mucormycosis has also been seen in patients who are recovering or have recently recovered from COVID.

Yipp is hopeful the research being conducted at Calgary’s Cumming School of Medicine could lead to treatments for these infections as well.

“We have some hunches that that could be a similar mechanism to what we see here with what we have found.” said Yipp. “So we think that this could be applied to multiple different types of fungi around the world.”

The research team, led by Sarden, published their findings in the journal Science Translational Medicine.

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Barrie hospital declares COVID outbreak in transitional care unit – BarrieToday

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Royal Victoria Regional Health Centre (RVH), in collaboration with the Simcoe Muskoka District Health Unit, declared a COVID-19 outbreak in the Barrie hospital’s transitional care unit on Friday, Jan. 27.

According to RVH, eight patients have tested positive for COVID-19 and have been isolated.

“Enhanced cleaning measures are underway, as well as swabbing of patients and staff,” RVH said in a news release Monday afternoon. 

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Admissions to the unit are on hold at this time, and visitors are not permitted. However, RVH says some exceptions may apply.

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Guidance for diagnosing and managing migraine – News-Medical.Net

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Migraine is a major cause of disability, affecting about 12% of people. A 2-part series published in CMAJ (Canadian Medical Association Journal) on diagnosing and managing the condition with both acute and preventive therapy provides guidance for clinicians. https://www.cmaj.ca/lookup/doi/10.1503/cmaj.211969.

“The goal of treatment of migraine attacks is to provide rapid relief from pain and other migraine-related symptoms, to restore patient function and to prevent recurrence,” writes Dr. Tommy Chan, Department of Clinical Neurological Sciences, Western University, London, Ontario, with coauthors.

“A stratified approach to treatment that empowers patients to choose from different options, depending on attack symptoms and severity, and encourages them to combine medications from different classes (e.g., nonsteroidal anti-inflammatory drugs and triptans) for severe or prolonged attacks, is preferred.”

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Part 2 of the review, which will be published February 6, focuses on preventive treatment to reduce the frequency and severity of migraine attacks.

Journal reference:

Tzankova, V., et al. (2023) Diagnosis and acute management of migraine. Canadian Medical Association Journal. doi.org/10.1503/cmaj.211969.

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